TASK Length: 1800 words
This assessment requires you to analyse a case study.
This case study is available in the Assessment Task One resources in the Interact 2 subject site.
Read the case study carefully, then answer the two (2) points (including sub-points) below.
1. Discuss how the chronic conditions identified in the case scenario relate to each other, therefore contributing to the complexity of the patient's condition and co-morbidities. In order to do this, you will need to consider the clinical manifestations of each condition.
2. Using the clinical reasoning cycle with the history and data provided:
Identify four (4) evidence-based nursing interventions that are appropriate to implement in planning the patient’s nursing care, and;
Provide a clear rationale for each intervention.
PLEASE NOTE: referrals to allied health professionals are NOT to be included.
You must structure the paper as follows:
Introduction
Discussion
Conclusion
References.
You may use headings and subheadings to organise your paper. Do not use tables or dot points in the paper.
A minimum of ten (10) credible and scholarly sources must be used to support your work.
case scenario for Joan
Case study
Joan has presented to hospital today and is feeling very unwell. After assessment in ED, she has been admitted to the medical ward and you are the nurse providing care to her.
On assessment you make the following findings:
Joan is alert and orientated, with no evidence of any cognitive impairment, other than anxiety related to her presentation.
T – 37.6
P – 68
R – 28
BP 123/86
SpO2 – 91% on 2l O2 via nasal prongs.
Joan denies pain.
She has increased work of breathing with use of accessory muscles, which is exacerbated by any exertion. Whilst she can speak in sentences, she is breathless during conversation.
She has noted lower limb pitting oedema, which extends to her knees. Joan advises this is considerably worse than usual. Her peripheries are cool, pale and clammy to touch.
Joan is clearly fatigued, and says she is unable to sleep well due to her breathlessness, which is worse when she lays down. She has been sleeping in her recliner chair for the past 4 nights.
Chest auscultation reveals diffuse crackles and some low level wheezing. There are no additional heart sounds of concern. Her JVP is reported to be elevated, and a pulse can be seen in her neck when she sits back.
Abdominal assessment does not reveal any issues of concern, Joan advises her bowels are regular, and she is voiding normally, with no symptoms of infection. Urinalysis in NAD.
Joan has no history of falls and uses a walking stick to support her mobility in light of her arthritis. Her skin is intact, no indication of skin tears or areas of concern in regard to pressure areas. However, the oedema and reduced mobility and reduced oxygenation are of concern.
Her appetite has been reduced over the past week, and eating is difficult with her shortness of breath. Her weight today is 83kg, which she acknowledges is higher than previous, with her medical history showing discharge weight on last admission was 78kg.
Her exercise tolerance is limited to 10-15 m at present, without significant shortness of breath. Joan reports she used to be able to walk 100-120 metres without issue. Her arthritis limits her exercise due to pain.
The medical orders for her admission include IV Frusemide, 80mg BD (0800 and 1200), fluid restriction of 1200ml/day, daily weight and the addition of 62.5mg digoxin to her medications.