Download A Case Study about Nursing

CASE STUDY ABOUT NURSING 1
A Case Study about Nursing
Name
Class
Professor
Institution
City
State
Date
CASE STUDY ABOUT NURSING 2
This essay aims to explore the casework of a patient undergone whilst on
clinical placement in hospital. For the purpose of this essay, the client will be referred
to under the pseudo name of ‘June Smith’, to comply with the patient confidentially act
(Nursing Midwifery Council [NMC] 2009). To further preserve confidentially,
identifying factors of the organization will not be specifically referred to.
I have received the consent from the patient to do the case study on her in the
presence of RN on duty and her husband. Before I received the consent, I explained her
rights to say no if she does not want it. Patient agreed and signed my consent form in
front of RN and her husband. I informed her that this signed consent form would be in
her medical record.
HISTORY
Mrs. June Smith’s admitted to hospital with chest tightness and increased
dizziness. Patient then admitted to cardio ward for? Angina – no event on telemetry,
negative trops, pain free. Admission complicated by neurological symptoms of ataxic
gait, L) Dysdiadokinesis. Query of brainstem/cervical cord ischemia at the time then
transferred to Rehab ward. Patient had MET call for reduced consciousness while in
rehab ward requiring transfer to ICU secondary to opioid medication. Managed with
naloxone. Worsening coordination, bilateral ptosis, ophthalmoplegia, trunchal ataxia,
peripheral sensory deficit, and difficulty swallowing and speaking. Query of
Myasthenia gravis- commenced on prednisolone by doctor. Transferred to neurology
medical ward then diagnosed with Gillian Barre syndrome- Miler Fischer Variety.
Lumbar puncture (LP) performed within normal range, CQ1B antibody results are
pending. Hypertensive emergency, which was managed with IV hydralazine, remained
fine afterwards. Received 5/7 of IV 1g then transferred to rehab ward.
CASE STUDY ABOUT NURSING 3
CURRENT ISSUES
1) GBS Miller Fisher Variety
2) Hypertension
3) AF
4) UTI
5) R) eye ectropion
PAST HISTORY ISSUE
1) Hypertension
2) AF
3) TIA
4) NSTEMI
5) Pacemaker
Gillian Barre syndrome- Miller Fisher Variety
Guillain-Barre’ syndrome is an autoimmune disorder that affects the peripheral
nervous system (the brain and spinal cord). A person’s own immune system attacks the
myelin sheath that surrounds the axon of the nerves. Once the myelin sheath is
damaged, the nerves cannot transmit signals properly. Nerve damage leads to muscle
weakness, loss of reflexes, and numbing or tingling of the hands and feet. This is caused
by the muscles loss of ability to respond to the brains commands. GBS is not often fatal
CASE STUDY ABOUT NURSING 4
but in rare cases people have died from GBS. GBS can be fatal if the respiratory muscles
become paralyzed, making it difficult to breathe. GBS can also be fatal if blood pressure
and heart rate are affected (Centers for Disease Control and Prevention 2014).
Miller Fisher syndrome is a rare variant of Guillain-Barre syndrome which is
distinguished by abnormal muscle coordination, paralysis of the eye muscles and
absence of the tendon reflexes. Symptoms of Miller fisher syndrome are usually
introduced by a viral illness or infections, which will cause muscle weakness and
serious respiratory problem (National Institute of Neurological Disorders and Stroke
(NINDS) 2015).
2) Atrial Fibrillation (AF) – AF is also referred as Arrhythmias. In this, heart bear is
fast and irregular which can cause palpitation. AF affects around 2-3 people in 100.
Risk of AF increases with age. Sign and symptoms of AF includes irregular heartbeat,
chest pain, dizziness and less tolerant to do exercise (Better health, 2015) . In many
cases, Hypertension, Ischemia and many other types of heart disorder can be the
underlie cause of AF. AF is very common and increasingly prevalent arrhythmia that
is associated with substantial morbidity and mortality.
3) Hypertension- Hypertension is continuing on becoming a major worldwide health
problem, 25% of the population are affected and it is estimated by 2025 it will increase
up to 60%, equaling to approximately 1.56 billion people (Adrogue & Madias, 2007).
Hypertension is classified as having a continuous elevation of systolic pressure above
140 mmHg or higher and a diastolic pressure of 90mmHg or higher (Coy, 2005). Most
CASE STUDY ABOUT NURSING 5
people are unaware of their condition as it is asymptomatic and is often referred to as
the silent killer.
Nursing Care-
Current Med Regime1) Rivaroxaban 15mg nocte
2) Metroprolol 50mg BD
3) Perindopril 10mg mane
4) Coloxy/senna BD
5) Vistil eye drop (1 drop both eyes ) TDS
6) Atorvastatin 40mg daily
7) Digoxin 125 mcg mane
8) Pregablin 50mg BD
9) Polyvisc eye ointment R ete nocte
10) Paracetamol 1g QID
MEDICATIONS
RIVAROXABAN- Rivaroxaban is an antithrombotic, factor XA inhibitor. It is used
for the prevention of stroke, systemic embolism in non valvular AF, for the treatment
of DVT, PE and prevention of recurrent DVT and PE. Usual dose is 10mg but it is also
available in 15mg and 20 mg.
Side effect- GI upset, Anemia, skin disorder, headache, jaundice and edema including
peripheral allergic.
Interactions: Drug affecting hemostatic e.g. NSAIDs, anticoagulant, antiplatelet,
CASE STUDY ABOUT NURSING 6
fluconazole; CY3A4 inducers for example phenytoin, carbamazepine, phenobarbitone.
Ref. MIMms.com.au- issue 2, may/june 2015 page 121\
METOPROLOL- Metoprolol is a selective beta1-adrenoreceptor blocking agent,
available as 25 mg, 50 mg and 100 mg tablets for oral administration.
Side effects: Hypotension, Fatigue, Bradycardia, headache, sleep disturbance, GI
upset, Hypoglycemia and hearing disorder.
Interactions: Gabapentin, Metformin, aspirin, Omeprazole, Atorvastatin and
Amlodipine.
Drugs.com.au august 2015
PERINDOPRIL: Perindopril is an ACE (Angiotensin converting enzyme) inhibitors.
It is used to treat hypertension and to prevent heart attack in people with coronary
artery disease. Side effect: Difficulty breathing, chest pain, runny nose, headache, body ache, cough
and congestion.
Interactions: It is recommended that if you are taking perindopril you should be
advised to avoid moderately high or high potassium dietary intake. This can cause
high levels of potassium in your blood. Drug affecting potassium levels for example
other kaliuretic diuretics, laxative, corticosteroids, ACTH. NSAIDs including aspirin
and alcohol.
COLOXY/SENNA- Coloxy Senna is a Laxative. It is used to prevent
constipation.
Side effects: Diarrhea, nausea, abdominal cramping, pain and vomiting.
Interactions: Antacids, milk products, fish oil/ mineral.
CASE STUDY ABOUT NURSING 7
VISTILL EYEDROP- Vistil Eye Drops is used for soothing relief for dry, irritated
or burning eyes. Vistil Eye Drops lubricate, sterile eye drops for dry eye due to wind,
sun, heating, air conditioning, smog, smoke, dust, swimming pool chemicals,
prolonged use of computers, or use of contact lenses. They are very effective and long
lasting. (NPS medicine vise)
ATORVASTATIN: Atorvastatin belongs to a group of drugs called HMG CoA
reductase inhibitors, or "statins. It is used to treat high cholesterol and to lower the risk
of stroke and heart attack.
Side effects: kidney problems, liver problems, muscle pain and upset stomach.
Interactions: Grapefruit juice can increase the blood levels of atorvastatin. This can
increase the risk of side effects such as liver damage. Other interactions includes
alcohol, aspirin, metoprolol and Omeprazole.WEBMD.com
DIGOXIN: Digoxin belongs to the class of medicines called digitalis glycosides. It is
used to treat congestive heart failure, AF, paroxysmal atrial tachycardia. Before
giving digoxin, heart rate needs to be checked. If HR below 60, then do not
administer it.
Side effects: Conduction disorder, arrhythmia including sinus bradycardia, PR
prolongation, dizziness, drowsiness, heartache, visual disturbance, GI upset,
thrombocytopenia. Interactions: Cardiac glycosides (within previous 2 weeks), amiodarone, captopril,
quinine, atorvastatin, K supplements.
Medicinenet.com
CASE STUDY ABOUT NURSING 8
PREGABLIN: Pregablin is anticonvulsants. It is used to treat neuropathy pain and
fibromyalgia. It works by decreasing the number of pain signals that are sent out by
damaged nerves in the body. Side effects: insomnia, dizziness, tremor, weight gain, fatigue, pulmonary oedema,
anxiety, back pain, hallucination and GI upset.
Interactions: Opioid analgesics e.g. Oxycodone, other CNS depressants, Lorazepam
and ethanol.
POLY VISC EYE OINTMENT- Poly visc Lubricating Eye ointment is a specially
formulated eye ointment designed to provide relief from the symptoms of dry eye,
particularly while you sleep.
Side effects: blurred vision in some people.
PARACETAMOL: Paracetamol is an analgesic and antipyretic. It is useful in patient
with headache, muscular or neuralgic pain, ulcer and gout. It also reduces fever.
Side effects: Seating, nausea, rash, erythema, dyspnea, hypersensitivity, acute hepatic
failure and cytolytic hepatitis.
Interactions:
Drug
effecting
gastric
emptying
propantheline, antidepressant and narcotic analgesics.
including
metoclopramide,
CASE STUDY ABOUT NURSING 9
NURSING CARE
It refers to medical procedures whose their aim is giving comfort to patients,
alleviating the patient’s pain or distress and involves hydration and oral nutrition. These
are services offered by the registered nurses (RN) for the benefit of the patient
(Hindmarsh &Lees 2012).Patients who need intensive care like those suffered a stroke
most likely require nursing care.
There are plans involved in the provision of the nursing care services. A nursing
care plan is a branch of the nursing process. It clearly indicates the chain of actions
implemented during the care. The care plan is completed by the RNs or the LPNs
(Licensed Practical Nurses) after a thorough assessment of the patient’s current
condition or from a previous medical history.
The importance of this plans in nursing care is that they save time. Using a
complete care plan, the RNs creates enough time for the treatment of the patient. It also
enables nurses to achieve their goals.
During patients discharge, they are used to determine if the patients met the
nursing outcome during treatment. When the patient recovers, a care plan is employed
in the provision of discharge care.
In nursing care, the patient’s condition might change. The nursing care plans
can quickly be reflected on to determine new treatment plans. This kind of flexibility
makes the nurse maintain focus in potentially stressful situations. The patient’s data is
present in the care plan hence time-saving and reducing the risks of mistakes
CASE STUDY ABOUT NURSING 10
ADVANCE DIRECTIVES
It refers to the nursing implications in the process of ensuring the rights of selfdetermination. The right of the patients to make their decisions even if it the refusal of
treatment (Lees & Holmes 2005). The RNs allows the patients to write instructions for
their desired medical care.
The advanced directives should be legal as they resemble a living will. The law
requires all the nursing facilities and home-based health agencies that participate in
medical care to provide in written form advance directives to their clients.
The PSDA (Federal Patient Self-Determination Act) requires the written
information to be supplied by the LPN to an adult individual. It can be offered at
different times depending on the place where the care services are available. In the
hospital, it’s provided during admission time as an inpatient. Lastly in a hospice
program, the information is offered at the initial receipt of the care
DISCHARGE PLAN.
Discharging of patients ensures care continuity, and an effective discharge plan is
crucial for that. For discharge planning to take place, there are steps to consider (Lees,
2006). They involve early planning before or during the admission of the patient. This
principle gets rid of any potential delay during the discharge process.
Identification of the patients’ needs either to be simple nor complex. It's better
when done at the ward level with the help of MDT (multidisciplinary team). Change of
residence or finance issues may amend the plan from being simple to complex.
Development of management plan in the clinic within 24hrs of admission also
aids in the discharge plan. For example, all the patients details admitted in a hospital
CASE STUDY ABOUT NURSING 11
beyond 5 pm should be reviewed by the MDT in the following day because most of the
officers during that time are juniors.
Lastly, setting an expected discharge date within 48hours of admissions makes
the discharging process faster and efficient (Webber-Maybank& Luton 2009).
Continuous assessment results of the patient can make the date changed. This estimated
discharge date helps to estimate the overall capacity of the health center over a
particular time.
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Reference:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/heart_conditions_atria
l_fibrillation
Heart conditions - atrial fibrillation | Better Health Channel. 2015. Heart conditions atrial fibrillation | Better Health Channel. [ONLINE] Available at:
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/heart_conditions_atria
l_fibrillation. [Accessed 27 September 2015].
Centres for Disease Control and Prevention 2014, Guillain-Barré Syndrome (GBS).
Available from: <http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm>. [15
September 2015]
National Institute of Neurological Disorders and Stroke (NINDS). 2015. Miller Fisher
Syndrome Information Page: National Institute of Neurological Disorders and Stroke
(NINDS). [ONLINE] Available at:
http://www.ninds.nih.gov/disorders/miller_fisher/miller_fisher.htm. [Accessed 12
September 2015].
Coy, V 2005, ‘Genetics of Essential Hypertension’, Journal of the American Academy
of Nurse Practitioners. Vol.17, no.6, p.219-224.
Adrogue, H.J. & Madias, N.E. 2007, ‘Sodium and potassium in the pathogenesis of
hypertension’, The New England Journal of Medicine, vol. 356, pp.1966-1978.
MIMS 100% Pure Knowledge, viewed on 3rd December 2014
http://www.mims.com.au/
CASE STUDY ABOUT NURSING 13
Department of Health 2003, ‘Discharge from Hospital: Pathway, Process and
practice’, DH press, London.
Efraimsson, E 2003,’ Expressions of power and powerlessness in discharge planning:
a case study of an older woman on her way home’, Journal of Clinical Nursing,
vol.12: no.5, pp.707-716.
Glaeconomics 2008,’Self-directed Adult Social Care in London’, Greater London
Authority Publishers, London. Levine, EB &Levine, ME 1965,’Hippocrates, father of
nursing, too’, The American Journal of Nursing, Vol. 65 no. 12 pp. 86–88.
Lees L 2012,’Improving the safety of patient transfer from AMU using a written
checklist: Acute Medicine’, vol.11: no. 1, pp.13-17.
Lees, L 2007,’Nurse Facilitated Hospital Discharge’, M&K Press, Keswick
Lees, L 2006,’Using post-take ward rounds to facilitate simple discharge’, Nursing
Times, vol.102: no18, pp. 28-30.O'Lynn, CE 2007, ‘History of men in nursing: a
review’, Springer Publishers. pp. 6–8, New York Ferngren, GB 2009,’Medicine &
health care in early Christianity’, Johns Hopkins University Press, Baltimore, pp. 121.
Lees, L & Holmes, K 2005,’Estimating a date of discharge at ward level: a pilot
study. Nursing Standard’, vol.19: no.17, pp. 40-43.
National Institute for Innovation and Improvement 2009,’High Impact Action for
Nursing and Midwifery: The Essential Collection’, NHSIII, Warwick
National Leadership and Innovation Agency for Healthcare 2008,’Planning, Cardiff
University Press, NLIAH.
Webber-Maybank M & Luton H 2009,’Making effective use of predictive discharge
dates to reduce length of stay in hospital’. Nursing Times; vol.105: no15, pp.12-13.