This task is your opportunity to explain the nursing care for an adult person experiencing a...

Question

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;
CO 2. Perform a comprehensive health assessment on adults from a range of different cultures.
CO 3.Apply an evidence-based framework to develop, implement and critically evaluate a plan of care for adults presenting with acute health problems.
CO4. Explain an inter-professional model of care for the management of adults with acute health problems.
CO5. Apply pharmacological knowledge and principles in the management of care for adults with acute health problems.
CO6. Analyse the legal and ethical considerations in caring for adults with acute health problems.
CO7. 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 thecase studythat 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. You can include your identified nursing problems discussed in the paper.

(You may also like to discuss what socio-economic factors may impact your discharge planning.)

Conclusion (200 Words)

Summarise the major findings of this case report.

Please note the word limit in each section is provided as a guide to help you structure this assignment..

General information:

This assignment must be supported by at least 20 credible references presented in Harvard Style. These references should include course readings and the wider nursing academic literature. For further information refer to Learnonline Assessment Folder for Mr Dury's scenario and the marking criteria. Please also refer to the School of Nursing and Midwifery, academic writing requirements located in the Learning and Teaching Resources on the Health of Adults Course Homepage.

Nursing Case study

Handover

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 becauseit 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 theprevious angiogram.

nurs2023casereportfeedbackrubric2020-003asd-2-1-nadjpw3w-1sycgzkf.docx

Paulami · Accepted Answer

Running head: NURSING
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NURSING
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NURSING
Name of the Student:
Name of the University:
Introduction
Mr. Ian Dury is an old man whose age is 58 and lives in rural South Australia. His wife named Elizabeth died 18 months before after a prolonged battle as she was suffering from cervical cancer. According to the past medical history of Mr. Dury, he was having Type 2 diabetes mellitus, hypercholesterolaemia. He also had the chronic disease of kidney stage 3b and hypertension. He is also a smoker and smokes 25 cigarettes per day. He is obese and also had Coronary Artery Bypass almost 5 years ago. Around 6 years ago, he had Anterior myocardial infarction. It has been stated by him that sometimes he has difficulty remembering the time when he needs to take medicines. In this given assignment, the two nursing problems along with the diagnosis and the nursing interventions are being discussed. The medications and the discharge along with the socio-economic factors are also analyzed and discussed.  
Primary Admission Diagnosis
Mr. Dury was admitted to the emergency department due to his complaints of chest pain. After examining, he was reported with heart failure and myocardial infarction. The very general etiological factor is atherosclerotic plaque in the area of the coronary arteries. Plaque in the artery is a situation where a presence of blockade is there in a plug form made of platelets, lipids and cholesterol (Gabriel-Costa, 2018). The actual plaque development which is enough large and can cause atherosclerosis symptoms takes many years in forming. Even though there can be few amount so erosion of plaque because of the action of metalloproteases that lead to thin the plaque, the thickness can be still enough large resulting in obstruction.  In the area of the dead cells, there is a formation of a collagen scar. As a result, that part of the heart will be damaged permanently. Such scarring of myocardium puts the patient in risk for possible cardiac arrhythmia which is life-threatening, since that portion of blood won’t be able of pumping ample blood as needed by the other parts of the body (Neri et al., 2017). Its fundamental is lying in the fact that injured tissue of the heart manages electrical impulse in rate which is quite slow as compared to normal tissue of heart. The variation in rate of conduction of impulses between the non-injured and injured heart tissue may trigger potential arrhythmias that even could be reason of death. 
Nursing Interventions 
	Nursing problem
	Nursing Assessment
	Intervention
	To monitor the important signs for the patient with cardiovascular disease: it includes pulse rates, blood pressure saturation, respiration and temperature. The pulse rate is high; the pulse pressure is shallow because of low cardiac output. The blood pressure will be subnormal, whereas the systolic pressure will be lower than normal. The saturation of the patient is likely to be lower than normal along with low cardiac output with pulmonary congestion and low distribution of oxygen in the failure of the heart. The respiration can be fast but shallow due to lack of energy. 
	Interview patient for symptoms: The patient should be interviewed for cardiac symptoms. Patients are the big source of information for assisting in the treatment of the issue. In the proper nursing assessment of the cardiovascular event, gathering information is necessary regarding the behaviors and symptoms which can affect the cardiovascular system indirectly or directly (Lanier, 2018). Gathering information include the things related to history like the previous cardiac problems, stroke etc, medications and lifestyle. 
	Oxygen must be provided according to the patient symptoms, ABGs, and oxygen saturation. It makes availability of gas exchange which assists in alleviating in signs of intolerance of hypoxia and subsequent activity. 
Implementation of strategies in treating electrolyte and fluid imbalances. It reduces the risk to develop cardiac output because of imbalance (Kapadia and Wyckoff, 2018). 
Providing encouragement to the patients for rest and assisting with every activity. It minimized cardiac workload and reduces consumption of myocardial oxygen. 
The patient should be assisted to assume a high position of Fowler. It allows better expansion of chest which can improve pulmonary capacity (Kinnear et al., 2019). 
	Administration of oxygen and medications therapy: In the healthcare centers, the medications are recommended by the physicians. The task of the nurses is of administering these medications as per the prescription. It is expected from the nurses of having adequate knowledge of medicines along with the side effects and therapeutic of these medicines (Hofmann et al., 2017). Administering without discretions can result in lethal effects of the prescribed medicines. It will help in progression of the patient along with the prevention of setbacks related to treatment. 
	Access symptoms and pain: pain in the chest may come in various forms. Moreover, the patient can be complaining of numbness, burning, or indigestion. Cardiovascular pain is generally located left to mid sternum, but can be radiating to the arm, neck, shoulder, or jaw. It is necessary that the location of the pain is known for such symptoms (Mayhob, 2017). A pain scale can be used for assessing the severity of the chest pain.

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...

Nursing Case study

Handover

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