Case Study of a Patient MG
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Nursing helps in providing proper care and medical attention to a patient or person who is suffering from certain kind of unhealthiest. In this report, the critical condition of M.G a 76 year old female has been discussed. Various complications related with her health and three types of nursing intervention to be provided by the nurses have been described in the report.
1. Pathophysiology, health assessment and clinical findings for M.G's conditions
Pathophysiology of M.G's conditions:
The pathophysiology helps in determining the pathology and physiology of a patient's condition. M.G has suffered from congestive heart failure recently. This kind of disease leads to heart failure because the victim faces heart blockage. It is important to understand the basic conditions which are contributing to such critical situations. Pathophysiology depicts the conditions which have occurred during the traumatic phase of patient (Dovancescu and et. al., 2017). For M.G the major symptoms were swollen feet and legs. She also faced breathlessness and severe coughing. The current observations which were recorded by the hospital staff when M.G recently got admitted to the hospital include irregular pulse rate, high blood pressure and lot of sweat. On performing the ECG, it was diagnosed that the patient suffered from atrial fibrillation.
Despite of being admitted in the hospital, M.G's condition worsened just in a few days of discharge. This implies that she did not follow the instructions which were provided by medical practitioner for retaining the state of health. Moreover, it was determined that she did not follow restrictions of salt and fluids. Salt is one of the triggering agents which can lead to severe conditions of heart and increase hypertension (Sagar and et. al., 2015). It is advised for patients suffering from heart diseases to look up for healthy eating habits and maintain the fluid intakes.
M.G's current conditions reflect that she has been suffering from congestive heart failure because she has following major symptoms:
- Atrial fibrillation
- Inability to breather or breathlessness
- High Blood pressure
- High pulse rate
- Severe sweating
- Swollen legs
The nursing staff of the hospital found that despite of taking a critical treatment, M.G was suffering from breathlessness. It has been reported that she gained 2 kgs after her discharge. This implies that there were no precautionary measures followed. Moreover, her symptoms of congestive heart failure are again dominating the health conditions. The past history of patient depicts that she has been subjected to hypertension and
Type 2 Diabetes.
Both these diseases are themselves very critical and can worsen the situation if medications and health restrictions are not followed.
There were various tests conducted on M.G to scan and verify the symptoms so that a conclusion can be reached. The radiology results depicted that after performing the Chest X-ray (CXR), there was cardiomegaly and pulmonary congestion. This determines that M.G had a blockage in her heart which was restricting her to breathe normally. Moreover, it was found that she was careless in controlling her salt and fluid intakes. Excessive salts in the blood causes the blood pressure to rise and sweating takes place.
2. Risk factors for cardiovascular disease
Cardiovascular disease is a disease which is caused to the heart and the blood vessels. There are variety of symptoms and risk factors which together contribute to this fatal problem. Some of these risk factors have been described as follows:
- Genetics: Children carry many traits from their parents as part of their genes. If parents have been subjected to any sort of heart problem then the risk increases for children or the next generation. Multiple single nucleotide polymorphisms are associated with the cardiovascular diseases that are acquired genetically.
- Age: Considered as the most important element for determining the health status, age plays a vital role in undermining the symptoms of cardiovascular diseases. Right from adolescence the coronary fatty streaks are formed. The risk of death is more in coronary heart disease patients who are above 65 years of age. In M.G's condition, she is also subjected to a cardiovascular disease according to her age.
- Sex: It has been evaluated from various reports and researches that risk of heart disease is more in men as compared to women. Gender differences depict more than half risks in men as compared to women when considering cardiovascular disease (Cardiovascular disease risk factors, 2017).
- Physical inactivity: Unhealthy lifestyle is the prime factor which leads to diseases and chronic problems. The inability to perform exercises or no physical exercises leads to congestion of heart walls which accumulates cholestrol and fatty cells around the sensitive heart area. This blocks the blood flow and as a result congestive heart failure or cardiovascular disease takes place.
3. What other complication does MG present with and why these have occurred
According to the case analysis, it has been observed that MG is having severe issue due to cardiovascular disease and at the same time, other health issues are also increasing accordingly. It is also observed that her Pulse rate is not normal and along with that, respiratory rate is also getting higher. Hypertension, chronic renal failure, type 2 diabetes mellitus and hyperlipidaemia are some of the issues which she is having and because of that her health condition is changing continuously. When she was admitted in the hospital, she was asked to have control on her fluid and salt consumption rate; however she failed to do so. Reportedly she has also gained 2 kg weight after getting discharged from the hospital.
It can be said that the issues of cardiovascular disease is getting more because MG has type 2 diabetes which is changing the blood sugar level. At the same time, she is also not adopting suitable dietary as asked and in terms of consequences, problems of obesity and fatigue has been developed. Further the chances of heart failure is also increasing because MG has hypertension along with type 2 diabetes. Besides the same, MG is also experiencing chronic renal failure which has also changed the functioning of kidney. It can also be said that due to family history, the risk factors for MG could also enhance. Hence, on the basis of present situation of MG, it is clear that she had not followed any of the prescribed things properly; thus this has increased other risks as well.
4. Using clinical Reasoning Cycle, identify three priorities nursing diagnoses
In the present case, MG is having several health problems; therefore nurses must carry out the diagnosis procedure in effective manner. It is also useful for the purpose of improving the health conditions of MG.
- Respiratory system
- Cardiovascular disease
- Chronic renal system
Henceforth, these are the major priorities that are identified and nurses must focus on these priorities so that proper care can be delivered to MG. Thus, with the use of Clinical Reasoning Cycle, it is essential for the nurse to render appropriate care services to MG according to the health priorities.
5. State the goal of care, specific nursing intervention and usefulness of such intervention
According to the above discussion, it is evident that MG is experiencing several health problems; thus on such basis, nurses must focus on adopting specific nursing intervention (Lehne & Rosenthal, 2014). While dealing with every single health issue, it is vital for the nurse to develop a goal of care so that accordingly medication and treatment can be provided.
Nursing diagnosis for Respiratory system
Respiratory failure is one of the most common reasons for which patients are admitted to ICU and this is also one of the factors that led MG to admit in hospital. Nursing care have a tremendous impact in improving efficiency of patient’s respiration and ventilation and at the same time it also increases the chance of recovery (Sidani & Braden, 2011). To detect the changes in respiratory status, it is essential for the nurse to access the patient’s tissue oxygenation status on regular basis. Nurses are also required to evaluate ABG results which indices end- organ perfusion. Nurse should also keep this in mind that brain is extremely sensitive to O2 supply and decreased O2 can lead to an altered mental status. Further, nurses should also stay alert for condition that can impair O2 delivery such as elevated temperature, anemia, impaired cardiac output, sepsis and acidosis.
Thus, these aspects needs to exist in the nursing intervention because that can assist MG to improve the functioning of respiratory system. Thus, in the process of diagnoses, nurses should include possible ineffective airway clearance and breathing pattern. In the present case, nurses will have to include determination of baseline respiratory status which assess patient’s ability to cough and deep breathe effectually. At the same time, nurse should monitor chest x-ray, blood gas levels, CBC, sputum cultures and pulmonary function tests as through that functioning of heart and kidney can be managed suitably (Lehne & Rosenthal, 2014).
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Another nursing intervention includes intubation and ventilator support which also supplements oxygen and consultation with pulmonologist. Nurses must also make use of chest physical therapy so as to manage deep breathing. At the same time, it is also vital to use inventive spirometer in every four hour so as to manage the process of breathing (Butcher & et. al., 2013). Thus, concluding it can be said that such intervention are required to be followed so that health condition of MG can be improved. This is also essential for the purpose of changing the degree of breathe.
Nursing diagnosis for Cardiovascular disease
According to the present case, it is being analysed that MG is having cardiac arrest, deep venous thrombosis and hypertension. The level of blood pressure is also low which leads to blood pooling; hence this has increased the risk of vascular stasis. Thus, according to the nursing intervention, it is vital for the nurse to include impaired gas exchange, decreased output, and altered tissue perfusion hypovolemia (Nordén, Hult & Engström, 2014). Nurses are required to monitor vital signs, cardiac monitoring so that to ascertain the flow of blood in the heart. The process of nursing should also include management of heart rate which is essential in terms of reducing problems associated with heart stroke and attack.
Thus, along with medication, MG must get assistance from physical exercises so that along with physical fitness, she can help herself to manage her life and work both. According to the prescribed medication, nurses must monitor that MG is continuously following it (Hockenberry & Wilson, 2014). Since, there is salt restriction on her, hence she must consider this fact that this can even worse health aspects. Moreover, nurse should also focus on proper dosage of medication as MG has several health issues. Type 2 diabetes is also one of the major causes that increases the problems related to cardiovascular diseases; hence it is essential for nurses to consider all such aspects.
Nursing diagnosis for Chronic renal failure
The nursing goal for clients with chronic renal failure is to prevent further complication and that is possible through supportive care. In this respect, client education is also essential as treatment takes long time to get recovered (Ignatavicius & Workman, 2015). Thus, in this situation, nurse is required to monitor the presence of tachycardia and heart beat so that accordingly medicines can be provided. Thus, nurse must investigate complaints of chest pain, radiation and other severity. Along with this, nurse should also develop a goal to maintain the ideal body weight without excess fluid as this is useful in balancing input and output. Therefore, MG is required to limit the intake of fluid and she should also respond positively to therapy.
Summing up the entire research study, it can be said that all such defined nursing intervention would be helpful for MG to get recovered as early as possible. In the present case, I have learned various things about the medication process for chronic renal failure and cardiovascular disease which lies among major health problems of MG. Thus, I can suggest that proper diet and medication should be followed from all domains.
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- Cardiovascular disease risk factors (2017). [Online]. Available Through:<http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/>. [Accessed on 7th April, 2017].
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