Reference no: EM133506325 , Length: 1800 Words

Case study

Task description: In response to a given case situation, you will apply knowledge and skills to analyse, plan, and act, taking a person-centred approach in the provision of care. Planning and action will be evidence-based and will demonstrate an understanding of the patient engagement time frame.

You will evaluate ongoing care provision and modify plans in accordance with health data and patient outcomes.

There are three (3) questions to be addressed in this assessment. Each question is related to the specific case study below. Your responses must be supported by peer reviewed, current and relevant evidence and address all three questions:

Mr Butterworth is a 41-year-old man who was admitted to the medical ward one week ago with poorly controlled hypertension. Mr Butterworth was diagnosed with hypertension five years ago; he also has type 2 diabetes. He told the admitting team that he has been troubled over the years by side effects from medications such as beta blockers which made him feel "sluggish mentally" and therefore often did not take the prescribed medications. On admission, the following assessment data was recorded:

Vital signs
Temperature: 36.5 degrees Celsius Pulse rate: 110 beats per minute
Respiratory rate: 18 respirations per minute Blood pressure: 205/100 mmHg

Blood profile
Total Cholesterol: 6.0 mmol/L
Low Density Lipoprotein (LDL): 3.4 mmol/L High Density Lipoprotein (HDL): 0.9mmol/L Triglycerides (TG): 2.3 mmol/L

Blood glucose level: 10.5mmol/L

Mr Butterworth has been treated over the past week and is now ready for discharge. As part of the discharge planning process, the following social history is obtained from Mr Butterworth, and physical assessment data is recorded.

Social history
Mr Butterworth lives 900km away from Brisbane where he is the office manager for his family's large cattle station. He has recently returned to the station after living in Brisbane for 10 years where he worked in a large company as the information technology (IT) manager. He lives alone in a small house on the property. Mr Butterworth reports that he
does not put effort into meal preparation and does not eat regular
meals. When he gets hungry, he prefers quick and easy food such as bacon and eggs or steak sandwiches. Mr Butterworth states that he is ‘hopeless at remembering to take his tablets.'

The property where Mr Butterworth lives is a 6-hour drive from the nearest town. There is good internet access in the area. The town is small, with one general practice medical centre.

Height: 175cm Weight: 115kg
Waist circumference: 105cm

Vital signs
Temperature: 36.8 degrees Celsius Pulse rate: 94 beats per minute
Respiratory rate: 18 respirations per minute Blood pressure: 178/100 mmHg

Blood glucose level: 9.3 mmol/L

Discharge medications Lisinopril 10mg daily Atorvastatin 10mg daily
Metformin 500 mg TDS with meals

Discharge instructions
Please make follow up appointment with general practitioner for blood pressure check within the next month.

Question 1
My Butterworth is concerned as the doctor told him that he is ‘at high risk of a stroke'.

Analyse the patient's history and identify three (3) pieces of objective assessment data which are abnormal. Justify why the chosen assessment data is of particular significance.

Draw on your understanding of pathophysiology and discuss the link between each piece of abnormal assessment data and Mr Butterworth's increased risk of stroke. You must use peer reviewed literature to support your discussion. [700 words]

Question 2
Mr Butterworth tells you that he would like to make lifestyle changes to assist in controlling his hypertension. In consultation with Mr Butterworth, the following goal is set:

- Resting blood pressure will be reduced to 150/85mmHg within 6 months post discharge.

Critically discuss two interventions which could be implemented to assist Mr Butterworth to achieve this goal. You must explain what is involved in implementing the intervention, justify the use of these interventions with reference to current evidence-based literature. The interventions can be either nurse initiated or collaborative. For collaborative interventions you must discuss the role a nurse would play when implementing the intervention. [800 words]

Question 3
Drawing on the NSQHS Standards and Person-Centred Care framework ‘Comprehensive Care' standard, discuss one (1) strategy you could use as a Registered Nurse to enable Mr Butterworth access to appropriate healthcare services. [300 words]