Case study Essay Example

Case study Report

  1. The process of aging brings about myriad structural and functional changes in cardiovascular, renal, pulmonary, genitourinary and other organs of the body. According to Gonik and Rudolph (2001, p. 339) these modifications in body health are more pronounced when an individual reaches 75 years and above. Some of these changes are explored below:

  • Cardiovascular system undergoes several changes since as one age the heart muscles becomes less efficient and more energy is needed to pump the same amount of blood though the body. This strenuous task can lead to high blood pressure and shortness of breath (Topol &Califf, 2007, p. 572). From the case study, Mrs. Leo is experiencing episodes of breathlessness which is a physiological change associated with old age.

  • Secondly, the bones, muscles and joints lose their strength and flexibility hence an individual have trouble coordinating the limbs functions (Topol &Califf, 2007, p. 570). For the case study, Mrs. Leo inability to dress up unassisted could be linked to muscle weakness which bring fatigue.

  • The bladder and the urinary tract losses control (Gonik & Rudolph, 2011, p. 338). This becomes a problem to patients with heart failure since urine output increases especially during the night or after resting in bed in an attempt to control shortness of breath (Gonik & Rudolph, 2011, p. 340). From the case study, Mrs. Leo frequent urination at night is partly associated with heart failure and old age body changes.

  • Respiratory changes related to aging leads to lung problems which in turn lead to low oxygen levels; thus decreasing a person’s tolerance to illness (Sharma & Goodwin, 2006, p.260). Mrs Leo sleep apnea condition can be explained in terms of age related changes in the lungs and also because of her heart failure condition.

  • Also as people becomes older the ability of their bodies to control blood pressure decreases leading to high risk of hypertension as well as other heart related problems as is the case with Mrs. Leo tachycardia condition (Sharma & Goodwin, 2006,p. 258)

  1. Health assessment interview is part and parcel of the nursing process. The nursing process consists of five stages namely; assessment, diagnosis, implementation and evaluation (Fennessey & Wittmann, 2011, p. 48). The assessment stages demands for a health assessment interview where the nurse collects, validates, organizes and documents data. According to Watson (2006, p. 34) this stage is very crucial as it sets the tone on which the rest of the process flows from. For this reason, the nurse in-charge should ensure thoroughness during the interview process so as to avoid messing up the remaining processes (Watson, 2006, p. 34).
    The process of assessment is a continuous process since the nurse has to keep on evaluating the patient’s strengths and weaknesses through the entire nursing process (Watson, 2006, p. 35).
    As a matter of fact health assessment aims at collecting data of patient’s health status so as to discover deviations from the normal (Fennessey & Wittmann, 2011, p. 48). In addition, they explain that the best way to obtain this kind of information is to conduct a health assessment interview. It is recommended that such interview should be directed to the patient directly unless otherwise. From the case study, Mrs. Leo age might limit her ability to answer questions and in this case the daughter comes in handy. In addition, the health assessment interview is purposed to discover the patient’s strengths and how they are coping with the condition at hand (Watson, 2006, p. 34). This kind of interview is also aimed at unearthing the factors that are likely to pose the highest risk to the health of the problem (Fennessey & Wittmann, 2011, p. 49). It is imperative to mention that the kind of data collected during the interview is called subjective data and this kind of data sheds light on the patient’s feelings, beliefs and perceptions about their underlying condition (Fennessey & Wittmann, 2011, p. 48). According to Watson (2006, p. 36) subjective findings can also be referred to as symptoms and he also explains that it is impossible to unearth such findings without conducting a health assessment interview.

  2. As stated in the question above, an interview is the first step while conducting a nursing assessment. It is regarded as the foremost step that lays the foundation so as to establish a nurse-patient relationship that is based on trust. For this reason, the choice interview skills employed during this process are very crucial because it is what determines the success or failure of the entire nursing process. According to Tanner (2006, p. 206) the first phase of conducting a verbal interview is the introductory phase where the nurse explains the purpose of the interview to patient or care take incase the patient is unable to answer questions. For this case study, (Tanner, 2006, p. 206) strategy will be adapted where as a nurse I will explain to Mrs. Leo and her daughter the kind of questions they should expect. I will also explain to them the reason why it is necessary for me to take notes and also assure them that their responses will be confidential. This kind of approach is important because it develops and promotes trust between the nurse and the patient and this rapport is crucial to ensure that the client does not withhold any information (Tanner, 2006, p. 210). During this interview process I will structure my questions in an open-ended format. This interview skill is crucial since it gives the patient a chance to provide detailed description of the process being undertaken (Buccieri, Pivko & Olzenak, 2011, pp. 18-20). It is imperative to note that open ended questions elicit more than one-word responses from a client and in the process the patient can reveal significant data about their health status. Secondly, I will make use of closed-ended questions in order to obtain specific facts. For instance, I can ask “when did the urination pattern change” Buccieri, Pivko and Olzenak (2011, p. 22) emphasize that such nature of questions are necessary to keep the interview on course especially when nursing assessment on physical therapy is being carried out. In addition, they can be used to clarify the issues disclosed during the open-ended questions session (Tanner, 2006, p. 209). Finally, I will use what Tanner (2006, p. 210) refers to as “well-placed phrases. This kind of phrases should be well placed during the interview process to encourage the client to continue with the description of their symptoms (Tanner, 2006, p. 210).

  3. The second key area to focus on is whether Mrs. Leo is experiencing fatigue. Therefore, the first question will be “Do you feel tired without having performed any strenuous task”. Evidence has shown that fatigue can arise from anorexia so the second question will be “has your appetite increased or decreased since you started experiencing the shortness of breath”.
    From the case study, my interview will focus on establishing the onset of the breathless and also to identify at what point the patients experiences acute shortness of breath. This is a key area that needs to be focused because shortness of breath is a common sign of heart failure that requires immediate intervention to minimize the risks. Therefore, this kind of question aims at establishing whether Mrs. Leo is experiencing orthopnoea, paroxysmal nocturnal dyspnoea, breathlessness at rest or all the above.

Finally, my interview will focus on establishing the underlying reason behind the infrequent urination schedule. This question is necessary to establish whether the schedule alteration is due to current condition of heart failure. Moreover, bed rest is likely to increase the volume of urine output in heart failure patients. The first question is “how can you describe your intake of fluids”. Assuming the patients confirms that she consumes drinks late in the day it is obvious that she will pass urine during the night.

Q. 5
Fatigue

Research has shown that fatigue is a common pathophysiological sign among patients with presenting heart failure conditions (Woung-Ru, Chiung-Yao, & San-Jou, 2010, p. 72). Mostly, fatigue arises from anorexia; therefore, as a nurse I will monitor the Mrs. Leo feeding chart to establish whether she has been feeding normally. Additionally, as part of health assessment process will monitor and record Mrs. Leo blood pressure every two hours to keep track of the progress of her fatigue level. Patient with reduced cardiac output also tend to have decreased temperatures and pulse which arises due to the reduced oxygenation of tissues (Woung-Ru, Chiung-Yao, & San-Jou, 2010, p. 72). For this reason, objective data to monitor pulse and temperature changes will be obtained and recorded regularly to ensure the patient stability (Kozier, Erb, Berman & Snyder, 2008, p. 112). The results of the above tests are necessary to determine how the patient is responding to treatment. Breathlessness

From the case study, it is evident that Mrs. Leo is experience breathlessness at rest, orthopnoea and paroxysmal nocturnal dyspnoea (Ekman & Ehrenberg, 2005, p. 81). For this reason, it is important to monitor objective data from laboratory and diagnostic results in order to come up with the best intervention mechanisms to reduce cardiac workload. As noted by Ekman & Ehrenberg (2005, p. 78) heart failure patients have high myocardial oxygen consumption and nursing assessment interventions should be directed at reducing the high consumption. Increased urine output
From the case study, Mrs. Leo urine output has destabilized owing to her condition. Literature shows that patients with heart failure condition are likely to have decreased urine output, which can be attributed to the disease or medication (Porth & Matfin, 2010, 508). For this reason additional objective data on electrolyte levels will be obtained in order to keep watch of any imbalances. In addition, Mrs. Leo weight will be monitored daily to keep track of fluid imbalances. Porth and Matfin (2010, p.509) expound that increase in body weight indicates excessive fluid volume and vice versa.

References
Buccieri, K., Pivko, S. & Olzenak, D. (2011). How Does a Physical Therapist Acquire the Skills of an Expert Clinical Instructor? Journal of Physical Therapy Education
, 25(2), 17-25.Ekman, I. & Ehrenberg, A. (2005). Fatigue in chronic heart failure – does gender make a difference? European Journal of Cardiovascular Nursing, 1:77-82Fennessey, A. & Wittmann, R A. (2011). Physical Assessment: A continuing need for clarification. Nursing Forum, 46 (1), 45-50. Gonik, J. & Rudolph, J. (2011). Vital Signs in Older Patients: Age-Related Changes. Journal of the American Directors Association, 12(5):337-343.

Kozier B, J., Erb, G., Berman, A. J. & Snyder, S. 2008.Fundamentals of Nursing: concepts process and practice. New York: Pearson Education Limited.

Porth, C. M. & Matfin, G. (2010). Essentials of Pathophysiology: Concepts of Altered Health States. Philadelphia: Lippincott Williams & Wilkins.

Sharma, G. & Goodwin, J. (2006). Effects of aging on respiratory system physiology and immunology. Clin Interv Aging, 1(2):253-260.

Tanner, C, A. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing Education, 45(6):205-214.

Topol, E. J.& Califf, R. M. (2007). Textbook of cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins.

Watson, D. 2006. The impact of accurate patient assessment on quality of care. Nursing times, 102(6): 34- 37.

Woung-Ru, T., Chiung-Yao, Y., & San-Jou, Y. (2010). Fatigue and its related factors in patients with chronic heart failure. Journal of Clinical Nursing, 19(1/2), 69-78.