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Case study

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14th September, 2011


John who is a retired bricklayer has a medical history of both emphysema and hypertension. Emphysema is on of the Chronic Obstructive Pulmonary Disease (CODP) affecting patients after the age of 50 years (Bucknall 2004, p.67. The patient has major medical problems that result to shortness of breath and a productive cough. Moser (2009 p.17) defines shortness of breath as a condition which leads to breathing difficulties and whose symptoms are: breathing fast, sitting with hands on the knees, patient may use chest and neck muscles to breath and the patient may also breath through pursed lips. This is John’s second admission to the hospital after his visit two months ago with the same symptoms. John’s first wife is said to have died of breast cancer and that he had not fathered any child. John’s situation is even further complicated by the fact that he used to smoke half a packet of cigarettes daily for 50 years. John’s situation is thus complicated and would call for an interdisciplinary approach of treatment as will be discussed in this paper.


John’s lips are dry and his eyes sunken which is a symptom of dehydration. Kosacka et al. (2009 p.34) identify that such a condition may be an indicator of recurring emphysema since the disease is progressive in nature. In addition, the patient is passing small amounts of urine that is dark and concentrated. This infrequent passing of small amounts of urine is a symptom of dehydration. The registered nurse can address dehydration as a medical problem by regulating fluid level. This may include putting John on a drip or asking him to drink some water to restore the normal body fluid level.

Another major problem is the high blood pressure registered by the patient at150/98 mmHg from a previous 135/82 mmHg. According to Nguyen & Nguyen (2009, p.41) the high blood pressure exposes a patient at risks of heart complications such as stroke and heart attack. In addition, this elevation of blood pressure can result to changes in the function of the heart. Further, Nguyen and Nguyen (2009, p.43) argue that this condition can not be handled by an RN alone and would therefore require a cardiologist. The condition would call for such a patient to be referred to the cardiological department for electrocardiography. The purpose of this confirmation is to determine systolic pressure in the pulmonary artery (Nguyen & Nguyen 2009, p.71). Further, John would need to undergo hemodynamic and vasodilatation tests so as to determine the median pressure of the pulmonary artery; these tests can only b performed by a cardiologist.

Hypertension specialists ought to address this problem since it requires more experienced and skilled practitioners. The patient is suffering from hypertension, which is a complex ailment and requires doctors’ intervention. However, the nurse is in a position to administer drugs that suppress the high blood pressure (Nguyen & Nguyen 2009, p.45).

His pulse rate is high at 106 beats / min from a previous 88 beats / min. The increase in pulse rate indicates complications in his heart beat rate. This high pulse rate requires the intervention of a cardiologist. This problem couples with an increase in his respiratory rate at 28 breaths / min from a previous 20 breaths / min. Emphysema, which is lung disease, is responsible for the changes in respiratory rate and requires the intervention specialists who are trained in handling Chronic Obstructive Pulmonary Disease (Kosacka et al. 2009, p.207).

A drop in SpO2 from 92% to 85% is another problems presented by John. This problem coupled with a rise in tympanic temperature from 37.4ºC to 38ºC requires the attention of a medical doctor. John is irritable and weak since he is not steady on his feet. In addition, the patient has difficulties breathing. The nurse is in a position to administer drugs earlier prescribed by doctors that suppress his breathing difficulty and give energy drinks to boost his energy (Berger et al 2006, p.76).

According to Khalid, Godfrey and Ouellette (2009, p.4) nursing assessment identifies the patient’s medical problem. In this case, John’s assessment includes collection, organization and documentation of data. The nurse collects medical information from John to identify his health status. This information includes his nursing medical history, physical assessment and diagnostic tests. In gathering information, the nurse carries out a physical assessment that includes observing, examining and interviewing the patient (Khalid, Godfrey and Ouellette 2009, p.5).

In addition, the RN identifies any psychological factors that affect the patient’s health (Jones & Bourgeois 2010 p.37). It is imperative for the nurse to interview the patient to acquire subjective information regarding pain and ailments affecting him. Objective data information is available through observation and examination.

In their article, Wang et al (2010, p.18) argue that the RN has a number of assessment techniques available in his data collection. These include inspection, palpation and auscultation. These techniques enable the nurse to record John’s temperature, blood pressure, pulse rate, respiratory rate among others. The nurse ought to refer these medical findings to other team members of the interdisciplinary team.

Validation involves verification of data and information. The nurse is responsible for data collection and documentation. It is important for the nurse to double check the information to establish if it is factual and complete. The nurse’s diagnosis and intervention depend on this information and it requires accurate information. It is crucial for the nurse to ensure that both objective and subjective data information agree (Wang et al 2010, p.19).

The registered nurse organizes the patient’s information details in a systematic manner with the help of computerized or written format (Wang et al 2010, p.21). The last phase of nursing assessment is documentation of data. This phase is important since information record help the practitioners evaluate the health status of John and determine if his health is improving. The nurse should avail all medical findings to other members of the interdisciplinary team.

Collaboration is evident in effective interdisciplinary teams and has a positive impact on the care and management of patients (Jones & Bourgeois 2010 p.56). In John’s case, collaborative process would involve inclusion of other members of the interdisciplinary team in the assessment and examination of the patient. Members of the team would be present to conduct a psychological and social examination on John. As defined by (Jones e& Bourgeois 2010 p.15) collaborative process is a shared communication and decision making process with an aim of satisfying the health needs of patients.

In addition, the members of the interdisciplinary team would be present when conducting physical examination that includes observation and recordings of medical measurements such as temperature. ANMC standards call for the members of the interdisciplinary team are well trained and competent (Berger et al 2006, p.46). According to Bucknall (2004, p.14) sharing of a patient’s medical information with other members would help in solving his medical problem since the team members share a common goal. The members would collaborate with an aim of providing quality medical care to John. All members of the team would communicate and make positive decisions regarding examination and treatment of the patient. In this collaborative process, each member in the team contributes based on knowledge and skills rather than the hierarchy system (Bucknall 2004, p.21).

Collaborative process has positive impact on care and management of the patient. Owing to the diversity in skills and knowledge of the team members there is improvement in patient satisfaction. Due to teamwork and dedication, members are able to treat and cure complex ailments (Nguyen & Nguyen 2009, p.56). A collaborative process has a common objective for patient’s outcome and the members are committed towards the common goal and this leads to better care and management of patients. ANMC competent standard for registered nurses develops standard for nurses with an aim of maintaining competency. It further ensures that nurses have knowledge and required skills in dealing with nursing procedures and processes. It is a prerequisite for registered nurses to collaborate with interdisciplinary members in managing care of patients. The ANMC standards require nurses to be accountable and responsible for their actions. The nurse should strictly adhere to laws and regulations while collaborating with other members as stipulated by ANMC competent standards (Bucknall 2004, p.52).

The registered nurse should respect other members of the team as well as patients. The nurse should coordinate with other members of the team to provide care without discrimination as required by the ANMC. In addition, (Jones & Bourgeois 2010 p.77) elucidates that the nurse should work together with the team to provide medical care and manage patients. In the collaborative process, the nurse shares responsibility and roles with other members to provide care for patients.

It is imperative for the nurse to use his/her knowledge to avoid supervision and improve on patient’s satisfaction. The nurse ought to cooperate and coordinate with other members of the interdisciplinary team to preserve the code of ethics of the nursing fraternity and maintain quality services provided to the patient.

All nurses and midwives to be elegible for registration with the regulatory authority must demonstrate ANMC competency standards. This includes collaboration with other members of the team. In case the laws and regulations stipulated by ANMC are broken, the nurse is required to report to authorities. The law requires the nurse to report any condition or situation that is a threat to the safety of the patient (Bucknall 2004, p.64).


The nurse should clearly understand his/her role and the roles of other members of the team. He/she should constantly maintain communication with other members and participate fully in decision-making. In addition, the nurse should coordinate with other members in providing therapy for the patient. The nurse is responsible for the provision of patient’s need according to ANMC. The nurse is responsible for safety and security of the patient together with the interdisciplinary team. He/she should identify potential threats and risks to the patient’s safety and act accordingly.


Berger A et al 2006. Principles and practice of palliative care and supportive oncology. New York: Lippincott Williams & Wilkins.

Bucknall C 2004. Measuring clinical outcome in asthma: a patient-focused approach. Sydney: Royal College of Physicians.

Jones T & Bourgeois S. 2010. The Clinical Placement: An Essential Guide for Nursing Students.2nd Edition. Sydney: Elsevier Publisher Australia.

Khalid I, Godfrey A & Ouellette D 2009. Chemical pneumonitis and subsequent reactive airways dysfunction syndrome after a single exposure to a household product: a case report. Journal of Medical Case Reports, 3(112): 1-6.

Kosacka M et al. 2009. Combined pulmonary fibrosis and emphysema: case report and literature review.Pneumonologia i Alergologia Polska, 77(2): 205–210.

Moser K 2009. Shortness of breath: a guide to better living and breathing. London: Mosby Publishers.

Nguyen A & Nguyen D. 2009. Learning from medical errors: clinical problems. New York: Radcliffe Publishing.

Wang T et al. 2010. Role of chymase in cigarette smoke-induced pulmonary artery remodeling and pulmonaryhypertension in hamsters. Journal of Respiratory research, 11(7): 12-27.