Nursing Case Study: Cardiovascular, Respiratory, and Endocrine Systems

This nursing case study presents three distinct patient scenarios, delving into the complexities of cardiovascular, respiratory, and endocrine health. Case Study 1 explores the cardiovascular and respiratory systems, discussing normal functions, the impact of aging, and the diseases of angina and emphysema, including risk factors and nursing interventions. Case Study 2 shifts focus to the endocrine system, outlining its glands, hormone functions, and the pathophysiology of Grave's disease, along with Isabella's blood report analysis. The study also touches upon the digestive system. The document provides valuable insights into patient assessment, diagnosis, and treatment plans, offering a comprehensive understanding of these interconnected physiological systems and their associated disorders. The cases emphasize the importance of interdisciplinary medical teams and appropriate nursing care in managing complex health conditions.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the Student
Name of the University
Author Note

1
NURSING CASE STUDY
Table of Contents
Case Study 1...............................................................................................................2
Case Study 2...............................................................................................................5
Case Study 3.............................................................................................................11
References................................................................................................................14

2
NURSING CASE STUDY
Case Study 1
1. Heart is the principal structure of the cardiovascular system. It pumps the
blood throughout the body. The flood of the blood occurs through the blood vessels.
These blood vessels are further subdivided into veins, arteries and capillaries. The
veins transport the blood (deoxygenated) towards the heart and arteries transport
the oxygenated blood away from the heart towards different organs. Capillaries are
regarded as the connection between the veins and the arteries. It links the arteries
with the veins and maintains the continuous flow of the blood. Capillaries are also
properly known as blood vessels (Herman, 2016).
(Source: Herman, 2016)
2. The normal function of the cardiovascular system is to adequately transport
blood (oxygenated) to different parts of the body and in exchange transport the used
or the deoxygenated or carbon dioxide containing to the heart for the purpose of
purification. The purification or the exchange of the oxygen in return of carbon
dioxide occurs at the lungs. The importance of the oxygenated blood reaching to the
different parts of the body is, it helps in the breakdown of Adenosine triphosphate
(ATP) to release energy that is required for the proper functioning of different organs
and other associated metabolic process (Herman, 2016).
3. The principal component of the respiratory system is a pair of lungs. It
helps in the entrapment of the atmospheric oxygen in exchange of carbon dioxide.
Other associated components include airway and muscles. The airways are the
passage through which the air enters or exist out of the human body and these are
nostrils, mouth. Nostrils and mouth are internally linked with the larynx, pharynx and
trachea and bronchi. The muscles of respiratory system are diaphragm and inter-
coastal muscles. The muscles aid the lungs to inflate and deflate and thereby
pumping and pushing the air both inside and outside the body (Gilbert-Barness,
Spicer & Steffensen, 2014).

3
NURSING CASE STUDY
Figure: Respiratory system
(Source: Gilbert-Barness, Spicer & Steffensen, 2014)
4. There lies an inherent relationship between the cardiovascular system and
the respiratory system. The respiratory system entraps the oxygen from the
atmosphere that are produced by the plants. The oxygen gets purified during their
passage through the pulmonary cavities. Once the oxygen gets purified it gets mixed
with in the blood and this oxygenated blood is pumped out to the different parts of
the body via cardiovascular system with heart as the principal member (Gilbert-
Barness, Spicer & Steffensen, 2014).
5. Aging is a natural phenomenon that is characterised by the apoptosis of the
cell. The phenomenon of aging is not only manifested as the appearance of wrinkles
on the face or the formation of grey hair on head. It also has a deep impact on the
organs and the organ system. Respiratory system passes through several
anatomical, physiological and immunological changes during the process of aging.
Here the structural changes includes transformation of the structure of the cell lining
the lungs along with the thoracic deformity that hampers the entire phenomenon of
breathing leading to the appearance of laboured breathing. The cell of the lungs,
parenchyma cells also loses its tough structure and thereby leading to a decrease in
the muscle strength and subsequent dilation of the air spaces. On the other hand,
cardiovascular system also gets affected via the process of aging. It undergoes a
gradual degenerative change. Aging is associated with a progressive increase of the
hyper tonicity of the cell wall of the heart, mostly ventricle. This increases the cardio
overload on the heart which is further aggravated via dilation and slow loss of the
peripheral resistance and vascular compliance (Gilbert-Barness, Spicer &
Steffensen, 2014).
6. Imbalance between the demand of oxygen and the mycocardial blood
supply give rise to angina pectoris. It is a disease of heart that is associated with
certain cardiac malfunction, myocardial ischemia. The disease is manifested by
retroernal discomfort in chest. The symptoms include heaviness of chest flowed by a
sense of extreme pressure, a burning sensation and a feeling of chocking. The
sensation of pain is mainly centralized over the neck, shoulders, back side of the
spinal cord and jaws (Gul et al., 2012).

4
NURSING CASE STUDY
Emphysema is defined as a physiological deformity that is manifested as an
abnormal increase in the air spaces of the pulmonary cavities that is located on the
distal end of the terminally situated bronchioles. Appearance of emphysema caused
fatal destruction of the alveolar walls. In medical science, emphysema is popularly
terms as chronic obstructive pulmonary disease (COPD). The main of the disease
signifies that the disease is associated laboured breathing. Other symptoms of
COPD include frequent infection in the respiratory tract along with shortness of
breath. Secondary symptoms are breath, fatigue and tightness in chest (Centers for
Disease Control and Prevention, 2012).
7. The main risk factors of angina are chewing of tobacoo, active and passive
smoking. The risk factors of emphysema is largely similar to that of angina but
prominence is given to cigarette smoking, which causes reduction in the respiratory
rate that is associated with the malfunction of the respiratory rate constant, alpha-1
antitrypsin of the lungs. There is a common link between the two diseases is, high
level of cholesterol in blood that leads to arthrosclerosis and thus increasing the
susceptibility of the disease (Centers for Disease Control and Prevention, 2012).
8. The immediate nursing assessment for John who is suffering from COPD is
immediate supply of oxygen from the external source in order to reduce his
shortness of breath while ensuring proper functioning of heart and brain. John must
also be given medications such as analgesic (acetaminophen) in order to reduce the
body temperature (as he is suffering from high fever). Following these, the chest X-
ray is mandatory; it will give a detailed insight of the degree of sputum congestion
inside the lungs (Punekar, Shukla & Müllerova, 2014).
9. In case of John, the medical interdisciplinary medical team must consist a
cardiologist and a pulmonary specialist. Apart from these, an experienced
physiotherapy is crucial for the urgent recovery of John. Physiotherapy message
over the back side of the chest will help in the fast removal of the sputum (green
thick cough) from his pulmonary cavity. John also needs a cholesterol restricted diet
in order reduce the risk factor of COPD and this can only be done via a professional
nutritionist via taking into account John’s height weight and age (Punekar, Shukla &
Müllerova, 2014).
10. Immunity that is acquired by vaccines is known as artificially acquired
immunity. The phenomenon involves a immunization with the help of desired antigen
that is capable to eliciting immune response against the antibody that shares
structural homology with the antigenic epitope of the antigen that is used as
immunogen. Acquired immunity also generates memory B-cells that help in the
prevention of recurrent infection or second time infection (Owen, Punt & Stranford,
2013).

5
NURSING CASE STUDY
Case Study 2
1. The interplay that occurs within the endocrine system mostly occurs via
endocrine glands. Endocrine glands secrete hormones that get mixed directly into
the blood body, without getting transported through the ducts. The principal
endocrine glands include hypothalamus, pituitary, parathyroid, adrenal glands, pineal
glands and reproductive organs of both the sexes (ovaries and testes). Once
exception in the endocrine system is pancreas, though it is not a gland, it is included
within the network of the endocrine system as it secrets hormone, insulin (Fuxe,
2013).
2. Endocrine system secretes hormones via glands and it is via these glands
that the function of the endocrine system is being executed. Hormones are regarded
as the chemical messenger that regulated the activity of the cells and the organ
system. For example, hormones promote growth, development of muscles and
maturation of the reproductive organs. The following table provides a tabular
representation of the endocrine glands, hormones secreted from them and their
respective functions.
Pituitary
Glands
Name of the Hormones Function of the hormones
Anterior Pituitary Somatotropic Hormone (STH) It is growth hormone with
anabolic function that facilitates
growth of the muscles and
skeletons. Over secretion of the
STH promotes gigantism and
under secretion of STH causes
dwarfism
Thyroid Stimulating Hormone
(TSH)
TSH signals the secretion of the
thyroid hormones via the
thyroid glands. It also facilitates
the growth and development of
the thyroid gland. The over
secretion of TSH causes
hypothyroidism and under
secretion causes
hyperthyroidism
Adrenocorticotropic hormone
(ACTH)
It controls and co-ordinates the
structure and the functions of
the adrenal glands that secrets
steroid hormones popularly
known as cortico-steriods.
Example Gluco-corticiods and
Mineralelocorticiods.
Gonadotrophic hormone (GTH)
(Follicle Stimulating Hormone
GTH controls the function and
the development of the

6
NURSING CASE STUDY
[FSH] and Luteinizing Hormone
[LH])
reproductive organs or gonads
in both the sexes However, the
rate of secretion of FSH and LH
differs among the sexes.
Prolactin Promotes production of milk
from the mammary gland during
pregnancy
Posterior
Pituitary
Oxytocin Helps in the uterine contraction
that triggers labour pain during
the time of delivery or child birth
Antidiuretic hormone Helps in renal re-absorption. It
is crucial for the proper
functioning of the kidneys and
helps to maintain the balance of
the potassium
(Source: Fuxe, 2013)
3. The production and the regulation of the thyroid hormone is done via
thyroid stimulating hormone (TSH), produced in the pituitary glands. Effective binding
of the TSH activates down chain production of the adenylate cyclase. The activation
of the adenylate cyclase leads to the generation of two thyroid hormones, thyroxine
(T4) and triiodothyronine (T3). A person suffering from Grave’s disease or
hyperthyroidism produces auto-antibodies that selectively binds to the receptor of the
TSH, mimicking the structure of the TSH. The TSH receptors recognise auto-
antibodies as TSH and up-regulates the activation of T3 and T4. However, the
malfunction arises due to the fact that these auto-antibodies are not regulated via
negative feedback inhibition. Thus, the production of the thyroid hormones from the
thyroid glands are over stimulated these to the enlargement of the thyroid gland and
formation of the Grave’s disease of hyperthyroidism (Owen, Punt & Stranford, 2013).

7
NURSING CASE STUDY
Figure: The Signalling and the pathophysiology of Grave’s Disease
(Source: Owen, Punt & Stranford, 2013)
The principal risk factors of development of Grave’s disease are genetic pre-
disposition, a family history of auto-antibodies. Other secondary risk factors include
problematic intake of iodine, over use of the steroid hormones and uncontrolled
smoking (Owen, Punt & Stranford, 2013).
4. Isabella’s blood report shows
Hormone Patient’s Parameter Normal Parameter
TSH 1.00 mirco ml per litre 0.5-4.2 micro ml per litre
Free T4 40pmpl/L 10-20 pmol/L
Free T3 10 pmol/: 3.5-6.0 pmol/L
Source: Case Study
The normal level of the TSH hormones shows that the Isabella’s condition is
not associated with the over-production of TSH hormone from the pituitary gland.
However, on the other hand, The extremely high level of T4 and T3 shows that the
over-stimulation of thyroid hormones are not associated with the action of TSH but
are regulated by some other factors. Here, comes the importance of the auto-
antibodies, which has no connection with TSH in the over stimulation of the thyroid
hormones, giving the justification of the Isabella condition in accordance with the
Grave’s disease or Hyperthyroidism (Fuxe, 2013).
5. The main organs that fall under the one of the biggest organ system of the
human body, digestive system are stomach, small intestine, large intestine, liver, gall
bladder and pancreas. However, digestion start from the mouth via the process of
chewing of food so the salivary glands, mouth and pharynx are also included within
the digestive system. After mouth digestion the food passes through the stomach
then the small intestine followed by large intestine (colon) and these three organs
forms the alimentary canal (Chapman, 2013).
The other associated structures of the digestive system is represented in the image
below

8
NURSING CASE STUDY
(Source: Chapman, 2013)
6. The process of digestion starts from the mouth under the action of the
salivary glands and teeth that help in chewing that breaks down the food into smaller
or minute counterpart. After the food is broken down into its smaller counterpart, it
slowly passes through the alimentary canal where further digestion takes place
under the action of several digestive hormones and stomach HCL. The digested food
gets absorbed from the small intestine and the undigested food gets deposited inside
the rectum via passing through the large intestine of colon (Chapman, 2013).
Figure: Digestive Hormones in the Gastro-intestinal (GI) tract

9
NURSING CASE STUDY
(Source: Chapman, 2013)
7. The main function of the immune system is protecting the body from the
harmful effects of the invading micro-organisms, which are pathogenic in nature.
This versatile defence system is sub-divided into two parts, innate immunity and
adaptive immunity. Innate immunity is also known as inborn immunity which is
acquired from the maternal antibodies that is passed on through the placenta or
breast milk like IgA. This is the first line of defence in the human body and provides
preliminary infection protection. The second line of defence is the adaptive immunity
that is composed of T cells and B cells and is known as adaptive immunity. It is
developed during the course of life (Owen, Punt & Stranford, 2013).
Figure: Non-specific host defence (innate immunity)
(Source: Owen, Punt & Stranford, 2013)
Figure: Overview of the adaptive immunity (humoral and cell mediated immune
response)
(Source: Owen, Punt & Stranford, 2013)

10
NURSING CASE STUDY
8. One of the best examples of auto-immune disease is systemic lupus
erythematosus (SLE). It generally occurs in women between the age group of 20 to
40 years of age. The affected individual produces auto-antibodies against DNA,
histone particles, platelets, RBC, leukocytes and clotting factors. These auto-
antibodies generated against RBC and blood platelets causes complement mediated
lyses of the cells leading to the generation of haemolytic anaemia and
thrombocytopenia respectively. The immune complex resulting out of the
complement mediated lyses gets deposited along the walls of the small blood
vessels giving rise to type III hypersensitivity reactions that leads to the disruption of
the blood vessels, causing vasculitis and glomerulonephritis (Owen, Punt &
Stranford, 2013).
9. The main interventions for Isabella will be administration of non-selective
beta blockers (propranolol). Beta blockers helps in eliminating the thyrotoxic effects
arising out of the over-stimulation of the thyroid hormones. It will help Isabella to
combat against her associated side effects of hyperthyroidism (Cohen et al., 2012).
10. The inter-disciplinary team of Isabella must consist Nephrologists and an
Nutritionist apart from an Endocrinologist.
Nephrologist will help Isabella to combat against the renal malfunction.
Thyroid hormones increase renal blood flow and glomerular filtration rate and a
nephrologist will help in controlling the situation (Basu & Mohapatra, 2012).
A dietician will help helps to fight against her rapid weight loss and will also
help her in controlling the iodine concentration within the body (Rotondi & Chiovato,
2013).

11
NURSING CASE STUDY
Case Study 3
1. The three main function of the nervous system are sensory, motor and
interpretative. The role of the sensory nervous system is to acquire new information
from both external and inter environment. The information thus collected by the
sensory nervous system is then transported through the nerves into the central
nervous system (CNS). The motor nerves have the same function like that of the
sensory nervous system but they collect the information from the motor neurons and
the muscle cells (Nieuwenhuys, Hans & Nicholson, 2014).
2. Multiple sclerosis (MS) is a chronic disease of the central nervous system
that causes demyelisation. It is mostly common among the people who fall between
the age bracket of 20 to 40 years (Solaro, Trabucco & Uccelli, 2013).
Myelin is the major lipid component of the neurons. The presence of myelin
sheath around the axon increases the rate of transmission of the nerve impulses (10
to 100 meters per second). In an non-myelinated neurons, the conduction velocity of
the nerve impulses at the action potential depends on the diameter of the axon
because bigger the diameter of the axon, more will be the flow of the ions of the
nerve impulses. So in case of the patients who are suffering from MS, there occurs
delayed in the propagation of the nerve impulses and thus delay in response (Miller
et al., 2012).
Figure: The structure of the axon and occurrence of the myelin sheath
(Source: Miller et al., 2012)
3. The common symptoms of MS are sensory impairment, muslce weakness,
visual impairment, urinary dysfunction, fatigue and pain. Pain i the most commonly
treated symptoms of MS. The pain symptoms of MS are classified into nociceptive
somatic/visceral and neuropathic pain. Nociceptive pain occurs in the encoding of

12
NURSING CASE STUDY
the noxious stimuli. It represents a physiological response that effects the behavioral
responses and coordinated reflexes. Neuropathic pain occurs as a result of primary
lesion in the central or the peripheral nervous system. It causes distress and
suffering (Solaro, Trabucco & Uccelli, 2013).
4. Urinary system is composed of a pair of kidneys, ureter, bladder and
urethra. The pair of kidneys is bean shaped and is situated on the posterior side of
the abdominal wall, just behind the peritoneum. Since liver is located on the right on
hand, the right kidney is slightly smaller than its counterpart. Ureters are thin-long
tube shaped organs and are composed of smooth muscle cells. The contraction of
these smooth muscle cells helps in the propagation of urine down the urinary bladder
(Jones, Hard & Mohr, 2013).
Figure: Components of Urinary System
(Source: Jones, Hard & Mohr, 2013)
5. The main senses of human body are vision, hearing, and maintenance of body
balance, smell and taste. The function of the senses and their stimulus is carried out
by the visceral afferents and somatic afferents. Apart from this, tough is also
regarded as a special sense which is transmitted via skin (Preston & Eichenbaum,
2013).
6.
Vision Hearing Taste Smell Touch
Problem with
vision occurs
as a result of
the optic
nerves
Inflammation
of the auditory
neurons
located inside
the brain
Hampers the
proper
functioning of
the taste buds
due to the
inflammation in
the temporal
lobe of the
brain, located
Demyelization
causes
reduction in
the olfactory
bulb giving rise
to problem in
smell detection
Te neurons
which are
running below
the skin also
undergoes
demyelization
resulting in
problem in
touch

13
NURSING CASE STUDY
at the frontal
side
(Source: Preston & Eichenbaum, 2013)
7.
Conditions Symptoms
Edentulous or Edentate Complete or partial loss of teeth
Dentate No loss of teeth
Table: Dental Anomaly
(Source: Müller, 2014)
8. Both periodontal disease and multiple sclerosis have inflammatory origin.
The people who are suffering from MS, fail to perform normal daily activities due to
extreme pain in the nerve ends. This effect of pain also tampers daily regime of
hygiene like brushing of teeth. This lack of proper dental hygiene may have been the
cause of Daisy’s dental problem. Moreover, the demyelination also hampers the
neurons and the axon terminals of the dental cavities and thus giving the link of
Daisy’s escalating jaw pain (Elemek & Almas, 2013).
9. The immediate nursing assessment in case of Daisy is a thorough support
of a nurse on a 24X7 basis. She will assist Daisy in performing daily activity and will
help her fight against memory loss (Calabresi et al., 2014).
10.
Health Professionals
Medical Health Allied Health
Neurologist Physiotherapist
Dentist Trained nurse
Table: Intradisciplinary health team for Daisy
(Source: Calabresi et al., 2014)

14
NURSING CASE STUDY
References
Basu, G., & Mohapatra, A. (2012). Interactions between thyroid disorders and kidney
disease. Indian journal of endocrinology and metabolism, 16(2), 204.
Calabresi, P. A., Radue, E. W., Goodin, D., Jeffery, D., Rammohan, K. W., Reder, A.
T., ... & Li, B. (2014). Safety and efficacy of fingolimod in patients with
relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind,
randomised, placebo-controlled, phase 3 trial. The Lancet Neurology, 13(6),
545-55
Centers for Disease Control and Prevention (CDC. (2012). Chronic obstructive
pulmonary disease among adults--United States, 2011. MMWR. Morbidity and
mortality weekly report, 61(46), 938.
Chapman, R. F. (2013). Structure of the digestive system. Comprehensive insect
physiology, biochemistry, and pharmacology, 165-211.
Cohen, J. A., Coles, A. J., Arnold, D. L., Confavreux, C., Fox, E. J., Hartung, H. P., ...
& Brinar, V. V. (2012). Alemtuzumab versus interferon beta 1a as first-line
treatment for patients with relapsing-remitting multiple sclerosis: a randomised
controlled phase 3 trial. The Lancet, 380(9856), 1819-1828.
Elemek, E., & Almas, K. (2013). Multiple sclerosis and oral health: an update. The
New York state dental journal, 79(3), 16-21.
Fuxe, K. (Ed.). (2013). Central regulation of the endocrine system (Vol. 42). Springer
Science & Business Media.
Gilbert-Barness, E., Spicer, D. E., & Steffensen, T. S. (2014). Respiratory system.
In Handbook of Pediatric Autopsy Pathology (pp. 329-354). Springer New
York.
Gul, M., Uyarel, H., Ergelen, M., Karacimen, D., Ugur, M., Turer, A., ... & Uslu, N.
(2012). The relationship between red blood cell distribution width and the
clinical outcomes in non-ST elevation myocardial infarction and unstable
angina pectoris: a 3-year follow-up. Coronary artery disease, 23(5), 330-336.
Herman, I. P. (2016). Cardiovascular system. In Physics of the Human Body (pp.
533-621). Springer International Publishing.
Jones, T. C., Hard, G. C., & Mohr, U. (Eds.). (2013). Urinary system. Springer
Science & Business Media.
Miller, D. J., Duka, T., Stimpson, C. D., Schapiro, S. J., Baze, W. B., McArthur, M. J.,
... & Lipovich, L. (2012). Prolonged myelination in human neocortical
evolution. Proceedings of the National Academy of Sciences, 109(41), 16480-
16485.
Müller, F. (2014). Interventions for edentate elders–what is the
evidence?. Gerodontology, 31(s1), 44-51.

15
NURSING CASE STUDY
Nieuwenhuys, R., Hans, J., & Nicholson, C. (2014). The central nervous system of
vertebrates. Springer.
Owen, J. A., Punt, J., & Stranford, S. A. (2013). Kuby immunology (pp. 427-444).
New York: WH Freeman.
Preston, A. R., & Eichenbaum, H. (2013). Interplay of hippocampus and prefrontal
cortex in memory. Current Biology, 23(17), R764-R773.
Punekar, Y. S., Shukla, A., & Müllerova, H. (2014). COPD management costs
according to the frequency of COPD exacerbations in UK primary
care. International journal of chronic obstructive pulmonary disease, 9, 65.
Rotondi, M., & Chiovato, L. (2013). Vitamin D deficiency in patients with Graves’
disease: probably something more than a casual association.
Solaro, C., Trabucco, E., & Uccelli, M. M. (2013). Pain and multiple sclerosis:
pathophysiology and treatment. Current neurology and neuroscience
reports, 13(1), 320.