Present Illness: A Case Study

The care and management of patients suffering with a long term condition is an integral part of the nurse’s role. With approximately 15 million people in the UK suffering from at least one chronic illness (DoH, 2012), it becomes apparent why the Department of Health (DoH) and the National Health Service (NHS) have had to put in to place advice and guidelines in order that the appropriate measures are taken to ensure that these patients are cared for in the most productive way. This essay is going to discuss the issues that are associated with long term conditions and chronic illness. The focus of this discussion is going to be a case study on a patient who is currently

Both rapid, shallow breathing patterns and hypoventilation effect gas exchange. Arterial blood gases will be monitored and changes discussed with provider. Alteration in PaCO2 and PaO2 levels are signs of respiratory failure. Patient’s body position will be properly aligned for optimum respiratory excursion, this promotes lung expansion and improved air exchange. Patient will be suctioned as needed to clear secretions and maintain patent airways. The expected outcome is that the patient’s airway and gas exchange will be maintained as evidence by normal arterial blood gases (Herdman,

of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The

Data: Pulmonary function testing dated 2010 showed moderately severe obstruction with positive bronchodilators response. Normal lung volumes. Evidence of air trapping. Severely reduced diffusing capacity for carbon monoxide.

The patient is 72 year old female who smokes. She complains of extreme fluid retention in lower two limbs and lower abdomen. Breathing is difficult and she is only able to sleep while sitting erect in a reclining chair.

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.

BH reports that he takes his medications as prescribed and reports he has tried to adjust his diet in order to decrease his glucose, triglycerides, and cholesterol. He continues to consume

HEENT: No thyroid enlargement, masses or adenopathy, JVP was 5 cm above sternal Angle, carotid pulse was strong and regular

History of Present Illness: Ms. Noseworthy is a 76-year-old woman who I had seen at the end of July for the evaluation of ILD. She is here today for followup of those results. She has stable cough and shortness of breath. She states that she is exercising on a treadmill on a daily basis and bought an oxygen saturation monitor, which consistently has shown her oxygen levels to be in the low to mid 90's. She denies any chest pain. She has no other complaints today.

Ht: 62”, Weight: 134 pounds, BMI: 24.5 Temp 98.4 BP 128/90 P 76 R18, even. The Oxygen saturation 98%.

(Cole, 2010) The chest x-ray for these babies generally presents with a ground glass appearance, hyper expanded lung fields with densities and possibly pulmonary edema. Extended periods of use on the mechanical ventilator for preterm and under weight infants can lead to BDP due to decreasing lung compliance from poor perfusion extending from a suspected hypoxemic and hypercapneic state. (ALA, 2008) Even though these babies are on the ventilator, they will still present with shallow breathing, cyanosis, tachypnea, retractions, and scattered rales on the chest x-ray. Later in life, babies who overcome BDP can suffer from developmental problems, poor growth, and possibly pulmonary hypertension. Upon auscultation, there will be coarse rhonchi breath sounds with possible rales, paradoxical breathing and an increase in the rate the patient is breathing. The dynamic lung compliance is reduced hindmost because of the increasing damage that is taking place in the small airway. (ALA, 2008)

Many who live in poverty and have a chronic illness are often faced with the consequence of not having their illness treated because of the incurring medical costs of treating a chronic disease and being viewed as non-compliant. This leads to costly emergency room visits that could have been preventable if the necessary medical treatment had been utilized. Many hospitals and physicians are currently screening patients that may need additional resources to pay for medications, need transportation for appointments, nutrition, and housing. Communities may elect to apply for government funded health centers to help address this gap. Hospitals are also partnering with community-based organizations to help the patient receive the resources needed

The seen environment present when reading The Death of Ivan Ilych story is the way Ivan’s family lived and the way Ivan treated everyone with coldness. The unseen was depicted by the atmosphere present in Ivan’s’ room, making friends and family members uncomfortable to be there. The storied environment is when Ivan realizes that his life has been a mistake and he converts religiously, he finds God and Ivan repents from all his sins, it is not until then that he found peace in his mind.

Objective Data Provided: Objective Needed: In Italics 5’8”, 105lbs, Temp, BP looking for hypotension, Pulse looking for bradycardia, RR, mental status exam- appearance, attitude toward

Vital signs: Temperature 98.7 Fahrenheit, BP 200/140 Pulse 80, Respiration 18, weight 345 IBS, BMI of 35.