Nursing Report: Analysis of Roseanne Chivers' Ocean Swim and Vitals

This nursing report presents a case study of Roseanne Chivers, a 63-year-old widow, after her first ocean swimming experience. The report analyzes both objective (vital signs) and subjective data, including body temperature, pulse rate, respiratory rate, blood pressure, and patient-reported symptoms like shivering, cold hands, and numb fingers. The interpretation of these cues suggests potential health concerns, particularly related to Raynaud's disease, given the patient's reaction to the cold water. The report also outlines further requirements for cue collection, including additional medical history, physical examinations, and blood tests, as well as diagnostic tools like nail fold capillaroscopy. The analysis considers the context of the patient's previous medical history and the environmental conditions during the swimming activity. References supporting the analysis are also included.

NURSING ASSIGNMENT
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Table of Contents
1. Concise Summary 2
2. Objective and Subjective data cues 2
3. Interpretation of identified cues 2
4. Further requirement of cues 4
References 6
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1. Concise Summary
As a recreational trip, the members of the rehabilitation centre were taken to the ocean for
swimming experience. The weather was cool, air temperature at 19°C which made the
experience pleasant for all the people present. The swimming activity lasted for about a
quarter of an hour and the temperature of the water was 17°C. After the activity ended, the
vitals of all the care users of the rehabilitation centre was checked. This study deals with the
case of Roseanne Chivers, a 63-year-old widow; this was her first experience in swimming in
the ocean.
2. Objective and Subjective data cues
a. Objective Cues
Vital name Measure
Body temperature 35.0 °C
Pulse Rate 102 beat/min
Respiratory rate 24 breath/min
Blood pressure 150/84 mmHg
b. Subjective Cues
Feature Remarks
Shivering Normal reaction
Cold hands Normal reaction
Numb and blue fingers Heightened reaction
3. Interpretation of identified cues
a. Categorisation of cues
Temperature
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The body temperature of Roseanne after the swimming trip is within the normal range. Her
body temperature appears to be lowered down by 2°C than the normal. This is possible that
day at the beach was a bit chilly and the wind was also blowing fast. Putting together the
situation, the dip in her temperature appears to reasonable.
Blood pressure
Her blood pressure is slightly elevated than the normal 120/80 mm/Hg. This can also be
reasoned by taking into consideration the strenuous swimming activity that she indulged it.
Her blood pressure needs to be checked when she has calmed down to be able to have a better
understanding of her body conditions.
Pulse and breathing rate
Her pulse rate is 102 beats/min and breathing rate is 24 breaths in a minute as opposed to the
normal pulse rate of 60-100 beats/min and 20 breaths in a minute. According to Stahl et al.
(2016), this is also within the eligible range of elevation that happens after intense activity for
45 mins.
Body reaction
She was noticed to be shivering at various incidents and was struggling to wear a jacket.
When asked she told that her hands felt cold. Her difficulty to put on the jacket could be
because her hands were stiff, numb and not moving smoothly. From the picture of her hands,
it is clear that the fingertips look pale and numb.
It is to be noted that this is not a normal reaction to swimming for 45 mins in the water at a
temperature of 17°C. Moreover, her body temperature has dipped only by 2 degrees. The
body induces shivering when the temperature has dipped very low and the vibrations help the
body to generate heat (Geneva et al. 2019). The weather and the water temperature were not
cold enough to guarantee to shiver as a reaction.
b. Comparison of the current situation to previous medical history
After her previous medical history, it appears that there are no markers that identify a
problem in homeostasis. Her body is able to maintain normal homeostasis condition and
nothing out of the ordinary is noticed. When compared to her vitals collected and her body
reactions on 5th April, it can be said that her reactions were brought on by the activity and the
cold.
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c. Explanation of vital signs and other cues
After taking into consideration all her vitals and previous medical history, it is possible that
Roseanne is suffering from Raynaud’s disease. However, the diagnosis can only be provided
when her reaction to cold and stress is continued. The above cues put together with the
condition of her numb hand may point to a health-related issue. According to Shier et al.
(2015), numb and blue fingers are not a normal reaction of the body and can be caused due to
constriction in the blood vessels.
4. Further requirement of cues
Her body temperature appears to be slightly lower than normal. This could be something
because of her long period of activity in water. However, it is recommended to check it later.
The pulse is also slightly higher than normal (Thakur et al. 2018). This may pertain to her
earlier swimming activity. Her breathing rate is over 20 breaths in a minute. If it persists long
after her activity has ceased (Priyadharshini et al. 2018). Then it is a need for concern. Her
blood pressure is also higher. Needs to be checked for later. Shivering is a normal reaction of
the body trying to warm itself after being in the cold for long. She complains that her hands
are cold and numb. It is again a normal reaction but needs to be looked into if it persists.
Raynaud’s disease is identified by an overreaction to cold and stress. The diagnosis criteria
are vasoconstriction and numbness in limbs. This reaction is attributed to a constriction in the
peripheral blood vessels. It is to be noted that the distinction between normal physiology and
Raynaud’s syndrome is yet not clear. Vasocontraction is hinted upon by the changed
appearance of the skin (Chen et al. 2015). It appears white and blue at times of cold and when
flushes red when movement returns. It is more common among women and among people
who have already been diagnosed with hypertension. Chances of having to discover
Raynaud’s syndrome is more if there is someone suffering from in the family.
It may not be different to diagnose Raynaud’s but it is difficult to make a distinction between
primary Raynaud’s and secondary Raynaud’s. Secondary Raynaud’s is an autoimmune
disorder which is accompanied by tremors or vibrations in various body parts (Sherwood,
2015). In order to provide complete and effective diagnosis, a complete medical history of
Roseanne is required. A few physical examinations and blood tests can also be performed to
eliminate other issues. A test has been formulated to assist diagnosis and differentiating the
normal and heightened reactions of the body. It is called nail fold capillaroscopy where the
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capillaries of below the nail are studied. Individual needing a diagnosis test require to rest in
a room with a temperature of 20°C to 22°C. Foley (2017) stated that a drop of immersion oil
can be placed on the cuticle to stain the capillaries to be able to visualise them better. At least
8 of the 10 fingers need to be examined, barring the thumbs, to provide a sound diagnosis.
Figure 1: Normal capillaroscopic pattern
(Source: Scielo, 2015)
Figure 2: Patten with micro haemorrhages, dilated capillaries and constricted
capillaries
(Source: Scielo, 2015)
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References
Chen, Y., Lu, B., Chen, Y. and Feng, X., (2015). Breathable and stretchable temperature
sensors inspired by skin. Scientific reports, 5, p.11505.
Foley, R., (2017). Swimming as an accretive practice in healthy blue space. Emotion, Space
and Society, 22, pp.43-51.
Geneva, I.I., Cuzzo, B., Fazili, T. and Javaid, W., (2019), April. Normal Body Temperature:
A Systematic Review. In Open Forum Infectious Diseases (Vol. 6, No. 4, p. ofz032). US:
Oxford University Press.
Priyadharshini, S., Preetha, S. and Devi, R.G., (2018). Determination of pulse rate and blood
pressure just before the exam. Drug Invention Today, 10(11).
Scielo, (2015), Nailfold capillaroscopy: relevance to the practice of rheumatology [Online],
Available at:http://www.scielo.br/scielo.php?
pid=S048250042015000300264&script=sci_arttext&tlng=en [Accessed 4 May 2019]
Sherwood, L., (2015). Human physiology: from cells to systems. Ed 3rd, Boston: Cengage
learning.
Shier, D., Butler, J. and Lewis, R., (2015). Hole's essentials of human anatomy & physiology.
New York: McGraw-Hill Education.
Stahl, P., Macherey, O., Meunier, S. and Roman, S., (2016). Rate discrimination at low pulse
rates in normal-hearing and cochlear implant listeners: Influence of intracochlear stimulation
site. The Journal of the Acoustical Society of America, 139(4), pp.1578-1591.
Thakur, A., Aggarwal, P. and Siddiqui, U., (2018), April. Analysis of Pulmonary Diseases
Using Wireless Breathing Rate and Pulse Rate Monitoring System. In 2018 Second
International Conference on Inventive Communication and Computational Technologies
(ICICCT) (pp. 1041-1044). IEEE.
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