BN710711: Case Study Analysis of Max Johnston's Health Condition

This case study analysis focuses on Max Johnston, a 59-year-old patient admitted to the emergency department with chest pain, stress, and a history of hypertension, high blood glucose, and obesity. The analysis includes a nursing diagnosis of the patient's condition, which is related to atrial fibrillation or ischemia of the heart, breathing issues, and tachycardia. A SMART goal is developed to reduce pain, improve oxygen saturation, normalize heart rate, and reduce tachycardia. The nursing interventions include medication administration, fluid balance monitoring, urine output monitoring, heart sound notation, chest pain notation, and patient positioning. The conclusion emphasizes the importance of diagnosis, goal setting, and intervention planning for improved patient outcomes. References to supporting literature are also included.

Running head: CASE STUDY ANALYSIS: MAX JOHNSTON
CASE STUDY ANALYSIS: MAX JOHNSTON
Name of the Student
Name of the University
Author Note

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CASE STUDY ANALYSIS: MAX JOHNSTON
Introduction
Max Johnston is a patient of 59 years and has been admitted to the emergency department
due to the sudden pain in the chest when he was sleeping. It has been reported that the patient is
in stress and he has past history of hypertension, high blood glucose level and also obesity. His
cholesterol level has also been in the higher side. However, the patient is experiencing sudden
weight loss in recent time and also have been affected with higher level of stress which can be a
cause of the acute condition of the patient (Ikoma et al., 2018). The patient likes to exercise as
well. However, the ECG and X-ray report of the patient showed that he is experiencing sinus
tachycardia as the pulse rate is elevated from normal, chest pain is 9/10 which can be marked as
severe pain and also his skin is pale. Thus, the nursing diagnosis and also proper intervention
should be considered with higher priority for improved health outcome of the patient. In the
following section the nursing diagnosis, SMART goal of intervention and also the most
recommended interventions will be discussed with consideration of the case of Max Johnston.
Nursing Diagnosis
Based on the case scenario it can be stated that the patient is having higher amount of
distress in this condition and should be relieved from the pain. Thus, the nurse should be able to
observe the patient and record the changes in the patient’s condition in a regular interval. The
condition of the patient is referring to the situation of the atrial fibrillation or ischemia of the
heart (Johnson et al., 2018). The patient is also experiencing breathing issue. Thus, the nurse
should provide the patient with supplementary oxygen supply to normalise the oxygen saturation
of the patient’s body and also focus on the vital sign recording. The primary nursing diagnosis in
this condition of the patient is to observe and develop the report according to the distress level

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CASE STUDY ANALYSIS: MAX JOHNSTON
and the changes in the ECG report of the patient with time (da Costa, da Costa Linch & Nogueira
de Souza, 2016). The patient should be monitored by the nurse with the consideration of the
tachycardiac condition of the patient and should be recorded the minute changes in the vital signs
and the pain level of the patient. Specially the oxygen saturation elevation in the body of the
patient along with the heart rate normalisation should be considered by the nurse. Thus, the
monitoring of the changes in the patient’s situation is the primary diagnostic procedure of the
nurse responsible for Max Johnston. On the other hand, the nurse can focus on the vital signs of
the patient for the improvement or the deterioration monitoring of the patient or focus on the
ECGs conducted in regular interval for the patient so that the tachycardia can be diagnosed
properly and intervened also the fluid balance of the patient as well (Rabasová, 2017). The
record of the patient should be maintained and reported to the doctor for the betterment and
planned intervention providence to the patient. Hence, it can be stated that in this situation of the
patient the nurse should focus on the vital sign and ECG data monitoring of the patient and
reporting the data to the doctor in regular intervals. Thus, the diagnosis of the patient is vital in
this situation as the minute changes in the patient’s condition can be effective for the proper
treatment and intervention planning for the patient (Ellis, 2020).
SMART Goal
Based on the scenario it has been found that the patient has been affected with
tachycardia and the nursing diagnosis showed that the patient is high amount of pain and
breathing distress as well. Hence, the nurse should develop an effective plan of intervention of
the patient. Thus, a goal should be developed by the nurse and the goal should be a SMART goal
that is specific, measurable, achievable, realistic and time effective. Hence, the SMART goal

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CASE STUDY ANALYSIS: MAX JOHNSTON
should focus on effective improvement of the patient in a short amount of time. The SMART
goal for Max Johnston care should be as follows:
S: The pain of the patient should be decreased up to 4/10 from 9/10 within 12 hours.
M: The oxygen saturation should be increased up to 96 per cent from 91 per cent and the
breathing distress of the patient should be improved within 6 hours.
A: The heart rate of the patient should be normalised within 4 hours.
R: The tachycardia of the patient should be reduced up to 50 per cent within 4 hours.
T: The breathing distress, oxygen saturation, pain and the tachycardiac condition of the patient
should be normalised within 6 to 12 hours effectively.
Nursing Intervention
Based on the goal set for the reduction of the distress and improvement of the patient’s
health condition the nurse should plan the intervention of the patient. In this context, the nurse
can develop several nursing interventions for the patient and the interventions should be focused
on the improvement of the patient’s health outcome. Thus, following interventions can be
planned by the nurse:
Administration of medication: The nurse can administer the medicines prescribed by the doctor
for reduction of the pain and the elevated heart rate of the patient. The medication of Max
Johnston would be including the diuretics, vasodilators, angiotensin-converting enzyme
inhibitors, antidysrhythmic and others. However, the nurse should be focused on the dosage and
the timings of the medicines as the side effects of the medicines can affect the health of the
patient as well. Hence, administering these medicines would be focused on the improvement of
the situation of the patient (Ruzieh et al, 2017).

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CASE STUDY ANALYSIS: MAX JOHNSTON
Monitoring fluid intake and maintaining the fluid balance: The nurse should also provide the
patient with saline water comprising the required electrolytes. The blood test report of the patient
highlighted that the electrolytes and some proteins of the body are imbalanced. Hence, the
intravenous intake of these essential compounds can be monitored by the nurse and properly
managed as well for the improvement of fluid and electrolyte balance of the body (Etheridge &
Shearer, 2018).
Urine output monitoring: The nurse should also monitor the urine output of the patient and
measure the amount of urination of the patient. It can be stated that the reduced perfusion of
kidney would result in reduced cardiac output as well. Hence, this factor should be considered
with higher priority (Richards, 2019).
Heart sound notation: The nurse should also note the rhythm of the heart sound of the patient.
The sound notation should focus on the S1, S2, S3 and S4 sound of the heart along with the
additional sound of lung crackles as well. Here, the patient is found with the breathing issues and
thus, the heart sound should be monitored for the rhythm of the heart identification as well as
presence of any kind of additional sound. This, process will help in the identification of the
negative factors present in the body that affects the breathing and the heart beats (Dzikowicz &
Carey, 2020).
Noting chest pain: The nurse should also focus on the chest pain quality, character, radiation of
the pain, severity and the duration of the pain as well. This will help in the identification of the
associated negative factors such as nausea and other as well. This factor can identify the rate of
blood flow to the heart as the pain in this case suggest the lower rate of blood flow to the heart.
Hence, the reduction is pain highlights the increase in blood flow and the opposite can also
occur. Thus, it can be stated that the process of the pain notation and management will end up in

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CASE STUDY ANALYSIS: MAX JOHNSTON
reduction of the distress of the patient and improve the situation for the patient effectively (Sara'a
et al., 2016).
Positioning of the patient: The patient is found with a pain and distress in the chest which is
caused due to the tachycardia. On the other hand, the patient is feeling shortness of breath as
well. In this context, it can be found that the positioning of the patient can paly a crucial role.
Hence, the semi or full Fowler’s position which is semi or full upright position can be
implemented for the improvement of the breathing and the blood loading in the ventricles
(Setten, Plotnikow & Accoce, 2016). Thus, this positioning can improve the situation of the
patient. It can be marked as one of the most effective intervention is the breathing distress and
also chest pain.
Conclusion
Based on the above discussion it can be concluded that the diagnosis and intervention of
a patient with acute cardiac and respiratory condition is required with higher priority. The
distress of the patient that is Max Johnston can be reduced with proper diagnosis, goal setting
and also intervention planning and implementation by the nurse. Thus, these factors are very
much important in the process of the improvement of the situation of a patient. The acute
condition of Max Johnston should be assessed and properly prioritised for the improvement of
the health outcome and should also be provided with proper intervention to the patient as well.
Hence, the effectiveness of the intervention is dependent on the diagnosis and the goal setting for
the improvement of the patient’s condition.

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CASE STUDY ANALYSIS: MAX JOHNSTON
References
da Costa, C., da Costa Linch, G. F., & Nogueira de Souza, E. (2016). Nursing diagnosis based on
signs and symptoms of patients with heart disease. International journal of nursing
knowledge, 27(4), 210-214.
Dzikowicz, D. J., & Carey, M. G. (2020). Cardiac Cases. Myocardial Ischemic Induced Non-
Sustained Ventricular Tachycardia in an Older Adult with Pneumonia. Medsurg Nursing,
29(1).
Ellis, P. (2020). Nursing diagnosis. Patient Assessment and Care Planning in Nursing, 75.
Etheridge, W. B., & Shearer, S. A. (2018). Management of Fluid Balance and Perioperative
Renal Complications. In Mechanical Circulatory Support for Advanced Heart Failure
(pp. 129-144). Springer, Cham.
Ikoma, Y., Kusumoto-Yoshida, I., Yamanaka, A., Ootsuka, Y., & Kuwaki, T. (2018).
Inactivation of serotonergic neurons in the rostral medullary raphe attenuates stress-
induced tachypnea and tachycardia in mice. Frontiers in physiology, 9, 832.
Johnson, L. S., Persson, A. P., Wollmer, P., Juul-Möller, S., Juhlin, T., & Engström, G. (2018).
Irregularity and lack of p waves in short tachycardia episodes predict atrial fibrillation
and ischemic stroke. Heart rhythm, 15(6), 805-811
Rabasová, P. (2017). Content validation of nursing diagnosis of deficient fluid volume
[dehydration] in the context of neonatological nursing. Central European Journal of
Nursing and Midwifery, 8(2), 622-631.
Richards, E. (2019). Postural Orthostatic Tachycardia Syndrome (POTS): A Primer for Nurse
Practitioner Practice.

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CASE STUDY ANALYSIS: MAX JOHNSTON
Ruzieh, M., Baugh, A., Dasa, O., Parker, R. L., Perrault, J. T., Renno, A., ... & Grubb, B. (2017).
Effects of intermittent intravenous saline infusions in patients with medication—
refractory postural tachycardia syndrome. Journal of Interventional Cardiac
Electrophysiology, 48(3), 255-260.
Sara'a, H. S., Zedaan, H. A., Ahmed, R. S., Owaid, H. A., & Mousa, A. M. (2016). Nurses'
Knowledge Concerning Early Interventions for Patients with Ventricular Tachycardia at
Baghdad Teaching Hospitals. kufa Journal for Nursing sciences, 6(2), 8-15.
Setten, M., Plotnikow, G. A., & Accoce, M. (2016). Prone position in patients with acute
respiratory distress syndrome. Revista Brasileira de terapia intensiva, 28(4), 452.