NRS 410V Pathophysiology and Nursing Management of Clients Health

Case Study 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay explain your answer and include rationale.

Case Study 2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Considering Mr. P’s condition and circumstance, write an essay of 500-750 words that includes the following:

• Describe your approach to care.
• Recommend a treatment plan.
• Describe a method for providing both the patient and family with education and explain your rationale.
• Provide a teaching plan (avoid using terminology that the patient and family may not understand).

Case Study 1 : Ms. A

In fact Ms. A most probably suffers from the IDA (Iron Deficiency Anemia) following the conditions and preliminary work up according to the medical decision making. The IDA professes where the iron deposits of the body fail to generate RBCs (red blood cells) under the desired range. The evidence-based clinical literature explicates breath shortness alongside weakness as the IDA’s preliminary symptoms (Bernstein, Franklin & Munoz, 2015, p. 366). She experienced low levels of energy as well as surged breath shortness patterns as Ms. A’s established symptoms denoting the IDA development likelihood. The acute dizziness episode experienced by her during her sporting activity also attaches to the non-specific IDA manifestation (Greer, 2009, p. 823).

According to Moini (2013, p. 168), the containment of low hemoglobin and hematocrit levels are advocated for to attribute to IDA diagnosis. Her levels of hemoglobin (8g/dl) and hematocrit (32%) fall beneath the desired therapeutic values. Thus, direct medical decision making towards IDA diagnosis. The clinical contention of IDA is described by Loue and Sajatovic (p. 121) in context to anemia from loss of blood emerging with extreme menstruation alongside gastrointestinal bleeding in females. Moreover, physical examination in this incidence unearths tachycardia patterns besides low blood-pressure as highlighted in the case study. The low erythrocyte count’s relevance in the IDA’s evaluation has been explained by Parthasarathy (2013, p. 357). Nevertheless, other differential factors’ influence like dehydration, medications, stress and attitude calls for careful probe whereas the evaluation of IDA patterns among the individuals’ predisposed.

Hemorrhage has been described by Greenberg, Glick and Ship (2008, p 388) following chronic aspirin use as one of the factors attributing to IDA development. In fact, excessive loss of blood remains the preliminary reason of pathologic IDA development among the people affected. This hemorrhage sources include menorrhagia as showcased in this case study’s findings. Hemorrhage reduces human body iron content from any reason leading to episode of post-hemorrhagic anemic. Nonetheless, bone marrow triggered to antagonize loss of hemoglobin that consequently decreases the general human body iron content. The mechanism of hemoglobin synthesis defect leads to microcytic and hypochromic erythrocytes generation which are apparently evident from the case study findings of red blood cells smear.

Iron-deficient erythropoiesis patterns have been unearthed by the evidence-based clinical literature leading to sustained reduction in serum hemoglobin beneath the normal concentration. In fact, Ms. A manifest identical patterns of symptoms linking to IDA condition in clinical setting. The heavy menses patters as a result of menorrhagia regarded as the utmost prevalent trigger of IDA among women relating to reproductive age, as anchored in clinical literature. Thus, breath shortness symptoms alongside those of fatigue, dizziness, nervousness and palpitations following heavy menses call for instant medical attention with the efficiently tracking IDA intent among the people predisposed. In fact, mild-IDA amongst young females displays no symptoms. Nevertheless, the modest to severe IDA forms stretches its tachycardia and tachypnea manifestations evident from findings of the physical examination of patients affected.

The sufficient hemoglobin amount is essential to carry enough oxygen to human body cells. The low amount of oxygen thus fails to meet the oxygen demand. Ms. A was also playing golf at region of higher attitude. Such an attitude is linked to reduced atmospheric pressure as well as falling beneath the oxygen pressure inspired. Thus, Ms. A had displayed a surged heart rate and respiration rate. Ms. A’s condition is regarded as critical because of low amount of oxygen carrying vector (hemoglobin) as a result of low blood volume. This influences indirectly the blood cells’ viability in overall as well specifically, vital organs. Hence, Ms. A must be carefully treated via the blood infusion and/or substitution of blood. Ms. A must be place in high air alongside ventilation environment to give suitable treatment to restore vital parameters. Where necessary, supplementation of oxygen could ensue to sustain vital organs’ viability. Ms. A must be educated to properly use Aspirin because it has negatively affected Ms. A’s health condition.       

Mr. P’s Cases Study 2

Preliminary assessment

 The assessment of the case begins with the physical parameters which includes body weight and height which will be recorded accordingly.  The step will then follow to various vital parameters such as the heart beat rate, blood pressure and pulse rate have to be will have to be measured and recorded after a given time span mostly likely 1 to 2 hours during the admission.

 The patient’s family history will be based on any health complication as well as family matters among other factors will be asked and details recorded in his files (Francis & Tang, 2003).  Another factor which will be considered is the dietary history of the patient and this will be based on what diet the patient takes regularly. It is important to note that physical exercise and nutritious diet is part of a healthy heart lifestyle.

Treatment plan

  The patient will be recommended to begin with blood sample diagnosis where creatinine, hemoglobin, clotting time of blood, bleeding as well as ions such as Na+, K+, Cl- and Ca+ ions will be checked. Through this analysis the medical team will be able to identify the causes of CHF and edema. In addition to the plan above, the patient will go through another diagnosis for the abdominal ultrasonography (Gomberg, Baran & Fuster, 2001).  Here Mr. P will be diagnosed for abdominal fluid and analysis, echocardiogram and electrocardiography.

After going through the above diagnosis, the treatment of Mr. P will be initiated based on the diagnosis outcome.  Since the patient shows a great congestion which is as a result of fluid accumulations and the increase in size of the cardiac muscles, the patient will be injected with drugs to reduce this congestion (Jefferies & Towbin, 2010).  The patient will be injected with Diuretics which includes: hydrochlorothiazide to initiate and promote excretion of slats and fluids; digoxin to facilitate tonicity within the cardiac muscles and to help as well with pumping of blood to various tissues and organs. Through this treatment the accumulated fluids will be decreased leading to easing of the congestion.

Family and patient education

Patient

Mr. P before leaving the hospital premises will go through counselling to relieve him from various negative thoughts which can hinder the healing process. By going through this counselling the patient will be able to heal as it helps him with boldness towards acquiring and developing resistance towards the disease symptoms (Jefferies & Towbin, 2010). After the counselling, the patient will be educated on the various benefits of physical exercise. He should be made aware that through physical exercise water congestion would be relieved. Mr. P should also be made aware of the effect of various drugs, for instance beta blockers surprises the hear bit rate.

Family

 The patient family members will be educated on the basis of how to supports and provide for the patient.  Patient with heart problems are very vulnerable in cases without the family support and can suffer great danger when living in isolated places. These patients should receive focused attention which family members should be well informed about (Rabelo, Aliti, Domingues, Ruschel & de Oliveira, 2007). Based on the patient’s poor self-care, the family members should therefore be educated on the dangers of leaving the patient alone. Moreover, the family members will be taught on how to deal with the patients emotions as heart failure patients are very vulnerable towards some emotions.

Teaching techniques

Use of novel techniques: application of this technique will enable family members to understand the danger of CHF symptoms. This technique will enable family members learn on how to reduce such symptoms and support the patient whenever he feels congestions in the chest.

Power point and animations technique:  this technique will be used to educate the patient’s family members on the diet required for the patient. Through power point presentation the family members will be able to learn which food staffs contain high proportions of compounds that promotes the aggravation and narrowing of the blood vessels. These compounds should be avoided greatly.

References

Francis, GS & Tang, WH (2003) Pathophysiology of congestive heart failure. Rev Cardiovasc Med. 4 Suppl 2:S14-20.

Gomberg-Maitland, M., Baran, DA & Fuster, V (2001) Treatment of congestive heart failure: Guidelines for the primary care physician and the heart failure specialist. Arch Intern Med. 161(3), 342-352. doi:10.1001/archinte.161.3.342.

Jefferies, JL & Towbin, JA (2010) Dilated cardiomyopathy. Lancet. 375(9716), 752-62. doi: 10.1016/S0140-6736(09)62023-7.

Rabelo, ER., Aliti, GB., Domingues, FB., Ruschel, KB & de Oliveira, BA (2007) What to teach to patients with heart failure and why: the role of nurses in heart failure clinics. Rev Lat Am Enfermagem. 15(1), 165-70