Disease Management

Semester 1, Assessment Item 1 - Case Study

Disease Management and Control:

Case Study: Victor Stanley

Lecturer: Sandra Walker

Student Name: Julie McDouall

Student Number: S0091732

Due Date: 8 May 2007

Student Declaration:

"I Julie McDouall certify that this assignment is my own work, based on my personal study and / or research, and that I have acknowledged all material and sources used in the preparation of this assignment whether they be books, articles, reports, lecture notes, and any kind of document, electronic or personal communication. I also certify that the assignment has not previously been submitted for assessment in any other course, unless by negotiation and that I have not copied in part or whole or otherwise plagiarised the work of other students and / or persons. I have read the CQU policy on plagiarism and understand its implication."

Table of Contents

Title Page 1

Table of Contents 2

Abstract 3

Introduction 4

Body 4 - 11

Conclusion 12

References 13 - 14

Abstract

The case study has been diagnosed with pneumonia and Acute Coronary Syndrome (ACS). A dual diagnosis occurs when an individual is affected by more than one illness. Each illness has symptoms that impede an individual's ability to function capably. Not only is the person affected by two separate illnesses, both illnesses may interact with one another. The illnesses may worsen each other and each disorder predisposes to relapse in the other disease. At times the symptoms can overlap and even disguise each other making diagnosis and treatment more difficult. Initially, the implications of a dual diagnosis are considered with blood gases obtained, an ECG performed and a sputum culture ordered to identify the actual cause of the illness to conclude a diagnosis. Medications are prescribed to modify/or rid a client of specific symptoms with the ultimate goal and outcome being the client is restored to his/her optimum health. The process of administering medication via a nebuliser includes the same steps necessary when administering any other form of medications including the ethical, legal and professional issues. IV therapy should follow strict hospital protocol ensuring client safety at all times with calculations accurate. The development of a health teaching plan will identify key issues that are required to improve understanding on how, why and when to correctly administer medication once the client is discharged, the importance of the prescribed medication and where to seek help should a complication arise.

Introduction

This paper is based on a case study of Mr Victor Stanley a 69 year old male client who lives alone. His daughter discovered him slumped in his chair; she brought him to the emergency department where he has been admitted to hospital with pneumonia and Acute Coronary Syndrome (ACS). The paper will initially analyse the information and consider the implications of the dual diagnosis. The nursing history determined Mr Stanley has a productive cough and expectorates lots of thick green sputum regularly. Admission observations noted; a moderately high temperature of 37.80C, elevated blood pressure 165/95, blood gases indicate an decrease in respiratory function compromising the homeostasis of the carbonic acid - bicarbonate buffer system and blood tests uncovered hyperlipidaemia. The medical officer has ordered a sputum culture, Intra Venous Infusion (IVI) antibiotics, Intra Venous (IV) therapy, bronchodilator inhalation and oral medication. The collection, maintenance and administration of these orders will be discussed. As well as, the development of Mr Stanley's health teaching plan to educate him on developing an understanding on how to correctly administer his medication at home and the importance of the prescribed medication. Concluding with an outline of the key points addressed in Mr Stanley's situation.

Body

Mr Stanley has been diagnosed with pneumonia and ACS; two separate illnesses that interact with one another. The illnesses may worsen each other and each disorder predisposes to relapse in the other disease (Brown & Edwards 2005). At times the symptoms can overlap making diagnosis and treatment more difficult.

Pneumonia is an acute infection of the lungs caused by a particular infecting agent usually bacterial, fungal, viral or parasitic (McCance & Huether 2006). Thick exudate, plugs the alveoli and bronchioles creating difficulty in breathing thereby, reducing the oxygen and carbon dioxide exchange in the lungs (Harris, Nagy & Vardaxis 2006). The client's productive cough and thick green sputum supports the reasoning for blood gas samples to ascertain the oxygen / carbon dioxide levels within the body; the results indicate respiratory acidosis with no metabolic compromise. Salbutamol (a bronchial-dilator) via a nebuliser has been ordered four hourly to assist Mr Stanley's oxygen / carbon dioxide inefficiency.

ACS (instable angina) is often a result of atherosclerotic plaque rupturing and/or ulcerations breaking off causing obstruction to blood flow in the blood vessels (McCance & Huether 2006). This unstable lesion may lead to ischemia; a lack of oxygen supply to the heart which inturn can progress to a myocardial infarct (MI) (McKillup 2007). Mr Stanley presented with chest pain on admission; an ECG was performed (which is standing order when a client presents with chest pain); it showed no evidence of a myocardial infarct. A slight elevation in body temperature is not uncommon post