Case Analysis- Case Study of an Acute Life-Threatening Condition
Word Count
There is a word limit of 1000 words. Use your computer to total the number of words used in
your assignment. However, do not include the reference list at the end of your assignment in
the word count. In-text citations will be included in the additional 10%-word count. If you
exceed the word count by 10% (1100 words) the marker will stop marking.
Aim of assessment
The aim of this assessment is to enable students to:
1. Demonstrate knowledge by analysing the information provided in the case study.
2. Apply the clinical information provided in the case study and describe this clinical
information within a pathophysiological and patient focused framework.
3. Discuss nursing strategies and evidence-based rationales to manage a patient with acute
heart failure
4. Discuss the pharmacological interventions related to the management of a patient with
acute heart failure
Details
You are to answer all questions related to the case study provided. Your answers must be
directly related to the clinical manifestations that your patient presents with. You must submit
your work with a minimum of six references from the past 5 years including peer-reviewed
journal articles, textbook material or other appropriate evidence-based resources.
Case study
Mr. Aloha Das is a 68-year-old gentleman presenting to the emergency department at
0400hrs with worsening shortness of
eath. Onset 2 days ago and progressively worsening.
He also developed wheeze and right sided pleuritic chest pain this morning. Vomited x1,
ongoing nausea. Has history of non-compliance with medication and adherence to fluid
estriction.
Past History
Hypertension, Inferior Myocardial Infarction in 2020, Heart Failure, non-ischemic
Cardiomyopathy, Permanent Pacemaker inserted 2021, DM Type II, GORD, Osteoarthritis.
Cu
ent medications:
Furosemide 40mg OD, Captopril 6.25 mg TiD, Digoxin 0.125 mg BD, Metformin 500mg
TiD, Nexium 40 mg BD.
On 1.2 L fluid restriction; Echocardiogram results in 2021- systolic dysfunction, mild mitral
valve regurgitation, dilated left atrium and ejection fraction (EF) 33%.
Nursing Assessment
A. Clear, speaking in short sentences
B. RR 28 bpm, SpO2 90% RA, bilateral crackles, diffuse wheeze anteriorly and posteriorly
C. HR 120 bpm, peripherally cold, centrally warm, BP 186/108 mmHg, capillary refill<3 sec
D. GCS 15 (E4V5M6) PEARL
E. Patient looks distressed, diaphoretic, right JVP distension++, bilateral pedal pitting edema
2+
F. No IV fluids in progress
G. BGL 14.0mmol/L
Plan
• Continuous cardiac monitoring
• 12 lead ECG
• Blood pathology order
• Troponin I High Sensitivity
• Chest X-Ray
• Insert IVC right hand
• Furosemide 40mg IV Stat
• Echocardiogram
Results of Investigations:
Chest x- ray: Left ventricular hypertrophy, interstitial edema noted by Kerley B lines in the
costophrenic angle.
ECG:
Blood Results:
Electrolyte, urea and creatinine:
Result Reference Range
Sodium 137 mmol/L XXXXXXXXXXmmol/L
Potassium 3.9 mmol/L XXXXXXXXXXmmol/L
Chloride 105 mmol/L XXXXXXXXXXmmol/L
Urea nitrogen
(BUN)
14.0 mmol/L XXXXXXXXXXmmol/L
Creatinine 147 µmol/L XXXXXXXXXXµmol/L
Coagulation profile:
Result Reference
ange
Partial thromboplastin time
(PTT)
35 sec 30-45 sec
Prothrombin time (PT) 12 sec 10-12 sec
Cardiac enzymes:
Result Reference range
High sensitivity Troponin T 25 ng/L 0-14 ng/L
Arterial blood gas analysis
Result Reference Range
pH XXXXXXXXXX
PaO2 75 mmHg XXXXXXXXXXmmHg
PaCO2 37 mmHg 35-45 mmHg
HCO3- 19 mmol/L 22-26 mmol/L
SpO2 94% >95%
BE -9 mmol/L -2 - +2mmol/L
Lactate 4mmol/L 0.5-1.6mmol/L
Impression: Exace
ation of Congestive Cardiac Failure and fluid volume overload
Question 1
In order to prioritise your nursing actions, you are expected to have a sound understanding of
the pathogenesis and pathophysiology.
Explain the pathogenesis and pathophysiology causing the clinical manifestations with which
Mr Das presents.
Question 2
Choose One high priority nursing intervention that you will perform for Mr Das
– Briefly explain why you chose this nursing intervention
– Explain how the nursing intervention will alleviate the clinical features of Mr Das
using physiological linking
– Describe
iefly the impact of not performing the intervention
Question 3
Mr Das has been prescribed Furosemide 40mg IV Stat and Glyceryl Trinitrate IV Infusion 10
mcg/min starting rate.
For both medications explain
– The mechanism of action
– Why your patient is receiving this medication in relation to his symptoms and diagnosis?
– What are the nursing considerations for this medication?
– What clinical response you expect?
– What continuing clinical observations will you need to undertake?
Submission
Refer to Section 2.5 of the Learning Guide- General Submission Requirements
Submit your assessment through Turnitin
Format
All assignments are to be typed
Typing must be according to the following format:
3 cm left and right margins, double spaced.
Font: Arial or Times New Roman
Font size: 12pt
See further submission requirements below
Submission Requirements
1. Electronic copy only. Students are to submit an electronic copy of the assessment. Students
are not required to submit the original hard copy of their assessment on campus
2. Submit your assessment electronically through the Turnitin link on the unit vUWS site.
3. Students are to upload the assessment with the following title:
Surname_Firstname_assessment title
4. Your assessment must be submitted in .doc, docx format.
5. This assessment is marked online; no paper copy will be accepted. Marks, comments and
the marking criteria will be released online. If you do not receive your marked assessment
when all others have been returned, it is your responsibility to contact the Unit Coordinator
for assistance.
Resources:
i. There are a number of textbooks and resources available through the Western Sydney
University Li
ary that may assist you. Please refer to the unit’s vUWS site for specific unit
esources.
ii. Assessments listed as individual assessments must be completed independently. Students
are advised to refer back to their notes, textbooks or appropriate academic, peer-reviewed
esources utilised during unit delivery