Fatigue Case Study

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

Hi Roseann. Good Job. Your Unit 7 Initial Post is very informative. Her verbal report of fatigue, bilateral lower lobe crackles, skin is cool to touch, +2 edema in bilateral ankles, and heart rate of 112 are signs and symptoms of congestive heart failure. Her medical history of high blood pressure and coronary artery disease could also lead to heart failure. My focus would be is to teach her with CHF symptom management and to prevent exacerbation. To avoid hospitalization I would educate and give her a list of preventable measures such as avoiding salts, measuring her weight every morning, and fluid restrictions. I would advise S.P to notify her doctor with weight gain over 2 pounds. Medication compliance is also important in managing her

At today’s visit she is accompanied by her husband and private aide. Her husband reports that she is doing much better. He states that her pain has improved and she has not taken her pain medication since last visit. He states that her anxiety had improved extremely with the recent change in her Xanax. He states that he has hired 24 help for the patient and since she has not fallen. She reports that she is feeling well. The caregiver reports that the patient continue to suffers from hypotension and hypertension with variation in blood pressure. The patient also continues to suffer from chronic tremors as a result of her Parkinson.

In this study, I believe the independent variables are the stage of illness of the patient, spiritual well-being, and gender. The dependent variable fatigue during the cancer treatment. In the setting and subject description, the selection criteria had inclusion, and exclusion criteria. Within the inclusion criteria, every one of the participants had to be 18, or older, and have active cancer related treatment with a cancer diagnosis with either a palliative or curative intent, willing to participate in the study. The criteria that was excluded were those individuals whom had completed the cancer treatment those whom only received treatment only palliative care.

Driver fatigue is a common occurrence for those who are driving long distances or driving at times of the day or night when they should naturally be sleeping. Becoming overtired when behind the wheel is dangerous and unfortunately highly common in a time where daily activities continue to move along, despite our need to rest.

There are barriers to CRF occurring at the patient, professional and system levels. The patients barrier is due to the patient believing that their fatigue is not important, that it is inevitable or untreatable. Patients usually do not consider fatigue as a valid problem to complain about to their providers. Even when patients communicate an overwhelming or severe fatigue, they are not sure about the process that care health care providers will use to diagnosis their fatigue (Borneman, 2007). Barriers at the professional levels, include a lack of knowledge about the complex nature of fatigue. Also there is lack in literature agreement about the definition of fatigue, it’s causes, effects and remedies used for fatigue management. Usually health care providers focus on managing pain and nausea because they interfere with quality of life but fatigue is not considered one of these symptoms that needs to be addressed.

In evaluating M.T.’s medication regimen it is noted she is currently taking metoprolol 50mg twice daily and it is proven to be ineffective in managing her blood pressure which is currently noted as 174/94 with a pulse of 90. The metoprolol is a beta blocker and is not a first choice for a monotherapy to treat hypertension. The regimen is twice daily and creates complications for the M.T. to remember to take the medication. In addition, there is no documented history of heart failure or MI in M.T.’s medical history but there is

Dealing with Mrs. Smith’s nursing diagnosis of decreased cardiac output related to cardiac dysfunction, I would educate her on common signs and symptoms of heart failure exacerbations and appropriate actions she must take if she becomes symptomatic again. Common symptoms of a heart failure exacerbation may include fatigue, shortness of breath, swelling in legs, ankles, and feet, reduced ability to exercise, persistent cough/wheezing, three to five pound weight gain overnight, and chest pain. I would explain to Mrs. Smith the importance of daily exercise, because in a study performed it showed that 91% of women did not exercise for fear that they would hurt themselves or increase their symptoms (Stamp, 2011). It is important to exercise daily to reduce living a sedentary lifestyle, while also knowing your limitations with your heart failure. Mrs. Smith who lives by herself and mostly eats TV dinners is at risk for exacerbating her factors related to her high sodium intake. It is important in this step to get a TV dinner box and a couple canned foods and educate her on the importance of looking at the sodium content in each meal that she

Fatigue is a growing concern for law enforcement agencies, especially when it comes to officers that work second jobs (Doerner, 2012). Another concern would be officers using their sick time to work a second job, thus causing staffing issues for the agency (Doerner, 2012). Depending on the type of secondary employment, there could also be a conflict of interest further concerning the law enforcement agency (Doerner, 2012).

“The usual clinical manifestation of heart failure is left ventricular dysfunction that occurs after some index event, such as myocardial infarction” (Chapa et al., 2014, p. 16). With the aging adults, like S.P., we have to be concern when they have presenting signs of heart failure, especially if they have not been diagnosed with one. Questions I may have to ask S.P. are what time of the day her fatigue and swollen ankles are worse. This is to determine if her fatigue and edema are cardiac related. Cardiac related fatigue is “worse in the evening, whereas fatigue from anxiety or depression occurs all day or is worse in the evening” (Jarvis, 2016, p. 472). Does her fatigue is accompanied with shortness of breath on exertion? Patient education

Last, hospital visit was to the emergency room. Last year she had an episode of SOB, and she was prescribed an albuterol inhaler. GL has been treated for hypertension for the past 13 years, her current medications are propranolol 40 mg twice daily and hydrochlorothiazide 15 mg daily. GL’s physical assessment and vitals are as followed; HR: 60 bpm, RR: 30 bpm, and B/P 152/85 mm Hg. Upon auscultation of her lungs, revealed an expanded chest, with diminished breath sounds and faint wheezes. Heart sounds were normal. The diagnosis includes COPD and asthma. Physician had ordered albuterol inhaler 1 unit does x 3 times a day and fluticasone provide anti-inflammatory, decreasing edema of airways 40 mg x 3 times a day, and oxygen 2L/NC PRN. With GL’s increasing fatigue fall precaution should be initiated and while ambulating CNA should monitor patient. Educate GL about using call light when needed and not to try and get up alone. She should also be educated daily on cessation of smoking and how to prioritize her days. Physician wants to admit

Hi Erin, thanks for the post. Determining the contributing factors of S.P.’s fatigue is important in order to guide us on how to proceed with education. Energy conservation is necessary and encouraging her to divide her activity in smaller tasks. I agree that proper management of HTN and hyperlipidemia, through diet, exercise, and medication regimen, can prevent complications. You made good points in keeping track of heart failure symptoms and the education regarding elevating the legs to decrease edema.

Adhering to the age-old advice above is necessary for managing chronic fatigue syndrome, though they are common. Experts suggest that these unique fatigue-fighting methods will also prove useful.

In the case study it discusses a patient, Mrs. Harris, who is a 72 year old and is complaining of fatigue and swelling in her feet. Mrs. Harris also expresses her concern on the swelling, as some days she is unable to put her shoes on despite proper elevation. She also states walking to her mailbox can be challenging because it causes her to feel more tired and to have shortness of breath, also known as dyspnea. Mrs. Harris is currently taking medication for high blood pressure, hypertension; and is also drinking approximately 8-12 glasses of wine a week. While examining Mrs. Harris it’s clear she is a little overweight and has swollen ankles. Upon listening to Mrs. Harris’s breathing, crackles are heard. Therefore, Mrs. Harris seems to have congestive heart failure.

At today’s visit she is accompanied by her daughter. She is awake and alert. She reports numbness, tingling and itchy feeling inside of bilateral lower legs. She reports that it is constant and there are no relieving factors. She complains of dull pain in her shoulder which she rates as 4/10 in severity. Her shoulder pain does not radiate, moving her arms makes her pain worse. She suffers from chronic depression for which she takes antidepressant. She suffers from chronic anxiety which is managed with Xanax. The daughter reports that the patient has a poor appetite and has loss 4 lb. the patient