choose one (1) of the case studies below and answer the associated questions.
The following questions relates to the patient within the first 24 hours since admission to the emergency department (ED):
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words)
a. This can be done in the form of a table – each point needs to be appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient(500 words).
Case Study 1: Myocardial infarction with history of stable angina and mitral valve stenosis
Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina
and mitral valve stenosis. Mr Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest
pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr Savea is an ex-
smoker, tobacco free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community.
On assessment Mr Savea’s vital signs are: PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2
indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has a ST segment elevated myocardial
infarction. Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain free on admission to CCU.
Case Study 2: Cushing’s Syndrome
Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was referred to the local hospital
for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple exacerbations of RA which have required the use of high dose
corticosteroids. She is currently taking 50mg of prednisolone daily, and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with
metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant.
On assessment, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9ºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and thefat is mainly distributed
around her abdominal area, as well as a hump between her shoulders. Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test
results show low cortisol and ACTH levels, and high levels of low density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for
a 24-hour cortisol level measurement.
Case Study 3: Decompensated Liver Cirrhosis
Mr Ronald Stone is a 47-year-old man who was brought in by ambulance to emergency department with haematemesis. According to his partner he vomited a total of 300 mL of fresh blood this morning. He
reported that he has been spitting blood stained sputum for the last few weeks with no associated cough or shortness of breath. For the past 3 days he has complained of increasing abdominal pain
but with no diarrhoea or black stools. Mr Stone tested positive for Hepatitis C virus (HCV) genotype 1A in June 2010. He has cirrhosis and a history of heavy alcohol use, although he no longer
drinks. He ceased intravenous drug use 10 years ago, and stills smokes tobacco and marijuana on a daily basis. He used to work with City Rail but has been made redundant 13 months ago and has been
unemployed since. He lives with his partner and 2 young children from a previous marriage.
On assessment Mr Stone’s vital signs are: PR 112 bpm; RR 24 bpm; BP 105/64mmHg; Temp 37.4 °C; SpO2 94% on room air. He has a body mass index (BMI) of 31.5kg/m2. He islethargic but orientated to
time, place and person. He has a swollen and tight abdomen typical of ascites and bilateral leg oedema. Blood test results show Hb 85 g/L, decreased WBC, platelets and albumin, and a marked
increase in both serum ammonia and total bilirubin levels. 6 months ago he underwent an eosophagogastroduodenostomy (EGD) which showed grade 2 oesophageal varices. He is ordered the following
medications: Vitamin K 1 mg IV stat, aldactone 25mg PO TDS, lactulose 15mls PO TDS, and vitamin B12 100mg IV TDS. He is awaiting a CT abdomen scheduled for this afternoon.
Q 1: Outline the causes, incidence and risk factors of the selected disease and how it can
impact on the patient and their family (400 words) :
Linked to case study. Provides comprehensive identification of causes, incidences and
risk factors. Provides comprehensive understanding of the disease impact on patient and family.
Q 2: List five (5) common signs and symptoms of the selected disease, and for each one
provide a link to the underlying pathophysiology (350 words) :
Provides a comprehensive look at the identified five (5) common signs and symptoms.
Provides a comprehensive link to pathophysiology.
Q 3: Describe two (2) common classes of drugs used for patients with the selected
disease including physiological effect of each class on the body (350 words) :
Two (2) classes of drugs appropriately identified.
A comprehensive understanding and explanation of the physiological effects on the body.
Identify and outline, in order of priority the nursing care strategies you, as the
registered nurse, should use within the first 24 hours post ED admission for this
patient (500 words