Patient Assessment: Comprehensive Analysis of Mr. Wiring's Case

This paper presents a comprehensive case study of Mr. Wiring, a 77-year-old man who presented with dizziness. It explores the causes of his symptoms, including hypotension, tachycardia, and tachypnea, and analyzes assessment test data. The paper delves into various aspects of patient care, including the importance of ECG, dietary considerations, and blood tests. It also examines the patient's blood pH, PaCO2, and other key indicators, along with an oxyhaemoglobin dissociation curve. The study further discusses central venous pressure and fluid therapy, and concludes with an analysis of Mr. Wiring's irregular heart rhythm, identifying it as atrial fibrillation, and finally comparing infrared and non-invasive temperature measurement techniques. The paper highlights the significance of choosing cost-effective and beneficial treatment approaches for patients.

Running head: PATIENT ASSESSMENT
MR WIRING CASE STUDY
Name of the Student
Name of the University
Author note

1PATIENT ASSESSMENT
Abstract
The paper focusses on case study of Mr. Wiring, a 77 years old man who was brought to the
clinic with his daughter stating feeling of dizziness as he was working in the wardrobe for last
few hours. The paper explains various cause of his dizziness and did an interpretive study on
the assessments test data provided in the case study. The paper also discusses about infrared
test as well as non-invasive temperature measurement and the reason behind non-invasive test
to be preferable over infrared temperature measurement.

2PATIENT ASSESSMENT
Answer 1
Hypotension is a state where the arterial pressure is quiet low. Mr. Wiring is having
an arterial pressure of 88/45mm. Therefore, the blood flow gets reduced and hence there is no
delivery of oxygen to every parts of the body. It further causes damage to the cells, tissues
and leading to dysfunction. When the cell damage starts, there is no oxygen supply to cells a
person proceeds towards circulatory shock (Chisholm & Anpalahan, 2017). It reduces cardiac
output. Cardiac output and arterial pressure are supported by numerous compensatory
mechanism, which becomes active for restoring arterial pressure and makes the volume of the
blood back to normal.
On other hand, tachycardia includes several heart related problems like hypertension
or high blood pressure. Improper supply of blood in the heart muscle occurs due to coronary
arterial disease, heart failure and muscle disease in heart. Tachycardia is denoted
postoperative sign that identifies an attempt by the compensatory mechanism of the body. It
balances sufficient cardiac output or delivery of oxygen.
Tachypnea is defined as the presence of respiratory gasses inside the body. The lower
level of oxygen in the blood as well as increased level of carbon-di-oxide in the blood case
tachypnea. The normal range for SpO2 is 95-100%, however Mr Wiring is having 94%,
which means he is suffering from hypoxemia or lower level of O2 (Löwhagen Hendén et al.,
2015). The compensatory mechanism for identifying cardiovascular, respiratory problem.
Wiring is having respiratory rate of 35, which means high respiratory rate that might lead to
stroke.

3PATIENT ASSESSMENT
Answer 2
Five other assessments the nurse needs to conduct are- ECG (electrocardiogram) as it
will measure the irregularities in the rhythm of the heart. It detects the heart signals that
would help in interpreting supply of oxygen and blood.
The nurse needs to measure reaction of the body towards the change of position. This
would help in predicting the whether low pressure is due to excess activity or not.
The nurse must also Wiring about his diet. In many cases it had been seen that
improper diet also reduced blood pressure. Dehydration is one of the important cause which
adds to decrease to pressure (Wolters, Mattace Raso, Koudstaal, Hofman & Ikram, 2016).
The nurse must conduct blood test to have a clear analysis of the haemoglobin count,
as he already had myocardial infraction. Hence it is mandatory to keep a track of
haemoglobin level in his blood.
The nurse need to make an assessment if he is taking his medication regularly.
Wiring’s daughter complained that he is having a tendency to forget the stuffs. Due to
improper medication also there no proper balance of oxygen in the blood that might lead to
series damage in this body.
Answer 3
The normal blood pH is 7.4, but Wiring is having pH of 7.49 which means her blood
is slightly basic. This is sign that he might be having some health problems like heart, kidney,
lung or asthma disease.
The normal PaCO2 value ranges from 35-45, Wiring is having 29 that indicates
alkalosis. His blood is alkaline. The level of CO2 is more in the blood that means blood
cannot supply O2, that might be a sign of heart problem (Parati, Ochoa, Lombardi & Bilo,
2015). Mr. Wiring is having normal SaO2 as well as HCO3-. However, his PaO2 value is less
proving lesser oxygen and the reason behind low pressure and dizziness.

4PATIENT ASSESSMENT
Normal sodium ranges from 136-145 mmol/lt. Wiring sodium level is high indicating
dehydration as he has been working at 39oC wearing cardigan. He hadn’t been drinking water
for several hours. Mr. Wiring is 77 years old man, the normal range of phosphate is 1.12 to
1.45 mmol/lt however Wiring have very low phosphate in his blood which is an indication of
his tiredness and dizziness. Low phosphate creates breathing difficulty thereby leading to
feeling of weakness (Pinna, Maestri & La Rovere, 2015).
The level of glucose in Mr. Wiring’s blood is high that indicates the he might be
suffering from heart issues as previously he was diagnosed with myocardial infraction.
Higher level of glucose, along with dizziness, low oxygen all are indicating heart disorder. If
not diagnosed correctly, he might suffer from serious heart disease.
Answer 4
Fig 1: oxyhaemoglobin association-dissociation curve (Dzhagarov, Lepeshkevich, Panarin,
Parkhats & Chaikovskii, 2018)
The plots demonstrate the haemoglobin proportion in the saturated formed in y-axis
against oxygen tension on x-axis. This curve provides an understanding of the way that
oxygen and carried by blood. At low pO2, oxygen does not bind with haemoglobin suggesting
that the amount of O2 in blood is high (Dash, Korman & Bassingthwaighte, 2015). On other

5PATIENT ASSESSMENT
hand, the pO2 increases, oxygen starts binding with haemoglobin. If the pO2 gets very high, it
means that the haemoglobin does not gets saturated and hence the curve leaves off.
Mr. Wiring is at risk of poor tissues oxygenation because there is less haemoglobin in
his blood therefore tissues are not getting oxygen as required. Low haemoglobin causes less
binding of O2 to it. Therefore, cells and tissues do not receive enough oxygen.
Answer 5
The normal CVP ranges from 2-6 mmHg. Now when the venous catheter is inserted
and is pumped the venous pressure increases which means the amount of blood returning to
the heart increase as well as the ability of the blood to pumped back to the arterial system
increase. As the inflow and outflow of the blood increases in the heart the heartrate decreases
due to sufficient blood supply (Berlin & Bakker, 2015). Therefore, catheter is controlling the
total blood supply. However, the moment the catheter is removed; that is after 30 min the
blood flow becomes less, hence the heart rate becomes faster so that all parts of the body
receive enough oxygenated blood. Therefore, it can be stated that fluid therapy is beneficial
for proper working of heart.
Answer 6
The rhythm is irregular. I have irregular PR intervals. This rhythm is defined as Atrial
Fibrillation. This rhythm is categorised by no waves earlier to the QRS complex in addition
to a very irregular heart rate (Fiala, 2016).
The two possible reason for this rhythm
 As mentioned in the case study that Mr. Wiring was suffering from dizziness. This
dizziness is one of the cause of this heart rhythm. Feeling of dizziness affects the heart
functioning and hence the ECG report does not show normal. The intervals are
irregular.

6PATIENT ASSESSMENT
 As per the data received from assessment done on Wiring that he is having low
haemoglobin count, now oxygen supplies all these add to the irregular rhythm of the
heart. As the heart cannot pump enough oxygen, it had to pump heavily giving
irregular heart beat and thereby showing irregular rhythm during ECG (New oral
anticoagulants for stroke prevention in atrial fibrillation, 2016)
Atrial fibrillation might enhance the chances of heart-related difficulties. The chambers of the
heart beats chaotically as well as irregularly.
Answer 7
Recently with the development in the technology nurses have started using infrared
measurement that includes forehead infrared devices required for reading the skin and ear
probe.
Infrared temperature sensors can identify the electromagnetic waves at a range of 700
to 14,000 nm. The spectrum extends up to 1,000,000 nm. The sensor focusses on the energy
emitted through an object towards photodetector. This photodetector can then convert energy
into electrical signals that is proportional to the infrared energy that are emitted by the object.
The emitted infrared energy of the object is directly proportional to the temperature. The
signal produces an exact reading of the temperature that it is pointing at. The signals are then
passed into the sensor through a window that are made up of different style of plastic
(V.Papathanasiou, 2015). This plastic normally does not permit the infrared frequencies to
pass through it and the sensor can then use a particular form that is transparent towards all the
frequencies. The plastic then filters out all the unwanted frequencies and protects the sensor
containing electronics to form dirt, dust and other foreign objects. However, infrared
thermometers are not always accurate and it can have repeated when temperatures are being
measured.

7PATIENT ASSESSMENT
The main focus of infrared thermometer is not accuracy but repeatability. On other
hand, other non-invasive devices measures body temperature. They give accuracy towards
the reading. The process of measuring the temperature is simple and it does not require any
shutdown of the equipment (Gul & Andsoy, 2015). It helps in easy calculation of the
temperature. The other invasive methods do not use any infrared and maintains a proper
safety and reduces the installation cost without hampering the quality of the product. The
devices highly focus on the accuracy however repeatability option is very rare.
Hence it can be suggested that for routine check-up other non-invasive methods are
more beneficial and cost friendly as compared infrared temperature measurement. Infrared
measurement of temperature is costly as it requires installation charge.
As the technology is developing, modern treatment methods are also coming. Hence,
nurses and other health professionals must choose a way that are both easily available,
beneficiary as well as cost effective for every patient.

8PATIENT ASSESSMENT
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9PATIENT ASSESSMENT
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