case study one and two

  

Case Study 2

Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Question

Considering Mr. P’s condition and circumstance, write an essay of 500-750 words that includes the following:

· Describe your approach to care.

· Recommend a treatment plan.

· Describe a method for providing both the patient and family with education and explain your rationale.

· Provide a teaching plan (avoid using terminology that the patient and family may not understand).

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In a short essay (500-750 words), answer the Question at the end of

Case Study 1

. Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin.

  
Case Study 1
Case Study 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.

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[Type text] [Type text] [Type text]

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CASE STUDY ONE

Case Study One

Ishwari Basnet

Grand Canyon University: NRS-410V

January 31, 2016

Iron Deficiency Anemia

There are many types of anemia; anemia is a medical condition when an individual lacks healthy red blood cells to carry oxygen in the body. One kind of anemia is iron deficiency anemia; this is a condition that occurs when the blood lacks adequate mineral, iron. In order to transport oxygen from the lungs to different organs and body tissues, iron is essential in order to make hemoglobin, a protein that is essential for oxygen transport. The lack of iron in the body depletes necessary oxygen, which lowers the function of the organs and body tissues (Cafasso & Nall, 2015). In the case of Ms. A, showing classic anemia symptoms, the paper studies the rationale methods of identifying iron deficiency anemia.

Identification of Anemia and Rationale

According to Ms. A’s symptoms, health history, and lab results, she is a iron deficient anemic. Ms. A has experienced multiple common symptoms that point to anemia like hypotension, fatigue, dyspnea, tachypnea, tachycardia, and is constantly light-headed due to the frequent blood loss. In addition to these symptoms, Ms. A has also experienced problems of extended continuous menstrual period of extreme bleeding for duration of 10-12 years. This indicates that she is experiencing chronic blood loss, which can result in becoming iron deficient. Another factor that contributes to her being iron deficient is her constant intake of aspirin during her period for joint stiffness. Studies have shown that continuous usage of an anti-inflammatory drug, like aspirin, has been shown to cause iron deficiency. Ms. A’s laboratory results also indicate iron deficiency due to her low hemoglobin level of 8 grams per deciliter and only 32% of hematocrit. These results are significantly low compared to the average results of a woman, whose hemoglobin levels are 12 grams per deciliter and 35 to 45% of hematocrit. Other lab results that would indicate iron deficiency anemia would be low Erythrocyte count of 3.1 x 10/mm, compared to normal RBC count of 4.10-5.10/mm, and more extensive lab reports of microcytic and hypochromic RBC smear.

Diagnosis

An individual can become iron deficient if there is a lack of iron in the blood. The lack of iron depletes the level of hemoglobin, and there is a decrease of oxygen flow from the lungs to the body. Thus, the symptoms of this condition are most commonly shortness of breath and constant fatigue due to the lack of oxygen in the body. The most common treatment of this condition is a prescription of iron supplement to help the body in binding with hemoglobin. This treatment is only a option if the case is simple, if there are further consequences of iron deficiency like internal bleeding, then there may be a need for further tests and extensive treatment (Iron deficiency anemia, n.d.). In this particular case, Ms. A, may need to undergo further tests analyzing her reproductive organs in order to decide if her prolonged bleeding is caused by her iron deficiency. Depending on each individual’s body, patients may not show any or show few symptoms in mild or moderate iron deficiency anemia, however, for extreme cases, the symptoms are usually obvious. Some of these symptoms can be paling of the skin, cold hands and feet, brittle nails, extreme and constant fatigue, restless leg syndrome, poor appetite, headaches and dizziness (Mayo Clinic).

It is vital to consider multiple aspects of a individual patients medical history, physical examinations, and lab results when diagnosing one with iron deficiency anemia. A patient’s medical history will allow the health worker to observe the patients history of iron count, diet, any previous, medical problems and any medications the patient might be using. Conducting a physical exam of the patient will allow the health care provider to examine for brittle nails, paleness of skins, and the opportunity to check for any unusual heart beating patterns, shortness of breath, and examination of pelvic and rectal area for internal bleeding. Lab results are also vital to diagnosing a patient with iron deficiency anemia because lab procedures can check the levels of hemoglobin, white blood cells, platelets and the size of RBC’s. These results then are checked against the normal numbers and levels, giving the health care provider more evidence for the diagnosis (Iron Deficiency Anemia, 2014).

In conclusion, the incapability to carry sufficient oxygen to body tissues and organs via the lack of healthy hemoglobin cells (binded to iron) is the medical condition, iron deficient anemia. The lack of oxygen in body tissue and organs can result in fatigued and weak patients, but can also cause more serious problems like internal bleeding. It is vital that one should visit the doctor if experiencing multiple of the common symptoms. Anemia can be an indicator of another serious illness and thus should be diagnosed as early as possible. Anemia can be most efficiently diagnosed via laboratory procedures, physical examinations and medical history. After positive diagnosis, the treatment can range depending on severity of the condition, iron deficiency can be treated with an iron supplement. It is important to include variety of vitamins in our diet in order to avoid anemia and other illnesses.

References

Anemia. (n.d.). Retrieved January 28, 2016, from

http://www.mayoclinic.org/diseases-conditions/anemia/basics/definition/CON-20026209?p=1

Cafasso, J., & Nall, R. (2015, October 15). Iron Deficiency Anemia. Retrieved January

28, 2016, from Healthline.

Iron deficiency anemia. (n.d.). Retrieved January 28, 2016, from

http://www.mayoclinic.org/diseases-conditions/iron-deficiency-

anemia/basics/definition/con-20019327

Mayo Clinic. (n.d.). Iron Deficiency Anemia. Retrieved January 28, 2016, from Mayo

Clinic: http://www.mayoclinic.org/diseases-conditions/iron-deficiency-

anemia/basics/treatment/con-20019327

Running head:

CASE STUDY 2

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CASE STUDY 2

Congestive Heart Failure

Case Study 2

This case study is about Mr. P, a 76 year old male, hospitalized usually to treat cardiomyopathy and congestive heart failure (CHF). The author describes the approach to care, treatment plan, method to provide education and a teaching plan about the CHF. Congestive heart failure is defined as “the state in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits usually accompanied by effort intolerance, fluid retention, and reduced longevity” (Denolin, 1983, p. 445).

Approach to care

· Assessment of patient: Physical examination of the patient (at each visit), with particular attention to assessment of their vital signs, cardiovascular system (including volume status), signs of deterioration and co-morbid conditions.

· Assessment and management of the patient’s cardiovascular risk factors (e.g. hypertension, dyslipidaemia, diabetes, smoking and obesity).

· Assessment of the patient’s nutritional status.

· Assessment of the patient’s potential for adverse effects of medicines

· Regular reassessment of the patient’s biochemistry (including urea and creatinine) and haematology (including haemoglobin) parameters.

· Assessment of the patient’s daily fluid and salt intake from food and drink.

· Ongoing monitoring of the patient’s electrolytes (particularly serum sodium and potassium levels) and renal function.

· Monitor intake and output strictly and take daily weight.

Treatment Plan

CHF is a complex clinical syndrome; therefore, treatment plan includes the focus on the fundamental causes. Appropriate combination of medicines, control over lifestyle with careful monitoring is the basic treatment for CHF.

· An Angiotensin-Converting Enzyme (ACE) inhibitor (captopril, enalapril etc) or an Angiotensin II receptor blocker (ARB) helps to relax the blood vessels and enhance the blood flow.

· Beta-blockers (bisoprolol, carvedilol etc) reduce the blood pressure and stabilize the heart beat rate.

· Diuretics (lasix, bumex etc) remove more sodium and water from the body, which helps in lowering blood pressure. Also, spironolactone and eplerenone called as potassium-sparing diuretics help to retain potassium.

· Other drugs include anticoagulant, statin and digoxin as per doctor’s recommendation.

Besides medication and diet alteration, devices and surgical procedures are available for the treatment of heart failure. An implantable cardiac defibrillator (ICD), coronary artery repair and valve repair or replacement (as appropriate) can be done (Heart.org, 2016).

Education method

Heart failure patients and their family members should acquire the education, problem solving abilities and motivation regarding the treatment plan, medications and effective participation in self-care. “Patient education and post discharge management have demonstrated benefits in patients with chronic heart failure” (Koelling, Johnson, Cody & Aarons). Patient and family are likely to adhere to treatment process and medications if they understand the education they are given. Teach-back and self-management tool are the most effective method to provide education to both patients and families (American Nurse Today, 2012). In this method, patient and family are asked to explain the material just taught. The educator may need to clarify, repeat or modify the content of teaching several times based on how well the learner comprehends and recalls. This method helps to understand the self-management approaches (self-monitoring, medication, diet control, exercise, weight control, and reduction in smoking and alcohol consumption) to assist the patients and their family.

Teaching Plan

Heart failure afflicts an individual but it affects entire families. Family support system is very critical for patient to live with CHF. Therefore family involvement is very important in teaching plan. Teaching plan includes.

· Daily weight monitoring: At the same time every day in lightweight clothing after urinating and before breakfast.

· Medication and its side effects: Take your medications exactly as directed and follow-up the doctor’s appointment. Also, should be well aware of its side effects.

· Physical activity: Exercise help to improve the condition heart muscles, balance the body, relieve the stress and maintain the body weight.

· Diet and Social activities:

1. Sodium intake: Follow a low sodium diet

2. Fluid intake: Avoid drinking excess fluids

3. Alcohol and tobacco consumption: Use of alcohol and tobacco should be avoided as these are associated with the strictly negative effect in CHF patients.

4. Vaccination: Annual immunization against Influenza is recommended.

· Aware of worse symptoms: Contact the doctor if symptoms such as fast and irregular heartbeat, severe crushing chest pain, dizziness, shortness of breath etc are noticed.

CHF is a complex heart disease associated with complex treatment plans. Hence, patient and their family members should be made aware of the disease and the health care providers should implement different method of education and teaching plan for the optimal care of the patients.

References

Denolin H, Kuhn H, Krayenbuehl HP, et al. (1983). The definition of heart failure. Eur Heart J (1983)4:445–8. Retrieved from

http://aje.oxfordjournals.org/lookup/ijlink?linkType=PDF&journalCode=ehj&resid=4/7/445

Heart.org,. (2016). Treatment Options for Heart Failure. Retrieved 27 January 2016, from

http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Treatment-Options-for-Heart-Failure_UCM_002048_Article.jsp

Target:HF, (n.d.). Taking the failure out of heart failure. Retrieved 28 January 2016, from

https://www.heart.org/idc/groups/heartpublic/@private/@wcm/@hcm/@gwtg/documents/downloadable/ucm_428949

Dinh, H., Clark, R., Bonner, A., & Hines, S. (2013). The effectiveness of health education using the teach-back method on adherence and self-management in chronic disease: a systematic review protocol. The JBI Database of Systematic Reviews and Implementation Reports, 11(10), 30-41. Retrieved from

http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/900/1634

Koelling, T., Johnson, M., Cody, R., & Aaronson, K. (2005). Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure. ACC Current Journal Review, 14(5), 25-26. http://dx.doi.org/10.1016/j.accreview.2005.04.003

Using teach-back for patient education and self-management – American Nurse Today. (2012, March 11). Retrieved January 13, 2016, from http://www.americannursetoday.com/using-teach-back-for-patient-education-and-self-management/