Mr. Aloha Das is a 68-year-old gentleman presenting to the emergency department at 0400hrs with worsening shortness of breath.

NURS3015 Health Variations 4 – Acute Life Threatening Condition

Case Analysis- Case Study of an Acute Life-Threatening Condition

Word Count

There is a word limit of 1000 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10%-word count. If you exceed the word count by 10% (1100 words) the marker will stop marking.

Aim of assessment

The aim of this assessment is to enable students to:

1. Demonstrate knowledge by analysing the information provided in the case study.

2. Apply the clinical information provided in the case study and describe this clinical information within a pathophysiological and patient focused framework.

3. Discuss nursing strategies and evidence-based rationales to manage a patient with acute heart failure

4. Discuss the pharmacological interventions related to the management of a patient with acute heart failure

Details

You are to answer all questions related to the case study provided for assignment help. Your answers must be directly related to the clinical manifestations that your patient presents with. You must submit your work with a minimum of six references from the past 5 years including peer-reviewed journal articles, textbook material or other appropriate evidence-based resources.

Case study

Mr. Aloha Das is a 68-year-old gentleman presenting to the emergency department at 0400hrs with worsening shortness of breath. Onset 2 days ago and progressively worsening. He also developed wheeze and right sided pleuritic chest pain this morning. Vomited x1, ongoing nausea. Has history of non-compliance with medication and adherence to fluid restriction.

Past History

Hypertension, Inferior Myocardial Infarction in 2020, Heart Failure, non-ischemic Cardiomyopathy, Permanent Pacemaker inserted 2021, DM Type II, GORD, Osteoarthritis.

Current medications:

Furosemide 40mg OD, Captopril 6.25 mg TiD, Digoxin 0.125 mg BD, Metformin 500mg TiD, Nexium 40 mg BD.

On 1.2 L fluid restriction; Echocardiogram results in 2021- systolic dysfunction, mild mitral valve regurgitation, dilated left atrium and ejection fraction (EF) 33%.

Plan

• Continuous cardiac monitoring
• 12 lead ECG
• Blood pathology order
• Troponin I High Sensitivity
• Chest X-Ray
• Insert IVC right hand
• Furosemide 40mg IV Stat
• Echocardiogram

Results of Investigations:

Chest x- ray: Left ventricular hypertrophy, interstitial edema noted by Kerley B lines in the costophrenic angle.

Blood Results:

Electrolyte, urea and creatinine:

Result/ Reference Range

Sodium - 137 mmol/L 135-147 mmol/L
Potassium - 3.9 mmol/L 3.5-5.2 mmol/L
Chloride- 105 mmol/L 95-107 mmol/L
Urea nitrogen(BUN) - 14.0 mmol/L 3.0-8.0 mmol/L
Creatinine- 147 μmol/L 64 -104 μmol/L

Question 1

In order to prioritise your nursing actions, you are expected to have a sound understanding of the pathogenesis and pathophysiology.
Explain the pathogenesis and pathophysiology causing the clinical manifestations with which Mr Das presents.

Question 2

Choose one high priority nursing intervention that you will perform for Mr Das

– Briefly explain why you chose this nursing intervention
– Explain how the nursing intervention will alleviate the clinical features of Mr Das using physiological linking
– Describe briefly the impact of not performing the intervention

Question 3

Mr Das has been prescribed Furosemide 40mg IV Stat and Glyceryl Trinitrate IV Infusion 10 mcg/min starting rate.

For both medications explain

– The mechanism of action
– Why your patient is receiving this medication in relation to his symptoms and diagnosis?
– What are the nursing considerations for this medication?
– What clinical response you expect?
– What continuing clinical observations will you need to undertake?

Submission

Refer to Section 2.5 of the Learning Guide- General Submission Requirements Submit your assessment through Turnitin

Format

All assignments are to be typed Typing must be according to the following format:
3 cm left and right margins, double spaced.
Font: Arial or Times New Roman
Font size: 12pt
See further submission requirements below

Submission Requirements

1. Electronic copy only. Students are to submit an electronic copy of the assessment. Students are not required to submit the original hard copy of their assessment on campus

2. Submit your assessment electronically through the Turnitin link on the unit vUWS site.

3. Students are to upload the assessment with the following title: Surname_Firstname_assessment title

4. Your assessment must be submitted in .doc, docx format.

5. This assessment is marked online; no paper copy will be accepted. Marks, comments and the marking criteria will be released online. If you do not receive your marked assessment when all others have been returned, it is your responsibility to contact the Unit Coordinator for assistance.