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Exploring Nursing Practice - Case Study Example

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For the present study for greater insight in nursing practice a 58-year-old man with an 8-month history of progressive dyspnoea and hypertension was kept under the scientific study focus. The history of the patient included his inability to climb a flight of stairs or walk across a room without stopping…
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Download file to see previous pages In addition, the patient had suffered from a fracture of his right tibia and fibula at the age of 35 because of road traffic accident. The patient has also been reported of being suffering from systolic hypertension and raised cholesterol levels. On examination the patient was reported of being apyrexial, having irregular pulse of 88 bpm, blood pressure of 180/90 mmHG, jugular venous pressure elevated by 4cm. On examination it was discovered that the apex beat is not palpable and on auscultation there is a grade 2/6 pan systolic murmur at the apex and an audible third heart sound. The patient has mild peripheral oedema and auscultation of the lungs reveal mild inspiratory crackling. Neuro-examinations revealed sensory neuropathy affecting his feet. The patient was diagnosed of dilated cardiomyopathy secondary to alcohol. The patient has been reported of being presenting with signs of congestive heart failure and an irregular pulse. The ECG revealed left bundle branch block and atrial fibrillation. An echocardiogram showed dilated cardiomyopathy, functional atrial regurgitation and evidence of atrial valve prolapse. The left atrium was dilated at 4.7cm.
This patient has been suffering from heart failure. He was initially given Frusemide intravenously and Perindopril 4mg once daily with improvements in symptoms. He was then prescribed Atenolol 100mg once daily and Amiloride 5mg twice daily.
As we have studied in the brief reference of the patient that he is being suffering of mild peripheral oedema, it is essential to focus our attention on oedema as an essential nursing problem for addressal for the patient. The scientific study of the patient has also brought to the medical knowledge that the patient was suffering with atrial fibrillation and the resultant consequences of which have been reported as being shortness of breath due to pulmonary oedema and oedema of the lower limbs. In addition study has also presented an essential finding of the patient being oedematous right up to his waist, which severely restricted her mobility. The prescription of Furesemide can therefore be presented for the removal of excess fluid.
The administration of Frusemide shall be seen as a general reduction of oedema. The improvement in mobility can thus result because of a reduction in leg swelling. An improvement in the mobility shall result in the venous return from his legs due to the action of his leg muscles. A reduction in the effects of pulmonary oedema resulted in an improvement in breathing. The improvement in breathing shall then benefit the process of healing by causing an increase in the level of oxygen in his blood (Phillips, J., 1997). It is also essential to note here that immobility can be considered as an extrinsic factor in the development of pressure sores. (Austin, 1999).
The patient may be nursed in the hospital and during his stay be provided with two pressure relieving aids, a Roho cushion and an alternating-pressure mattress. The use of pressure relieving aids has been considered essential because of the high risk of developing pressure sore. This can be presented to the platform of scientific knowledge by the use of the Waterlow scale.
The health benefit of pressure relieving aids can positively be guided by the Waterlow scale, however the beneficial effect can respire with even greater prominence by encouraging the patient to change position ...Download file to see next pagesRead More
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