NRS211: Clinical Presentation Discussion Report - Case Study

This report presents a comprehensive analysis of the clinical presentation of John Jenkins, a 72-year-old male admitted to the emergency department with shortness of breath. The report begins with a primary survey, assessing the patient's immediate condition and gathering relevant assessment data. It then delves into the underlying pathophysiology of John's condition, including the disruptions to normal physiology associated with pneumonia and hypertension, explaining how these disruptions manifest in the patient's symptoms. The core of the report focuses on nursing management strategies, drawing upon best practice guidelines to prioritize interventions such as psychological care, breathing exercises, sputum clearance, nutritional support, oxygen therapy, and the use of inhaled bronchodilators. The report emphasizes the importance of a multidisciplinary approach and home care development to encourage physical exercise and improve the patient's quality of life. The case study highlights the critical nature of dyspnea and the need for effective interventions to manage respiratory and cardiovascular challenges.

Running Head: CLINICAL PRESENTATION DISCUSSION REPORT
Clinical Presentation Discussion
Report

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Clinical Presentation Discussion Report
Table of Contents
Introduction....................................................................................................................2
Primary survey...............................................................................................................2
Underlying pathophysiology..........................................................................................6
Nursing management.....................................................................................................8
Conclusion....................................................................................................................10
Reference list................................................................................................................11

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Clinical Presentation Discussion Report
Introduction
Clinical presentation includes the patient’s daily routine as per their criteria of health
condition. The condition of an individual includes the constellation of physical signs and
symptoms, which leads to a specific diagnosis of the individual (Douw et al., 2018). The case
study of John Jenkins will be identified in the currents study. The case study of John Jenkins
will be presented with a clinical presentation with proper diagnosis and productive treatment
process. It is effective to develop proper diagnosis and progression with a clinical assessment
to the primary survey, underlying the path physiology and nursing management. The study
will be focused on a primary survey about clinical condition and treatment process of John
Jenkins, pathophysiology and nursing management of the clinical condition of John Jenkins.
John Jenkins is 72 years male presented at the Emergency Department due to shortness of
breath. He had a history of gastro-oesophageal reflux disease and hypertension. An initial
assessment had done for John Jenkins for evaluating the respiratory rate and high temperature
of him in the emergency department. John Jenkins was diagnosed with CAP after chest X-
ray. Particular specifications and specific diagnosis of John Jenkins will be described and
evaluated in the study with possible intervention process for him.
Primary survey
The primary survey has been done with 5 family members and medical attendants of
him in emergency care. 5 respondents were asked about John Jenkins’s clinical assessment
and diagnosis process of him. A primary survey was conducted to focus on assessment
criteria and clinical presentation of John Jenkins due to his John Jenkins.

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Clinical Presentation Discussion Report
It is found that John has a breathing problem as he was admitted to the emergency
department of a rural hospital. It is clear that 3 respondents noticed uneasiness in breathing
while spending leisure time. On the initial clinical assessment, it is found that John's
respiratory rate is 28/Minute. From the above table, it is clear that 4 out of 5 respondents said
the respiratory rate of John is 28/Minute. As per the assessment, it is stated as per the
evaluation through the respiratory rate is changeable as depending on the situation. As per the
clinical assessment of John, a regular heart rate is found of John. 3 respondents said yes that
John has a regular heart rate and blood pressure rate. It is clear that John has a daily BP rate
with progression and breathing problem for him. It is found that 5 respondents noticed that
John felt uncomforted while speaking in a long sentence. It is clear that he had a problem in
speaking in a long sentence and it is mentioned in the case study about speaking problem
during his condition. From the above table, it is clear that most respondents think that home is
a better option for John. 3 out of 5 respondents think that home is better and 2 respondents
think that hospital is better for John. It is needed to develop and establish the proper
environment for John to ensure a healthy atmosphere for him. It is found that 2 respondents
think that John takes his medicine properly while 2 respondents are not sure about his
medication. The medicine in a daily manner is essential for John to focus on progression
concerning his breathing and other problems. From the above table, it is clear that 3
respondents think that John takes proton-pump inhibitor and receptor once a day. Inhibitor
and receptor are prescribed for overcoming the issues with shortness of breath. It is found
that 2 respondents think that the likelihood of risk of middle and lower lung lobe is medium
for the respondents. 2 respondents think that the possibility of risk is high for John. On
auscultation, it was found in John.

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Clinical Presentation Discussion Report
Underlying pathophysiology
Shortness of breath includes asthma, pneumonia, anaemia and others for John. It is
clear that John needs pathophysiological conditions and establishment to focus on the
abnormal commotion of him (Steindal et al., 2018). Shortness of breath is known as
dyspnoea while pathophysiological lies with developing the condition of extreme temperature
and massive obesity for him. Breathing shortness and hypertension of the patient has been
identified to analyse the disease context and pathophysiology of the disease. Critical
evaluation and treatment process includes the significant risk factors to fit the health and
causes of a disease condition in recent times (Mahmoud, EL-Din & Sadek, 2017).
Breathing shortness or dyspnea:
Breathing shortness of the John includes the better assessment and treatment process
in both home and hospital as per the primary survey. As per the view of Gardner et al.
(2017), treatment and assessment include the breathing problem and normal living
progression for the treatment of dyspnea. Dyspnea is caused due to substantial disability and
mechanisms are understood to lead with the sensation of neural position and transmission
further. The uncomfortable sensation is found in John as per the primary survey on airway,
breathing, circulation, disability, and exposure. Breathing shortness of Mr. Jenkin is found
that jaw thrust, removing the obstruction, and recovering the safe process for c-spin.
According to Hendriks et al. (2015), in dyspnea, people use different phrases of stimuli
arising and breathing discomfort. People with respiratory problems feel the shortness of
breath and discomfort while speaking. Increasing the breathing rate and senses of breath are
found to lead in the treatment process of breath. Cause of dyspnea includes asthma, COPD,
heart attack, low blood pressure, enlarged heart, choking, abnormal heartbeats, pulmonary
embolism, and others. The chronic obstructive pulmonary disease of Jenkin is found by acute,

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Clinical Presentation Discussion Report
chronic airway involvement. Jenkin is suffering from COPD and shortness of breath, which
needs to manifest the infection level and inflammatory treatment process. The risk factors of
dyspnea focus on risk factors including prior lung diseases, low hemoglobin, and muscle
weakness as low conditionals of the patient (Park, Moon & Lee, 2017). Having prior
hypertension and gastro-esophageal reflux disease, the patient needs to take care of regular
medicines against the condition.
John needs to develop the microorganisms colonize and inflammatory of immune
response. It damages the bronchial and alveolar mucous membranes that influence the
impaired gas exchange. Shortness of breathing of John includes the emergency case and
facility to conduct the medical profession and establishing the persistence treatment process.
Respiration as an act of vital functions is regulated to automatic centres to control the rate and
pattern to affect the individual to remedy the physiologic derangement of sensation. As per
the view of Norozi et al. (2017), long-term visibility focuses on assessment, treatment
process to develop the treatment procedures for shortness of breath. It is needed to evaluate
the new strategies of recent activity and interactions with the physiologic mechanism of
respiratory discomfort. John is tachypneac, and it enhances the effort and necessary treatment
process to develop the intercostals signals to maximum pressure generating capacity.
Hypertension:
Hypertension is a cause of morbidity and mortality to affect the level of blood
pressure and treatment of hypertension with increased vascular stiffness and increased the
responsiveness of stimuli (Sari, 2016). There is increasing isolation and change impact over
the long-term complications to develop the treatment and condition of the individual. John
had a history of hypertension, which affects the cerebrovascular risk and particular breath
shortness of individual. John has faced intensive crackles and irregular heart beat with high

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Clinical Presentation Discussion Report
blood pressure. He had hypertension and gastro-esophageal reflux. He is taking medication
and lower lung lobe with proton-pump inhibitor daily. According to De Sousa et al. (2016),
control of blood pressure and prevention of cardiovascular events are reviewed to implement
the high-normal blood pressure to prevent the cardiovascular system. Regulation of blood
pressure includes maintaining hypertension to overcome the arterial pressure to increase
active medications and treatment. Pulse pressure and blood pressure include the important
aspect of increasing the sensitivity to stressful stimuli. In essential human hypertension, it
focuses on characterised hypertension and complications in excretion to result in causing
hypertension. It is considered as explaining hypertension and risk factors to focus on salt-
sensitive hypertension (Mahmoud, EL-Din & Sadek, 2017).
Nursing management
Psychological care:
Psychological care provides care against the increased anxiety and cause of more
breathlessness and intervention of the disease. Psychological care for dyspnea is effective to
develop and implement the reduction of discussion towards the benefits of the patients. John
needs psychological therapy to interpret the intervention process of the individual. Ensuring
the psychological treatment of dyspnoea needs a tactile approach, gentile rubbing back and
stroking arm (Bashi et al., 2018).
Breathing exercises and sputum clearance:
Specific breathing exercise for John can be helpful with chronic dyspnoea (Mahler,
2017). Controlled breathing techniques and sputum clearance are needed to convey the
discomfort and issues of the patient. John needs to develop regular exercise and sputum

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Clinical Presentation Discussion Report
clearance while it is controlled to reduce the discomfort and respiratory rate for the breathing
exercise. Removing sputum can be used to reduce the dyspnoea for encouraging the patients
with reducing discomfort. Sputum pots should be changed to reduce the risk factors of the
individual (Taha & Ali, 2015). The patient should be encouraged to enhance the regular terms
treatment to develop the oral mucous membranes over uncomfortable side effects.
Eating and drinking:
Eating and drinking are found to be difficult for the patients, and it needs more
encouragement and nutrition in eating to involve in daily activity. It needs to develop
nutrition and patient regulation, which needs oxygen therapy. Offering several and regular
meals are needed to execute the intervention process of dyspnoea. It needs to reduce the risk
and develop the improvement and discomfort to focus on nutritional intervention process
intake (Tripathi & Sharma, 2017). It is needed to develop and maintain the meals to focus on
pharmacological interventions for the care users.
Oxygen therapy:
It is used to develop and improve the low level of oxygen input any patient. John had
breathing shortness as it develops the treat hypoxia as a low level of arterial oxygen.
Evidence suggests the psychological benefits of using oxygen. Oxygen is prescribed to John
as medicine (Johnson et al., 2015). Nurses ensure the correct percentage of oxygen input
daily for each patient per needed. The therapy is used to develop a common prescription to
treat dyspnoea with the correct percentage of oxygen. Humidification is required to prevent
the oral mucous membranes towards the tenacious sputum and retention of it (Rakhshan et
al., 2016).
Inhaled bronchodilators:

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Clinical Presentation Discussion Report
There is a common prescription of inhaled bronchodilators to include the cause of
breathlessness in airway obstruction. In the case of chronic obstructive pulmonary disease,
drugs help to open the airways after relaxing the bronchial smooth muscle, which delivers
through ensuring adequate drug deposition (Detailleur et al., 2017). It is essential to establish
an adequate treatment policy to establish airway inflammation and antibiotics for treating
pulmonary infections. It is effective to treat pulmonary infections and airway inflammation to
prescribe the asthma-related issue and driving factors of treating the disease (Mahler, 2017).
Conclusion
In order to conclude the study, it can be said that chronic breathlessness allows for
assessing the impact in daily life to establish the intervention process of disease. It is effective
to drive and control the treatment process in indicating the reduction rate of the disease. It is
needed to establish the multidisciplinary team management to assess the impact and home
care development to encourage physical exercise. John Jenkins faced from shortness of
breath and hypertension. John needs to assess the concerns to develop respiratory and
hypertension. The 5 interventions are developed to control and assess the medicinal
approaches and intervention process. As per a recent study, dyspnea is critical to be
endangered for pulmonary disease with chronic cardiopulmonary access. Reductions in the
functional activity and specific limitation of maximum therapy are implemented for the
patients.

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Clinical Presentation Discussion Report
Reference list
Bashi, N., Hassanzadeh, H., Varnfield, M., Wee, Y., Walters, D., & Karunanithi, M. (2018).
Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute
Coronary Syndromes: Qualitative Study on Health Care Providers’
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https://cardio.jmir.org/2018/2/e10183/?
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_0
de Sousa, V. E. C., Pascoal, L. M., do Nascimento, R. V., de Matos, T. F. O., Beltrão, B. A.,
da Silva, V. M., & de Oliveira Lopes, M. V. (2016). Ineffective breathing pattern in
cardiac postoperative patients: diagnostic accuracy study. Applied Nursing
Research, 32, 134-138. Retrieved on: 16 April 2019, from
http://repositorio.ufc.br/bitstream/riufc/24246/1/2016_art_vecsousa.pdf
Detailleur, V., Cadenas de Llano Perula, M., Buyse, B., Verdonck, A., Politis, C., & Willems,
G. (2017). Are Sleep Disordered Breathing Symptoms and Maxillary Expansion
Correlated? A Prospective Evaluation Study. Journal of Sleep Disorders-Treatment &
Care, 6(1). Retrieved on: 16 April 2019, from https://lirias.kuleuven.be/1663077?
limo=0
Douw, G., van Zanten, A. R., van der Hoeven, J. G., & Schoonhoven, L. (2018). Surgical
ward nurses’ responses to worry: An observational descriptive study. International

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journal of nursing studies, 85, 90-95. Retrieved on: 16 April 2019, from
http://www.intensivistenopleiding.nl/downloads-36/files/Douw%20IJNS.pdf
Gardner, J., Swarbrick, M., Ackerman, A., Church, T., Rios, V., Valente, L., & Rutledge, J.
(2017). Effects of Physical Limitations on Daily Activities Among Adults With
Mental Health Disorders: Opportunities for Nursing and Occupational Therapy
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Hendriks, S. A., Smalbrugge, M., Galindo-Garre, F., Hertogh, C. M., & van der Steen, J. T.
(2015). From admission to death: prevalence and course of pain, agitation, and
shortness of breath, and treatment of these symptoms in nursing home residents with
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Mahler, D. A. (2017). Breathe Easy: A Guide to Better Breathing. University Press of New
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Norozi, H. M., Golmohammadi Kavaki, M., Hajiabadi, F., & Behnam Vashani, H. (2017).
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