Daisy casy study: She has a fairly active life doing part-time volunteer work for the CWA and local heritage museum Research Paper Background information Daisy is a 70 year old widow who lives alone. She has a fairly active life doing part-time volunteer work for the CWA and local heritage museum. Her daughter lives nearby and works full time. She relies on Daisy to look after her 3 year old son on Fridays. Daisy is a non-smoker, occasional social ETOH drinker (1 – 2 standard drinks) though was a moderate risk consumer of ETOH in her middle- age. Health history: • Hypertension • Hyperlipidemia • Mild obesity Surgical: hysterectomy at 42 years of age Diet: Does some cooking but prefers instant microwave meals. Enjoys a daily pastry or cake from the local bakery. Exercise: Recently started walking every 2nd morning following GP advice to lose weight. Minimal exercise for last 30 years. Medications • Perindopril 5mg daily • Atorvastatin 20mg daily • Aspirin 150 mg daily • Progynova 2mg daily Daisy was recently diagnosed with colorectal cancer following complaints of lethargy, abdominal discomfort and episodes of frequent diarrhoea. She was admitted to hospital for elective surgery to remove the tumour and required the formation of a temporary colostomy. On day two post- operatively, Daisy complained of sudden dizziness and palpitations. Her nurse found that she was tachycardic and hypotensive and called a Rapid Response. Vital signs: • Pulse 130-150 irregular • BP 100/65 • RR 24 • SpO2 98% on 2L NP. • Temp 37.2 PCA – moderate wound pain Following the Rapid Response, Daisy was transferred to the High Dependency Unit for treatment and monitoring. Part A You are the RN working in the HDU and accept Daisy into your care. Discuss your nursing management for Daisy on her admission to the unit. Your response should be evidence-based demonstrated by an engagement with the literature and any relevant guidelines. In your discussion, include: • The assessments you would do to gather data regarding her cardiovascular status • The interventions that you would anticipate to investigate and treat atrial fibrillation with a focus on your role and responsibilities as an RN. (Word guide 500 – 600 words) Your Response On your next shift you have been allocated two HDU patients to care for, one of them is Daisy. Over the preceding 24 hours, Daisy has required several IV fluid boluses to maintain her mean arterial pressure above 65 mmHg. She has had an arterial line inserted to allow continuous blood pressure monitoring and blood samples to be taken. On your initial assessment of Daisy you notice that her respiratory rate is 28 bpm and her SpO2 is reading 92% despite being on a Hudson mask at 6L/min. Discuss your immediate interventions, including: • Further assessments that could gather data regarding her respiratory status. • Interventions that you would anticipate to manage and treat pulmonary oedema. (Word guide 500 – 600 words) Your Response Part B Two weeks later Daisy has recovered from her surgery and has had no further complications. She has spent ten days on the surgical ward and is coping with caring for her colostomy. During her recovery, Daisy was informed that she may have had a small myocardial infarction post-operatively and that she should have a coronary angiogram in a few weeks. You are the nurse caring for Daisy over her last couple of days in hospital. Discuss her discharge plan including a focus on: • Education on what a percutaneous cardiac intervention (PCI) involves • Daisy’s cardiovascular disease risk factors • A chest pain action plan. (Word guide 1000-1200 words) Your Response]]>
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