NURSING ASSIGNMENT: Patient Case Study Analysis and Review

This nursing assignment presents a detailed analysis of a patient admitted to the hospital, focusing on Mrs. Hall, a 98-year-old female admitted for shortness of breath. The report delves into the patient's past and present medical history, including ischemic heart failure and joint problems, linking them to the breathing difficulties. It explores the pathophysiology of the patient's condition, considering factors like COPD and osteopenia. The assignment also examines the pharmacological aspects of the patient's treatment, discussing medications such as Colace, Senna, Frusemide, GTN spray, and Panadol, including their pharmacodynamics and pharmacokinetics. Furthermore, the report assesses the patient's condition through investigation findings, highlighting blood pressure, oxygen saturation levels, and other relevant details. Finally, the assignment provides recommendations for the patient's care, including weight regulation, continuous monitoring, and patient education, with a focus on improving healthcare outcomes and the importance of the nurse's role in patient care.

Running Head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student
Name of the university
Author note

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Introduction
This paper is an analysis of the patient who has been admitted to the hospital
following certain medical problems. In order to maintain the privacy and the confidentiality
of the patients the name and places of the patient has been changed. However, proper
consent has been taken from the patient both in the written and verbal forms and the
consent has been secured in the resident notes of the patient. The patient chosen for the
study is Mrs. Hall who has been admitted to the hospital on 18th August, 2014. The patient
has been admitted to the cardiac ward of the hospital.
Mrs. Hall was born in 18th April 1921and is a 98 year old female who has been
admitted to the hospital following shortness of breath. She has a daughter and a son and
her daughter comes to visit her every day in the hospital. She has been experiencing
shortness of breath, fragility and difficulty in mobility. She was also facing problems in her
back and thus has to depend a lot on her family members for support. Thus, this paper
ensembles the present and past pathophysiology of the patient along with addressing the
pharmacological aspects of the patient. Finally, the paper outlines certain recommendations
for Mrs. Hall in order to recover quickly.
Discussion
Pathophysiology
The past medical information shows that the patient was suffering from ischemic
heart failure, joint problems as well as back problems. This can be well related to the
problems of breathing as ischemic heart diseases are linked to the breathing difficulties in
the patient. Most instances of breathlessness are caused by disorders of heart and lung
(Sundh & Ekström, 2016). The lungs and heart are involved in transmitting oxygen to

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the tissues and extracting carbon dioxide, and thus breathing is impaired by complications
with either of these processes. For people with chronic obstructive pulmonary disease
(COPD), breathlessness is a central symptom. Despite successful management of the actual
disease, many patients have chronic debilitating breathlessness (Shoaib et al., 2014). As far
as the diagnosis of persistent disabling breathlessness is concerned, it is hypothesized that
the patient with persistent disabling breathlessness may suggest that ischemic heart disease
care has not been given the same attention as comorbid heart failure. The inference is that
it is very important for COPD patients to treat comorbid conditions that themselves cause
breathlessness (DeMarco, Aroor & Sowers, 2014). Although shortness of breath is a classic
symptom and cause of impairment in COPD, symptomatic treatment is of utmost
importance in patients with chronic debilitating breathlessness to enhance symptom
regulation, mastery, and quality of life (Walthall, Jenkinson & Boulton, 2017).
The patient also suffers from joint pain as a result of which she cannot move
properly and always needed support to move. This can be due to osteoporosis or
osteopenia. Osteopenia is a bone disease defined by reduced bone mineral density,
resulting in weakening of the bone and higher risk of fracture (Mediati, Vellucci & Dodaro,
2014). Yet osteomalacia signs include joint pain and muscle twitching, tenderness of the
bone, muscle weakness, and spasms (Uzun, Ayhan, Beksac & Karaman, 2013). The risk of
fracture increases as osteoporosis gradually robs bone density or core bone strength. If the
patient has severe kyphosis, then it can be a reason for Mrs. Hall to have difficulty walking
and balance problems, which means that she is at enhanced danger of falling and breaking
the hip bones. ⠀

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The patient also reported the instances of back pain and that can be due to
gallstones. Any signs or symptoms can be caused by gallstones. The resulting signs and
symptoms may include sudden and quickly intensifying pain in the upper right part of
the abdomen just below the breastbone, back pain between shoulder blades, and pain in
the right shoulder (Bobé et al., 2014).
Pharmacology
Colace and Senna
Pharmacodynamics:
It is administered to the patient in order to clear the bowel movements. The
medicine causes more water to move from the body inside the colon that will help in the
softening of the stool. Senna works by activating the bowel muscles that ultimately results in
the evacuation pr release of the stool.
Pharmacokinetics:
50 mg tablets of colsace should be taken by the patient and 8.6 mg of Senna should
be consumed by the patient. This will help in producing a bowel movement in 6-12 hours
(Camilleri et al., 2014).
Frusemide
Pharmacodynamics:
Frusemide is a diuretic that prevents the absorption of sodium and chloride in
Henle's loop's ascending limb. It has no other important role than the renal function. The
response of the medicine on the tubule is regardless of the inhibitory effect of the medicine.

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Pharmacokinetics:
The gastrointestinal tract quickly absorbs it and the diuresis happens within 1 hour of
the drug's administration. The impact is 6-8 hours long. But, it's on the high when the
medication was given in the first and second hours. Within 24 hours of drug administration,
almost 80% of the drug is excreted in the urine (Patsalos, 2016). Frusemide is one of the
most effective drugs to reduce the patient's risk of heart failure as it helps to regulate body
weight. it prevents the body from absorbing too much of salt and allows the salt to pass in
the urine. Thus, it helps in the regulation of body weight by treating the fluid retention in
the patient’s body.
GTN spray
Pharmacodynamics:
It is generally used for vasodilation. It is a biotransformation mechanism-based
pathway that produces nitric oxide (NO) and directly contributes to vasodilution. The second
is a biotransformation or detoxification pathway dependent on clearance that creates
inorganic nitrite anions (NO(2)-).
Pharmacokinetics:
Glyceryl trinitrate (GTN) absorption, delivery and removal in humans are extremely
rapid processes. Enzymatic denitration occurs in blood and other tissues as well as in the
liver. The half-life of the terminal is 2-6 minutes, with clearance approximately 30 l / min. A
large volume of delivery suggests that GTN is consumed by peripheral tissues, resulting in
greater concentration at the site of action than in blood (Patel, Khan & Thapar, 2016).

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Panadol
Pharmacodynamics:
This distributes quickly and uniformly across most tissues and fluids and has a
distribution capacity of about 0.9L / kg. The drug is bound by 10 to 20 percent of red blood
cells. It is thoroughly metabolized in the liver, the sulphate and glucuronide conjugates
being the main metabolites.
Pharmacokinetics:
The dosage of the medicine is dependent on the fact that whether it is administered
orally or in other forms. For an adult who is suffering from pain it can be 1000 mg IV every 6
hours OR 650 mg IV every 4 hours parenterally and orally 325 mg to 1 g orally every 4 to 6
hours (Arno et al., 2017).
Investigation
In this section the detail assessment of the patient condition is being done. The
patient had a blood pressure of 140/75 and the patial pressure of oxygen was 96. This
shows that the patient was suffering from hypertension and the SpO2 that shows the
saturation of the oxygen is 96 which is normal level. The patient was admitted to the
hospital following chest pain and difficulty in sleeping. The doctor last visited the patient in
12th December, 2018 and was subjected to parandol and GTN spray in order to relieve the
patient from pain.
As the patient was very old and weak thus, there were complications for the
treatment of the patient. The patient also had a vision problem and after the primary
diagnosis it was found that the patient was deaf and that increased the risk of the fall in the
patient. Thus, the doctor recommended that the patient is subjected to bed rest so that she

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does not incur any more joint or bone problems. Along with this, she was also on warfarin
and thus, it was necessary that the patient does not get any bruises in the skin as that can
impact the recovery process of the patient. She is thus booked for INR blood test and is
recommended to use a walking frame in order to facilitate her mobility and to reduce the
dependency on the family members and other staff in the hospital.
Recommendation
The recommendation that can be used by the patient is the regulation of the weight.
The patient can take up the facility of gym that is available in the hospital in order to
manage the weight and also to lead a healthy aging. The patient can also be subjected to
continuous observation and monitoring. This will help the nurse to know the changes in the
treatment and diagnosis of the patient (Murphy et al., 2017). The patient can also be
subjected to education that will help them to know the details of the treatment and patient
condition. Doctors need to spend more time with patients to improve healthcare outcomes.
The relationship between the teaching physician and the patient must be positive, inspired
and responsive to the needs of the individual patient. There is a need for a strong, heartfelt
engagement between patients and physicians to realize the benefits of medical education
for individual members of our society (Agbor-Etang & Setaro, 2015).
The physiotherapist was active in the treatment and to avoid future complications,
several exercises were prescribed to the patient. Taking into account the importance of the
pharmacological component, it was ensured that upon discharge the patient received all the
usual and freshly prescribed medications (Palei et al., 2013). After 3 weeks of discharge, a
follow-up appointment with the cardiologist was made. Given the patient's complex heart

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condition, there was more interest in medical care than in nursing care to avoid the
possibility of readmission or elevated complications.
Conclusion
English is my second language and because the medical terminology is new to me, I
sometimes misrepresented the conditions. In the future, I will make sure that if I am unsure
about it, I will ask the nurse working with me to pronounce the conditions correctly. Despite
this, I got a positive response for my duties and job role. I have studied about the overview
of the drugs recommended for the patient excluding the details and as a result of that I
could not answer the side effects of certain drugs and their role inside the body. In this
article, by providing detailed pharmacodynamics, pharmacokinetics and side effects of
drugs, I have taken that approach.
I think this input was very relevant as, according to Australia's Nursing and Midwifery
Council, Registered Nurse Practice Standards 2016, Standard 3 allows the nurse to be able
to practice. This requires the use of a lifelong learning method for the nurse's professional
development by seeking and responding positively to input and taking responsibility for
actions and roles. Standard 2 also demands that the nurse engage in relational and
professional relationships that help to improve by including others in the dialogue and
understanding their perspectives. It also involves a mix of monitoring and teamwork that
helps by communicating with others to understand and achieve the desired outcomes and
reduce errors.
This is going to help me in my ongoing professional experience as it taught me the
way to approach the patient and also to know the details of the patient condition. It gave
me the details of the nursing standards and the manner to practice, implement and execute

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these standards. Thus, this was helpful for my professional career as it guided me to do my
duties properly.

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References
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