Case Study: Community Health Nursing for Managing Chronic Conditions

This case study focuses on Mr. Tim Hewson, a 61-year-old male suffering from Hypertension, Ischemic Heart Disease, and Gastroesophageal Reflux (GERD). The solution discusses his current medications, including Lisinopril, Frusemide, Aspirin, Cymbalta, Panadol, Ibuprofen, Nexlum, and Coloxyl with Senna, and addresses the persistence of his symptoms and adverse reactions. The role of a community health nurse is explored, emphasizing the importance of assessing Tim's eating habits and medication compliance, providing health education on managing GERD and minimizing complications, and conducting physical exams to develop a priority nursing care plan. The analysis identifies potential issues such as the chronic use of Ibuprofen worsening hypertension and heart disease, and the need for a physician's checkup to reconsider tests and medications. The goal of the community visit is to evaluate nursing interventions and assess the need for replanning, ultimately recommending a physician visit for further evaluation and potential medication adjustments.

Running: PATIENT HANDOVER.
Patient Handover
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Mr. Tim Hewson is a 61 yr. old male patient who stays in Mawson. He is suffering from
Hypertension, ischemic Heart Disease and Gastro esophageal Reflux (GERD). He has a history
of ischemic stroke that happened 6 months ago, is a widow with no children and lives alone.
Hypertension is characterized by chronic elevated BP. GERD is a condition where the
esophageal sphincter is abnormal leading to presentation of heartburn and regurgitation.
Ischemic heart disease presents with basically angina due to coronary insufficiency (Marie &
Visvikis-Siest, 2018). He is under the following treatment; Lisinopril 20mg, Frusemide 40mg,
Aspirin 150mg, Cymbalta 60mg nocte, panadol 1g PRN, Ibuprofen 400mg TDS, Nexlum 40mg,
Coloxyl and Senna 2 tablets. Lisinopril is an ACE inhibitor and is used to manage hypertension
(Wu, Yang, Chang & Wei, 2016). Frusemide is a diuretic and is used to treat hypertension and
heart disease. Aspirin is used in the treatment of pain and inflammation that may result due to the
ischemic heart disease. Nexlum (esomeprazole) is used in treatment of reflux and heartburn by
reducing acid production. Ibuprofen is an NSAID and work to relieve pain and inflammation,
symptoms of heart disease (Packer, Anker, Butler, Filippatos & Zannad, 2017). Cymbacta is an
antidepressant that can be used to treat chronic pain. Panadol is used to relieve mild pains such as
headaches that may result due to high blood pressure (Maumus, 2018)Coloxyl and senna are
laxatives that softens stool hence facilitating gastric emptying hence relieving symptoms of
reflux.
Mr. Tim’s symptoms are persisting and he is also suffering adverse reaction due to
treatment. It seems Jim has not been completely compliant to the medication and the general
measures advised in regards to his condition. As a community health nurse, I would request Tim
to explain to me his eating habits and drug taking frequency. In regards to GERD, Tim ought to
be aware that he should use a big pillow while sleeping and he should not sleep immediately

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after eating (Scarpellini, Ang, Pauwels, Santis, Vanuytsel & Tack, 2016). He should also avoid
acidic meals. Failure to comply to the measure leads to worsening symptoms. During assessment
of the conditions, the cues expected; pain on the chest, headaches, edema, complaints of
heartburn and reflux. The information required is having prior knowledge about the conditions,
precipitating factors, management and general measures of prevention in the community.
As a community health nurse, I will be planned to carry out a physical exam and come
out with priority nursing care plan. The next focus will be on the health education (Sacks, Alva,
Magalona & Vesel, 2015). I will educate Tim on the measures in attaining comfort and pain free
and how to minimize complications. Due to the continued use of NSAIDs, the symptoms of
GERD are persistent. Tim is also thought to be taking meals just before bed time and high acidic
meals. This is the reason for persistent symptoms. Due to the chronic use of Ibuprofen, this has
increased the hypertension symptoms and heart disease. Asprin increases of the risk of
gastrointestinal bleeding in cases where GERD has led to ulceration. Esomeprazole acts after a
long period of time up to 4 days. During this period, the symptoms of reflux and heartburn are
persistent. Lisinopril in its action it can worsen the symptoms of heart disease such as chest pain
and cough. It also worsens the headache that may be present since the patient is suffering from
hypertension.
The main reason for taking a community visit is to be able to reach patients who are
unable to visit a facility. In the community, one I able to diagnose it as one, identify the common
problem hence making a community diagnosis. The goal of the visit is to evaluate the nursing
interventions for Tim and assess the need for re planning. Prior to this visit one has to be aware
of the history of Tim, the treatment regime and the patient centered management.

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In the assessment, I would assess the vital signs to ensure whether they are within normal
ranges. I would monitor the symptoms and check if they are resolving or fluctuating and consult
the subjective concept of the patient. I will also assess the occupational adjustments and
adaptation as far as his condition is concerned. Tim’s symptoms are worsening and this may led
to complications. I would recommend him to visit a physician for a checkup and reconsider more
tests, hospitalization and change of medications.

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References
Marie, P. Y., & Visvikis-Siest, S. (2018). Do we need diagnostic strategies enhanced with
genetic information for ischemic heart disease?.
Maumus, M. (2018). Solving America’s Prescription Epidemic: Pathophysiology, Ethics,
Chronic Pain, and Addiction. In Clinical Approaches to Hospital Medicine (pp. 181-200).
Packer, M., Anker, S. D., Butler, J., Filippatos, G., & Zannad, F. (2017). Effects of sodium-
glucose cotransporter 2 inhibitors for the treatment of patients with heart failure: proposal
of a novel mechanism of action. JAMA cardiology, 2(9), 1025-1029.
Sacks, E., Alva, S., Magalona, S., & Vesel, L. (2015). Examining domains of community health
nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in
rural Ghana. Human resources for health, 13(1), 81.
Scarpellini, E., Ang, D., Pauwels, A., De Santis, A., Vanuytsel, T., & Tack, J. (2016).
Management of refractory typical GERD symptoms. Nature Reviews Gastroenterology
and Hepatology, 13(5), 281.Springer, Cham.
Wu, S. J., Yang, Y. H., Chang, H. W., & Wei, C. C. (2016). Pharmarcogenetic Mechanism of
ACE I/D Polymorphism Adversely Responding to ACE Inhibitors in Regulating the ACE
Promoter Activity in Neurons. Alzheimer's & Dementia: The Journal of the Alzheimer's
Association, 12(7), P856.