NRSG 366: Case Study of Partnership in Chronicity for Mrs. Bradford

This case study, prepared for NRSG 366, examines Mrs. Melanie Bradford, a 48-year-old woman with hypertension, ischemic heart disease, and gastroesophageal reflux. The assignment utilizes the clinical reasoning cycle to analyze her condition, medications (lisinopril, frusemid, aspirin, etc.), and medical history. It outlines the nursing care plan, including the need for diagnostic assessments, monitoring vital signs, and providing emotional support. The student proposes a 21-day care plan, emphasizing the importance of patient communication, doctor collaboration, and the potential for alternative therapies. The case study highlights the interconnectedness of Mrs. Bradford's conditions and the need for a comprehensive and patient-centered approach to chronic disease management, referencing relevant literature for support. The author reflects on the care plan and potential improvements for future appointments.

Running head: NRSG 366 PARTNERSHIP IN CHRONICITY
NRSG 366 PARTNERSHIP IN CHRONICITY
Name of the Student
Name of the University
Author note

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The given case study is about a woman named Mrs. Melanie Bradford who is 48 years of
age. The patient’s problems or any situation, the planning and interventions of the nursing, the
outcomes of the nursing care plan and the analysis are presented through the clinical reasoning
cycle. The cycle involves the details of her disease, the history and the nursing care plan that
needs to be carried out for her.
Mrs. Melanie is a woman of 48 years. She is married and has two children who goes to
school. She has an accountancy business which she manages by working from home only. She
has two dogs who are very large in size and are very friendly. I will be visiting her because the
ways that she will be treated will help the students to understand the nursing activities
properly.
Before my visit to the patient I need to know in details about the medicines that she
is taking, her medical history and also the environment in which she lives. Currently the
patient is under different medications. She is taking lisinopril 20 mg once day, she is taking
frusemid 40 mg once a day, aspirin of weight 150 mg once in a day, coloxyl and senna 2 tablets
once in a day, nexium 40 mg 0nce in a day and ibuprofen of weight 400 mg as per needed. Her
medical history shows that she has hypertension, ischemic heart disease and gastro oesophageal
reflux. The patient becomes tensed at simple things this proves that she has hypertension. She
has heart diseases which can be characterised by the reduction in the supply of blood to the heart
(Hoos et al., 2015). So she must have blockage in the coronary artery which reduces the supply
of the blood to the heart muscle. She may have atherosclerosis, which is very difficult to identify
at the initial stages and so the disease get increased. She also has gastro oesophageal reflux, so
she might be vomiting quite often as the acidic juices of the stomach, foods and different fluids

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move to the oesophagus from the stomach. While talking with the patient I must be make
sure that she is telling in details all about her diseases and medicines.
The diseases that the patient is suffering are quite interrelated. She is suffering from
hypertension, ischaemic heart diseases and gastro oesophageal reflux. One of the root cause of
the heart disease is the hypertension, though in the given case of ischaemic heart disease the
main causative agent is the blockage in the arteries of the heart. If the patient becomes tensed
frequently, then the heart disease may get effected. Acid reflux is also reported so she definitely
is facing vomiting tendencies. If she gets tensed frequently then the acid reflux will occur again
and again. The present medication of the patient shows that she is suffering from heart diseases.
Some of the medicines she is using are given to patients to cure heart disease. She takes aspirin,
which is used to reduce the hypertension of the patient. Nexium is used to reduce the acid reflux
that the patient is suffering, it cures any oesophageal abnormalities. Medicines to reduce
constipation is also prescribed to her. So the patient is still taking the medicines against the
diseases which are mentioned in the history of the medical background.
Mrs. Bradford needs to be diagnosed properly for each of the respective diseases. The
nurse must measure the cardiac output, notice the emotional needs of her and also find the
altered heart rates. Diagnoses of gastro oesophageal reflux is easy as it has different symptoms.
The symptoms are not taking food properly, alteration in taste, loss in weight, pain in the
abdomen and discomfort, not able to tolerate the fatty foods and feeling of heart burn
(Boeckxstaens et al., 2015). The symptoms of hypertension can be diagnosed clearly by properly
noticing her reactions to every actions. Hypertension can be cured by providing mental
assistance to her (Gopalan, Delcroix & Held, 2017). Other information like whether the patient

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has allergy against any medicines or not, the living environment of the patient or whether she has
other health issues or not.
My goal is that I will cure the patient as far as possible within a framed time span. I
will prepare a care plan to make her cure within a fixed period of time. I will take care of
her for 21 days. For taking care of her, I will at first need to collect all the information
about her. I need to properly communicate with her and check all her vital signs time to
time (Wang, Yu & Hailey, 2015). I need to properly discuss this matter with the doctors.
Next I need to analyse all the collected information about her and also I need to know how
can I take care of her by following more improved ways (Westra et al., 2015). The outcome
of this care plan is needed to be noted down. In this care plan, she is expected to improve,
her hypertension will decrease and the acid reflux will also get cured (Kvale et al., 2016).
After preparing the care plan for Mrs. Bradford, I think if I would have taken some other
alternative methods of treatment along with the medicines, she would have cured more quickly.
So in the next appointment I will be much more cautious about the selection of the treatment
procedures and to invent what new alternative ways of therapy can be applied to the patient.

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References
Boeckxstaens, G., El-Serag, H. B., Smout, A. J., & Kahrilas, P. J. (2015). Republished:
Symptomatic reflux disease: the present, the past and the future. Postgraduate medical
journal, 91(1071), 46-54. doi.org/10.1136/postgradmedj-2013-306393rep
Gopalan, D., Delcroix, M., & Held, M. (2017). Diagnosis of chronic thromboembolic pulmonary
hypertension. European Respiratory Review, 26(143), 160108. DOI: 10.1183/16000617.0108-
2016
Hoos, A., Anderson, J., Boutin, M., Dewulf, L., Geissler, J., Johnston, G., ... & Schneider, R. F.
(2015). Partnering with patients in the development and lifecycle of medicines: a call for
action. Therapeutic innovation & regulatory science, 49(6), 929-939.
doi.org/10.1177%2F2168479015580384
Kvale, E. A., Huang, C. H. S., Meneses, K. M., Demark‐Wahnefried, W., Bae, S., Azuero, C. B.,
... & Ritchie, C. S. (2016). Patient‐centered support in the survivorship care transition:
Outcomes from the Patient‐Owned Survivorship Care Plan
Intervention. Cancer, 122(20), 3232-3242. doi.org/10.1002/cncr.30136
Wang, N., Yu, P., & Hailey, D. (2015). The quality of paper-based versus electronic nursing care
plan in Australian aged care homes: A documentation audit study. International journal
of medical informatics, 84(8), 561-569. doi.org/10.1016/j.ijmedinf.2015.04.004
Westra, B. L., Latimer, G. E., Matney, S. A., Park, J. I., Sensmeier, J., Simpson, R. L., ... &
Delaney, C. W. (2015). A national action plan for sharable and comparable nursing data
to support practice and translational research for transforming health care. Journal of the

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American Medical Informatics Association, 22(3),
600-607.doi.org/10.1093/jamia/ocu011