CNA255: Detailed Case Study of Mr. Clive Jenkins' Health and Treatment

This assignment presents a comprehensive case study analysis of Mr. Clive Jenkins, a 78-year-old patient with a history of myocardial infarction, congestive cardiac failure, and recent dementia diagnosis. The analysis begins with interpreting assessment findings, distinguishing between normal and abnormal data, and relating these findings to the patient's medical history and current symptoms, including elevated blood pressure, respiratory rate, and decreased SpO2 levels. The assignment then explores the physiological implications of these findings, predicting potential health deterioration if no immediate action is taken. It prioritizes nursing diagnoses, including decreased cardiac output, ineffective airway clearance, and imbalanced body nutrition, and develops detailed care plans for the two highest priority diagnoses. Each care plan includes goals, related nursing actions, rationales, and evaluation outcomes, providing a structured approach to patient management and highlighting the importance of continuous assessment and intervention in managing complex cardiac conditions and fluid imbalances. The assignment references relevant literature to support the nursing interventions and clinical reasoning.

Your student number:
CNA255 AT2 Scenario: Mr Clive Jenkins
Interpret:
In the following table, list the data that you consider to be normal/abnormal (not included in word count)
Normal (Subjective & Objective) Abnormal (Subjective & Objective)
Blood glucose level.
Body temperature is normal
GCS is 14 which is normal.
BP- The blood pressure is 150/90. It should be 120/80.
RR – 24. The normal value is in between 10 to 12.
SPo2 is 94%. The normal value is in between 95% to 100%
Body weight – 97kgs
Pulse rate 112 bpm. The normal value is 70bpm.
JVP is also abnormal as it is properly visible
Relate & Infer (450 words):
In the given case study, the medical history of the patient is showing that Mr. Jerkins has suffered from myocardial infarction in the year 2016. He has also suffered from
congestive cardiac failure and recently he has also been diagnosed with dementia. His medications include ramipril, Spironolactone which mainly help him in managing
the symptoms. He has a tendency of not renewing the scripts timely and for this reason he was previously admitted to the hospital. It is also said that since the last three
days the he is also not taken his medicines. The cues that show that the he is suffering from cardiac problems are the abnormal values of the vital signs. His blood
pressure is 150/90 which is quite high as compared to the normal range of blood pressure (120/80). The pulse rate is also quite high, 112 beats per minute where the
normal pulse rate is 70 beats per minute. The normal rate of respiration is within 20 but the value of respiratory rate of this person is 24 which can be considered as very
high. The oxygen carrying capacity of healthy persons must be in between 95% to 100%, but the SpO2 value of this patient is 94% which is slightly lower than the normal
value (Lichtman et al., 2015). Other significant cues are the CGS value is 14 which means that the patient is in very confused state of mind. His weight 97kgs which means
he is an obese person. Recent studies have revealed that the functions of heart and kidney are interrelated. If one of the organ start malfunctioning then the function of
the other organ will also be hampered. A person suffering from heart failure shows decreased function of the kidneys (Thygesen et al., 2018). The interaction of kidney
and heart are very important in the prognosis of the organs individually along with doing the overall prognosis of both the organs. The person has gained three kgs of
weight and the reason of this may be the kidney malfunctions, Even it is mentioned that the person had oedema in leg. One of the main reasons of oedema is the
malfunction of kidneys (Shah et al., 2015). So it can be said that the patient is also passing through his acute stage of kidney problems. The patient is taking saline water
for maintaining the balance of the body fluids. The patient is also not taking medicines since the last three days and this has affected his respiratory rate. His level of
oxygen in the blood has also decreased a lot because he is not taking the medicines. He is breathing rapidly because of his low level of oxygen in the blood. So it can be
said that all the health issues that the patient at present is suffering is because of his cardiac malfunctions (Smolderen et al., 2015).
s
Predict (100 words):
If no action is taken at present then the health conditions of the patient will deteriorate and can turn into fatal. The patient may again suffer from myocardial infarction
and the condition of the heart may get worsened much more. The pulse rate, blood pressure and the respiratory rate may get increased. The most important thing is the
kidney condition will also deteriorate (Thygesen et al., 2018). At present the oedema has occurred only in the hand, in future if the conditions are not treated then the

person will suffer from body oedema and his weight will also increase (Thygesen et al., 2018). The blood sugar level at the present condition is normal bur if problems in
the kidney increases then the blood sugar level may get changed.
Develop, Articulate and Prioritise Nursing diagnoses – at least 3 (not included in word count)
The three important nursing diagnoses are decreased cardiac output, ineffective airways clearance and imbalanced body nutrition less than body requirements. These
are the nursing priorities as the values of the vital signs are showing high rate of respiration, high pulse rate and reduction of the overload of fluid.
Goals, Actions and Evaluation 2 highest priority diagnoses only (450 words)
Diagnosis 1 Goal/s Related actions Rationale Evaluate outcomes
Deceased cardiac output
The goal should be the cardiac
output should be increased.
Assessment for and document-
the status of mental condition.
Sounds of the lungs
Blood pressure
The cerebral perfusion is
proportional directly to the
cardiac output and also the
pressure of the aortic
perfusion. This is also very
much influenced by the disease
hypoxia and the changes or
variations in the electrolyte
and also in the variations in the
presence of acid and base
(Cavalcante et al., 2015)
The crackles of the sounds may
lead to the alterations of the
myocardial infarctions
The rationale of this are
hypoperfusion, hypotension,
dysrhythmias or malfunctions
in the ventricles (Lopes et al.,
2015).
After the completion of 8 hours
of nursing intervention the goal
of this action was met partially
After the nursing intervention
was over slight disturbance
was found.
Endorsement in the next shift
should be done for any further
interventions and any revisions
of the care.
Diagnosis 2 Goal/s Related actions Rationale Evaluate outcomes
Reduction of the excess
volume of fluid
To make the patient concern
about the excess volume of
fluid and to treat or prevent
The action should be the nurse
must review the medical
history of the patient to find
The reasons for using such
actions are such information
After the completion of nursing
interventions, the goal of this
intervention was achieved. The

the formation of excess
fluids.
the cause of the imbalance of
fluid. The weight of the patient
must be checked regularly and
the same weighing scale must
be used. The input volume and
the output volume must be
checked regularly. The weight
must be assessed according to
the nutrition that the patient is
taking (Beck et al., 2016). If the
patient is on fluids then the
intake of the fluids must be
checked regularly. The urine
output must be assessed
according to the intake of the
fluids regularly. It must also be
checked whether the patient
has oedema on hands or feet
or not. The nurse must also
check whether any crackles is
there in lungs or not.
help in doing the assessment
directly. Suddenly gain in
weight depicts retention of
fluid in the patient’s body.
Sometimes dehydration
results in loss of fluids.
Sometimes lack of nutrition
leads to loss of weight which
gets compensated by the
intake of fluid (Abzizanda et
al., 2015).
patient was found to become
much more conscious about
the need to keep the fluids of
the body in balanced condition.
The patient has also become
concerned about the reasons
about the effects of the
presence of extra fluids in the
body.
Reference list:
Abizanda, P., López, M. D., García, V. P., de Dios Estrella, J., da Silva González, Á., Vilardell, N. B., & Torres, K. A. (2015). Effects of an oral nutritional supplementation plus
physical exercise intervention on the physical function, nutritional status, and quality of life in frail institutionalized older adults: The ACTIVNES study. Journal of
the American Medical Directors Association, 16(5), 439-e9.
Beck, A. M., Christensen, A. G., Hansen, B. S., Damsbo-Svendsen, S., & Møller, T. K. S. (2016). Multidisciplinary nutritional support for undernutrition in nursing home and
home-care: A cluster randomized controlled trial. Nutrition, 32(2), 199-205.
Cavalcante, A. M. R. Z., Brunori, E. H. F. R., Lopes, C. T., Silva, A. B. V., & Herdman, T. H. (2015). Nursing diagnoses and interventions for a child after cardiac surgery in an
intensive care unit. Revista brasileira de enfermagem, 68(1), 155-160.
Lichtman, J. H., Leifheit-Limson, E. C., Watanabe, E., Allen, N. B., Garavalia, B., Garavalia, L. S., ... & Curry, L. A. (2015). Symptom recognition and healthcare experiences of
young women with acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 8(2_suppl_1), S31-S38.
Lopes, C. T., Dos Santos, T. R., Brunori, E. H. F. R., Moorhead, S. A., Lopes, J. D. L., & Barros, A. L. B. L. D. (2015). Excessive bleeding predictors after cardiac surgery in
adults: integrative review. Journal of clinical nursing, 24(21-22), 3046-3062.
Shah, A. S., Griffiths, M., Lee, K. K., McAllister, D. A., Hunter, A. L., Ferry, A. V., ... & Walker, S. (2015). High sensitivity cardiac troponin and the under-diagnosis of
myocardial infarction in women: prospective cohort study. bmj, 350, g7873.
Smolderen, K. G., Strait, K. M., Dreyer, R. P., D'Onofrio, G., Zhou, S., Lichtman, J. H., ... & Krumholz, H. M. (2015). Depressive symptoms in younger women and men with
acute myocardial infarction: insights from the VIRGO study. Journal of the American Heart Association, 4(4), e001424.
Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2018). Fourth universal definition of myocardial infarction (2018). Journal

of the American College of Cardiology, 72(18), 2231-2264.