Case Study on "Chest Pain the Presenting Patient"

Quoted Instructions for "Chest Pain the Presenting Patient" Assignment:

i will be sending through some info:

Written Case Study Assignment HNB2102

THIS IS A 1200 WORD WRITTEN ASSESSMENT STUDENTS ARE REQUIRED TO AN***** THE CASE STUDY PROVIDE AND JUSTIFY WHY THE 3 PATIENT PROBLEMS CHOSEN ARE CRITICAL PROBLEMS AND THEN DESCRIBE THE NURSING INTERVENTIONS REQUIRED.

PLEASE NOTE: MR HAY HAS ALSO BEEN DIAGNOSED WITH COPD

Mr Hay is an 82 year man who has been in your ward for the past week. On admission he was complaining of sharp pain in his chest which is worse on deep inspiration and coughing. His respirations were shallow and he tended to use purse lip breathing with use of accessory muscles. His temperature was 38 C heart rate 106 beats per minute and his respiratory rate 28 breaths per minute. His family were concerned as he was found on the kitchen floor by a neighbour, and he had been laying there for some time as he had signs consistent with a Stage 1 pressure injury to his right hip, ankle and shoulder.

He also had a productive cough, with thick yellow sputum. He stated that he had been to his General Practitioner (GP) approximately a week prior to admission and was given antibiotics for the cough.

Medical History

2010: Fractured neck of femur (#NOF) and pulmonary embolism

2011 January: Partial thickness burn to left hand

No other significant medical history

Social History

Married for 45 years, wife deceased 2011

Retired from coal mining in 1990

Social drinker, likes a scotch in the evening

Lives by himself and states he copes well. Family lives a few hours away but they visit him regularly

Present Vital Signs

Pulse: 98 beats per minute

Temperature: 37.6o C

Blood Pressure 150/95 mmHg

Respirations: 28 breaths per minute at rest and shallow with ongoing complaint of pleuritic chest pain

Electrolytes

K+ - 5mmol/L

Na+ - 135mmol/L

CL- - 92mmol/L

Arterial Blood Gases

PaCO2 - 49 mmHg

PaO2 - 82 mm Hg

HCO3 - 29 mmHg

pH: - 7.4

Chest X-Ray (AP and Lateral view)

Results The lungs are hyperinflated. There are several poorly defined small pleural plaques evident bilaterally which may be consistent with long standing inflammatory change. High resolution CT scanning of the chest may be advisable to further characterise these lesions. The heart shows moderate enlargement and the lung fields are free of any focal abnormality.

Doctors Requests

IV therapy 1000 mL 24 hrly Normal Saline

Titrate O2 to keep SaO2 >94%

Ambulate as tolerated.

Your preceptor asks you to identify the patients 3 priority problems from this list

NOTE; WHERE THE *** I choose to use these 3 priority problems

***Activity intolerance

***Airway clearance, ineffective

Breathing pattern, ineffective

****Pain

Self care deficit

Tissue integrity impaired

RECOMMENDED REFRENCES:

REFERENCES

Australian Institute of Health and Welfare: Australia*****s health 2006, cat. No. AUS 73, Canberra, 2006, AIHW.

Doran, D. (2011). Nursing Outcomes: The State of the Science, Jones & Bartlett Learning, Canada.

Farrell, M. D., J., Ed. (2011). Smeltzer and Bare's Textbook of Medical - Surgical Nursing, Wolters Kluwer, NSW.

Healey, F 2010, 'A guide on how to prevent falls and injury in hospitals', Nursing Older People, 22, 9, pp. 16-22, CINAHL with Full Text, EBSCOhost, viewed 20 April 2012.

Lemone, P., Burke, Karen M (2011). Medical - Surgical Nursing - Critical thinking in Client Care, Vol 1,2,3 Pearson, Australia.

Marieb, E. N., Hoehn, K (2010). Human Anatomy and Physiology Pearson International, California. P 819,

McCance, K., Huether, S., Brashers, V., Rote, N. (eds.) 2010,. Pathophysiology: The Biologic basis for Disease in Adults and Children: Mosby Elsevier, Missouri.

Potter, P. A., Perry, Anne (2009). Fundamentals of Nursing 3rd Edition, Mosby Elsevier, Sydney.

Tollefson, J. (2007). Clinical Psychomotor Skills; Assessment Tools for Nursing Students, Thomson, Australia.

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