Nursing Case Study: Beverly and Mr. Manuel's Chronic Conditions

This nursing case study presents two cases involving patients with chronic conditions. The first case focuses on Beverly, who exhibits symptoms of chronic kidney disease and potential cardiomyopathy, including shortness of breath, pulmonary edema, and the need for dialysis. The assignment explores her medical history, potential complications, medications (like Pantoprazole and Metoprolol), and nursing interventions, including fluid restrictions and the importance of baseline assessments. The second case involves Mr. Manuel, a patient with type 2 diabetes, who has experienced a stroke and requires care following an amputation. The assignment discusses his medications (Metformin, Furosemide, Gliclazide, etc.), potential complications like visual impairment and body paralysis, and the importance of foot care and dietary management, including the role of a diabetic educator. The case study also addresses peritoneal dialysis and potential complications like peritonitis, and outlines the essential nursing diagnoses and interventions for both patients.

Running head: NURSING
Implement and monitor care for person with chronic disease
Name
Institution

NURSING
Case study 1
Question 1 answer
From Beverly’s past health history based on the symptoms presented, the actual health
problem she might be undergoing is identified as the chronic kidney disease which has posed the
above symptoms.
The potential health problem Beverly might be experiencing can be linked to the heart disease
following its effects on the cardiovascular mortality in patients which causes cardiomyopathy.
Question 2 answer
The shortness of breath experienced by Beverly can be linked to the impacts caused by the
chronic kidney disease which has affected proper function of the heart since most of the veins
responsible for the circulation of oxygenated blood in the body is tampered with.
Question 3 answer
Coughing of pink, frothy sputum by Beverly indicates the signs of pulmonary edema. Other
signs of pulmonary edema experienced by Beverly are anxiety and excessive sweating which is
caused by the failure of left ventricular. The pathophysiology of the pulmonary edema is a
condition where fluid leaks into the alveolar spaces which is due to the hemodynamic caused by
pulmonary venous obstruction or micro vascular injury.

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Question 4 answer
The medication for chronic kidney disease has not been established since the condition cannot
be completely treated but medication can be given in order to control the symptoms from getting
worse. Dialysis treatment can be done in order to replicate some of the kidney functions which is
necessary for stage five of the chronic kidney disease. Kidney transplant is also necessary for
controlling the disease as it controls some of the symptoms during stage five of the chronic
kidney disease.
Question 5 answers
Cardiomyopathy can be treated through medications provided by the qualified medical
practitioners through the following process.
Diuretic: This involves increasing the production of urine by the body in order to get rid of the
excess saltwater in the body.
Statin: This involves decreasing the production of harmful cholesterol by the liver.
Blood thinners: This medication will help to prevent the blood clot from forming in the veins.
Question 6 answer
The condition that is chronic kidney disease will negatively impact the daily activities of
Beverly following the medication process she is undergoing. Personal hygiene of Beverly will be
altered with following the symptoms of her conditions which is considered unhygienic therefore
she is expected to improve her hygienic condition than before. Daily activities like doing heavy
work on her farm will be hindered since the condition does not require more energetic activities.

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Question 7 answers
The 1.5 litres fluid intake restriction for Beverly is necessary based on her health condition.
Restriction is necessary in order to reduce the ultrafiltration function of the kidney so as to
reduce the fatigue.
Question 8 answer
Beverly may have a renal dysfunction complication due to the excess consumption of sugar
due to her love for wine. Excessive consumption of sugar into the body will increase the
ultrafiltration work of the kidney leading to kidney fatigue which may result in renal dysfunction
due to overworking.
Question 9 answer
The permanent pacemaker will be essential in implantation on the hemodynamic profile so as
to relieve symptoms on patients with sick sinus syndrome since it will control the pace at which
the ventricular pumps the blood to the whole body.
Question 10 answer
Nursing diagnosis for the chronic kidney disease for Beverly thus according to her health
condition is dialysis process. Kidney dialysis will be necessary in the case of Beverly since it
involves artificial removal of excess body fluids and waste products from the body. The process
of hemodialysis involves filtering waste products and extra fluid from the blood using a thin tube
which is inserted into the abdomen filling abdominal cavity with a dialysis solution that absorbs
wastes and extra fluids from the blood.

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Question 11 answer
The doctor’s recommendation for the daily weigh before six o’clock in the morning is
essential for Beverly who has a chronic kidney disease since at this time, there will be no excess
fluid buildup in the body, therefore, Beverly will be able to know her exact weight. At this time,
the body weight obtained will be similar to the weight which a person with normal kidney
function weighs.
Question 12 answer
The symptoms associated with the hypothyroidism include:
• Whole-body fatigue, lethargy or feeling cold even on a hot day
• There will be a slow growth rate and delayed puberty development
• There will hair loss and dryness of the hair
• Slow heart rate
• Sexual dysfunction
• Irregular uterine bleeding
Question 13 answer
Pantoprazole helps in reducing the amount of the acids in the stomach, heartburn thus also
help treat stomach ulcers. GORD is a condition where one keeps on getting acid reflux.

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Question 14 answer
In managing Beverly’s daily activities following her tired nature due to her health condition,
finding a house help will be appropriate for her to help her to manage some of the household
chores which might need more energy to complete. Hiring people to help her with the farm's
work will be a good idea for managing her daily activities as she will not be involved in most of
the activities due to her medical condition which makes her feel tired and unable to complete her
daily activities.
Question 15 answer
The information and findings based on Beverly’s condition of shortness in the breath before
reporting the condition to the doctor involves gathering information on her daily activities which
might make her feel short in breathing. Her past medical history would be appropriate
information for her condition in order to identify some of the possible cause for the condition.
Question 16 answer
Salbutamol is used to relieve symptoms on asthma by relaxing the muscles of airways into the
lungs which make it easier to breathe therefore it aid to relieve shortness in breathing.
Question 17 answer
Baseline assessment of Beverly’s condition is important so as to get a medical history. The
medical history will provide information on her health status so as to help the doctor to perfectly
analyze her health condition for better medication.

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Baseline assessment will also be essential to her caretaker in attending to her medical needs in
case of an emergency. This quill ensures proper medication for Beverly.
Question 18 answer
Metoprolol is considered as the treatment for cardiomyopathy since it is well-tolerated,
improved symptoms and cardiac function and prevented clinical deterioration in patients with
symptomatic idiopathic dilated cardiomyopathy.
Question 19 answer
Cardiomyopathy is a state where the heart stretch and becomes weak hence cannot pump
blood effectively while heart failure is a condition where the pumped blood does meet the needs
of the body because the heart is week. Therefore the two terms are not similar.
Question 20 answer
In Beverly’s case, the doctor can either use the blood test to be able to check for the glomerular
filtration rate or the urine test for the albumen. Measuring the level of protein content in
Beverly’s urine will also be an option for the doctor in testing chronic kidney disease.

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Case study 2
Question 1 answer
Metformin medication has been administered to Mr. Manuel as a treatment of type 2 diabetes.
Furosemide medication is prescribed to Mr. Manuel since it cures fluid build-up in the body due
to heart failure.
Gliclazide was prescribed for Mr. Manuel since it’s a cure for diabetes mellitus type 2.
Gabapentin is an anticonvulsant medication used to treat restless leg syndrome according Mr.
Cortes case.
Salbutamol was administered to Mr. Cortes in order to cure shortness in breathing.
Panadol osteon was prescribed for Mr. Manuel since it will help to manage osteoarthritis
symptoms.
Irbesartan was prescribe in order to treat high blood pressure experienced by Mr. Manuel health
condition.
Question 2 answer
According to Mr. Manuel health history, he might have suffered a stroke because he had been
previously diagnosed with high blood pressure which might have triggered the stroke. Mr.
Manuel smoking habit might have been a chance for stroke since smoking causes stroke more so
in older age just as Mr. Manuel’s case.

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Question 3 answer
1. Visual impairment. Mr Manuel will not be able to do his daily activities which requires
good eyesight like operation of machines or cooking.
2. Body paralysis. Due to the stroke, some parts of his body will be paralyzed hence he will
not be able to walk normally or do other activities like farming.
3. Body fatigue. Due to his health condition, he will not be able to do some of the heavy jobs
which requires energy due to his tired nature.
Question 4 answer
Mr. Manuel had experienced the following mentioned symptoms of diabetes mellitus
• He experienced increased thirst
• He experienced increased hunger especially after eating
• He had a dry mouth
• He experienced frequent urination
• His Weight reduced
• He was very weak and tired

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Question 5 answer
According to Mr. Cortes case, type 1 diabetes mellitus is due to the pancreatic islet B cell
destruction predominantly by an autoimmune process and there he is prone to the ketoacidosis
while types 2 diabetes is more prevalent form and result from insulin resistance with a defect in
compensatory insulin secretion.
Question 6 answer
Foot care is very important to Mr. Manuel thus following amputation of one foot so as to
prevent any infection which might affect the remaining foot since he is vulnerable to such
infections.
The educational priorities on foot care for mr Manuel includes
1. He must attend regular medical check-up so as fight some foot related infections
2. Mr. Cortes must eat a well-balanced food in order to boost his immune system
3. He should priorities his hygienic status in order to facilitate healing of the imputed leg
and prevents infections.
Question 7 answer
I should contact diabetic educator to meet Mr. Manuel so as to advise him on the diets he
should take that is his eating habit which is very essential since Mr. Manuel is diabetic hence

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there is some particular food he should exclude from his diet like sugary food so as to control
some of the diabetic symptoms.
Question 8 answer
Mr. Cortes’ daughter should also meet with the educator for the guidance on the diet selection
for her diabetic father and mode of preparation which should be less sugar content and little
spices. She will be guided on the best diet for her father according to her father’s diabetic
condition.
Question 9 answer
Mr. Cortes does not need to be treated with insulin in control of his diabetic condition since
insulin can be directly consumed in the diet through food with natural insulin content. Mr. Cortes
can safely consume insulin through his daily diet by eating some of the insulin-containing food.
Question 10 answer
Peritoneal dialysis will involve circulating of cleansing fluid in Mr. Cortes’ body through
catheter in the abdominal cavity or peritoneal cavity. The dialysate absorbs waste products from
blood vessels in the abdominal linings and then discarded out of his body.
Question 11 answer
According to Mr. Cortes dialysis program, peritonitis is caused by the following:
• When he had abdominal wound or injury
• When he had been suffering from stomach ulcer
• If he had perforated colon

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• If in any case he had been diagnose with inflammation of pancreas
• If his gallbladder, intestines or bloodstream are infected
Question 12 answer
Mr. Cortes might experience the following signs and symptoms due to Peritonitis infection:
• Abdominal pain
• Bloating or feeling of fullness
• Fever
• Loss of appetite
• Nausea and vomiting
• Low urine output
• Thirst
Question 13 answer
Peritonitis can be medically treated through the administration of antibiotic drugs which stops
the growth of the bacteria by killing the specific bacteria responsible for the cause of the
infection.
The condition can also be treated through surgical removal of the appendix.
Question 14 answer
According to Mr. Cortes health condition, hemodialysis process qill be used to clean the blood
since it has a special filter called artificial kidney or dialyzer which is divided into two parts, thus