Answer To: PLEASE LOOK AT ALL FILES attached case study etc
Dilpreet answered on Aug 30 2024
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Introducing new grad RNs and identifying patient
The patient who was transferred from the emergency unit to the acute medical unit, is Maria Smith, a 79-year-old female, with a critical history of medical condition. She was diagnosed with dyspnoea, dizziness, and fatigue in the medical unit which suggested that she had a heart failure (Albert et al., 2010). Apart from that, during this medical assessment and thorough check-up, it has been identified that she has a much longer list of some critical medical conditions such as high cholesterol, hypertension, type 2 diabetes mellitus, Hashimoto’s thyroiditis and depression over the years. It has also been assessed that due to her past medical conditions, the suggestion of her heart failure can be worsened in nature. As a newly appointed registered nurse, I have already completed assessing Maria’s condition and past medical records in a well-mannered way. In this regard, I think I must take care of Maria effectively. Though she is admitted to the medical unit for her health, she is constantly worried about her husband Bill in managing household chores. As a nurse, it is my responsibility to provide her comfort, and assurance along with monitoring her condition to plan an effective care system for Maria.
Situation
Maria Smith, a 79-year-old elderly female, was transferred from the ED (Emergency Department) to the acute medical unit at 6 AM sharp this morning. For context, Maria was presented to the emergency unit last night for her worsening fatigue, dyspnoea (sudden shortness of breath), orthopnoea (facing difficulty in breathing while lying down, flat) and dizziness (Mebazaa et al., 2010). It was also recorded that she has been struggling with these burdening conditions for the last five days. These heightened symptoms critically hurt her ability to be involved in daily activities, such as managing household chores and walking. The initial working diagnosis made at her admission was suspected of heart failure. Though not confirmed this condition needs careful and immediate management to eliminate any possible deterioration.
On her arrival at the acute medical care unit, Maria was seated upright, supported by two pillows, in bed. This indicates she was quite comfortable in that semi-upright position due to having problems breathing (i.e., especially when lying flat). This also reduced the discomfort caused by orthopnoea, which is common in patients with heart failure (Mebazaa et al., 2010). It is critical to mention that Smith was able to respond in full sentences. However, she also reported a feeling of ‘puffiness’ and trouble with ‘bothering cough’. This indicates a fluid overload, common with heart failure condition. As a newly graduated Registered Nurse (RN), I observed that Maria was using her accessory muscles to breathe properly. This clear sign of respiratory distress can be an indication of worsening heart failure, encouraging pulmonary congestion, which eventually causes breathing difficulties. However, Maria was oriented and alert as she was responding to primary assessment questions. This suggests the adequate oxygen level in her cerebral.
Apart from this primary clinical situation, Maria expressed anxiousness about Bill, her husband. As an elderly husband, Bill was dependent on Maria for most of the household tasks. Their youngest daughter brought Maria to the hospital last night and at present the father-daughter duo is managing to complete the household chores on their own, including cleaning and cooking. This sudden burden concerns Maria as she is worried about how they will cope without her. Mari also added that she used to walk with her daughter thrice a week; however, it has been tough for her to continue the walk for the last few weeks. I also found that this tension of not being able to help her family is adding extra psychological distress to her situation, impacting her overall recovery and well-being.
In summary, the present situation of Maria presents a complex and suspected case of risky heart failure. This primary concern is coupled with respiratory distress which also suggests underlying chronic medical conditions that need urgent care, monitoring and management. Judging these, the medical team has advised a series of tests. First, a chest X-ray and “transthoracic echocardiogram”, to rule out potential causes and severity of heart failure (Siew et al., 2022). Second, some pathology tests to monitor her electrolyte balance, renal function, thyroid status and liver function.
Medical/Surgical/Psychosocial history
Being a 79-year-old woman, Maria Smith possesses a complex surgical, medical and psychological history that contributed to her present health status. Diagnosed with different chronic conditions Smith has been under strict medication routine and lifestyle adjustments. This demonstrates her commitment and resilience toward maintaining health.
Medical History: Maria Smith has a very critical and complicated medical history as she was diagnosed with certain health issues that worsened her physical health simultaneously. First and foremost, Maria has Hashimoto's thyroiditis which is a rare kind of autoimmune disease. The symptoms of this disease are extreme fatigue, dizziness, uncontrollable weight gain and slow rate of heartbeat (Yuan et al., 2023). While conversing with her, it has also been known that her sister also has the disease. Previously, to reduce the symptoms of this disease, doctors have prescribed her to take levothyroxine in terms of maintaining her daily physical...