NRSG265 Principles of Nursing: Nursing Intervention Case Study

This document presents three nursing case studies, each detailing a different patient scenario and the corresponding nursing interventions. The first case focuses on a 9-year-old patient, Haley, diagnosed with type 1 diabetes, highlighting the assessment of hyperglycemia, polyuria, and polydipsia. The case analyzes the pathophysiology of the condition, identifies nursing priorities such as managing hyperglycemia and low blood pressure, and outlines the actions taken, including patient education and medication administration. The second case continues with Haley, presenting her in the ICU with severe dehydration, low blood pressure, and metabolic acidosis. The case emphasizes the importance of managing hypoglycemia and establishes goals to stabilize the patient's condition. The final case introduces Tom Habury, a 58-year-old with a history of depression and chest pain due to chronic angina. This case explores the assessment of his condition, including high blood pressure and the administration of GTN and morphine. The document emphasizes the importance of monitoring vital signs, managing chest pain, and preventing potential complications like heart attack or stroke. Each case includes reflection on the learning process and the application of the clinical reasoning cycle.

Running Head: Nursing Intervention
Nursing Intervention
Name of the Student:
Name of the University:
Author’s note:

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Case Study 1
Considering the Patient
Initial impression of the patient
Haley is 9 year old she had an evident skin fold that is evident for a single second. She
looks tired and has minimal physical activity. She comparatively had a high rate of
respiration.
More information about Haley
Haley has been presented with a medical history of polyuria and polydipsia. She had a
high blood sugar level. She suffered weight-loss and complained of abdominal pain. She had
a lethargic feeling. Urine test exhibited excess amounts of ketones and glucose.
Information that are significant
The significant information of Haley includes that she is hyperglycaemic. She also
exhibits polyuria and polydipsia.
Collection of the Information
The other information that are required is whether Haley has acquired a skin infections, if
she has a fruity smell breath. If this elevated blood sugar level is not controlled it would lead
to kidney, heart, eye damage in the child. It can also cause nerve damage and osteoporosis
(Atkinson, Eisenbarth & Michels, 2014)..
The pathophysiology of the type 1 diabetes includes destruction of the beta cells of the
pancreas that results in insulin deficiency. This is an autoimmune disorder that causes
ketoacidosis (Marik & Bellomo, 2013).
1. A normal blood glucose level is 4-6mmol/L.
2. All the signs and symptoms pertain to hypoglycaemia except Kussmaul breathing.

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3. Injections are more effective in comparison to tablets and since Haley has a
comparatively higher blood glucose level than her grandmother and immediate action should
be taken to reduce it to prevent the damaging effect of high blood pressure. Injectable are
directly injected into the blood and the drug is freed to act where as in case of tablets the
processing to get released in the blood takes longer (Lind et al., 2014)..
Processing of the information
Haley has elevated level of blood sugar that is 17mmol/L, she has ketones present in urine
and also polyuria.
The priority list includes:
 Hyperglycaemia
 Low blood pressure
 Ketones in urine
Two outcomes that might occur if Haley does not have meal within 15 minutes of the
administration of Novorapid is that she will be irritable and moody and also she will
experience hypoglycaemic response (Semenza, 2014).
Identification of the issues
The low oxygen distribution in the blood causes hypoxia that is exhibited by the severe
headache and lethargy exhibited by Haley. This is a condition when the body is deprived of
the required amount of oxygen.
The abdominal pain in high blood sugar is the manifestation of diabetic ketoacidosis as
well as metabolic decompensation.
Establishment of the goals
The three immediate goals to attend Haley is:

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To attend to the hypoxic state of the body and ensure sufficient amount of oxygen input.
To attend to the low blood pressure of the patient.
To attend to the diabetic ketoacidosis that is causing physical distress to Haley.
Actions taken
Haley’s mother should be given education about managing her daughter’s diabetes
symptoms. She should avoid long meal intervals. And medication should be administered
time to time.
Evaluation of the Outcomes
The signs of improvement in Haley’s condition includes:
 Reduction in the high blood sugar level
 Elevated levels of physical activity
 No complains of abdominal pain
 No complains of headache
 Normal blood pressure
Reflection
The progress of the health of Haley was an encouragement for my work. This case aided
in understanding the criticality of the case based on the clinical reasoning cycle. This case
study also enhanced my knowledge due to the evidence based study that was done.

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Case Study 2
Considering the patient condition
Impression of the current status of Haley
Haley has an IV cannula located in her right cubital fossa.
More information of Haley
She has been diagnosed with type1 diabetes and she has been in the ICU due to severe
dehydration and dehydration. She exhibited low blood pressure and respiratory
compensation. Suffered from abdominal pain due to metabolic acidosis.
Information that are relevant and significant
The valid information include her elevated blood sugar and blood ketone level. The low
blood glucose and metabolic ketoacidosis. She also exhibited respiratory compensation as
well as low blood pressure (Ball et al., 2013).
Collecting information
1. The common acute complication of type 1 diabetes includes damage of the major organs of
the body like kidney, eyes, heart.
2. 2.4 mmol/L of blood glucose level is considered as low.
3. (a) True
(b) True
(c) False
4. The role of the diabetes educator is to ensure that the patient is educated about the
condition and aim to achieve behavioural goals to get better clinical outcomes and improved
health status (Kisely et al., 2015).

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5. The discharge plan of Haley should take medication from time to time. Her blood glucose
level should be monitored by her mother at regular intervals exploiting glucometer strips. She
should be given meals at regular intervals to avoid fasting.
Process information
Three outcomes of the hypoglycaemic condition if not managed is:
 Risk of brain stroke and can collapse
 Neuronal impairment
 Acute paralysis
Identify problems
She is suffering from hypoglycaemia due to injecting insulin medication.
She is also suffering from low blood pressure.
Establish goals
The goals should be ensure stable conditions of Haley and make her blood glucose level
get back to normal.
Her blood pressure should also be restored to normal
Take actions
Immediately a sugar coated toffee should be administered to restore the blood sugar level
to level. She should be laid sown to ensure rest and the room should have ope doors and
windows to ensure proper aeration.
Evaluation of the outcomes
The statements that suggest that the management has been effective includes:
c. Forty-five minutes after consuming the glucose, Haley’s BGL is 3.0 mmol/L

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d. Two hours after consuming the glucose, Haley’s BGL is 3.0 mmol/L.
Reflection on the learning
I have learned the appropriate use of the evidence based practice and excellent utilisation
of the clinical reasoning cycle for better understanding of the case scenario. Proper
exploitation of the databases to manage the case. The evaluation of the outcome aided in
boosting my confidence level.

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Case Study 3
Consideration of the situation of Tom Habury
Initial impression of Tom
Tom Habury is a 58 year old individual who is being transferred from the Emergency
department to the Coronary Care Unit (CCU) due to a substernal pain in the chest that is
radiating to his jaw.
Information about Tom
Tom intakes a dosage of 10mg sertraline daily as Tom has a history of depression. . His
body was not responding to the chest pain with the normal GTN dosage that he was taking.
GTN is glyceryl trinitrate is administered to reduce chest pain in patients. His blood pressure
was high 155/98 mm Hg. The ECG did not show any ST segment elevation. He had a normal
respiratory rate. He was administered 5mg of morphine and 0.8 mg GTN before being
transferred to the CCU. The medical orders are to be monitored every 4 hours. GTN should
be sprayed every 5 minutes for three doses. If the patient is not responding to GTN then
0.5mg morphine should be administered to Tom.
Relevant and significant information
The significant and relevant information of Tom Habury is that he has a frequent chest
pain due to chronic angina that is aggravating. He has a high blood pressure. This is a
symptom of coronary artery disease. And if untreated he might be at risk of stroke or heart
attack (Puchner et al., 2014).
Collection of cues and information about Tom
1. Atherosclerosis is defined as formation of plaque that consists of fat, cholesterol, calcium
and other substances in the arteries that carry oxygen rich blood to the heart and other body
parts. The plaques harden up and leads to hardening of the arteries.

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Arteriosclerosis mainly occurs in the old age that is characterized by thickening and
hardening of the walls of the arteries (Khella, 2017).
2. Angina is a symptom of coronary heart disease that is characterised by chest pain due to
lack of oxygen flow to the heart. Stable angina occurs mainly due to pain that arises due to
emotional stress or work. It does not change in frequency and neither aggravates over time.
Unstable angina can occur at rest, on exertion or even due to stress. It occurs when the critical
level of the oxygen required by the blood is not met due to multiple blockages in the arteries.
It can change in frequency and aggravate over time (Braunwald & Morrow,2013).
3. Tom Habury experiences chest pain when he is at work because he is suffering from stable
angina that aggravates when at work or at times of stress.
4. The risk factors for Coronary artery disease is old age, gender where males are more prone
to CAD, high blood pressure and high levels of cholesterol in the blood.
Processing Information
Tom Habury has normal body temperature and his level of oxygenation of the blood is
also normal. He has a normal heart rate as well. But he has elevated level of blood pressure
which is 158/97 mm Hg.
The list of assessment findings include:
 Chest pain
 High blood pressure
The administration of oxygen to Tom Habury is important because if the flow of blood is
at a low rate then his heart is deprived of oxygen and it may lead to temporary spasms in the
coronary arteries that would result in heart attack.

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The GTN also known as nitroglycerin is exploited as a sublingual spray. It causes the
arteries to widen to ensure more blood flow and it also relieves the strain in the heart, easing
the heart to pump blood to the body.
Morphine is an opioid that is considered to be an ideal analgesic. It aids in reducing the
heart rate, the elevated blood pressure and the venous return. Cumulatively, morphine aids in
decreasing the demand of oxygen by the heart.
1. The patient experiences chest pain on exertion that is caused by the vasoconstriction of the
heart.
2. The patient may feel headache and dizziness after administration of nitroglycerin.
3. The conduction of the electrical impulse in the heart is in the sequence:
b. SA node→ AV node→ bundle of His → Purkinje fibres
The two outcomes for the continuous chest ache of Tom Habury is heart attack and heart
failure.
Identification of the problem
His continuous chest pain should be controlled else he might be at risk of heart attack or
stroke.
Establishment of goals for the management of Tom
The goals are as follows:
The blood pressure of the patient should be sustained at normalcy.
His respiration rate should also come to normal.
His elevated pulse rate also be reduced to normal.

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Actions taken to achieve the goals
The action taken are as follows:
Slowly he should be encouraged for more physical activity.
The patient should be asked to rest in bed in a semi-Fowler’s position when experiencing
pain in the chest. This decreases the requirement of the oxygen of ischemic myocardium.
Utilise oxygen therapy in the level of saturation of oxygen decreases.
If not controlled GTN, beta blockers and calcium blockers can be administered and the doctor
should be informed immediately.
Evaluation of the outcomes
The reduction in his chest pain, balanced pulse rate and respiration rate. His blood pressure
should also decrease.
Reflection on the process
Tom Habury was a patient of stable angina.
From this case I gained knowledge on the vital signs to look for when a patient with CAD is
admitted in an emergency situation. The situations that can aggravate and should be
monitored on a regular basis. In Tom’s case his pulse rate became erratic and his respiratory
rate also was abnormal post his admission to the CCU.

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References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The
Lancet, 383(9911), 69-82.
Ball, J. W., DrPH, R. N., Bindler, R. C., & Cowen, K. J. (2013). Child health nursing.
Prentice Hall.
Khella, R. (2017). Rule Based System for Chest Pain in Infants and Children
Kisely, S. R., Campbell, L. A., Yelland, M. J., & Paydar, A. (2015). Psychological
interventions for symptomatic management of non‐specific chest pain in patients with
normal coronary anatomy. Cochrane Database of Systematic Reviews, (6).
Lind, M., Svensson, A. M., Kosiborod, M., Gudbjörnsdottir, S., Pivodic, A., Wedel, H., ... &
Rosengren, A. (2014). Glycemic control and excess mortality in type 1 diabetes. New
England Journal of Medicine, 371(21), 1972-1982.
Marik, P. E., & Bellomo, R. (2013). Stress hyperglycemia: an essential survival
response!. Critical care, 17(2), 305.
Puchner, S. B., Liu, T., Mayrhofer, T., Truong, Q. A., Lee, H., Fleg, J. L., ... & Ferencik, M.
(2014). High-risk plaque detected on coronary CT angiography predicts acute
coronary syndromes independent of significant stenosis in acute chest pain: results
from the ROMICAT-II trial. Journal of the American College of Cardiology, 64(7),
684-692.
Semenza, G. L. (2014). Oxygen sensing, hypoxia-inducible factors, and disease
pathophysiology. Annual Review of Pathology: Mechanisms of Disease, 9, 47-71.

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Braunwald, E., & Morrow, D. A. (2013). Unstable angina: is it time for a
requiem?. Circulation, 127(24), 2452-2457.