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  • Care of the Patient with Complex Care needs

    Patient Scenario 1 Analysis

    This study is based on the healthcare situation of a 70 years old lady Mrs. Pearl Cole. This part will be based on the aims and will help to analyse the situation of the lady. An evaluation of the scenario will also be added. The aim of the study is to discuss and analyse the problem of the lady Mrs. Pearl Cole along with a signified evaluation. The objective will go to help the service provider to understand the basic health problem as well as the requirement. The overall assessment of blood pressure, temperature, pulse rate, respiratory rate and weight as well as oxygen saturation along with the pain score will help the matron to understand the health issues which are swelling of leg, lack of sleep and unhealthy diet consumption tendency. This study tells about the health issues and healthcare need of an old lady. In this scenario it has been stated that the single lady is managing her health somehow with help of a local community. Her daughter is living nearby and seems caring to her. Due to some cardiac issues, the lady was admitted to the local hospital and discharged home for the issues as well as disease specific care management under community matron.

    As per this scenario of Mrs. Pearl Cole there are several issues have been found out. The primary issues are mainly related to Heart and Hypertension. During the time of treatment from home she suffered from Bilateral leg swelling and pain, Unable sleeping on bed comfortably as she is sleeping upright with number of pillows and sometimes sitting the whole night on a chair. Apart from that she is facing some problem related to food as she is instructed to low sodium diet, a tendency to have high sodium oriented food has been found in her case. The ABED (Attitude Breathing Exercise Diet) method will help Mrs. Pearl Cole to precede a systematic approach so that the critical assessment of the patient can be done. Apart from that, the method will help the healthcare professionals to identify the level of seriousness of relative issues like respiratory function, oxygen consumption and body weight maintenance. In fact, this is an authentic measure to understand any health situation and analysis (American Diabetes Association, 2015, p.98).

    PSE is another method which can be used in this particular case to find the nursing related issues. This method contains the elements of problem, aetiology and symptoms. The overall assessment of the scenario revel an overall diagnosis of cardiac failure and hypertension along with painful leg swelling.

    As per the opinion of Hong et al. (2014, p.18) SMART goals is also required for the overall estimation and analysis of healthcare problem along with the needs of a patient. In the case of the lady Pearl Cole, a solution is required for her subordinate issues like painful leg and sleeping disorder. Apart from that for high blood pressure and cardiac problem signified maintenance of diet with proper medication is also required.

    Name: Mrs. Parle Cole

    Age: 70

    Function

    Result

    BP

    150/94

    Temperature

    36.5°

    Pulse

    98 bpm

    Respiratory

    22 bpm

    Oxygen saturation

    95%

    Weight

    82 Kgs

    Pain Score

    2/3

    Table 1: Health card of Mrs. Parle Cole

    (Source: Influenced by the opinion of Sklenarova et al. 2015, p.1525)

    In the overall health card it has been found that, Mrs. Cole has excessive high blood pressure along with high temperature and pulse rate. These aspects are showing the lady is required for proper care and medication. The holistic approach in nursing might be helpful for the lady. Apart from that the weight of Mrs. Cole is around 82, which is not considerable for a lady at the age of 70. That is why some suggestion can be made based on the issues.

    • Proper diet chart for maintaining weight.
    • Proper management of personal issues so that the heart and blood pressure cannot affect the overall health as she is having hypertension.
    • Having proper medicines at the time.
    • Exercise or meditation may help her to reduce her problem related to sleep.
    • A proper communication with the doctor and the healthcare professionals are required for the betterment and overall examination of the patient.
    • The chronic care model (CCM) should be follow so that productive practice and interaction can be measured properly.
    • The lady has to maintain low sodium diet as she is instructed for less intake of sodium.

    As the lady is being discharge from the hospital and the doctor asked her for a home based treatment as well as care. The holistic care approach may be helpful for her case. Andersen et al. (2014, p.35) stated that the mean age of the life span in this present time is 57.8 year. 93% of woman is living on this age range. In the given scenario the lady is 70 years old and having various health issues are present in her body. On the other part she is staying alone and that is why she requires Primary care integration with complex care management (CCM) in order to take proper care of her health. The CCM will help her to engage in healthcare and good activities which are mostly required for her betterment. Apart from that close attention of the healthcare professional will help her to develop a mental wellbeing along with her physical betterment.

    On the ending note, it can be said that the lady needs proper care of family and healthcare professional in order to overcome her difficulties. Moreover, she needs to have exact medicines as prescribed by the doctor and start workout to maintain her weight which may cause diabetes and other issues. From the aspect of human being, it can be said the lady highly needs a homecare based on holistic method along with a regular health professional. The lady is enough ill and she needs a person who can provide her primary health care if required. Moreover, the overall holistic method will help her to recover gradually.

    In this case scenario, it has been seen that the patient is suffering from severe hypertensions which lead to less intake of Sodium in her diet plan. In the diagnosis of cardiac, it has been observed that she also have a major heart failure issue. Due to such issue, she needs proper take care from the clinic and only stable nursing can cure her. The community has assessed her heart and to detect and maintain that she is continuing to maintain well from the initial time of diagnosis. In order to get rid of such heath issues, she needs to be strictly prescribed with some medicines. These include, Paracetamol 1 g bd, which will help her to resist body pain, Furosemide 40 mgs od will help to reduce excess fluid in her body to reduce leg pain, mainly caused due to heart disease, Carvedilol is helpful for extreme hypertension which is mandatory for the patient as she is suffering in this so, Lisinopril 15 mg od will help to serve high blood pressure in order to lower the high blood pressure to prevent from heart attacks and Clopidogrel 75 mgs od will help in preventing strokes and heart attacks too as she has major heart issues. As her past admission has created it clear that she mainly desires to be in her own resident and does not desire to go in any clinic or hospital, the present community is serving her desired food and proper nursing like the ambience of home to Mrs. Pearl Cole of the 70 years old.

    Patient Scenario 2 Analysis

    The main of the paper is to elaborate and critically assess the problem of Mr. Kumar with a proper investigation of his admission in the ward of productive cough, general weakness and breathlessness. The main motive of this research work is to assist the service supplier to understand the main health issues with proper needs to the patient. This assessment will assist to recognize two most important nursing issues in given case scenario it is exact breathlessness. This will be critically analyzed with the help of pathophysiology and nursing interventions will also be investigated in this paper. Moreover, evaluation of caring the patient will be terminated at the end of the paper.

    The patient, Mr. Kumar is one admitted person to the ward with the issue of general weakness, breathlessness and a productive cough issues. With the aid of the blood gas of arterial, it has been observed that he has chronic bronchitis in the respiratory system. This is because of the disease of COPD that is Chronic Obstructive Pulmonary Disease. With the help of ABCDE method, that is Airway, Breathing, Circulation, Disability and Exposure, it will permit an approach of systematic to evaluate and serve critically victimized patient (Blumenthal et al. 2016, pp.910). This is because; it is a qualified method to evaluate the criticalness of such situation and permits the team of health professional to precedence the interventions of clinic (Osborn et al. 2014, p.2247). The comprehensive evaluation expresses a diagnosis of nursing of acute respiratory issues based on the acute aggravation COPD as provided by hypoxia, tachypnoea, and wheezing, extreme production of mucus and breathing issues. The second issue in nursing is the irregular pulse with a rate of about 125 beats per minute at a temperature of 37.5 degree.

    According to Fiscella et al. (2017, p.361), the goals of this assessment need to be SMART, that is specific, measurable, attainable, realistic and time-bound. For the issue of acute breathlessness, the main motive is to enhance the ventilation and secure sufficient tissues with proper providing of oxygen within half an hour. The aims need to be included the rate of respiratory in between 12 to 20 inhale and exhale per minute, moreover, the saturation of oxygen needs to be within 88 to 92% (Kitson et al. 2014, p.331). Whereas, the patient is wheezy at a rate of 28 inhale and exhale per minute and also it has been marked ankle oedema.

    Chronic bronchitis is featured by extreme sputum creation which lasts for more than three months in a year for minimum two positioned years. This is because of the inflammation of the respiratory system, bronchi (Braithwaite et al. 2015, p.418). This is mainly caused due to the excessive smoking and for air pollutants sometimes. The patient used to take 20 to 25 cigarettes per day. Such noxious elements with the inflammation also results in the enlargement of secreting gland of mucus and dysfunction of ciliary. Moreover, the goblet of cells result in more formation of mucus which is very hard to justify because of poor function of ciliary and which causes severe cough. As per Wong et al. (2017, p.226), there occurs a great failure of elastic tissue around the small paths of air, which results in the small collapse in this path and enhanced smooth tone in muscle and results in impaired exchange of gas, trapping of air and failure in respiratory system.

    The Arterial Blood Gas of Mr. Kumar has been revealed, which has shown that he is suffering from the failure of two orders, these are, failure of respiration and acidosis of respiratory with a pH: 7.25, whereas a normal man needs pH: 7.35 to 7.45. This occurs due to the maximum retention of pCO2 (Coccia et al 2016, p.32). Moreover, medulla oblongata analyzed the hypercapnia which assures that the impulses are progressed to the respiratory system in the brain to enhance the rate of respiratory by invigorating muscles of aspiratory to enhance the rate of respiratory.

    The patient, Mr. Kumar has received 24% of oxygen with the help of facemask and his oxygen saturation has fallen till 75%. With the aid of this, it can be analyzed that the sensitivity of enhanced pCO2 is failed; therefore, hypoxemia is the prime stimulant of respiratory, but not that hypercapnia (Blumenthal et al. 2016, p.909). Therefore, the patient will be helped to sit up at first and then 28% at the liters of 4 per minute will be regulated with the aid of the mask, venturi in order to accomplish an oxygen saturation of about 88 to 92%. The purpose of maintained oxygen maintenance is to demolish the retention of carbon dioxide, perfection of tissue as well as hypoxia of alveolar and to enhance the pH of blood.

    The patient will be helped to sit up or to place in the position of semi-fowler and lean forward on the table beside the side of bed because, this place permits for maximum excursion of diaphragmatic and expansion of lungs, generating the exchange of gas. Such location will be more attainable by placing on a chair. In fact, due to the critical condition of the patient, there is a high challenge of falls. However, the arms of Mr. Kumar will be depended with pillows to secure slumping that can result abdominal contexts to be pressured against the diaphragm, limited expansion of lung. In addition, when Mr. Kumar is placed on one side, the influence area of lung need not be dependent. Putting the most influenced lung areas in the position of dependent mainly enhances perfusion and ventilation imbalance.

    However, the patient will be termed to a physiotherapist of respiration who will mainly help him with the postural and percussion drainage methods to enhance the mobilization of secretions, building it easier to incorporate mucus and perfect paths of air which in return enhance the exchange of gas as the alveoli are unblocked and his activity of respiration is enhanced. In fact, as per Celedón et al. (2017, p.814), he will be guided with effectual coughing methods and trained regarding manoeuvres like deep respiration that highlights oxygenation and secures atelectasis. In fact, a pushed respiration method operates airflow with the aid of the airways, which assists mobilize and proper mucus from the tract of respiratory system. He needs to be capable to perform activity sufficiently due to anxiety and fear, which could result shallow hyperventilation or respirations. Moreover, he will need reassurance and support as this is vital to accomplish his cooperation and trust at the time of this stressful condition.

    Mr. Kumar needs to be re-evaluated for an hour after the first qualified therapy in medical to evaluate his answer. In case, his ABG and observations do not enhance, and then NIV that is non-invasive will be contemplated. Moreover, in case, the patient shows signs of more deterioration then he needs to be shifted to an intensive care ward and intubation needs to be contemplated. Moreover, the second diagnosis of nursing of Mr. Kumar is reduced cardiac rate due to the issues in respiration; he has main factors of risks that mainly predispose the patient to establishing the Atrial Fibrillation like smoking, ischemic heart issue and obesity. Other reasons like diabetes, pulmonary embolism, and lung cancer would require to be analyzed.

    There is a certain concern with respect to the understanding of various dyspnoea that deviated from various pathways of neurophysiologic and observing them as socio-culturally exception paths of explaining the similar neurophysiologic issue.

    Reference List

    American Diabetes Association, (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Arlington: Clinical diabetes

    Andersen, R.M., Davidson, P.L. and Baumeister, S.E., (2014). Improving access to care. Changing the US health care system: key issues in health services policy and management. San Francisco: Jossey-Bass, 36(3) pp.33-69.

    Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J. and Selberg, J., (2016). Caring for high-need, high-cost patients—an urgent priority. New England Journal of Medicine, 375(10), pp.909-911.

    Braithwaite, J., Wears, R.L. and Hollnagel, E., (2015). Resilient health care: turning patient safety on its head. International Journal for Quality in Health Care, 27(5), pp.418-420.

    Celedón, J.C., Burchard, E.G., Schraufnagel, D., Castillo-Salgado, C., Schenker, M., Balmes, J., Neptune, E., Cummings, K.J., Holguin, F., Riekert, K.A. and Wisnivesky, J.P., 2017. An American Thoracic Society/National Heart, Lung, and Blood Institute Workshop Report: Addressing Respiratory Health Equality in the United States. Annals of the American Thoracic Society, 14(5), pp.814-826.

    Coccia, C.B., Palkowski, G.H., Schweitzer, B., Motsohi, T. and Ntusi, N.A.B., 2016. Dyspnoea: Pathophysiology and a clinical approach. SAMJ: South African Medical Journal, 106(1), pp.32-36.

    Fiscella, K., Mauksch, L., Bodenheimer, T. and Salas, E., (2017). Improving care Teams' functioning: recommendations from team science. The Joint Commission Journal on Quality and Patient Safety, 43(7), pp.361-368.

    Hong, C.S., Siegel, A.L. and Ferris, T.G., (2014). Caring for high-need, high-cost patients: what makes for a successful care management program. Issue Brief (Commonw Fund), 19(9), pp.1-19.

    Kitson, A.L., Muntlin Athlin, Å. and Conroy, T., (2014). Anything but basic: nursing's challenge in meeting patients’ fundamental care needs. Journal of Nursing Scholarship, 46(5), pp.331-339.

    Osborn, R., Moulds, D., Squires, D., Doty, M.M. and Anderson, C., (2014). International survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Affairs, 33(12), pp.2247-2255.

    Sklenarova, H., Krümpelmann, A., Haun, M.W., Friederich, H.C., Huber, J., Thomas, M., Winkler, E.C., Herzog, W. and Hartmann, M., (2015). When do we need to care about the caregiver? Supportive care needs, anxiety, and depression among informal caregivers of patients with cancer and cancer survivors. Cancer, 121(9), pp.1513-1519.

    Wong, A.H.W., Combellick, J., Wispelwey, B.A., Squires, A. and Gang, M., (2017). The patient care paradox: an interprofessional qualitative study of agitated patient care in the emergency department. Academic Emergency Medicine, 24(2), pp.226-235.

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