Health Alterations Case Study Answers

Health Alterations Case study

Introduction
Pathophysiology is a medical discipline that is the study of the health alterations accompanying the diseased organ or the diseased individual. The case is of a 70 years old Mr. Smith who has come with a complaint of exacerbation of CHF and has hypercholesterolaemia, hypertension and has type 2 diabetes. He is on medication for all the above. The goal of this case study is to identify the role of RN in the proper assessment of individual experiencing health alterations when access to healthcare is suboptimal or compromised. The paper would include the identification of primary priorities according to ABCDE framework. These primary priorities are properly linked with the assessment data provided and the pathophysiological changes are discussed. The interventions for each of the primary priorities will be set out. The interventions that are made to implement to manage the patients primary priorities followed by the discharge plan.
The primary priority of the patient will be the shortness of breath. According to ABCDE framework, a patient is first checked for airways. The life threatening airways are checked and treated first (Thim et al. 2012). The breathing is checked just afterwards. The patient complaints of SOB so, with relevance to ABCDE framework the first priority would be his breathing. Its pathophysiology is complex and to increase the breathing it requires activation of chest wall, several receptors related to the upper and lower airway and so on (Coccia et al. 2016). The second primary priority of a patient will be the exacerbation of CHF. Due to the pleuritic pain in the chest, the patient is feeling weak and thus causing fatigue. According to ABCDE framework, circulation is the third step. The circulation is affected in the heart that is the reason for the chest pain. In circulation, the peripheral and central pulses are palpated and the blood pressure is measured (Olgers 2017). The blood pressure is high thus reducing the heart output. The interventions that can be made for above two primary priorities of patients are first is the administration of oxygen. The second intervention that can be used is the medication therapy as prescribed by the doctor. The third intervention that can be used is the fluid restriction. Fluid restriction is very important for such patients to ensure a long and quality life.
Interventions
The interventions made by the nurse in case of the heart patients are goal directed (Wick 2017). The first intervention made by the nurse is the administration of oxygen as prescribed by the doctor. The second intervention is the medication therapy as prescribed by the doctor. The third intervention made by the nurse for CHF patient is by giving the educational and supportive need to the patient and family members and to involve them in their own plan of care.
Intervention 1 Administration of oxygen
The oxygen therapy and its dosages are prescribed by the doctor but the nurse administers it. The nurse is sent for its administration because it is her duty to educate the patient and the patients family on its use. To check if the patient is receiving the correct amount of oxygen, the nurse might do a quick vital check and a pulse oximeter check (Oxygen concentrator store 2019).Since the patient has difficulty in breathing due to shortness of breath, oxygen therapy will be prescribed by the doctor. It could be fatal if it is given inappropriately. So it should be given it safe, comfortable and appropriate way. This is an important intervention made by RN because oxygen therapy is generally the first line of treatment in many emergency cases. RN should regularly and carefully monitor patients with oxygen therapy like monitoring PR, RR, BP, level of consciousness and so on. The RN should be alert of target oxygen saturation, range of oxygen flow, indications, oxygen delivery device and the percentage of inspired oxygen (Mayhob 2018). Administration of oxygen is the nurses role because the right amount is necessary as high amount may lead to oxygen toxicity. The nurses role is also to tell the family members about its use and dosage and its lethal effects on overuse. The intended outcome of this intervention by RN would be the correct administration of oxygen therapy by the nurse and the family members of the patient. This would ensure the quality of life of the patient and correct administration of oxygen is in the plan of care of nurse. In future, if the patient would suffer from shortness of breath again the family members would immediately act upon it and administer it in correct manner.
Intervention 2 Medication therapy as prescribed by the doctor
The second intervention made by the nurse is the medication therapy. After the doctors have prescribed the patient with the medicines, it is the nurses duty to administer the proper medication. The nurse verifies the prescribed medicine order and makes sure it is complete. The RN checks the medical record for any allergy and if found, informs the doctor before proceeding (Robinson 2016). RN chooses the correct dosage and the route of administration. It is the nurses responsibility to make the patient adhere to the medication therapy for the prescribed time. The patients with CHF are high at risk and their medicines needs to be administered properly by the nurses. The medicine for symptomatic treatment of heart failure is prescribed by the doctors in a clinical setting. The nurses duty is to administer them accordingly. In order to make sure of the improvement of the patient, nurse is expected to have pharmacological namely knowledge, the side effects of medicines, the therapeutic uses. The nurse is responsible for nursing actions with regard to medication administration. The medications of heart failure can have lethal effects on the patient if they are administered without discretions (Amakali 2015).The patient is taking furosemide and there are very well known side effects of this medicine such as dry skin, mucosa which are the signs of dehydration. So in this case the patient needs to be monitored for imbalanced serum potassium signs, palpitations, muscle cramps and so on (Friedman 2018). The medication administration complexity and the volume contribute to the risk of errors. During the administration phase of medication delivery, one third errors are made (Durham 2015).The route of administration is very important aspect of medication therapy. Not every medicine can be taken orally. Some are taken orally, some are taken intravenously, intra-muscular medications are also given. The RN should also educate the patient and the family members about the medication regime and the route of administration, side effects, volume to reduce the medication error rates (Marynaik 2018). It also includes monitoring the patient after giving the medication therapy. If the nurse addresses any kind of discomfort or the problem in the patient then the medicines might be reacting so the doctor is consulted. The intended outcome will be the reduced errors in medication and safety of the patient in case of CHF.
Intervention 3 Fluid restriction and providing educational and supportive need to the patient and family members.
The third intervention is to educate the patient and the family members regarding CHF and other complexities from which the patient is suffering from. In the CHF, the patient suffers from extreme chest pain which sometimes become unbearable. As its consequence, the cardiac output gets reduces and which fails at fulfilling the peripheral demands of the body. The patient has increased heart rate and has suffered from myocardial infarction so the patient and the family members need to be vigilant for future. The patient has type 2 diabetes and the hypercholesterolaemia, and hypertension. The heavy users of the healthcare systems are the heart patients and they need proper clinical management. The fluid restriction and its knowledge is very crucial for both the patients and the family members. As per the case study, the patient is on diuretics so the fluid imbalance has high probability to occur. To control the high level of fluid imbalance, fluid restriction is adviced by the doctor which is followed by the nurse for its proper administration. There is a need to design the educational intervention to resolve the learning barriers like functional and cognitive limitations, self-esteem, low motivation and misconceptions (Wick 2017). One of the cornerstones for heart failure for the self-care is the fluid restriction (Johansson, Stromberg and Waldreus, 2016). The fluid restriction based on the individuals body weight is preferred for the heart failure. The nurses should take time to explain every detail of CHF and fluid restriction and to ensure that the patient feels supported and is well aware of what is to be done in future (Smith 2019). The nurses should educate the patient of the proper medicines, diet and the physical activities. This is an appropriate intervention because the patients and the family members lack the basic knowledge of CHF and they have high misconceptions regarding it. So education and guidance in this field is very essential. The RN should take care of the patients low sodium diet so as to balance the fluid and electrolytes. The intended outcome would be the increase knowledge and more vigilant patients would come and they would have taken the step to save their life.
Discharge plan
The discharge planning is the planning that starts as soon as the patient is admitted in the hospital and it contains all the information about the follow ups, details of GP with name and consultant, medication details and the future medical appointments (Care Information Scotland 2017). It is the nurses role to prepare a discharge plan. Social justice framework should be followed while designing the proper discharge plan. By using principles of social justice in discharge planning, there will be strong commitment to care and the education lasting beyond the health care institution walls (Hatchett 2015).The potential factors indicated for re-hospitalization are discharge plan that is inadequate and the non-adherence of the patient to the instruction provided on discharge. The discharge plan includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. It is the most important tool that follows after the patient leaves the hospital (Research gate 2019).The patient is an old man with multiple comorbidities. He has decreased physiological reserve so it would resist the change and stress. The social environment in which the patient will be discharged needs to be assessed. The discharge plan for Mr. Smith will be a collaborative process between the heart failure team and the social team (Riley 2015). The discharge plan for this patient will be as follows
Activity
The patient should start with mild exercise. Walking/ gardening is prescribed. Exercising most days can make the patient feel better. Indulge in enjoy full activities like brisk walking, dancing and so on.
Diet
A healthy heart diet is to be followed. Restricted salt intake, limited or no dried, canned and packaged foods are allowed. No alcohol drinking is prescribed and the liquid intake should also be increased but not too much.
Tobacco
Smoking increases the chances of heart attack because it harms the blood vessels that provides heart with oxygen. If a person smokes, he should quit it.
Medicine
It is prescribed to take the medicines properly and on time. Accurate dosages should be taken and no dose should be missed.
Weight monitoring
The BMI is 34 which means the patient is obese. The patient is advised to monitor the weight regularly and report if the weight increases beyond 2 pounds in a day.
Follow up care
As directed, follow up appointments should be made. The first follow up should be in 7 days after discharge.
Conclusion
From the above mentioned case study and reading its pathophysiological changes, it can be concluded that the role of RN in implementing the interventions is mandatory. The identification of the primary priorities as soon as the patient comes with the complaints of chest pain and exacerbation of CHF, and then using appropriate interventions for the same is done by RN. Providing the patients and their family members an education and supportive needs is very important. Involving them in their own plan of care, guiding them on lifestyle changes, medication administration, diet changes and so on are the nurses duty.
Reference
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