Nursing Case Study Help CRICOS - 080229E - victoria university - melbourne Australia

Introduction

In order to ensure quality care is given to the patient it is vital to use an effective approach to meet patient needs. In this essay, we are going to discuss Mr. Gordon Deltori's case study who complained about chest when present at the emergency department, In past Mr. Gordon has suffered from hypertension, osteoarthritis, atrial fibrillation and type 2 diabetes. He is addicted to smoking he tries giving up the addiction but was not able to. The purpose of this essay is to discuss the Mr. Gordon Deltori case study utilizing jones clinical reasoning cycle that comprises, considering the person in context, collecting cues and information, process the information, identify issues, establish goals, take appropriate action to attain that goal, evaluate the outcome, reflect on the process and new learning, in end, a conclusion relevant to it will be given.

Discussion

Patient presenting problem focusing on pathophysiological issues

Mr. Gordon Deltori 68 year old male is our person in context, he was present at emergency department and complaining about the chest pain at 0900/hrs, Mr Gordon described the pain as dull and achy radiating toward the neck, he states that he felt tight in chest which is rated 4/10 after few minutes he rated his pain 6/10 but denies any other SOB symptoms. However, he think pain is worse this time, and he use his anginine if five month but it didn’t helped this time in releasing the pain. In past Mr. Gordon has suffered from the hypertension, osteoarthritis, atrial fibrillation and type 2 diabetes. He is addicted to smoking he tries giving up the addiction but was not able to. General information of Mr. Gordon diaphoretic, alert, cooperative, anxious, well-groomed male, appear older than real age. Vital sign: Temp 37.1 C, HR 125BPM regular, RR 24, BP 169/90 mm Hg. All pulses palpable, precordium: 120 bpm apical impulse regular and strong S1 and S2 with no murmur, visible pulsation with thoracic heave observed.  Neck: jugular distention, pulsation noted with patient in supine position.. The examination data of MR. Gordon show he has low grade fever which is generally 37.1 C to 38.1 C which is normal, he has high bpm 120 that needed to considered, a normal heart rate is about 60 to 100 bmp (beats per minute), usually, lower rate of heart implies efficient heat function and good cardiovascular fitness, heart beat above 110 is high and thus patient need to visit doctor and continually look for symptoms like such as short of breath (Ross et al., 2019). Also, looking at Mr Gordon examination data the respiratory rate is also high, the normal respiratory rate for elderly is 20- 25 breaths per minute, and normal blood pressure is 120/80  (Hill & Annesley, 2020).

It is evident that he is suffering from heart disease, and his onset symptoms and examination data indicates that he is risk of heart failure. After evaluating is examination that it been identified that he has high blood pressure, heart beat rate, respiratory rate, etc.  Jugular distention also signifies that his heart ability to pump the blood is affected increasing risk of heart failure. Considering the patient medical history patient has suffered from hypertension, osteoarthritis, atrial fibrillation and type 2 diabetes, his smoking addiction may have contributed in accelerating the condition. Smoking affect heart vessels as when individual smoke their arteries get tight affecting the functioning of heart, this trigger heart rate, increase blood pressure, increasing risk of stroke, smoking is one of the key reason for people suffering from type-2 diabetes that can damage the blood vessels of heart (Townsend et al., 2016). When heart didn’t pump blood affectively jugular detention arise, as we know that people who suffer osteoarthritis are three time more likely to suffer from cardiovascular disease, Cardiovascular disease is condition in which individual heart function is compromised, symptoms of the disease include chest pain, breathing difficulty, abnormal heart rate and blood pressure increasing risk of heart attack (Visman et al., 2019). Thus, it is evident that medical history of patient has contributed to the condition.

Identifying all care priorities and two nursing intervention within clinical reasoning cycle.

We are now going to evaluate the scenario data in consideration to Jones clinical reasoning cycle, which comprise evaluating the case in consideration to person context, collecting cues and information, process information, identify problem and issue, establishing goals, taking action, evaluating outcome, and reflection.   

Person context: Mr. Gordon Deltori 68 year old present at emergency department and complaining about the chest pain, the pain as dull and achy radiating toward the neck. Collecting cues and information: Considering the scenario it is evident that Mr Gordon has high respiratory and blood pressure that is due to underlying condition and need immediate intervention. Visible pulsation with thoracic heave in Mr Gordon case indicates that the patient have cardiac disease, as precordial impulses are visible that originate on great vessels of heart.  As jugular distention increased pressure of superior vena cava that cause jugular vein to bulge and became visible on person neck (Chernomordik et al., 2016).

Process information: evaluating the above information indicates that patient suffer from the cardiovascular disease which is result from patient medical history and smoking addiction, present sign and symptoms put patient at risk of heart failure. Hypertension, type-2 diabetes, osteoarthritis, and atrial fibrillation can signficnalty affect the person heart function (Visman et al., 2019).

Identify problem and issue:   MR Gordon is suffering from cardiovascular condition, as jugular vein distention cause by heart condition that affect blood vessels, and can lead to inflammation or infection of the lining of heart and may affect ability of heart to pump blood increasing risk of heart failure (Visman et al., 2019).  2+ pitting oedema indicates fluid retention in body which arise in condition when heart didn’t pump blood increasing risk of heart failure (Gonzales, 2019). Though no lesion present. The BMI of patient is 30. 41 for 91 kg weight and 173 cm height. Evaluation of sign and symptoms and medical history of patient indicates that patient is risk of heart failure. Therefore two immediate nursing intervention is needed.

Nursing intervention:

Establish goals: Mr Gordon treatment goal or nursing interventions to relive the symptoms and prevent the cardiac event.

First nursing intervention: The treatment plan comprise giving drugs such as artery relaxers, nitro-glycerine generally taken orally under the tongue in tablet form effective in relaxing the heart arteries so that flow of blood is easy through narrowed spaces. Few blood pressure medicines and thrombolytic medicine can also help the patient in widen blood vessels and managing the condition (Gonzales, 2019).

Second nursing intervention: setting goals to ensure patient stop smoking and understand the effect of smoking on his health, regular exercising and healthy food intake to manage his condition and ensure healthy wellbeing and safety.

Taken action

• Blood pressure medication and thrombolytic medicine to wide blood vessels and manage the condition
• nitro-glycerine to relax arteries
• Continuous monitoring of patient condition

Evaluate outcome

• Blood pressure coming to normal
• Heart rate and respiratory rate normal
• Decrease in chest pain

Reflection: The reflection as per jones clinical reasoning cycle comprise learning through the experience, analyzing what went well and what could be improved (Ricros & Riviere, 2018 ). In consideration to the case study, it is important to relate the patient onset symptoms to medical history that can help in understanding patient's condition immediately till the examination result come, through this I was able to understand instantly that patient suffer from cardiovascular disease. I learned how even patient was unable to identify symptoms related to the condition, I need to recognise sign and symptoms of patient through visual and verbal observation and evidence based practice to manage the condition.

Pharmacokinetic of two medication patient takes.

The two medication taken by the patient are anginine and perindopril. The pharmacokinetic of anginine which is taken orally to ensure effective blood flow, it is type of amino acid in which protein are diagnosed in it which absorbed by the body. Anginine improves the endothelial function in human, the oral dose of the medication 5 to 7 g or 10 or 30 mg of intravenous dose help in recognising plasma concentration, the plasma concentration of anginine remained above the baseline after the administration of the medication though no significant changes observe in peak plasma concentration.  The anginine medication use for treating blood vessels, high blood pressure, coronary disease (Boland, Jiang & Fenning, 2019).

The perindopril used for treatment of hypertension and prevent heart attack, pharmacokinetic of perindopril comprise rapid absorption with plasma concentration which take place one hour approximately, after that around 30 to 50%  perindopril available is hydrolysed to metabolite actively.  Perindopril Peak plasma concentrations can be achieved 3 to 7 hours after administration.  The medication demonstrate multi-exponential pharmacokinetics after administration medication orally, mean half-life of medication is related to its elimination, at low concentration of plasma half-life elimination like ACE inhibitors (Tao et al., 2018).

 Conclusion

Mr Gordon who complained about chest pain having history of hypertension, osteoarthritis, atrial fibrillation and type 2 diabetes, and smoking addiction apparently cause cardiovascular condition, that is evident through his medical history, examination result and onset symptoms, jennet jones clinical reasoning cycle is effective in analysing the person information, establishing goals and assessing outcome to make effective decision to meet patient need to ensure health and safety of the patient.

References:

Boland, J. E., Jiang, F., & Fenning, A. (2019). Drug therapy in the cardiac catheterisation laboratory: A guide to commonly used drugs. Interventional Cardiology and Cardiac Catheterisation: The Essential Guide.

Chernomordik, F., Berkovitch, A., Schwammenthal, E., Goldenberg, I., Rott, D., Arbel, Y., ... & Klempfner, R. (2016). Short-and long-term prognostic implications of jugular venous distension in patients hospitalized with acute heart failure. The American journal of cardiology, 118(2), 226-231.

Gonzales, P. J. (2019). Identification of the Essential Elements in the Clinical Reasoning Process in Health Care Professionals (Doctoral dissertation).

Hill, B., & Annesley, S. H. (2020). Monitoring respiratory rate in adults. British Journal of Nursing, 29(1), 12-16.

Ricros, D., & Rivière, E. (2018). Analysis of midwifery teachers’ approach to identifying student midwives with poor clinical reasoning skills. Midwifery, 66, 10-16.

Ross, M., Zhou, K., Perilli, A., Van, N. G., Pace, A., Melendez, E., ... & Carroll, W. (2019). Screening for Cardiovascular Disease Risk Factors in a Physical Therapist Wound Care Practice: A Retrospective, Observational Study. Wound management & prevention, 65(8), 20-28.

Tao, Y., Wang, S., Wang, L., Song, M., & Hang, T. (2018). Simultaneous determination of indapamide, perindopril and perindoprilat in human plasma or whole blood by UPLC-MS/MS and its pharmacokinetic application. Journal of pharmaceutical analysis, 8(5), 333-340.

Townsend, N., Wilson, L., Bhatnagar, P., Wickramasinghe, K., Rayner, M., & Nichols, M. (2016). Cardiovascular disease in Europe: epidemiological update 2016. European heart journal, 37(42), 3232-3245.

Visman, I. M., Van den Oever, I. A. M., de Rooij, M., Roorda, L. D., Lems, W. F., Nurmohamed, M. T., ... & Van der Esch, M. (2019). Cardiovascular disease is associated with activity limitations in osteoarthritis patients. International Journal of Clinical Rheumatology, 14(3), 99