Nursing Case Conference Report

This academic paper requires students to articulate in writing the patient presented at their Clinical Case Conference. It should be su mitted as a report. There must be analysis of the patient's medical condition(s) demonstrating the ability to applytheoretical concepts including (but not limited too) pharmacology; patho-physiology; anatomy and physiology. There must be presentation and evaluation of nursing and medical management of the patient. Sound clinical rationales must Re pro¥1idetd that support the care afforded the patient. Appropriate evidence sources must be used and Harvard referencing used roug ou Please according to the patient's case. (I have attached it) Follow the structure and marking rubic. The requirement and structure of this essay: Introduction: (200 words) 1.lntroduces patient student presented at Case Conference 2.Presents biographical data 3.Presents current medical history of this patient 4.Presents past medical history of this Patient Discussion: (12oowords) 1.Demonstrates understanding of patient's medical condition(s), including relevant anatomy and physiology and in depth Sathophysiology discussion. Nursing management lncluded clinical assessment presented using lSBAR(lntroduction, Situation, Background,Assessment, Recommend), explanation of how nursing management relatesto medical management with clear clinical rationales provided, role of interdisciplinary team involvement explained and primary health care strategies evident. 3.Medical management and Treatments described including all relevant pharmacological, non- pharmacological treatments, pain management explained and clear clinical rationales provided ggeldev ant Laboratory results/ Diagnostic tests included (put in appendix if word count is high) VI ence of ability to make clinical inferences based upon the data av ailable. 5.Psychosocial I Environmental [Economic aspects of the case discussed 7.Ethical and legal aspects included if relevant B.Education of patient lfamily 9.Discharge Planning Article Discussion: (500 words)(lv e attached for you,please use that one) Shrivastava R, Shrivastava S & Ramasamy J,2013, Role of self-care in management of diabetes mellitus, Journal of Diabetes & Metabolic Disorders, Vol.12, No.14 1.Description of how this literature findings/recent evidence is related to the case 2.Comparison and critique of the management I nursing care of the case against the literature. 3.Suggestions of alternative management [nursing care Summary and conclusion: (100 words) 1.Summary of the case 2.Education needs of the patient 3.Short and long term outcomes 4.other relevant comments I need at least 20 reference for this essay and must less than 6 years(2009-2014). The article should mention about Type 2 Diabetes management and self-care. In this essa y, just following the requirement of the numbers, mention all of the essay requirement and structure. Patient's Case Conference 1. Patient Data Name: Mr X Gender: Male Age: 84 yrs 2. Psychosocial leconomic background He's Independent with ADL's. His wife died 2 years ago. He was born in Italy, He came to Australia in 1945. He's living in Adelaide now. He speaks English. He worked at Car factory. He retired for a long time ago. He has1 daughter and 2 sons. They live in Adelaide. Now he lives in a house with his daughter. is daughter and son-in-law take care of him. He has medical insurance. He has quit smoking when he was 35-year-old. Drug free. Before he came to the hospital, he drinks 2 glasses of wine a day. He can drive, and shopping by himself. 3. Date and reason for admission/Current medical history This patient admitted with left pleural effusion on 3/1012014. He was admitted with Pneumonia in Ashford Hospital,for 3 weeks last month. On the admission day, pt is A + O. coughing and shortness of breath. No chest pain. Ankles moae swollen. He has low BP. Systolic pressure between 90-11ommHg. Diastolic pressure between 50-6ommHg. Other Obs stable. Cough improvec nIg 4 Past medical history Type 2 Diabetes(T2DM)(He had for 4 years), Congestive Heart Failure(CCF), Pneumonia, Arial Fibrillation(AF), Left Ventricle Failure(LVF), Gout, Osteoporosis, Low Blood Pressure, High Cholesterol, Constipation Please Discuss Only Focus on three PMHX-T2DM, CCF, Pneumonia. Discuss pathophysiology of a pleural effusion and also need to relate this to why it is occurring in this patient- related to the patients CCF. Why he had pneumonia before? What isthe connection? And also discuss in much greater etail- including your terminology of preload and afterload and the workload of the heart. How are we managing this is hospital? Whattreatment doesthe patient have for this? The patient has heart failure- CCF. You needed to discuss how the effects of alcohol can worsen the CCF. T2DM- covered the multidisciplinary team that should be involved in this patients care- diabetes educator, physiotherapist, dietician- who else would have been of benefit for the patients care. how often was the BGL's monitored? Was there an associated insulin treatment regime?? 5 Diagnosis ('l'esting/confirmation & pathology results) ECG - Showed AF (No P Wave) Troponin - positive Chest X-Ray small bilateral pleural effusions Echo - heart size is generally enlarged. Blood test - high Urea & Creatinine- Kidney Dysfunction lNR - Result 1 .1 (because using Warfarin) The target is 2-3.5 They may hav e been holding Warfarin in hospital due to the pleural tap. Please discussthe therapeutic range for this patient we would be aiming or. Need to discuss how this is related to the patient's condition 5 Treatment Medical Management Pt had Pleura luid tap on 5/10/1 4. It is the thoracentesis. Discuss the reason why patient had this tap, and complications for this tap. Ex plain what is the assessment after the tap, how often check the Obs, In particular we are assessing the patient respiratory system asthere are high risk of complications such as a pneumothorax with the procedure. Held Warfarin for the tap, but still need Keep an eye for the wound-How assess the wound Pharmacological tre atment Medication: Metformin SR(Slow release) 5oomg For his T2DM His BGL 7.7mmol/L@ 210 with good controlled- Always between 6-7.9mm/L Bisoprolol 2.5mg - Beta-Blockers - Hypertension, -For his CCF Amiodarone 2oomg BD ForhisAF &CCF Anti-arrhythmic medication This is for the patients AF and can have a good effect on his CCF if the AF is controlled but you need to explain this- it is not a medication all patients with CCF are generally put on Clex‘ane (Subcutaneous Injection) 5omg BD-For his CCF. Prevent Blood Clots due to prevent stro e. (His on the treatment dose, Because his Warfarin was stopped for the Pleura fluid tap) We are most commonly trying to prev ent a DVT which could lead to a P - pulmonary embolus. Due to the patients having decreased mobility whilst in hospital. Frusemide 12omg Oral BD For hisCCF is a loop diuretic Side effect- electrolyte imbalance Spironolactone 12.5mg For his CCF & Oedema potassium Sparing Diuretic - CCF manage the patients CCF and this needsto be considered during your discussion- if we manage the CCF then we will also manage the associated oedema. Need to have a brief discussion on why we use the two together when they are both diuretics and what do we need to monitor prior to administration?? Digoxin 125mg (5 days MAX) helps Keep regular heart rhythm. is used to treat heart failure &AF This medication should be giv en after checking the patient's pulse. If the pulse is lessthan 6obpm, the drug should not be given. Please discuss pharmacology and explain all these mecgcation about the mechanism of action well. Do not go into any detail of the complications. Please relate to the patient's con ition. Assessment Baseline Cognition : Alert +Orientated Obs QID BGL (6-7.9 mmol/L) Make sure before and after meal check BGL Metformin at night Please explain hypo/hyperglycemia Vital Signs Admit ay for 4 hrsly Obs, if stable, TlD Obs. RR 4- O2 Airway problem Pulse - AF, BP - low BP Pain (Pleural Tap site)- Factors(coughing & Movement) -lntensity - Pain scale -Quality -Onset 4- duration -Locafion Fluid Restriction FBC & Daily Weight Fluid ov erload - increase heart workload Frgsse'mide & Fluid restriction with good effect -79Kg on admission day 3/10/1 4 on 7/1 0/14 Skin - lntact & Dry He has legs oedema problem. See the legs color, and pitting. Ask aboutthe shoes become small or not. Elev ating the legs for good circulation. Fall" - nil Fall history, poor bone strength(Osteoporosis), still has risk on sycrhological - Upset before he came to FMC. Because patient complain about Ashford Hospital didn't solve his problem and sent Im ome. Good relationship with families. Still sad for his wife died Recommendation(You must find reference to support your opinoin) Monitoring BGL Regularly-educate T2DM , tell him about hypoglycemia & hyperglycemia, av oid these problems Medication - educate all meds and tell him how to take them. Chest pain - how treat for this Constipation - stool check daily. Diet- - High Fiber Low Fat, Low salt, Low Sugar, soft diet Encourage cut drink after go home, educate alcohol damage to the heart failure. Ex ercise - Regular activity-Refer to Physio 9 Discharge planning Transfer to Home Endocrine and cardiology RN Doctor RN uo fiarer support at home in the moment, but daughter & Son-in-law take care of him e as handle in the toilet. daughter and 2 sons support him. Big family. Follow up his appointment with GP PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET AN AMAZING DISCOUNT :)