CASE STUDY
Clinical Scenario
Mr Ian Dury is a 58 year old male living in rural South Australia. His wife Elizabeth passed away 18 months ago from a prolonged battle with cervical cancer.
Mr Dury has been transferred to the Sisters of Mercy Memorial Hospital (SMMH) Adelaide South Australia for investigation of chest pain and it is planned that he will undergo a coronary angiogram with iodinated radiocontrast medium. Mr Dury has been diagnosed with a long history of Ischemic Heart Disease otherwise known as Coronary Heart Disease (CHD)
Past Medical History
● Type 2 diabetes mellitus
● Hypercholesterolaemia
● Chronic Kidney Disease stage 3b
● Hypertension
● Current smoker 25 cigarettes a day
● Obesity
● Coronary Artery Bypass 5 years ago
● Anterior myocardial infarction 6 years ago
● EtOH 50grams daily
Medications
● Aspirin (300mg daily)
● Losartan (50mg daily)
● Atenolol (100mg bd)
● Atorvastatin (80mg daily)
● Hydrochlorothiazide (25mg daily)
● GTN spray as needed
Mr Dury states that he sometimes has difficulty remembering when to take his medication.
He commented that he does not like taking his fluid tablets before he goes out because it makes him go to the toilet too often.
Upon admission Mr Dury is alert and orientated but appears slightly anxious. During is admission assessment his vital signs seem unremarkable however, he has noted pitting oedema in both legs with an associated diminished pedal pulse. He states that he gets breathless on exertion and has used is GTN spray on average about 4 times a day. He states that he has not spoken to his son about his admission to hospital. Mr Dury has been scheduled for a coronary angiogram the following morning.
Nursing notes 48 hours following the coronary angiogram that was undertaken to diagnose coronary artery disease Mr Dury’s fluid balance chart indicates that his previous 24 hour urine output has dropped from 1200ml to 450ml. Urgent blood tests for kidney function demonstrate a rise in creatinine and a fall in eGFR and Mr Dury is diagnosed with worsening CKD induced by the contrast used for the coronary angiogram.
Upon commencement of your shift Mr Dury’s vital signs are the following: Pulse 100bpm, BP
170/90, RR 18, SaO2 94% on room air and temperature 36.5.
His fluid balance chart has had a positive balance of over a litre in the past 24 hours.
It is noted that Mr Dury has a haematoma on his right wrist from the previous angiogram.
Task aims:
This task is your opportunity to explain the nursing care for an adult person experiencing a cardiovascular event by linking it to pathophysiology and pharmacology, explaining the nursing care required, while applying an inter-professional model of care.
The course objectives being assessed are;
1. Perform a comprehensive health assessment on adults from a range of different cultures.
2. Apply an evidence-based framework to develop, implement and critically evaluate a plan of care for adults presenting with acute health problems.
3. Explain an inter-professional model of care for the management of adults with acute health problems.
4. Apply pharmacological knowledge and principles in the management of care for adults with acute health problems.
5. Analyse the legal and ethical considerations in caring for adults with acute health problems.
6. Apply the principles of quality, safety and risk management in caring for adults presenting with acute health problems.
Write and present your essay using the following headings:
Introduction: (200 Words)
Introduce the client and provide a brief overview of their case. Provide an outline of the purpose and structure of the report.
( You might like to think about the overview of the case study like a verbal clinical handover:
what is the key information from the case study that would be relevant for the plan of care for this client?)
Primary Admission Diagnosis (200 Words)
Identify the primary diagnosis for the client (i.e. the reason the client was admitted to hospital). Provide a brief description of the pathophysiology of the disease and demonstrate how the presenting manifestations support the client’s primary diagnosis.Identify the complication experienced during admission. Provide a brief description of the pathophysiology of this complication in relation to the clients pre-existing medical conditions.
Nursing Problems (200 Words)
Using your knowledge of pathophysiology and the clinical manifestations of the client; identify two (2) nursing problems that arise as a result of the client’s complication developed during the admission. These problems may be actual or potential nursing problems. Provide a brief description for why these problems arise for this client. Support this discussion using current literature.
Nursing Management (800 Words)
The nursing management must focus on the inpatient nursing assessment, nursing interventions and the role of the Registered Nurse (RN) related to medication management for this client and will address the two (2) identified nursing problems. Support this discussion using the current literature.
(This section of the report focuses on assessments and interventions that the Registered Nurse conducts. So avoid reverting to simple referrals to other members of the health team.
What does the nurse physically do to provide optimal person-centred care as part of the nursing management plan? You should also prioritise your care. What is the most pressing concern for the client at this stage?)
Nursing Problem 1 : Nursing assessment, nursing intervention, medication management.
Discuss one (1) method of nursing assessment that would need to be performed related to the ongoing nursing management of this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted in this case.
Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.
Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.
Nursing Problem 2 : Nursing assessment, nursing intervention, medication management.
Discuss one (1) method of nursing assessment that would need to be performed related to this nursing problem. Provide a rationale for this type of assessment and briefly describe how this assessment would be conducted in this case.
Discuss one (1) nursing intervention that you would need to implement related to the ongoing nursing management of this nursing problem. Provide a rationale for the intervention.
Discuss the role of the RN in the medication management related to the ongoing nursing management of this nursing problem.
Discharge Planning (400 Words)
The discharge plan must focus on the multidisciplinary management for this client and can refer to the nursing problems addressed throughout the paper.
Discuss the aim for discharge planning and the importance of using a multidisciplinary approach. Discuss the role of the Registered Nurse to facilitate the multidisciplinary discharge plan for this client. Identify the members of the multidisciplinary health care team and the role that they would play.
