Multiple factors influence the care of patients with chronic conditions. As a Community Health….
NRSG366: Nursing – The Medical Journal Australia – Case Study Assignment Help
Multiple factors influence the care of patients with chronic conditions. As a Community Health Nurse, it is important that care given is prioritised based on both clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions.
This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions. Students will be expected to identify and discuss two PRIORITIES OF CARE and apply the clinical reasoning cycle to these as a means of justification. Please refer to the unit outline and marking rubric when answering this question.
PLEASE CHOOSE ONE OF THE FOLLOWING SCENARIOS
The scenarios are your referral information and no additional information is available.
Scenario One: Peter Mitchell
Peter Mitchell is a 52-year-old male with type 2 diabetes who was admitted to the medical ward with poorly controlled diabetes, obesity ventilation syndrome and sleep apnoea. Peter was referred by his GP after he presented with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and difficulty breathing whilst sleeping. Peter has been a smoker for approximately 30 years and smokes approximately 20 cigarettes per day.
On his previous admission, Peter was seen by a dietician and commenced on low energy, high protein diet (LEHP) to assist with weight reduction. His GP had previously discussed weight loss with Peter, however, he had never wanted to do anything about it as it seemed ‘too hard’. Peter was also reviewed by the physiotherapist and was commenced on light exercises which he was to continue at home on discharge.
Peter has been discharged home with a referral to you as the community nurse for ongoing support and follow up, after four weeks in the medical ward to manage his weight and clinical comorbidities .
Social History Peter is an unemployed male who receives government benefits. Peter lost his job three years ago as a fork lift driver at the Moranbah coal mine in far North Queensland. Peter states that he has always been a ’biggish guy’ with his ‘normal weight’ sitting at around 105kg but since starting insulin and losing his job he has gained a significant amount of weight.
Consequently, because of his weight issues, Peter has difficulty finding work due to fatigue and feeling generally ‘uncomfortable’ about his size. Peter is a divorcee who lives alone, his two sons live in the same state but live in different cities and rarely visit him. He has increasingly become socially isolated as he is embarrassed by his size. Peter is also finding it increasingly difficult to perform activities of daily living (ADLs). Peter realises that he is in the prime of his middle age life and is motivated to lose weight and quit smoking but isn’t sure where to start.
Obesity – weight 145kgs
Type 2 diabetes (Diagnosed 9 years ago)
Gastro oesophageal disease reflux disease
insulin Novomix 30 B D (34 units mane & 28 units nocte)
metformin 1000mg BD
lisinopril 10mg daily
Nexium 20mg daily
metoprolol 50mg BD
pregabalin 50mg nocte
Scenario Two: Jenny Peterson
Jenny Peterson is a 23-year-old single parent with a two-year-old girl named Samara. Jenny was diagnosed with epilepsy 6 months ago and is attending the outpatients’ neurology clinic for stabilisation of her epilepsy.
Jenny and her daughter live in an outer suburb of a major city. Jenny is a receptionist at a major hotel chain and works morning and afternoon shifts on a rotating roster. Samara’s father is not supportive emotionally or financially.
Jenny’s parents live two suburbs away and are very supportive of their daughter and granddaughter – they take care of Samara while Jenny is at work.
Jenny sustained a head injury in a car accident when her car was hit by a drunk driver. Jenny spent three days in intensive care before being transferred to the rehabilitation unit where she spent one week. Upon discharge, she appeared to have no residual health issues. Three months after the accident however Jenny experienced a tonic-clonic seizure one night while visiting her parents. Jenny was initially hospitalised for investigation of the seizures. Whilst in hospital, Jenny’s seizures were controlled with medication (sodium valprorate) and she was therefore discharged on sodium valprorate with follow up appointments in the neurology clinic.
Initially it appeared that Jenny’s seizures were under control and so she returned to work, using public transport and taxi services as she was not allowed to drive. In the last few weeks she has been having seizures again and she is currently on sick leave. She has almost no sick leave left, causing Jenny a great deal of financial distress.
Both Jenny and Samara have had a few bouts of illness in the past month – mainly common colds and one episode of nausea and diarrhoea. Samara is now well but Jenny feels tired, run-down and is still nauseous occasionally. She wants to ‘go off’ her medications to see if she feels better. She states that she is afraid of the future and how she would care for Samara. She is particularly concerned about having seizures while alone at home with Samara.
sodium valprorate 200 mg
daily lamotrigine 200 mg daily.