NRSG366 Case study Medicine and Nursing Assignment Australian Catholic University

Assessment Task One: Case Study Two

Multiple factors influence the care of patients with chronic conditions. As a Primary Heath Care nurse, it is important that care given is prioritised based on both clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating and collaborating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions. This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions. Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification. Please refer to the unit outline and marking rubric when writing your assignment.

Case scenario : NRSG366 Case Study Medicine and Nursing Assignment

NRSG366 Case study Medicine and Nursing

Phillip is an active semi-retired person, working part-time in the local specialty tea store. He is married to Klara with three adult children, all of whom live out of home:

Vanessa 35 years old-3 children under 10

Adam 33 years old-new born baby; and

Anton 30 years old with a 1 year-old child.

Each of the adult children is located interstate and has young family. Klara had previously participated in many outdoor activities with her husband and her hobbies include bushwalking, cryptic crosswords and gardening. Phillip and Klara have recently separated and are living separately.

Recently, Phillip has had a number of minor mishaps at work and has been increasingly dropping things. He has been experiencing a slight right-hand tremor and his gait has become unsteady. The tremor appears to worsen at night particularly when sitting down and when resting in bed. Phillip has been increasingly fatigued and forgetful. This was becoming more noticeable and problematic as the tremor did not subside and Phillip felt he was becoming clumsier. Phillip has been increasingly concerned that he would fall asleep at work so has tried not to sit down unless he is at lunch. It is at work that the hand tremor is particularly troublesome.

ORDER This NRSG366 Case study Medicine and Nursing Assignment NOW And Get Instant Discount

Order Your Assignment

Phillip was discharged home, being collected by Klara. Klara indicated that she would not be able to be Phillip’s carer, Phillip was adamant that he would be fine at home on his own. You have been asked to see Phillip in the community as part of his discharge plan.

Symptoms experienced:

Intermittent fatigue for approximately 8 months.

Bradykinesia for approximately four months.

Phillip has been increasingly dropping equipment and stock at work.

He has been unable to deal with hot water at work and was not able to make tea to serve as samples.

Increasing hand tremor for 4 months, most evident at rest.

Emotional lability for 4 months with out of proportion emotional reactions to small incidents.

Unsteady gait for approximately four months including stumbling without cause

Increasing levels of confusion;

Increasing drooling;

Increasingly being told he is hard to hear;

Increasing nausea.

ORDER This NRSG366 Case study Medicine and Nursing Assignment NOW And Get Instant Discount

Order Your Assignment

Medical history

• High cholesterol

Surgical history

• L knee arthroplasty – age 44

• Tonsillectomy and adenoidectomy as a child

• Other

• semi-retired; works part time in Tea shop;

Medications

• Lipitor 25mg mane

• Dopamine releaser-Amantadine HCL – 100 mg daily

• Dopamine agonists – Carbergoline – 0.25mg BD

• Dopamine replacement – Levodopa 10mg TDS

• MAO-B inhibitors – Selegiline -25mg patch changed daily

• Maxolon for nausea 10mg prior to meals

• Paracetamol PRN

Assessment Task One: Case Study One

Multiple factors influence the care of patients with chronic conditions. As a Primary Heath Care nurse, it is important that care given is prioritised based on both clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating and collaborating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions.

This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions. Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification. Please refer to the subject outline and marking rubric when answering this question.

Case scenario

Peter Mitchell is a 52 year old male with morbid obesity and type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping. Peter has been a smoker for approximately 30 years and smokes approximately 20 cigarettes per day.

On his previous admission, Peter was seen by a dietician and commenced on low energy, high protein diet (LEHP) to assist with weight reduction. His GP had previously discussed weight loss with Peter however he had never wanted to do anything about it as it seemed ‘too hard’. Peter was also reviewed by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.

Peter has been discharged home, with referral to community care unit for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities.

ORDER This NRSG366 Case study Medicine and Nursing Assignment NOW And Get Instant Discount

Order Your Assignment

Past medical history

 Obesity (weight 145kgs with a BMI of 50.2m2).

 Type 2 diabetes (Diagnosed 9 years ago)

 Hypertension

 Depression (Diagnosed three months ago by GP).

 Sleep apnoea

 Gastro oesophageal disease reflux disease

Social History

Peter is an unemployed male who receives government benefits. Peter lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland. Peter states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 105kg but since starting insulin and losing his job he has gained a significant amount of weight.

Consequently, because of his weight issues Peter has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is a divorcee who lives alone, his two sons live in the same state but live in different cities and rarely visit him. He is socially isolated because he is embarrassed by his size and he rarely goes out. Peter is also finding it increasingly difficult to perform activities of daily living (ADLs). Peter realises that he is in the prime of his middle age life and is motivated to lose weight and quit smoking but isn’t sure where to start.

Current Medication

 Insulin Novomix 30 B D (34units mane & 28units nocte)

 Metformin 500mg BD

 Lisinopril 10mg daily

 Nexium 20mg daily

 Metoprolol 50mg BD

 Pregabalin (Lyrica) 50mg nocte

Last observations on discharge

 Weight 145kgs

 Height 170cms

 BP 180/92mmHg

 RR 23 Bpm

 HR 102 Bpm

 Sp02 95% on RA

ORDER This NRSG366 Case study Medicine and Nursing Assignment NOW And Get Instant Discount

Order Your Assignment