Case study Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Masters
  • Page:
    3
  • Words:
    2218

Subject: Case Study

Question 1

Identify five (5) age-related body system changes that are typical of people in Mrs Lee’s age group. Compare these age-related changes with the data you have been provided with in the case study and the pathophysiology of heart failure. You may use dot points for this answer. Provide references for thisquestion using one pathophysiology text and a minimum of two current nursing journal articles (200 words).

Some of the body system changes that are common in elderly people in the age group of Mrs. Lee include:

  • Progressive changes in the blood vessels and heart obstruct the ability of the body to regulate blood pressure (Minaker 2007; Schwartz &Zipes 2007). The changes can be attributed to Mrs. Lee condition which is characterised by high blood pressure.

  • Deterioration of lung function and lung defense mechanisms leading to airway obstruction (Sharma & Goodwin 2006). These changes often lead to shortness of breathe among the elderly thus the shortness of breather experienced Mrs. Lee could be as a result of these changes.

  • Reduction in the efficiency of the respiratory due to the deterioration of elastic tissue in the entire body thus minimizing the ability of the lung to inflate and deflate. Similarly, these changes lead to shortness of breathe among the elderly thus the shortness of breather experienced Mrs. Lee could be as a result of reduction in the efficiency of the respiratory.

  • Reduction in renal function due to decrease in urinary flow and capacity and increase in the amount and urgency of residual urine. These changes in turn contribute to an increase in nocturia i.e. repeated urination during the night and increased risk in urinary tract infections (Zurbig et al 2009). This is the same condition experienced by Mrs. Lee.

  • Decline in muscle mass, this in turn contributes to disability and body weakness. As a result of this change Mrs Lee’s body experiences weakness thus she constantly requires assistance in taking a shower, going to the toilet and getting dressed.

Question 2

What are the purposes of conducting a health assessment interview? Use a minimum of two current nursing journal articles to support your answer (200 words).

Conducting a health assessment interview can help the caregiver or the health practitioners to identify some of the factors causing the patient’s condition. The health assessment interview can also help to determine the appropriate treatment plan for the patient. The information obtained by the nursing staff in the health assessment interview is the cornerstone from which a comprehensive health treatment plan can be created (Rhoads 2006). Moreover, health assessment interviews are conducted so as to aid in the decision making process particularly with regards to decisions on the kind of intervention and treatment that is appropriate for the patient (Dannenberg & Bhatia et al 2008). According to Keefe et al (2006), conducting a health assessment interview enhances the chances of realizing better outcomes for patients. It helps care givers to establish to understand the cognitive performance of their patients and their functioning in the real world. Furthermore, health assessment interviews provide suitable co primary measures that can be used for clinical trails particularly when it comes to assessing both physical and cognitive changes in elderly patients. In addition, health assessment interviews may also help care givers or physicians seeking to evaluate the level of physical and cognitive impairment amongst elderly patients (Keefe et al 2006).

Question 3

Select three (3) interview skills that you would use when gathering subjective data from Mrs Lee. Provide rationales for your choices. Use a minimum of two current nursing journal articles to supportyour answer (300 words).

Foremost, I would use non-verbal communication skills such as eye contact in the course of the health assessment interview. Non verbal communication skills help to build a trustful relationship with the patient. When using non-verbal communications such as eye contact a patient is bound to open –up and feel comfortable since it shows that one is concerned about the well being of the patient Moreover, non-verbal cues such as nodding at appropriate times and keeping an even and calm time can cause the patient to feel comfortable and free in the course of the health assessment interview. (Yuji et al 2010).

Secondly, I would use observation skills. Observing the facial expressions, body language and non-verbal cues portrayed by a patient can help to identify any discrepancies or inaccurate information provided by the patient in the course of the health assessment interview. For example the facial expression portrayed by a patient can help the interviewer to determine whether the information provided by the patient is reliable. In some instance, keen observation of the patient during the interview can help to identify physical signs and symptoms that can aid in the decision making process particularly with regards to decisions on the kind of intervention and treatment that is appropriate for the patient.

Lastly, for most patients to completely open up or freely talk about their condition during the interview there is need to create a rapport. In order to create a rapport with the patient relationship building skills are important on the part of the interviewer (Schrader & Schrader, 2011)
Therefore, I would use relationship building skills such as communicating clearly, listening, fostering empathy and understanding and encouraging the patient. For example, when the patient does not want to answer a particular question, it is essential to communicate to the patient that you understand and respect their decision rather than pressurising them to answer the question.

Question 4

Based on the information provided in the case study, identify three (3) key areas that you would focus on during the interview. For each key area, identify two (2) relevant questions you would ask Mrs Lee (ensure you write each as a question). Provide a rationale to support each question you have identified (300 words). You do not need to reference this answer.

During the health assessment interview one of the areas that I will focus on is the medical history of the patient. It is essential to establish the medical history of the patient so as to gather the necessary information needed to give the patient effective individualised care. Furthermore, the medical history of the patient can help in the diagnosis of process. Some of the questions that I would ask in order to establish the medical history of the patient include;

  • In the past years, have you ever received treatment for any cardiovascular related conditions or any other major conditions?

  • What kind of medical procedures or treatment have you undergone so as to address any of the conditions you have been diagnosed with?

Secondly, during the health assessment interview, I will focus on the lifestyle choices of the patient. For instance, I will seek to establish whether the patient was or is a regular smoker. I would also seek to establish whether in the patient exercises. It is important to establish the life style choices of the patient since some lifestyles choices are often the main contributors to ineffective treatment and health deterioration. Some of the questions that I would ask in order to establish the lifestyle choices of the patient include;

  • Do you smoke or were you a smoker in the past years?

  • Do you engage in any physical exercise activities?

Lastly, in the health assessment interview, I will focus on the current heath condition of the patient. I will seek to establish some of the symptoms and signs experienced by the patient. It is important to establish the signs and symptoms portrayed by the patient as this might help to diagnose the condition of the patient. Some of the questions that I would ask in order to establish the current health condition of the patient include;

  • How frequently do you experience shortness of breath?

  • What other unusual symptoms do you experience?

Question 5

Using the three (3) key areas you identified in Question 4 as headings, explain what additional relevant objective data you would collect. Provide rationales for why you have focused on these specific assessments. Provide references for this question using one pathophysiology text and a minimum oftwo current nursing journal articles (500 words).

Establishing the medical history of the patient is one of the key areas that I will focus on during the health assessment interview. An additional data that would collect includes the family medical history of the patient. Gathering an accurate and comprehensive medical history of the patient’s family can help to identify the genetic abnormalities and disorders that contribute to health problems. For example in this case, an account of the patient’s family history can help to identify chromosomal abnormality or a single gene disorder that affect family members and as a result contributes to heart failure. Moreover, knowledge on family medical history can help improve patient care. Early identification of chronic conditions such as heart disease that are prevalent in families can help improve the kind of care given to a patient. Information on the patient’s family medical history can help physicians to provide to their patients personalised treatment so as to counter the identified risk factors that run in the family (American Medical Association 2011).

Lifestyle choice is also one of the key areas that I will focus on during the health assessment interview. With additional to the data collected on the lifestyle choices of the patient, an additional data that would collect in the course of the health assessment interview includes; the patient’s typical diet or the nutrition of the patient. Nutrition greatly influences the health condition of patients. A study conducted by Witte et al (2006), shows that there is a close link between diet and chronic heart failure in elderly patients. According to Witte et al, the type of diet that a patient intake, greatly influences ventricular functioning and the quality of life in elderly patients who have chronic heart failures (Witte et al 2006). Moreover, a study by Feng et al (2011) depicts that there is a close link between salt intake and blood pressure. This study also established that there is increasing evidence which shows that a high salt intake contributes to left ventricular hypertrophy which is a risk factor for the advancement of heart failure. It is therefore apparent that lower salt intake can help avert the development heart failure. In patients who already experience heart failure, high salt intake aggravates salt and water retention thus exacerbating symptoms of heart failure (Feng et al 2011). It is therefore evident that nutrition plays a great role in influencing the condition of patient’s diagnosed with heart failure and high blood pressure. Therefore, while conducting the health assessment interview additional data on the patient’s typical diet or the nutrition of the patient will be collected.

In addition to collecting data on the prevalent symptoms and signs experienced by the patient, the health assessment will collect additional data on the type of interventions or care given to the patient in order to counter these symptoms. It is essential to establish the kind of care or treatment given to the patient since it affects the overall condition of the patient. The symptoms in patients who do not receive the appropriate care are bound to aggravate or become worse. Therefore, it is imperative to collect data on the kind of care or treatment given to the patient.

Bibliography

American Medical Association (AMA), 2011, Family medical history in disease prevention, Retrieved on August 25, 2011 from <http://www.amaassn.org/resources/doc/genetics/family_history02.pdf>

Dannenberg, A. & Bhatia, R., et al, 2008, Use of Health Impact Assessment in the US: 27 Case studies, 1999-2007. American Journal of Preventive Medicine, Volume 34, Issue 3, pp. 241-256.

Feng, H, Burnier, M. & MacGregor, G., 2011, Nutrition in cardiovascular disease: salt in hypertension and heart failure, European Heart Journal, Published online on June 23, 2011 <http://www.actiononsalt.org.uk/news/salt/2011/50636.pdf>

Keefe , R., et al, 2006, The schizophrenia cognition rating scale: An interview-based assessment and its relationship to cognition, real –world functioning and function capacity, American Journal of psychiatry 163, pp. 426-432.

. 23rd Ed, Saunders Elsevier; Philadelphia. Cecil MedicineMinaker , L., 2007, Common clinical sequelae of aging. In: Goldman L, Ausielo D, eds.

Rhoads, J., 2006, Advanced health assessment and diagnostic reasoning, Lippincott Williams and Wilkins, Philadelphia.

Schrader, D. & Schrader, E., 2011, Interaction goals in the primary care medical interview, Journal of the American Academy of Nurse Practitioners, Volume 23, Issue 7, pp.370-375.

. 8th ed. Saunders Elsevier, Philadelphia. Braunwald’s Heart Disease: A Textbook of Cardiovascular MedicineSchwartz, B. &Zipes, P., 2007, Cardiovascular disease in the elderly. In: Libby P, Bonow, O., Mann, D. & Zipes, P.

Sharma, G. & Goodwin, J., 2006, Effect of aging on respiratory system physiology and immunology, Journal of Clinical Interventions in Aging Vol 1, Issue 3, pp. 253-260.

Witte, A., Nikitin, P., Parker, .C., von Haehling, S., Volk, D., Anker, D., Clark, L. & Cleland, F., 2005, The effect of micronutrient supplementation on quality-of-life and left ventricular function in elderly patients with chronic heart failure, European Heart Journal 26, pp.2238–2244.

Yuji, N., Yoshioka, Y. & Hayano, K.. Et al, 2010, Medical Interview Skills and Patient Satisfaction Levels in a Setting Utilizing Electronic Medical Records, General Medicine Vol 11, No.1, pp.17-23.

Zurbig, P. et al, 2009, The human urinary proteome reveals high similarity between kidney aging and chronic kidney disease, Proteomics Vol 9, Issue 8, pp. 2108, 2117.