Patient C. Z Case Study Nursing

The patient's comorbidities include Hypertension, hyperlipidemia, CAD, and GERD. The patient had a CABG operation a few days back from admission day on 4-10-2017. In addition to the CABG surgery, other procedures such as TEE, cardiopulmonary bypass, vein harvest, and a thoracotomy with a chest tube and JP drain. Significant surgical procedures also include angioplasty and left and right knee arthroplasty.

(Ramani, Uber, & Mehra, 2010). My grandmother had heart failure and I saw how she had a time trying to breath and her ankles were swollen all the time. She thought the medicine was hurting her instead of helping. She took several different medications to try to control her symptoms, but she eventually succumbed to heart disease.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

The profession of nursing includes: promoting health, preventing illness, as well as providing care. NUR 102 teaches student nurses, like myself, a wide range of information and knowledge needed in order to become a successful nurse and also aids in the preparation for clinical placement. Nonetheless, this course teaches essay writing, critical thinking, nursing theories, as well as the roles and responsibilities that I will have as a nurse.

R.O. is a 43-year-old female Latino patient who has been living at home alone since she got divorced three months ago. She does not have any living or available family in the United States. She is the oldest of three children. Her parents died of an accident when she was little. Two of her sisters live in Mexico. She has lost contact with her family in Mexico when she got married and move to the United States. She also has stopped communicating with her ex husband since they got divorced. Although she does not have any support from her family, she states that her church member has been very supportive. Moreover, R.O. states she was a homemaker until the divorce. Currently, she has been working as a dishwasher near her house.

Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.

An elderly male with congestive heart failure was brought to a clinic because he was experiencing atrial fibrillation and had a ventricular response of 110 beats/min with palpitations and shortness of breath1. Medications that he was taking includes angiotensin-converting enzyme inhibitor, Lisinopril, Carvediol, Digoxin, and Furosemide1. His left ventricular ejection fraction has been reduced to 25%1. Further examinations showed that he had edema in his legs and crackles at the base of his lungs1. He was then told to increase the dosage of Furosemide by taking the drug twice daily instead of once, and doubling the dose per administration1. One week later, the electrocardiogram revealed that he had ventricular arrhythmias such as premature

Patient C.B. is a 32 –year-old African American female, G2P2 who came to clinic with complaint of burning and frequency with urination and foul odor urine that she said began four days ago.

Due to delay in meeting with Mr. Reid, the adjuster approved submitting the report after our initial meeting.

There are a plethora of treatments available for patients with heart failure including but not limited to diuretics, ACE inhibitors, angiotensin receptor blockers, and oral nitrates. The Vasodilator heart failure (V-HEFT) studies show that enalapril has less cumulative mortality among study participants when compared to patients taking a combination of isosorbide dinitrate and hydralazine. (MGMT) This is not to say that the combination of isosorbide dinitrate and hydralazine is not efficacious because when compared to placebo, mortality rates improved with the combination treatment.

The change project involves the implementation of post-discharge calls to monitor patients, hence prevent readmissions. Thus, the hospital needs resources that include personnel, equipment, technology, and travel in some instances. Additionally, Sullivan (2012) argues that employee motivation and continual development helps improve the job performance. As such, the hospital will be required to put additional resources for the purposes of employee motivation and education.

In the given scenario, I am a family nurse practitioner in a busy emergency room. Early in the evening hours, I am presented with a concerned mother who is seeking medical attention for Paige, her six-year-old daughter. The mother reports the patient has been displaying cold symptoms for a few days with a cough that continues to worsen. The issue that the patient faces is limited access to healthcare providers in the area who accept Medicaid, which is Paige’s health insurance provider. After discovering Paige’s physician’s office does not have any appointments available for three days, the concerned mother decides to seek care for her daughter at the emergency department. Considering the patient’s condition is considered non-urgent, and our

Multiple studies have shown that high dose nitrates are superior to furosemide in the treatment of acutely decompensated heart failure (5, 6, 7, 8). Mattu et al

Now, Ms. Matson claims her current disabling medical conditions are to her lower back which inhibits her from not walking not more than ten minutes at a time while using a walking cane. Furthermore, the pain to the left side of her neck because of her left shoulder injury has caused the nerves from her left shoulder travel up to the left side of her neck which is now painful enough where she cannot turn her head to the left.