Case 1
1. Discuss the pathophysiology of each condition in Linda’s past medical history
2. What are the clinical manifestations of chronic heart failure which are evident with Linda’s case?
3. Outline the nursing interventions that should be performed when Linda is found bending over the bedside table and provide appropriate rationales. Note any potential risks or complications related to these interventions if applicable.
4. Provide three nursing diagnoses (and a rationale for each) that can be made in relation to Linda’s physiological and psychosocial health problems.
5. Outline the nursing interventions that should be implemented following the diagnoses made in Question 4.
6. Identity two health support services that Linda may require on admission to the ward and briefly discuss their role.
Case 2
1. Discuss the pathophysiology of each condition in Linda’s past medical history
2. What are the clinical manifestations of chronic heart failure which are evident with Linda’s case?
3. Outline the nursing interventions that should be performed when Linda is found bending over the bedside table.
4. Provide three nursing diagnoses (and a rationale for each) that can be made in relation to Linda’s physiological and psychosocial health problems.
5. Outline the nursing interventions that should be implemented following the diagnoses made in Question 4.
6. Identity two health support services that Linda may require on admission to the ward and briefly discuss their role.
Asthma is said to be an airway complication, which can be categorized physiologically as variable and partly reversible airflow obstruction and pathologically with overgrown mucus glands, bronchoconstriction, inflammation and thickening of airways because of scarring (Frieri, 2005). Bronchoconstriction is said to be the condition where airways become narrowed down within the lungs because of tightening of associated smooth muscle. Bronchial inflammation causes narrowing sown of airways because of swelling and edema caused by various immune reactions to allergens.
Pathophysiology of chronic obstructive pulmonary disease (COPD)
Severe damage of small airways leads to the buildup of big air pockets that is medically known as bullae and changes the tissue of the lungs. These complications are referred to as bullous emphysema (Rodríguez-Roisin, 2005). COPD occurs as constant and significant inflammatory response to the inhaled irritants. Continual bacterial infectivity may sometimes take part in inflammatory condition. Inflammatory cells, which are associated with COPD: neutrophil granulocytes, macrophages and few white blood cells. In addition smokers pose eosinophil, TC1and lymphocyte association.
The hypertension pathophysiology is very much complicated. Various factors can modulte blood pressure for sufficient tissue perfusion (Zanchetti, 2014). These are: humoral mediators, circulating volume of blood, blood viscosity, cardiac output, neural simulation. Humoral factors may include balance of vasodilators and vasoconstriction.
The pathophysiology of chronic heart failure and leg swelling are correlated. The swelling of leg might have arisen because of fluid accumulation inside Linda’s system. Fluid accumulation takes place because of reduced blood flow out of the heart and causes blood to return to heart through veins. This initiates accumulation of fluid within the lower limbs (Coats, 2000).
2. Clinical manifestations of chronic heart failure includes shortness of breathing or dyspnoea, fatigue, wheezing or chronic cough, irregular heartbeat, nausea or lack of appetite, impaired thinking, fluid buildup and quick weight gain. Important clinical manifestations, which go along with Linda’s condition may include: productive and persistent cough, breathing shortness or dyspnoea, fluid buildup in legs and recent weight gain (Des Jardins and Burton, 2011). Dyspnoea may takes place because of the feeling of inadequate oxygen, chest tightness and daily living activity. Congestive heart failure takes place when a heart fails to properly circulate the blood successfully and fails to maintain the flow of blood to meet the system’s requirements. If the case of chronic heart failure worsens, a patient may retain fluid inside his/her system. This takes place because of restricted blood flow to the kidneys (Skrabal et al., 2014). Consequently, kidneys generate hormones, which retain water and salt. This results in fluid accumulation inside the system, especially in leg or ankle region. Fluid buildup inside the lungs is the main reason for productive and persistent cough in Linda’s case. Fluid buildup throughout the system may cause Linda to gain recent weight.
3. Linda’s bending over the bedside table is might be because of her weakness, persistent coughing that makes her more tired, increased heart rate and little elevated respiratory rate.
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Nursing intervention |
Rationale |
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Take notes on respiratory depth, rate and ease of breathing. Observation of associated muscles, change in color of mucous membrane |
Respiration rate may get increased because of pain or initial compensation to accommodate lung tissue scarcity. Nevertheless, increased breathing may indicate rapid oxygen consumption and immense energy expenditure or diminished respiratory reserve. |
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Auscultation of lungs for the movement of air and abnormal sounds of breathing |
Lack of the movement of air on damaged side of the lungs |
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Evaluation of restless condition and alterations in consciousness level |
Specify increased hypoxia |
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Encourage resting periods and restrict activities to patient acceptance |
Increased consumption of oxygen can give rise to increased dyspnoea and alterations in vital indications with activity. Nevertheless, primary mobilization is preferred to assist the patient to avoid pulmonary difficulty and to attain and retain circulatory and respiratory efficiency (BURKE, PENSTON and RILEY, 2008). |
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Maintain airway by properly positioning patient, application of suctioning and airway adjuncts |
Airway obstruction hampers gas exchange and ventilation. |
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Frequent reposition of patient, place patient in sitting pose and to side position from supine position |
Maximize drainage secretion and lung expansion. |
These interventions are associated with impaired gas exchange.
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Nursing intervention |
Rationale |
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Suctioning can be applied if breathing sounds do not get cleared after cough effort. After suctioning patient should be advised for deep breathing and coughing soon. |
Routine suctioning process can increase the chance of mucosal damage and hypoxemia. It should be performed gently to induce effective coughing |
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These interventions are associated with inefficient airway clearance.
Nurses should take care of Linda’s safety factor. Linda has a chance to fall down so Linda should be assisted with bedrails or nurse aide, who can look after her during her movements.
4. Three nursing diagnoses for Linda should include pain management, fluid management and anxiety control. Pain management in nursing care is very much significant. It helps to evaluate cancer associated pain indications that may involve bone tissues, nerve or viscera. Application of rating scale helps patient to evaluate the pain level and offers tool for examining efficiencies of analgesics and this also enhance pain control. Patient should be provided with proper diet chart that will help the patient to maintain proper fluid balance for the entire day. Linda should be emotionally supported that will help her to initiate discovering and coping with the realism of cancer and associated treatment (Sloman, 2002). Linda might ask for time to recognize feelings or might ask for time to convey them.
5. Nursing intervention associated with pain management may include: asking patient regarding pain, determining characteristics associated with pain, for example: aching, burning and continuous and measure the pain intensity with the help of 0-10scale (Carr, Christensen and Layzell, 2010). Patient should be asked about their complication associated with fluid accumulation in the legs, whether it is painful or what other difficulties the patient is experiencing (Yarbro, Wujcik and Gobel, 2011). The reality about patient’s concerns and fear should be acknowledged and patient should be supported so that patient can express the inner feelings.
6. Linda’s immediate support service might include a nurse aide, who can assist her with activities, movements and she might be support with emergency registered nurse, who can start monitoring and reviewing her ongoing health condition.
1: Mr. Papadakis is a diabetic patient. The blood pressure of him found to be 156/72. He has high blood pressure. The normal heart rate is 100 beats per minute but his heart rate is more than normal rate that is 104 beats per minute. The normal temperature of human body is 37º C but his body temperature is slightly more than the normal temperature. 15 years ago he was diagnosed with type 2 diabetes and now his blood sugar level is 16.2 mmol/L. His body weight is 78 kgs which is not good for his health. He should reduce his body weight. He is suffering from chronic kidney disease because of the prolong time of diabetes. Recently he was diagnosed with parkinson’s disease which is a disorder of central nervous system. The symptoms of this disease are sleeping problem, emotion problems, slowness of walking, dementia, rigidity etc. Because of his extreme blood sugar level he is now taking insulin twice a day. H e was not control his blood sugar level when it was diagnosed initially. For this reason oral dose of anti diabetic drug is not working. It is clear that his health condition is deteriorating day by day. He is not maintaining a proper diet chart. A diabetic patient should maintain a proper diet chart for his high blood sugar level but he eats whatever his wife puts infront of him. His health condition is not good but he is not aware of his health. When he had extra insulin when he feels he has eaten too much. The life style of him is not healthy.
2: Diabetes is a vast problem for a society. A person dies from diabetes in every six seconds. Diabetes is a group of metabolic diseases characterized by a chronic hyperglycemic condition effecting from inadequate action of insulin (‘Dyslipidemia Management in Adults With Diabetes’, 2003). The blood glucose level of Mr. Papadakis is 16.2 mmol/L. An increased amount of glucose in the blood is an indication that diabetes is out of control. It happens when the body cannot use the insulin or does not have enough insulin. Signs of hyperglycemia are great thirst, dry mouth and need to urinate often (Kidney.org, 2015).
For non-diabetic person: Pre-prandial plasma glucose: 4-5.9mmol/L
Post-prandial plasma glucose: <7.8mmol/L
For type II diabetic patient: Pre-prandial plasma glucose: 4.7mmol/L
Post-prandial plasma glucose: >8.5mmol/L
Because of the diabetes the small blood vessels are damaged. So the function of the kidney is hampered and they cannot clean the blood. For that reason the amount of water and salt is increasing (‘Pathophysiology of Type 2 Diabetes and Its Treatment Policy’, 2015).
3: Prolong hospitalization is very painful for any patient. Mr. Papadakis is 72 year old diabetic patient (‘Dyslipidemia Management in Adults With Diabetes’, 2003). Normally he is very lazy in nature and he is not following any direction which is advised by his general physician. So it is more difficult for Mr. Papakadis to maintain a strict routine in hospital. Five possible complications that he may experience as a result of prolonged hospitalization are (Merckmanuals.com, 2015):
Hospital- acquired infection: Hospital- acquired infections are known as nosocomial infection. The patients who are hospitalized for prolonged time have the risk for hospital- acquired infections.
Urinary tract infection: Sometimes urinary catheter is used for the bed rest patients in the hospital. They are infected by the bacteria and urinary tract infection is developed.
Blood clots: The patients who are not moving their arms or legs, they have risk to clot the blood. The patients with bed rest usually cannot move so blood moves slowly. As a result blood will clot.
Depression: Due to prolong hospitalization patients become depressed. Because of the less contact with the people patients are feeling helpless.
Constipation: Due to less activeness the stool passes slowly all the way through the intestine. So constipation occurs (Uknowledge.uky.edu, 2015).
4: The process of reduction of addiction to abusive drugs is called rehabilitation. Mrs. Papakadis have the tendency to use drugs for a small reason and that is not good for his health. So he needs rehabilitation therapy where a proper care is given by the health professionals. It is very important for the patient to get a support a faith from their family and friends during the rehabilitation process. Because of his age Mr. Papakadis needs a extra care. (‘Drug abuse : an opposing viewpoints guide’, 2015)
5: The nurse should communicate with the patient. It is the responsibility of the nurse to motivate the patient and encourage for his health awareness (Mukhamedzhanov & Esyrev, 2013). In case of Mr. Papakadis he is very lazy in nature and he has not much energy to do some effective exercise. Nurse patient interaction plays an important role in the health care service. Failure in communication can start negative outcomes. The effective nursing care is the major role for the nurse because a patient and the family of the patient both are totally dependent on the care of nurse. The nurse should advise for a good diet chart and motivate for exercise. Mr. Papakadis should check his blood sugar level regularly (Volpe, 2011).
Answer 6: Mr. Papakadis should follow a proper diet chart which is made by his general physician. Mr. Papakadis should change his life style. Mr. Papakadis needs a good lifestyle and proper nutrition counseling. Mr. Papakadis is a diabetic patient with high blood pressure. By changing his lifestyle behavior he can improve his health condition. He should follow the proper medication and instructions made by her general physician. His health condition is very poor because of his ignorance.
References
BURKE, K., PENSTON, H. and RILEY, J. (2008). Audit of specialist nurse pharmacological intervention in chronic heart failure. European Journal of Cardiovascular Nursing, 7, pp.S14-S15.
Carr, E., Christensen, M. and Layzell, M. (2010). Advancing nursing practice in pain management. Chichester, West Sussex: Blackwell Pub.
Coats, A. (2000). The pathophysiology of chronic heart failure. Perfusion, 15(4), pp.281-286.
Des Jardins, T. and Burton, G. (2011). Clinical manifestations and assessment of respiratory disease. Maryland Heights, Mo.: Mosby/Elsevier.
diabetes management therapy. (2015). Retrieved 17 March 2015, from https://diabetes management therapy
Drug abuse : an opposing viewpoints guide. (2015). Retrieved 17 March 2015, from https://Scherer, L. (2012). Drug abuse. Detroit: Greenhaven Press.
Frieri, M. (2005). New concepts in asthma pathophysiology. Curr Allergy Asthma Rep, 5(5), pp.339-340.
kidney failure. (2015). Retrieved 17 March 2015, from https://kidnye failure
Kidney.org,. (2015). About Chronic Kidney Disease – The National Kidney Foundation. Retrieved 17 March 2015, from https://www.kidney.org/kidneydisease/aboutckd
Merckmanuals.com,. (2015). Problems Due to Hospitalization: Hospital Care: Merck Manual Home Edition. Retrieved 17 March 2015, from https://www.merckmanuals.com/home/special_subjects/hospital_care/problems_due_to_hospitalization.html
Mukhamedzhanov, E., & Esyrev, O. (2013). Novel approach to pathophysiology of type 2 diabetes mellitus. Diabetes Mellitus, (4), 49. doi:10.14341/dm2013449-51
National Service Framework for Diabetes: Standards. (2015). Retrieved 16 March 2015, from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198836/National_Service_Framework_for_Diabetes.pdf
Nice.org.uk,. (2009). Type 2 diabetes | Guidance and guidelines | NICE. Retrieved 16 March 2015, from https://www.nice.org.uk/guidance/cg87
Pathophysiology of Type 2 Diabetes and Its Treatment Policy. (2015). Retrieved 16 March 2015, from https://. Kaku K et al . Pathophysiology of Type 2 Diabetes and Its Treatment Policy. JMAJ, January/February 2010— Vol. 53, No. 1
Rodríguez-Roisin, R. (2005). The Airway Pathophysiology of COPD: Implications for Treatment.COPD: J. of Chronic Obstructive Pulmonary Disease, 2(2), pp.253-262.
Skrabal, F., Pichler, G., Gratze, G. and Holler, A. (2014). Adding “hemodynamic and fluid leads” to the ECG. Part I: The electrical estimation of BNP, chronic heart failure (CHF) and extracellular fluid (ECF) accumulation. Medical Engineering & Physics, 36(7), pp.896-904.
Sloman, R. (2002). Relaxation and Imagery for Anxiety and Depression Control in Community Patients With Advanced Cancer. Cancer Nursing, 25(6), pp.432-435.
Volpe, M. (2011). High Blood Pressure & Cardiovascular Prevention is now on MEDLINE. High Blood Pressure & Cardiovascular Prevention, 18(2), 41. doi:10.2165/11593500-000000000-00000
Yarbro, C., Wujcik, D. and Gobel, B. (2011). Cancer nursing. Sudbury, Mass.: Jones and Bartlett Publishers.
Zanchetti, A. (2014). Predictive medicine, pathophysiology and therapeutics. Journal of Hypertension, 32(9), pp.1725-1726.
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