Case Study – Assignment 2 NUR20006
2000 words +/- (10%) words included. Over 2200 words will not be...

Question

Case Study – Assignment 2 NUR20006
2000 words +/- (10%) words included. Over 2200 words will not be marked.
Assignment Instructions:
 This assignment must be completed individually.
 Please consider the suggested word count when responding to each part of
the question. Please ensure you include a word count at the end of your
assignment.
 The word count includes quotes (excluding the citation, e.g. Adams, 2015)
and headings. The word count does not include appendices, contents page
or reference lists.
 An introduction and conclusion should be incorporated into your
assignment with suggested word count for each only up to 150 words.
 Please ensure you pay close attention to the mark allocations in the marking
rubric for Assessment two.
 You will be expected to use evidence-based literature to support your
writing including in-text referencing and a complete reference list.
 Provide justification for all of your discussions using current literature from
the last 7 years.
 A minimum of 10 references should be used. If you undertake an
appropriate literature search, you will be able to find many more than this.
 Please utilise the APA (7 th ) referencing guide for both in-text citations and
reference list formatting. This is available via the library at Swinburne
University from the following
website: http://www.swinburne.edu.au/library/referencing/apa-style-
guide/(Links to an external site.) (Links to an external site.)
Submission Instructions:
 You are required to submit your assignment electronically via Canvas.
 Please submit only Word Doc format, as Canvas does not accept other
document writing platforms.
 Use 2.5cm margins on each side of the page with double spacing between
lines. Font used should be 11 or 12 points Arial or Times New Roman style.
 Please ensure you include an assignment pdf Download
Coversheet.pdf with your submission.
 An electronic copy of your assignment must be retained by you, and this
copy must be available on request if resubmission is required.
 For assistance with academic writing, referencing, submission, extensions or
special consideration please review Part C of your unit guide.
 The marking rubric Download marking rubriccan be downloaded
here.
CASE STUDY
ISBAR Handover
Identify
Mr. Thomas Coates, 65-year-old male DOB – 2/3/1956
Ward 3 East, Bed 24
Situation
Mr. Coates was admitted to the medical ward yesterday with an acute exacerbation of
Emphysema.
Background
Tom was diagnosed with Emphysema 6 years ago and has been a cigarette smoker for
over 40 years. Tom still smokes 1 pack of cigarettes per day when not in hospital. He
recently has had a chest infection and has been taking oral antibiotics. The antibiotics
have not been effective, so Tom has presented to ED after referral from his GP for IV
Antibiotic treatment for an acute exacerbation of his Emphysema. Tom has also tested
negative to COVID 19 on admission to the ED yesterday.
Mr. Coates has a medical history of Hypertension and Peripheral Vascular Disease; he
is currently prescribed Captopril 25mg BD for his blood pressure.
Socially, Mr. Coates is a widower and lives at home alone. Tom has 2 daughters that
sometimes help him, but they are very busy with their own families.
Assessment
 CNS: PEARL Nil complaints of pain. Pt complaining, he is tired and does not
want to do physio today.
 CVS: BP last recording 162/102mmHg. HR 106bpm irregular. Peripheries
cool to touch. Capillary refill sluggish and limbs pale in colour.
 RESP: RR 24 breaths per minute; SaO2 – 90% on Room air; wet cough with
yellow sputum expectorated; crackles heard bilaterally in both bases of the
lungs.
 GIT: Bowels last open yesterday, type 4. Pt tolerating a FWD.
 MSK: Peripheral neurovascular observations indicate some minor
numbness reported in his left foot; this is a new observation for Tom.
Moderate falls risk identified due to current poor peripheral sensation and
perfusion.
 METAB: Temperature 37.9 o
 RENAL: Pt independent with toileting. Currently using a bottle as Tom finds
walking to the toilet difficult due to shortness of breath on exertion.
 SKIN: No signs of oedema. Skin is dry and fragile but there are no apparent
skin wounds. Patient is a pressure area risk due to limited mobility and PVD.
 OTHER: No contact from relatives today; daughters aware of admission.
Need to pursue options for transporting patient home and how he can
manage at home with input from hospital in the home.
Recommendations
 Mr. Coates is planned to be discharged home in 2 days time.
 Mr. Coates needs to continue his physio treatment and be seen by his allied
health case management team.
Your assignment will need to include the following information:
1. An introduction to what you are going to cover in your discussion about Mr. Coates
and his care (up to 150 words).
2. You have been allocated Mr. Coates for your morning shift. Explain what abnormal
findings you need to investigate when completing your nursing assessment of Tom this
morning. Include in your explanation, which three (3) body systems require a focused
nursing assessment. Ensure you use appropriate literature to support your assessment
priorities (400 – 500 words).
3. Outline the pathophysiology of why Mr. Coates has been admitted to the hospital
related to his recent medical history (400 – 500 words).
4.Identify and discuss three (3) specific nursing care interventions you will need to
undertake for Mr. Coates this morning. Provide rationales for each of your three (3)
interventions XXXXXXXXXXwords).
5.There is an interprofessional team that works together to care for Mr. Coates that
includes physiotherapists, pharmacists, occupational therapists, social workers and
dieticians. Pick one member of the interprofessional team and discuss their role in
safely discharging Mr. Coates from hospital XXXXXXXXXXwords).
6. A conclusion summarizing the main points of your assignment (up to 150 words).

Dr Insiyah R. · Accepted Answer

Introduction	1
Body systems require focused nursing assessment	2
Pathophysiology of emphysema	4
Nursing intervention	5
Interprofessional team	5
Conclusion	6
Reference	6
Introduction
This assignment will discuss all the care aspects of Mr Thomas Coates, who has been a smoker for nearly 40 years and was diagnosed with emphysema 6 years ago. When not in the hospital, Tom continues to smoke a pack of cigarettes a day. He's been taking oral antibiotics for a recent chest illness. Tom has come to the ED after being referred by his primary care physician for IV Antibiotic therapy for an acute aggravation of his Emphysema since the medications have not worked. Tom's admittance to the ED yesterday also revealed negative results for COVID-19. Mr Coates' blood pressure is being treated with Captopril 25mg BD due to a history of Hypertension and Peripheral Vascular Disease. Mr Coates is a recluse who is a widower who no longer has a partner. His two daughters assist Tom on occasion, but they are both quite busy with their own families and can't always be relied upon. 
This assignment will cover the abnormal findings, pathophysiology and nursing care intervention provided to Mr tom. 
Body systems require focused nursing assessment
The three systems which will be focused on in toms case will be the cardiovascular system, the Nervous system and the Musculoskeletal system 
Cardiovascular system: Smoking, getting older, and inactivity are all risk factors for both emphysema and coronary artery disease, so it's not surprising that people with emphysema also have heart problems (Abdolrahimi et al,2017). It is not known at this moment whether or not the left ventricular functioning is healthy in patients who are stable while having emphysema and who do not have coronary artery disease or overt cor pulmonale. It seems that the connection between cardiac output and CO2 is retained since cardiac output regularly increases during exercise, even in severe emphysema (Agarwal and Epstein,2018). Although peak workout CO2 is larger than in a normal participant of the same age, cardiac output is only about half of what it might be. The discovery may have two different interpretations. To begin, while having the potential for a larger cardiac output during exercise, patients with lung illness may continue to maintain a degree of control so that their cardiac output remains consistent with the amount of activity and, therefore, CO2 accomplished. The second and more fascinating idea is that even in the absence of obvious cardiovascular disease, left ventricular function may be reduced in emphysema, making it unable to achieve greater cardiac output (Appah,2020). Despite its implausibility, this idea might be worth exploring further in light of the fact that processes analogous to those outlined for skeletal muscle may also be at work in the myocardium. The endothelium is now understood to be a highly active tissue with critical physiological activities in the regulation of arterial tone and tissue perfusion rather than just a passive barrier. Endothelial function is disrupted in COPD or emphysema based on in vitro studies of lung tissue that has been removed. In Mr tom's case, his last BP recording was 162/102mmHg. HR 106bpm irregular. His Peripheries were cool to the touch. Capillary refill is sluggish, and limbs are pale in colour (Bayliss-Conway et al,2020).
Nervous system effects: Patients with emphysema may have abnormalities in many regions of the neurological system. Studies using nuclear magnetic resonance spectrophotometry have shown, for example, that the bioenergetic metabolism of the brain is altered in such people. This may be a systemic effect of Emphysema communicated by additional unidentified routes, or it may be a physiological response to prolonged hypoxia, as occurs at altitude (Bhandari,2013).
The high rates of depression in people with Emphysema suggest that this disease may have far-reaching effects on the brain and neurological system (Cammarota et al,2022). Perhaps this is just the body's way of coping with the effects of a lifelong condition that has severely limited your physical activity. Several animal models have connected TNF, as well as other cytokines and substances, such as nitric oxide, to the genesis of depression. Therefore, it is probable that it is linked to the inflammatory responses that characterise emphysema. New approaches to treating emphysema may be developed if these aspects were better understood (Dhont et al,2020).
And last, emerging evidence suggests that Emphysema patients may also have abnormalities in their autonomic nervous system. Indirect indications of aberrant autonomic nervous system control in Emphysema patients in those with low body weight—and a corresponding disruption of leptin's typical circadian rhythm have been found in studies.

Case Study – Assignment 2 NUR200062000 words +/- (10%) words included. Over 2200 words will not be marked.Assignment Instructions: This assignment must be completed individually. Please consider the...

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