Case Study Analysis: Prioritizing Nursing Care for Reggie Simpson

This case study analyzes the clinical scenario of Reggie Simpson, a 42-year-old indigenous Australian suffering from decompensated heart failure. The assignment utilizes the clinical reasoning cycle to identify two primary nursing priorities: managing excessive fluid volume and addressing respi...Read More

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
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CASE STUDY ANALYSIS
The assignment is based on a case study of an indigenous man named Reggie who is 42
years old and lives with his wife and 3 children near Blackall in central Queensland. However,
he is now shifted and admitted to a healthcare organizational for management of cause
decomposition of the heart failure. The respiration rate and oxygen saturation value had been
found to be 28 rates per minute and 92% respectively. He is suffering from respiratory issues
and feels fatigued. He complained about a pin on inspiration and is also seen to be suffering from
pitting edema and visible ascites as well. He had gained for about 10 to 15 kg in the last few
months. Moreover, he is also seen to have high blood pressure of about 184/75 and had also
suffered a wound at his workplace which was not recovering and is now found to be infected as
well. This assignment would mainly be utilizing the clinical reasoning cycle to identify the
nursing priorities successfully and this should then be followed by developing nursing
interventions. These would help in helping the patient to live better quality live by overcoming
his sufferings.
The respiration rate of the patient named Reggie is found to be quite high for about 28 in
one minute when the rate of normal respiration should be between 12 to 20 breaths per minute.
This shows that Reggie is having breathing difficulty. This breathing difficulty resulting in
shortness of breath can be attributed to the conditions of the pulmonary edema that might occur
in patients who are suffering from heart failures (Ong et al., 2016). Congestive heart failures can
result in backing up of fluids in the lungs and might interfere with oxygen getting in the blood
making the patient suffer from dyspnea. This condition mainly means that extra fluid is
accumulated in the lungs that make it hard for the patients to breathe. Studies are of the opinion
that when the heart is weak or become damaged, it fail in pumping of enough blood that it gets
from the lungs. When such situations take place, pressure is seen to get built in the heart which

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eventually pushes fluid into the air sacs of the lungs. This, in course of time interferes with the
breathing ability of the lungs making the patients suffer from shortness of breath. Studies have
found out that when the left side of the heart begins failing, fluid gets eventually collected inside
the lungs (Hassan et al., 2018). This extra fluid that gets accumulated in the lungs makes it more
critical for the airway passages to get expanded as the person inhales. Breathing is therefore seen
to become more difficult and this might has been the reason that makes it painful for Reggie
during inspiration. Moreover, pitting edema is another symptom that shows retention of fluid
taking place in the body of the patient. It has been found that when the right side of the heart
starts failing, the fluid is seen to get collected in the feet as well as the lower legs. This mainly
occurs because the failure of the ability of heart to collect blood from all part of the body back to
it because of its loss of pumping ability (Mebazza et al., 2015). Puffy leg edema is a sign that
right heart failure had taken place in the patients. As the right heart failure gradually worsens
over time, the upper legs are seen to be swelled and eventually the abdomen collects fluid as well
as giving rise to situation called the ascites. Weight gain is also seen to accompany the fluid
retention and is thereby a reliable measure of how much the fluid is being retained (Dunlay et al.,
2017). Reggie is seen to gain weight over time and is seen to suffer from pitting edema and
ascites. Hence, m the nursing priority that should be set for Reggie would be management of
excessive fluid volume in his body and helping him to overcome shortness of breath and help
him overcome his sufferings.
In order to help the patient named Reggie overcome edema, the nursing professionals
should be administering intravenous diuretics as the first line of the medication. This medication
mainly helps the kidneys in removing excess of the fluid from the body. Diuretics can be
categorized into three important categories, which are the thiazide-like that get help the body to

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get rid of a moderate amount of water and can be used for a for long time (Guder et al., 2015).
Another category is the loop category which are the more powerful group and are found to be
extremely important in emergencies. Another group is the potassium-sparing category, which
mainly keeps the potassium while getting rid of the water and the salt. This medication can be
provided with any one of the medication belonging to the other two groups. Studies are of the
opinion that bumex medications like that of bumetanide has proved to be successful in reduction
of the extra fluids in the body like in edema that had been caused by conditions such as the heart
failures, liver disorders as well as the kidney disorders (Carthon et al., 2015). These medications
are also seen to be helpful in lessening the symptoms of the shortness of breath as well as
swelling in arms, legs, and abdomen. This medicine is also called water pill, which causes the
kidney to make more urine helping the body to release he extra fluid. This medication can be
given to Reggie by the nurse to be taken orally about once or twice daily. The nurse should also
monitor if the patient is not occurring any side effects like that of dizziness, lightheadedness,
dehydration, muscle cramps, unusual tiredness, vomiting, confusion, fainting, drowsiness,
irregular heartbeat, and many others. The dosage should be 0.5 mg to 2 mg and should be given
in a single dose (Sethares et al., 2016). Another intervention that can be applied for the patient
named Reggie is the oxygen therapy. Oxygen therapy includes providing oxygen to the patient
with the help of a facemask or nasal canula, which is a flexible plastic tube that has two
openings, and help in delivering oxygen to each of the nostrils. This helps in easing out the
symptoms of the respiratory distress. Increase in the blood oxygen would help in temporarily
restoring normal level of the blood gases and this helps in developing tissue function thereby
promoting healing. This would help Reggie feeling stable and overcome the pain and suffering
he is going through with his symptoms of shortness of breath.

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CASE STUDY ANALYSIS
Another issue that was also observed was that the patient had high blood pressure, which
was 184/75. The normal blood pressure of human beings should be around 120/80 mgHg. This
blood pressure can be one of the greatest causes of the development of heart failure. It can be
found that Heart failure can be described as the heart condition where the heart cannot pump
sufficient amount of that of the blood to the rest of the body (Ziaien et al., 2016). Studies are of
the opinion that that narrowing and blocking of the blood vessels caused because of the high
blood pressure can result in increasing the risk of developing heart failure. It can be seen that the
high blood pressure mainly results in addition to the heart’s workload. Narrowed arteries that are
less elastic make it much difficult for the blood to travel smoothly as well as easily thoroughly
the body making the heart to work harder. So when there is high blood pressure, heart has to
work extra hard to meet the demands of the oxygen supply to different parts of the body. The
heart is gradually seen to thicken and thereby becomes larger. The larger the heart becomes, it
becomes harder for it to meet oxygen demand of the body and this results in causing heart
failure. High blood pressures which is also undiagnosed or which are infectively managed can
result in damage to the heart as well as the blood vessels. This can result in impacting the blood
flow. Studies are of the opinion that this can result in decreasing the nutrients as well as the
oxygen that are being delivered at the cellular level. This in turn has the ability to impeded
wound healing. Another perspective of the issue of wound healing can also be discussed. In
congestive heart failure, the heart is seen to gradually lose their ability in pumping effectively.
Excess of the fluid when collects in the lungs affect oxygenation and similar aspect takes place in
the legs and feet causing peripheral edema (Albert et al., 2016). All these aspects can be seen to
impede wound healing. Rheumatoid heart disorder had taken place in Reggie and is often seen to
have higher prevalence among the native people in the nation (Greenhall et al., 2019). This is the

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CASE STUDY ANALYSIS
heart condition in which the heart valves become permanently damaged because of rheumatic
fever. When left untreated as well as under treated, such streptococcal infection can result in
heart valve damage increasing the chance of the heart failures in the adulthood. All these can be
explained as the various reasons that are resulting in heat failures. In such situation, the main
priority would be helping the patient to manage his high blood pressure and treating to his
wounds successfully (Reeder et al., 2015).
One of the best interventions to manage the high blood pressure in the patient is to
administer medication therapy. One of the best categories of medication that the nurse can
suggest to Reggie is calcium channel blockers. These medications mainly help in relaxing the
muscles of the blood vessels and this help in slowing the rate of the heart. However, the nurse
should instruct the patient not to take grape juice when using this medication as this would result
in increasing the blood levels of the medication and would put the patient at a much higher risk
of side effects (Milfred et al., 2017). Amlodipine is used as one of them that help in treating high
blood sugar. Lowering of the high blood pressure would help in preventing strokes, heart attacks,
and kidney problems. It mainly works by relaxing the blood vessels so that blood flow can take
place much easily. This medication also helps in preventing chest angina and increases the
ability of individual in exercising and reducing the frequency of the angina attacks. This
medication can be suggested to Reggie to bring his high blood pressure under control. This
medication can be taken by the mouth with or without food once daily. Some of the side effects
that the nurse should warn to Reggie about taking of the medication are dizziness,
lightheadedness, swelling of the ankles, flushing and many others. Another intervention that
needs to be taken for Reggie is development of the health literacy of the patient. This is to be
done so that he can be educated about the proper lifestyles that contribute to managed level of

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blood pressure and reduce the risks of any further development of chronic ailments as high blood
pressure act as the risk factors for many chronic disorders (Inamdar et al., 2016). The nurse
should recommend Reggie of changing their lifestyles to reduce high blood pressure. These
would include eating a heart healthy diet that would have less salt. Studies opine that DASH diet
is one of the best diets that help to prevent heart disorder and control the blood pressure levels
(Passmore, 2016). The nurse should also educate Reggie about getting regular physical activities
as exercises and physical activities have showed evidences to reduce the chances of further heart
attacks and prevent occurrence of many other disorders along with bringing the blood pressure
level under control (Murga et al., 2017). She should instruct Reggie to maintain a healthy weight
or losing weight if Reggie is overweight and obese. Indigenous people have the customs of
drinking alcohol and smoking tobacco that are intricately associated with traditional norms.
Hence, Reggie should be also made aware about the negative impacts that smoking and drinking
alcohol have on heart conditions and on blood pressure (Sako et al., 2017). In this way, Reggie
can bring changes in his life in this way which would help in controlling the blood pressure level
and prevent further heart disorders. Apart from these, the nurses should dress his wounds and
educate him and his family how to take care of the wounds (Nitecki et al., 2017). Once, the blood
pressure and the heart conditions along with edema can be taken care of successfully, wound
healing will rescue back its natural pace leading to faster recovery.
From the above discussion, it can be seen that using the clinical reasoning cycle can help
nurses to collect cues from the patient’s conditions and relate them with the symptoms and
patient history. Following this, pathophysiology can be associated with the present situation of
the patient following which nursing priorities are set. The two nursing priorities that had been
found for Reggie are the effective management of excessive fluid volume in the patient and

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shortness of breath and the other nursing priority was the effective management of the high
blood pressure that would help in healing wounds and preventing further heart damage.
Following these, the different interventions that was set for the former priority was diuretic
therapy and that of the application of the oxygen therapy. For the later priority, the two
interventions that were set are the use of the calcium channel blockers and the effective patient
education. The different interventions that are set would not only help the patient to overcome
her present suffering but at the same time, it would also contribute to recurrent of the heart
disorder and reduce chances of other chronic ailments as well as in his life.

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References:
Albert, N. M. (2016). A systematic review of transitional-care strategies to reduce
rehospitalization in patients with heart failure. Heart & Lung, 45(2), 100-113.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of
hospital work environments and missed nursing care is linked to heart failure
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Dunlay, S. M., Griffin, J. M., Redfield, M. M., & Roger, V. L. (2017). Patient Activation in
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heart failure irrespective of ejection fraction. European Heart Journal, 39(suppl_1),
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Ong, M. K., Romano, P. S., Edgington, S., Aronow, H. U., Auerbach, A. D., Black, J. T., ... &
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