Case study:

Identification: James Clark is a 68-year-old cisgender man who is travelling around Australia with his wife Geraldine on the “trip of a lifetime” with a 4WD and caravan. They left Queensland 5 months ago. When he unhooked the caravan last night, he noticed tingling in his left arm and he felt short of breath. He sat quietly for 30 mins and the feeling passed. James really doesn’t like to make a fuss. He woke up during the night to go to the toilet and felt dizzy. Geraldine has insisted he get checked at the hospital before they start the drive across the Nullarbor Plain.

Situation: You are working in an Adelaide ED and James is a patient in the sub-acute area.

Observations: His vital signs are BP 135/90mmHg, HR 95 BPM regular, RR 22, SaO2 97 % on RA. Temp 36.9 degrees. His ECG has no acute changes (No ST elevation or ST depression). Air entry is equal in both lung bases and no crackles or wheeze evident. He has a superficial wound on his left lower leg (5 cm x 5 cm) that he states was “a scratch from a piece of firewood that I mishandled but it’s been there for a month now”. There is no elevation in his troponin blood level and his GCS 15/15 and CT head is normal.

Background: James has had asthma since childhood with periods of exacerbation of asthma related to seasonal pollen in the air and infrequent chest infections.  James has brought his medication in to the clinic and shows you a list of the medication he takes (he states he “doesn’t really know what all his medications do”).

These are James’ medications:

Responsibility: You have been allocated the care of James and decide that James could benefit from nursing interventions about his chronic health concerns.

Questions:

1) Identify TWO (2) potential or actual chronic condition concern/problem for the patient described in the case study and justify your selection (this may include mortality & morbidity statistics, specific burden of disease for the case study or other justified reasons);

2)  Identify patient data relevant to the potential or actual chronic condition concern and specify any additional assessment techniques or tools you would use to collect patient data;

3)  Identify and prioritise TWO (2) goals for care of the patient in planning the nursing care (ensure these are SMART goals);

4)  Describe and justify TWO (2) evidence-based nursing interventions you would implement for EACH of the identified goals; and

5)  Predict expected outcomes and describe how these would be evaluated for each nursing intervention.

ANSWER

 Nursing Care for Chronic Health Concerns: A Case Study Analysis

In the realm of nursing practice, addressing chronic health concerns demands a comprehensive approach. This essay delves into the case of James Clark, a 68-year-old man with a history of asthma, as he seeks care in an Adelaide ED. The focus is on identifying potential or actual chronic condition concerns, collecting relevant patient data, setting SMART goals, proposing evidence-based nursing interventions, and predicting outcomes for each intervention.

 Potential or Actual Chronic Condition Concerns

a) Potential: Cardiovascular Disease (CVD):Given James’ age, presenting symptoms of tingling, shortness of breath, and dizziness, there is a potential concern for cardiovascular disease. The risk is substantiated by the fact that CVD is a leading cause of morbidity and mortality in Australia, accounting for 43% of all deaths (Australian Institute of Health and Welfare, 2020).

b) Actual: Skin Wound Infection: James’ superficial wound that has persisted for a month could indicate a potential skin wound infection, particularly considering his age, compromised immune system, and wound’s delayed healing. Skin infections are common in older adults, posing a significant burden on health (Nussbaum et al., 2018).

Relevant Patient Data and Assessment Techniques

To evaluate these concerns, relevant patient data includes:
Cardiovascular: Medical history, vital signs, ECG results.
Wound Infection: Inspection of wound site, assessment of wound characteristics (size, color, odor), and patient-reported pain or discomfort.

 Prioritized Goals for Care

a) Cardiovascular Concern
SMART Goal: Within two days, reduce cardiovascular risk by ensuring James receives comprehensive cardiac assessment, including ECG, cardiac enzymes, and lipid profile.

b) Wound Infection Concern
SMART Goal: Within three days, promote wound healing by providing wound care interventions to prevent infection and facilitate healing.

Evidence-Based Nursing Interventions

Cardiovascular Concern
Cardiac Monitoring: Implement continuous cardiac monitoring to track any arrhythmias or changes in heart rate.
Patient Education: Educate James about the importance of adhering to medication (Metoprolol) for blood pressure and heart health.

Wound Infection Concern
Wound Cleansing: Clean the wound using aseptic techniques to prevent infection.
Antibiotic Ointment: Apply appropriate antibiotic ointment to the wound to prevent infection and promote healing.

 Predicted Expected Outcomes and Evaluation

Cardiovascular Concern
Outcomes: Regular heart rate, absence of arrhythmias, stable blood pressure.
Evaluation: Monitor ECG results, heart rate variability, and blood pressure trends to assess improvement.

Wound Infection Concern
Outcomes: Wound healing without signs of infection, reduced pain or discomfort.
Evaluation: Regularly inspect wound for signs of healing, such as reduced redness, swelling, or discharge. Evaluate patient-reported pain scores.

Conclusion: Nurturing Patient-Centered Chronic Care

Navigating chronic health concerns requires a holistic approach, considering both potential and actual issues. By collecting relevant patient data and setting SMART goals, nurses can tailor evidence-based interventions to address patient needs effectively. In James Clark’s case, prioritizing cardiovascular assessment and wound infection prevention exemplifies how nursing care can positively impact patient outcomes.