Nursing Case Conference Report

 

This academic paper requires students to articulate in writing the patient
presented at their Clinical Case Conference. It should be su mitted as a report. There must be analysis of the patient’s medical
condition(s) demonstrating the ability to applytheoretical concepts including (but not limited too) pharmacology; patho-physiology; anatomy
and physiology. There must be presentation and evaluation of nursing and medical management of the patient. Sound clinical rationales must
Re pro¥1idetd that support the care afforded the patient. Appropriate evidence sources must be used and Harvard referencing used
roug ou
Please according to the patient’s case. (I have attached it)
Follow the structure and marking rubic.
The requirement
and structure of this essay:
Introduction: (200 words)
1.lntroduces patient student presented at Case Conference
2.Presents
biographical data
3.Presents current medical history of this patient
4.Presents past medical history of this Patient
Discussion:
(12oowords)
1.Demonstrates understanding of patient’s medical condition(s),
including relevant anatomy and physiology and in depth
Sathophysiology discussion.
Nursing management lncluded clinical assessment presented
using lSBAR(lntroduction, Situation,
Background,Assessment, Recommend), explanation of how nursing management relatesto
medical management with clear clinical rationales
provided, role
of interdisciplinary team involvement explained and primary health care strategies evident.
3.Medical management and
Treatments described including
all relevant pharmacological, non- pharmacological treatments,
pain management explained and clear
clinical rationales provided
ggeldev ant Laboratory results/ Diagnostic tests included (put in appendix if word count is high)
VI ence
of ability to make clinical inferences based upon the data av ailable.
5.Psychosocial I Environmental [Economic aspects of the case
discussed
7.Ethical and legal aspects included if relevant
B.Education of patient lfamily
9.Discharge Planning
Article Discussion:
(500 words)(lv e attached for you,please use that one)
Shrivastava R, Shrivastava S & Ramasamy J,2013, Role of self-care in management
of diabetes mellitus, Journal of Diabetes & Metabolic Disorders, Vol.12, No.14
1.Description of how this literature findings/recent
evidence is related to the case
2.Comparison and critique of the management I nursing care of
the case against the
literature.
3.Suggestions of alternative management [nursing care
Summary and conclusion: (100 words)
1.Summary of the
case
2.Education needs of the patient
3.Short and long term outcomes
4.other relevant comments
I need at least 20 reference for this
essay and must less than 6 years(2009-2014). The article should mention about Type 2 Diabetes management and self-care.
In this essa y,
just following the requirement of the numbers, mention all of the essay requirement and structure.
Patient’s Case
Conference
1. Patient Data
Name: Mr X Gender: Male Age: 84 yrs
2. Psychosocial leconomic background
He’s Independent with
ADL’s. His wife died 2 years ago. He was born in Italy, He came to Australia in 1945. He’s living in Adelaide now. He speaks English. He
worked at Car factory. He retired for a long time ago.
He has1 daughter and 2 sons. They live in Adelaide. Now he lives in a house with
his daughter. is daughter and son-in-law take care of him.
He has medical insurance.
He has quit smoking when he was 35-year-old. Drug
free. Before he came to the hospital, he drinks 2 glasses of wine a day.
He can drive, and shopping by himself.
3. Date and reason for
admission/Current medical history
This patient admitted with left pleural effusion on 3/1012014.
He was admitted with Pneumonia in
Ashford Hospital,for 3 weeks last month.
On the admission day, pt is A + O. coughing and shortness of breath. No chest pain. Ankles
moae swollen. He has low BP. Systolic pressure between 90-11ommHg. Diastolic pressure between 50-6ommHg. Other Obs stable. Cough improvec
nIg
4 Past medical history
Type 2 Diabetes(T2DM)(He had for 4 years), Congestive Heart Failure(CCF), Pneumonia, Arial
Fibrillation(AF), Left Ventricle Failure(LVF), Gout, Osteoporosis, Low Blood Pressure, High Cholesterol, Constipation
Please Discuss Only
Focus on three PMHX-T2DM, CCF, Pneumonia.
Discuss pathophysiology of a pleural effusion and also need to relate this to why it is
occurring in this patient- related to the patients CCF. Why he had pneumonia before? What isthe connection? And also discuss in much
greater etail- including your terminology of preload and afterload and the workload of the heart. How are we managing this is hospital?
Whattreatment doesthe patient have for this?
The patient has heart failure- CCF. You needed to discuss how the effects of alcohol can
worsen the CCF.
T2DM- covered the multidisciplinary team that should be involved in this patients care- diabetes educator,
physiotherapist, dietician- who else would have been of benefit for the patients care.
how often was the BGL’s monitored? Was
there an associated insulin treatment regime??
5 Diagnosis (‘l’esting/confirmation & pathology results)
ECG – Showed AF (No P
Wave)
Troponin – positive
Chest X-Ray small bilateral pleural effusions
Echo – heart size is generally enlarged.
Blood
test – high Urea & Creatinine- Kidney Dysfunction
lNR – Result 1 .1 (because using Warfarin)
The target is 2-3.5
They may hav e
been holding Warfarin in hospital due to the pleural tap. Please discussthe therapeutic range for this patient we would be aiming
or.
Need to discuss how this is related to the patient’s condition
5 Treatment
Medical Management
Pt had Pleura luid tap on
5/10/1 4. It is the thoracentesis.
Discuss the reason why patient had this tap, and complications for this tap.
Ex plain what is the
assessment after the tap, how often check the Obs,
In particular we are assessing the patient respiratory system asthere are high risk of
complications such as a pneumothorax with the procedure.
Held Warfarin for the tap, but still need Keep an eye for the wound-How assess
the wound
Pharmacological tre atment
Medication:
Metformin SR(Slow release) 5oomg For his T2DM
His BGL 7.7mmol/L@ 210 with
good controlled- Always between 6-7.9mm/L
Bisoprolol 2.5mg – Beta-Blockers – Hypertension, -For his CCF
Amiodarone 2oomg BD ForhisAF &CCF
Anti-arrhythmic medication
This is for the patients AF and
can have a good effect on his CCF if the AF is controlled but you need to explain this- it is not a medication all patients with CCF are
generally put on
Clex‘ane (Subcutaneous Injection) 5omg BD-For his CCF. Prevent Blood Clots due to prevent
stro e.
(His on the treatment dose, Because his Warfarin was stopped for the Pleura fluid tap)
We are most commonly trying to prev ent a
DVT which could lead to a P – pulmonary embolus. Due to the patients having decreased mobility whilst in hospital.
Frusemide 12omg
Oral BD For hisCCF
is a loop diuretic
Side effect- electrolyte imbalance
Spironolactone 12.5mg
For his CCF & Oedema
potassium Sparing Diuretic – CCF
manage the patients CCF and this needsto be considered
during your discussion- if we manage the CCF then we will also manage the associated oedema. Need to have a brief discussion on why we use
the two together when they are both diuretics and what do we need to monitor prior to administration??
Digoxin 125mg (5 days
MAX)
helps Keep regular heart rhythm.
is used to treat heart failure &AF
This medication should be giv en after checking the
patient’s pulse. If the pulse is lessthan 6obpm, the drug should not be given.
Please discuss pharmacology and explain all these
mecgcation about the mechanism of action well. Do not go into any detail of the complications. Please relate to the patient’s
con ition.
Assessment
Baseline
Cognition : Alert +Orientated
Obs
QID BGL (6-7.9 mmol/L) Make sure before and after meal
check BGL
Metformin at night
Please explain hypo/hyperglycemia
Vital Signs
Admit ay for 4 hrsly Obs,
if stable, TlD Obs.
RR 4- O2 Airway problem
Pulse – AF,
BP – low BP
Pain (Pleural Tap site)- Factors(coughing & Movement)
-lntensity – Pain scale
-Quality
-Onset 4- duration
-Locafion
Fluid Restriction FBC & Daily Weight
Fluid ov erload – increase heart workload
Frgsse’mide & Fluid restriction with good effect -79Kg on admission day 3/10/1 4
on 7/1 0/14
Skin – lntact & Dry
He has legs oedema problem. See the legs color, and pitting. Ask aboutthe shoes become small or
not. Elev ating the legs for good circulation.
Fall” – nil Fall history, poor bone strength(Osteoporosis), still has risk on
sycrhological – Upset before he came to FMC. Because patient complain about Ashford Hospital didn’t solve his problem and sent
Im ome.
Good relationship with families.
Still sad for his wife died
Recommendation(You must
find reference to support your opinoin)
Monitoring BGL Regularly-educate T2DM , tell him about hypoglycemia & hyperglycemia, av oid these
problems
Medication – educate all meds and tell him how to take them.
Chest pain – how treat for this
Constipation – stool
check daily.
Diet- – High Fiber
Low Fat, Low salt, Low Sugar, soft diet
Encourage cut drink after go home,
educate alcohol damage to the heart failure.
Ex ercise – Regular activity-Refer to Physio
9 Discharge planning
Transfer to
Home
Endocrine and cardiology RN
Doctor RN
uo fiarer support at home in the moment, but daughter & Son-in-law take care of him
e as
handle in the toilet.
daughter and 2 sons support him. Big family.
Follow up his appointment with GP

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