Diploma of Nursing Case Study: Comprehensive Patient Care Strategies

This case study focuses on the nursing management of a patient presenting with a complex medical history including emphysema, hypertension, myocardial infarction, benign prostate hypermegaly, and a history of transient ischemic attacks (TIAs). The study addresses the pathophysiology of each condition, including alveolar destruction in emphysema, the impact of high blood pressure, angina resulting from inadequate blood flow to cardiac muscles, and myocardial infarction due to atherosclerotic plaques. It further explores fluid accumulation leading to pulmonary edema and swelling. The case study also outlines appropriate nursing interventions, such as administering diuretics and beta-blockers for hypertension, and the roles of allied health professionals like nutritionists, nurses, occupational therapists, and physiotherapists in patient rehabilitation. Additionally, it discusses the FAST acronym for stroke detection, potential symptoms, and suitable positioning for patients experiencing respiratory distress. The document provides comprehensive understanding of the case along with references. Desklib offers many such solved assignments.

Running head- DIPLOMA OF NURSING
Case Scenario
Name of the Student
Name of the University
Author Note

DIPLOMA OF NURSING 1
Part A
Answer 1
Emphysema is the abnormal enlargement of the air spaces and destruction of alveolar
walls. The alveolar septum gets eroded resulting in airspace enlargement (Jankowich & Rounds,
2012).
Answer 2
High BP will occur due to alveolar capillary wall destruction. Respiratory rate will also
get increased.
Answer 3
Inadequate blood flow to cardiac muscles results in chest pain or angina. It occurs due to
an imbalance between supply and demand of oxygen to the heart (Kosiborod et al., 2013).
Answer 4
Reduced blood flow to a part of heart, results in myocardial infarction. Atherosclerotic
plaques reduce the blood flow (Thygesen et al., 2012). This leads to oxygen deprivation, cell
injury and ischemia. ST elevation MI might have occurred due to blockage of the major arteries
(Jneid et al., 2012).
Answer 5
Huge demand for oxygen and limited supply of blood results in heart failure. The
coronary arteries of the heart get blocked. This deprives the heart of oxygen and the cells die.
Answer 6
Fluid accumulation in the body might have resulted in swelling in the legs and ankles.
This indicates more risk of heart failure.
Answer 7

DIPLOMA OF NURSING 2
Non-cancerous prostate gland enlargement leads to benign prostate hypermegaly.
Common symptoms are loss of bladder control, urination problems, renal failure, bladder stones,
and urinary tract infection (Barry et al., 2017).
Answer 8
Fluid accumulation in lung air-spaces leads to pulmonary oedema. Gaseous exchange
gets impaired and there is respiratory failure (Davison, Terek & Chawla, 2012).
Paroxysmal nocturnal dyspnoea and coughing up pink sputum can be observed.
Answer 9
Problem Goal Course of action
Hypertension Blood pressure maintenance  Skin colour,
temperature an oedema
measurement
 Thiazide diuretic
administration
COPD Airway patency maintenance  Fluid intake increase
 Breathing sound
auscultation
Myocardial infarction Chest pain control  Morphine drug
administration
 Beta-blocker
administration
Answer 10

DIPLOMA OF NURSING 3
Allied health workers help rehabilitation of patients. Diagnosis and recovery of the
patients get facilitated. These workers also handle diagnostic instruments and provide necessary
care (Duncan & Murray, 2012)
Answer 11
 Nutritionist- Will prepare a diet plan that is less in cholesterol and fats, thereby
improving patient health.
 Nurses- Will administer COPD, hypertension and cardiac failure drugs.
 Occupational therapist- Will devise rehabilitation programs and improve occupational
performance.
 Physiotherapist- Will improve patient mobility and help him regain motor control.
Part B
Answer 1
Interruption of blood supply to the brain leads to brain injury and stroke. Blood clots
block the arteries present in the brain (Zhang et al., 2012).
Temporary artery blockage causes transient ischemic attack. It does not last for more than an
hour (Wang et al., 2013).
Answer 2
The FAST acronym stands for Facial drooping, Arm weakness, Speech difficulty and
Time to call emergency service. It helps in increasing responsiveness to stroke patients (Bietzk et
al., 2012).
Answer 3

DIPLOMA OF NURSING 4
Previous 3 TIAs are a major concern as the patient can become more susceptible to heart
failure. The patient reports tachycardia or rapid heart rate that can be managed by administering
thiazides (diuretics) and beta-blockers.
Answer 4
Probable symptoms include rapid breathing, dyspnoea or shortness of breath, cough,
tachypnoes, pain and stiffness in the chest, cyanosis and haemoptysis.
Answer 5
 Dyspnoea- It is a disease of the lungs, airway and heart. The term encompasses a
subjective experience, in ehich people often report symptoms of breathing difficulty,
shortness of breath, extra effort to inhale and tightness in the chest (Davenport et al.,
2013).
 Tachycardia- This condition refers to an elevation in heart rate, beyond the rate of 100
beats per minute. It can occur due to restricted blood flow in the cardiac muscles ad other
parts of the human body (Nyegaard et al., 2012).
 Haemoptysis- It refers to spiting up of pink froth or blood stained sputum that is created
in the airways or lungs (Larici et al., 2014).
 Diaphoresis- This medical term refers to excessive perspiration or sweating in context of
the person’s activity or the surrounding environment (Hanafusa et al., 2017).
Answer 6
Bronchioconstriction occurs due to inflammation of the airways upon exposure to dust,
smoke or pollen grains. This leads to narrowing of the airways and production of excess mucus
that causes breathing difficulties. Inhaled allergens often reach the inner airways and get ingested
by antigen presenting cells, thereby triggering bronchial inflammation (Maslan & Mims, 2014).

DIPLOMA OF NURSING 5
Answer 7
The patient would be advised to sit in Fowler’s position. This would make him sit semi-
upright, at an angle of 45 to 60 degrees, thereby promoting chest expansion (Dellamonica et al.,
2013).
Answer 8
The respiratory rate will increase above 25 in resting condition, thereby providing
evidence for hyperventilation or rapid breathing. Heart rate would also increase to more than 100
beats per minute of the upper threshold.
Answer 9
 Physiotherapist- Will help in reducing limb impairment.
 Speech-language therapist- Will help the person swallow food easily and would also
facilitate improvement of muscle movement.
Answer 10
Pleurisy c. inflammation of pleura
Pneumonia c. inflammation of lungs due to infection
Atherosclerosis e. narrowing of blood vessels due to
development of plaques
Pneumothorax a. abnormal collection of air or gas in the
pleural space
Symptoms of atrial fibrillation include b. rapid, irregular heartbeat

DIPLOMA OF NURSING 6
References
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& Cockett, A. T. (2017). The American Urological Association symptom index for
benign prostatic hyperplasia. The Journal of urology, 197(2), S189-S197.
Bietzk, E., Davies, R., Floyd, A., Lindsay, A., Greenstone, H., Symonds, A., & Greenfield, S.
(2012). FAST enough? The UK general public's understanding of stroke. Clinical
Medicine, 12(5), 410-415.
Davenport, M. S., Viglianti, B. L., Al-Hawary, M. M., Caoili, E. M., Kaza, R. K., Liu, P. S., ... &
Hussain, H. K. (2013). Comparison of acute transient dyspnea after intravenous
administration of gadoxetate disodium and gadobenate dimeglumine: effect on arterial
phase image quality. Radiology, 266(2), 452-461.
Davison, D. L., Terek, M., & Chawla, L. S. (2012). Neurogenic pulmonary edema. Critical
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Dellamonica, J., Lerolle, N., Sargentini, C., Hubert, S., Beduneau, G., Di Marco, F., ... &
Brochard, L. (2013). Effect of different seated positions on lung volume and oxygenation
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Duncan, E. A., & Murray, J. (2012). The barriers and facilitators to routine outcome
measurement by allied health professionals in practice: a systematic review. BMC health
services research, 12(1), 96.

DIPLOMA OF NURSING 7
Hanafusa, N., Lodebo, B. T., Shah, A., & Kopple, J. D. (2017). Is There a Role for Diaphoresis
Therapy for Advanced Chronic Kidney Disease Patients?. Journal of Renal
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DIPLOMA OF NURSING 8
Nyegaard, M., Overgaard, M. T., Søndergaard, M. T., Vranas, M., Behr, E. R., Hildebrandt, L.
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