Nursing Case Study

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

1. The nurse is asked to implement a new, complex, and invasive procedure and is concerned that this may violate the state’s nurse practice act.

A is an 87 year old women, with a long history of health troubles including chronic kidney disease, congestive heart failure, coronary artery disease, a pacemaker insertion for her atrial fibrillation, type 2 diabetes, dyslipidemia, colon cancer, breast cancer, mild cognitive impairment and most recently paranoid psychosis.

Susan is a 78 year old widowed lady who was admitted to a medical ward following an episode of coffee brown vomiting and breathlessness. Susan has a past medical history of chronic

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Lungs: Diminished breath sounds in all lung fields. Resonant to percussion. No wheezes, rales, or rhonchi. Symmetric chest expansion. Breathing nonlabored.

CHIEF COMPLAINT: This is a post op note from a procedure performed July 21, 2015 by David Lin, MD.

She was diagnosed in December of 1997. Overall, she is reported to be in stable health and has no known allergies to food or medications. Paula does not have a history of seizures. She is being monitored for high cholesterol, however her mother indicates Paula is not taking the medication and instead is exercising regularly and monitoring food intake as a means to reduce cholesterol levels to a normal range. Paula does not take prescribed medication and taking a variety of natural supplements. She has a history of sleep insomnia and will stay up late perseverating on past events, when this occurs, her mother will administer 12mg melatonin to help her sleep. Paula was recently diagnosed with sleep apnea following a sleep study completed by (______) on (___). Results indicated she stopped breathing 10 times per hour during her study and it was recommended she use a continuous positive airway pressure (CPAP) device when sleeping or taking a nap. She is on a regular diet and requires supervision to monitor food intake. Paula has a preference for eat, take food, and if able to will consume in excess. Mother reports that Paula is monitored by physicians and dentist on a regular basis and receives medical coverage through

At today’s visit she is found in her room at Tiffany hall SNF. She is awake, alert and confuse. The facility staff reports that the patient often refused care. She is wheelchair dependent. She is assist with most ADLS. She has chronic edema in lower extremities and refuses to elevate legs. She also refused

Claimant reports history of multiple medical complaints. Since the age of 60 she reports struggling with urinary incontinence, which impacts her functioning at work. She reports feeling ashamed and guilty that she is unable to control her urination and has the need to periodically utilize the restroom or go to her car taking time away from her responsibilities. In the past few years claimant has severe intensification of physical symptoms, including back pain, right shoulder and hand weakness, blood pressure, headaches, sleep difficulty, and depression-related fluctuating appetite, fatigue and sluggishness. She reports experiencing heart palpitations present (racing heart), dizziness, and fear of actual fainting, a feeling of choking and not being able to breathe, chest pains, nausea or intestinal pains, shortness of breath, tremors in the hands, hot flashes and tunnel vision. The claimant reports that she sleeps very minimally; averaging 3-4 hours of sleep per night on an interrupted basis due to physical and emotional pain. She reports that she has very poor mobility due to pain and depression-related poor motivation.

This is 39 year old AAM. Patient is here with several complaints. Patient has no medical condition, or long term medications. Patient denies any other issues except as listed.

My new role as an adult/gerontology nurse practitioner (AGNP), will be part of team that provides care for Long-term acute care LTAC, Skilled Nursing Facilities (SNF), or Rehabilitation hospital. After gaining considerable experience, my focus in future will be working in home healthcare and primary care clinics. My scenario will involve an organization that provides innovative, collaborative, health care team for one hundred bed LTAC Hospital. Working as an LTAC registered nurse, I noted that, despite the variety of diagnosis, majority of patients’ presents to LTAC hospital have wounds that require complex wound care management. The wounds can range from pressure ulcers to non-healing illness/injury wounds such as diabetic foot ulcer, venous leg ulcers, and post-surgical wounds among others. For this assignment, my scenario will focus on the role of Nurse Practitioner (NP) on skin care and wound managements.

My patient is a 68-year-old Indian male. His health issues include hypertension, Type 2 diabetes, hyperlipidemia, cellulitis, and insomnia. He has been in the facility for 3 years. My patient’s weight is 156 lbs. and there were no major weight changes for the time he has been in the facility. My patient needs assistance with either wheelchair or a walker, is able to ambulate with or without a device. He is not allergic to anything, therefore, no modification to the medication is needed. The primary the patient is in the facility is because of a foot ulcer. The foot ulcer is unable to heal at a normal pace because he has diabetes. My patient did not take any medication prior to admission to the facility.

My current area of practice is in the twenty-three-bed surgical intensive care unit (SICU) at Vanderbilt University Medical Center (VUMC). It is a Level I trauma center and tertiary care center that provides some of the complex care in middle Tennessee. One major patient population frequently admitted to the SICU are patients diagnosed with acute respiratory distress syndrome (ARDS). ARDS is a complicated lung disorder that causes profound hypoxia. It is seen in up to 10% of critically ill patients and is associated with a mortality rate of 46% source, (Taylor, Chambers, & Liu, 2017). It is often under recognized and difficult to treat. While there are risk factors that increase the risk of the development of ARDS (such as pneumonia,