Sample NURS3015 Health Variations 4 Assignment

NURS3015 Health Variations 4 – Acute Life Threatening Condition

Case Analysis- Case Study of an Acute Life-Threatening Condition

Word Count

There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% (1100 words) the marker will stop marking.

Aim of assessment

The aim of this assessment is to enable students to:

1. Demonstrate knowledge by analysing the information provided in the case study.

2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework.

3. Discuss nursing strategies and evidence-based rationales to manage a patient with acute heart failure

4. Discuss the pharmacological interventions related to the management of a patient with acute heart failure

Details

You are to answer all questions related to the case study provided for assignment help. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past 5 years including peer-reviewed journal articles, textbook material or other appropriate evidence-based resources.

Case study

Mr. Aloha Das is a 68-year-old gentleman presenting to the emergency department at 0400hrs with worsening shortness of breath. Onset 2 days ago and progressively worsening. He also developed wheeze and right sided pleuritic chest pain this morning. Vomited x1, ongoing nausea. Has history of non-compliance with medication and adherence to fluid restriction.

Past History

Hypertension, Inferior Myocardial Infarction in 2020, Heart Failure, non-ischemic Cardiomyopathy, Permanent Pacemaker inserted 2021, DM Type II, GORD, Osteoarthritis.

Current medications:

Furosemide 40mg OD, Captopril 6.25 mg TiD, Digoxin 0.125 mg BD, Metformin 500mg TiD, Nexium 40 mg BD.

On 1.2 L fluid restriction; Echocardiogram results in 2021- systolic dysfunction, mild mitral valve regurgitation, dilated left atrium and ejection fraction (EF) 33%.

Plan

• Continuous cardiac monitoring
• 12 lead ECG
• Blood pathology order
• Troponin I High Sensitivity
• Chest X-Ray
• Insert IVC right hand
• Furosemide 40mg IV Stat
• Echocardiogram

Results of Investigations:

Chest x- ray: Left ventricular hypertrophy, interstitial edema noted by Kerley B lines in the costophrenic angle.

Blood Results:

Electrolyte, urea and creatinine:

Result/ Reference Range

Sodium - 137 mmol/L 135-147 mmol/L
Potassium - 3.9 mmol/L 3.5-5.2 mmol/L
Chloride- 105 mmol/L 95-107 mmol/L
Urea nitrogen(BUN) - 14.0 mmol/L 3.0-8.0 mmol/L
Creatinine- 147 μmol/L 64 -104 μmol/L

Question 1

In order to prioritise your nursing actions, you are expected to have a sound understanding of the pathogenesis and pathophysiology.
Explain the pathogenesis and pathophysiology causing the clinical manifestations with which Mr Das presents.

Question 2

Choose one high priority nursing intervention that you will perform for Mr Das

– Briefly explain why you chose this nursing intervention
– Explain how the nursing intervention will alleviate the clinical features of Mr Das using physiological linking
– Describe briefly the impact of not performing the intervention

Question 3

Mr Das has been prescribed Furosemide 40mg IV Stat and Glyceryl Trinitrate IV Infusion 10 mcg/min starting rate.

For both medications explain

– The mechanism of action
– Why your patient is receiving this medication in relation to his symptoms and diagnosis?
– What are the nursing considerations for this medication?
– What clinical response you expect?
– What continuing clinical observations will you need to undertake?

Submission

Refer to Section 2.5 of the Learning Guide- General Submission Requirements Submit your assessment through Turnitin

Format

All assignments are to be typed Typing must be according to the following format:
3 cm left and right margins, double spaced.
Font: Arial or Times New Roman
Font size: 12pt
See further submission requirements below

Submission Requirements

1. Electronic copy only. Students are to submit an electronic copy of the assessment. Students are not required to submit the original hard copy of their assessment on campus

2. Submit your assessment electronically through the Turnitin link on the unit vUWS site.

3. Students are to upload the assessment with the following title: Surname_Firstname_assessment title

4. Your assessment must be submitted in .doc, docx format.

5. This assessment is marked online; no paper copy will be accepted. Marks, comments and the marking criteria will be released online. If you do not receive your marked assessment when all others have been returned, it is your responsibility to contact the Unit Coordinator for assistance.

Solution

Question 1:

RHD (Rheumatic heart disease) indicates a major cause of cardiovascular diseases. In this case study, a brief explanation of pathophysiology and pathogenesis causing the clinical manifestations with Mr. Das. This particular case study is based on the diagnosis and clinical manifestations of RHD for Mr. Das, and this includes pathogenesis, diagnosis, epidemiology, prevention of acute rheumatic, and treatment. According to this case study, a 68 years old gentleman, Mr. Das, presented himself to the emergency department with the condition of shortness of breath. It is seen that, 2 days ago, with progressive worsening, Mr. Das suffered and presented to the department of emergency at 0400 hrs.

Due to this, pathophysiology and pathogenesis caused clinical manifestations, and Mr. Das developed right side chest pain this morning along with on-going nausea and one-time vomiting. As per the case analysis of "Acute Life-Threatening Condition", this cannot be managed with successful results, and that is critically dependent on prompt therapy and early recognition (Caraher et al., 2018). For example, in the case of an "Acute Life-Threatening Condition", the person can face different symptoms before the death, and all the symptoms occur within 2-5 days after facing the first symptom.

Question 2:

A chosen high priority nursing intervention is “monitoring of vital signs and recovery progress” and that is considered as independent nursing intervention for this particular case study. Vital signs are most important component for this case of Mr. Das to monitor patient’s health as well as allow prompt detection for delaying recovery or addressing the breathing problem. Furthermore, several plans like Continuous cardiac monitoring, 12 lead ECG, Blood pathology order, Troponin I High Sensitivity, Chest x-ray, IVC insertion in right hand Furosemide 40mg IV Stat and Echocardiogram are included in the nursing intervention (Burchum & Rosenthal, 2021). Current medications include several medicines which are allocated for the patient where Furosemide 40mg OD, Captopril 6.25 mg TiD, Digoxin 0.125 mg BD, Metformin 500mg TiD, Nexium 40 mg BD are used.
On the other hand, on 1.2 L fluid restriction, Echocardiogram resulted in 2021- systolic dysfunction, mild mitral valve regurgitation, dilated left atrium and ejection fraction (EF) 33% are also utilised ((Lewis et al., 2020)). In the nursing assessment, several details of the patients have been discussed. Thus, “monitoring of vital signs and recovery progress” is best nursing intervention for this particular case of managing the health condition for Mr. Das.

Discussion of how a nursing intervention will alleviate the clinical features of Mr. Das physiological linking
As per the case study, a Nursing intervention will help to give alleviation to the patient, Mr. Das. After that, corresponding to the current medications as different medicines including Furosemide 40 mg OD, Captopril 6.25 mg TiD, Digoxin 0.125 mg BD, Metformin 500mg TiD, Nexium 40 mg BD have been allocated. Furosemide 40 mg OD is mainly used for the treatment of fluid retention blended with heart failure, including left ventricular failure. Besides, Captopril 6.25 mg TiD is used for congestive heart failure (Bullock et al., 2017). In order to treat irregular heartbeats, Digoxin 0.125 mg BD is used for the treatment of DM type 2 as Mr. Das is suffering from DM type 2 as per the case study. Creatinine and Urea nitrogen (BUN) is high from the reference rate. Along with that, Nexium 40 mg BD is utilised for the treatment of erosive reflux esophagitis, including the prevention of rebreeding of peptic ulcers. With several intervention reports like blood reports, x-ray and others report the right diagnosis will be taken as per the case study (Suen et al., 2020).

Describe the impact of not performing the intervention

In such accordance with not managing and performing a well nursing intervention, different issues can occur if the intervention is not performed as several medicines as per the case study is too significant for the treatment of heart failure and DM type 2 (Xu et al., 2018). If the restrictions cannot be performed, Mr. Das may suffer from several symptoms. Along with that, if blood reports and x-ray are not considered, medication will not be procured.

Question 3:

The mechanism of action

According to this case study, Mr. Das has been prescribed two medicines for his "Acute Life-Threatening Condition", and these are Furosemide 40 mg IV stat and Glyceryl Trinitrate IV Infusion 10 mcg/min in starting rate. For Mr. Das, the initial dose is to be administered through an intravenous application with 40 mg Furosemide, and if needed, another injection could have to be given after 30-60 minutes (Huether & McCance, 2019). On the other hand, according to the health condition of Mr. Das, Glyceryl Trinitrate IV Infusion 10 mcg/min has been given, and the dosage of 10 mcg/ min was able to obtain Glyceryl Trinitrate 6 ml of admixture/hour. These two prescribed medicines were helpful to manage his health condition at the starting rate.

Why is your patient receiving this medication to his diagnosis and symptoms?

In case of patient diagnosis and symptoms, Furosemide 40 mg IV stat helps the body get rid of some extra water by increasing the urine in the patient's body. Additionally, another one helps to reduce the tone of "vascular smooth muscle" (Atherton et al., 2018). After that, the action is more suitable to manage venous capacitance vessels compared to arterial vessels.

What are the nursing considerations for this medication?

Medication administration is a nursing intervention, and that includes five major activities for prescribing and managing the health of Mr. Das. These are such as diagnosis, implementation, assessment, planning, and evaluation.

What clinical response do you expect?

The major aim of the clinical response is to evaluate changes in lung volumes, diagnosis, and perception of breathing discomfort intensity with pharmacological intervention.

What continuing clinical observations will you need to undertake?

The major clinical observations in the case of "Acute Life-Threatening Condition" for Mr. Das is to manage the pathogenesis and pathophysiology causing the clinical manifestations along with ECG report, and checking irregular heartbeat and sugar test for DM type 2, and many more.  

Reference

Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... & Connell, C. (2018). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart, Lung and Circulation, 27(10), 1123-1208.https://www.heartlungcirc.org/article/S1443-9506(18)31777-3/fulltext

Burchum, J., & Rosenthal, L. (2021). Lehne's Pharmacology for Nursing Care E-Book. Elsevier Health Sciences.https://books.google.com/books?hl=en&lr=&id=VGNCEAAAQBAJ&oi=fnd&pg=PP1&dq=PHARMACOLOGY+NURSING+CARE++BOOK+Lehne%27s+pharmacology+for++nursing+care&ots=rRXRiaAdxd&sig=zF4O9V3tIDIScLRzMNYRkvNSLjI
Byrne, J. E., Bullock, B., & Murray, G. (2017). Development of a measure of sleep, circadian rhythms, and mood: the SCRAM questionnaire. Frontiers in psychology, 8, 2105. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.02105/full

Caraher, M.C., Sophocleous, A., Beattie, J.R., O'Driscoll, O., Cummins, N.M., Brennan, O., O'Brien, F.J., Ralston, S.H., Bell, S.E., Towler, M. & Idris, A.I., (2018). Raman spectroscopy predicts the link between claw keratin and bone collagen structure in a rodent model of oestrogen deficiency. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1864(2), pp.398-406. https://www.sciencedirect.com/science/article/pii/S0925443917303848

Huether, S. E., & McCance, K. L. (2019). Understanding Pathophysiology-E-Book. Elsevier Health Sciences.http://repository.stikesrspadgs.ac.id/104/1/Study%20Guide%20for%20Understanding%20Pathophysiology-345hlm.pdf

Lewis, P., Wilson, N. J., Hunt, L., & Whitehead, L. (2020). 1 Nursing in Australia. Nursing in Australia: Contemporary Professional and Practice Insights.https://api.taylorfrancis.com/content/books/mono/download?identifierName=doi&identifierValue=10.4324/9781003120698&type=googlepdf

Suen, L. K. P., Guo, Y. P., Ho, S. S. K., Au-Yeung, C. H., & Lam, S. C. (2020). Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures. Journal of Hospital Infection, 104(3), 336-343. https://www.karger.com/Article/PDF/488001

Xu, S., Zhang, Z., Wang, A., Zhu, J., Tang, H., & Zhu, X. (2018). Effect of self-efficacy intervention on quality of life of patients with intestinal stoma. Gastroenterology Nursing, 41(4), 341. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078485/