Medical History Of Joylene Sims Samples †MyAssignmenthelp.com

Question: Discuss about the Medical History Of Joylene Sims. Answer: Introduction The purpose of this paper is the case study of Ms. X, name not mentioned to protect confidentiality, to understand her medical history, events leading to her admission, health risks, Pathophysiology of the clinical conditions experienced by the patient, pharmacological interventions that might be applicable (including the outcomes, side effects, contradictions andnursing considerations), assessment of the diagnoses and provide recommendations based on the findings. The patient is a 66-year-old lady, residing in SA Housing with her son and primary care giver, Matthew. She previously was able to live independently with little assistance, needed 4WW for walking, and was able to manage her own medication, finances, toileting, and personal care. She was admitted to Finders Medical Centre on 02/05/2017 after her son found her collapsed on the floor. The patient also had a medical history of Diabetes Mellitus (type 2), Hypertension, Migraine, Fatty Liver, Depression, Right Sub Arachnoid Cyst, Recurrent pain of lower back, Left Shoulder Bursitis and Anxiety disorder. A drastic drop in blood sugar levels caused by Diabetes Mellitus can cause loss of consciousness (Fainting diabetes2017). She was subsequently diagnosed with chest infection and right leg cellulitis with septicemia. She was administered with intravenous antibiotics immediately. Her condition worsened, and developed rapid Arterial Defibrillation, Acute Kidney Injury, pneumonia and edema in her legs and arms. Her urine tested positive for APMC (multi resistant gram-positive bacterium). She has also admitted to the Intensive Care Unit twice for respiratory failure, which along with her present medical condition caused significant deconditioning and a loss of functional abilities. Consent was obtained as per the healthcare policy guidelines to access her information, for ethical concerns (Nursing and Midwifery Board of Australia Policies, 2017). The health risk was aggravated by the history of diabetes, which could have had stressful effects on the other organs (Matsuda and Shimomura 2013). Hypertension, and arterial fibrillation further complicated the condition, and a damage of the kidneys could be attributed to it, which can also explain the onset of edema (Bonde et al. 2014). Depression and Anxiety may also be the effect of her clinical condition.She is also suffering from Obesity and Deconditioning. Pathophysiology/ Pharmacology During the shift the patient experienced a plethora of signs and symptoms that worsened his condition. The primary concern in the patient was diabetes. Type 2 Diabetes occurs due to an insufficient production of insulin by the pancreas or an insulin resistance (which causes the failure of cells of muscles, liver and fatty tissues to respond to insulin, even if they exist in high levels in the blood). This resulted in a rise in blood glucose level, and a depletion of the stored glycogen. Insulin resistance can be caused due to obesity and lack of physical activity (Mandal, 2017). Type 2 diabetes represents about 90% of all reported diabetes cases, and can lead to other complications like cardiac arrest, problems with vision and foot ulcer (Diabetesaustralia.com.au, 2017). The risk factors include family history, age more than 45 years with obesity or High Blood Pressure, and certain ethnic groups. Typical symptoms include: excessive thirst, frequent urination, lethargy, persistent hunger, slow healing of wounds, skin infection and itching, blurry vision, obesity, mood swings, headache, dizziness, leg cramps (Kirk et al. 2015). Study of the patients clinical condition shows a clear association with diabetes related complications. Her diagnosis of septicemic infection of the leg, Hypertension, Migraine, Fatty Liver, Depression and Anxiety can be attributed to Diabetes. Pharmacological intervention should involve administration of Metformin HCL (1g) daily (Mujeeb and Mutha 2015). This medicine will help in improving her sensitivity to insulin, and will result in a lowered glycogenesis in the liver. However, lifestyle changes like weight reduction and exercise is needed for the medicine to be effective in reducing blood sugar levels. Side effects include nausea and diarrhea. The patient also reported signs of hypertension, evidenced by blood flow through the vessels with a higher pressure than normal. This requires attention as the condition can create stress on the heart, damage blood vessels, and can also heighten chances of cardiac arrest or myocardial infarction, cerebrovascular accident, renal dysfunction. It can even lead to death (PubMed Health, 2017). The physiological mechanisms underlying hypertension includes a decrease in peripheral resistance and elevated cardiac output; low levels of rennin and angiotensin II; interaction between the autonomous nervous system and renin-angiotensin system; endothelial dysfunction and genetic factors (ncbi.nlm.nih.gov, 2017). These will lead to headaches, dizziness and anxiety. The history of migraine headache and anxiety can be attributed to hypertension, which in turn could be related to her obesity (Ahmad et al. 2016). Pharmacological intervention should include administration of Nebivolol (5mg) once daily and Frusemide (40mg) thrice daily. Nebivolol is a beta receptor blocker and vasodilator (Perros et al. 2015), and Frusemide helps in the treatment of the buildup of fluid caused by cardiac failure, liver scarring and kidney dysfunctions (Tamargo, Segura and Ruilope. 2014). The drug will inhibit the absorption of sodium and chlorine in the proximal and distal convoluted tubules of the nephrons. Thus, both these medications can be used as effective interventions to treat hypertension in the patient. The side effects of Nebivolol may result in hypersensitivity, low blood sugar, dizziness, breathlessness, gain in weight, and swelling of arms or legs, slowing of heartbeat, headache and fatigue (Velasco et al. 2016). Therefore, the drug should be administered with or before food, at a single time without missing any doses (however, double doses/extra doses should be avoided, if timely administration is missed). Frusemide may also lead to increased urination, weakness, muscle cramps, thirst, rashes, dizziness, diarrhea/ constipation, stomach pain, fever, nausea and dehydration. However, it should be noted that the medication can increase nephrotoxicity of cephalosporin and aminoglycosides, and should not be administered with phenytoin and indomethacin. The presence of atrial fibrillation in the patient is another concern. It is caused by irregular beating of the atrium of heart, causing irregular or rapid heartbeat. This increases the risk of strokes, heart attack and other cardiac dysfunctions (January 2014). The irregularity can be due to chaotic electrical signals to the Aurio-Ventricular (AV) node, and increase the heart rate to 100 to 175 beats per minutes, and can also cause ventricular fibrillation (Andrade 2014). Previous history of hypertension, lung disease, heart attack, congenital heart defects, coronary arterial disease, and abnormal valves of heart, thyroid dysfunction and viral infections might have contributed to the incidence of atrial fibrillation in the patient. Common symptoms include weakness, palpitation, fatigue, dizziness, short breath, confusion, chest pain and light headedness (Heart.org. 2017). Based on the symptoms being manifested by the patient, her pharmacological interventions should include daily administration of Amiodarone (200mg). The drug will block electrical signals to the heart that causes irregular heartbeats (Roy et al. 2000). However, she may suffer from some side effects such as, nausea, constipation, appetite loss, fatigue and shakiness (Drugs.com.2017). Her allergic and medical history (liver/ lung /thyroid dysfunction) should be checked before administering the drug. The patient also exhibited signs and symptoms of obesity, following her admission. This condition is principally characterized by an excessive accumulation of body fats, causing adverse health conditions. A body weight that is 20% more than the normal weight and a Body Mass Index above 30 is considered as obese (WHO, 2017). Excessive calorie intake, sedentary lifestyle, lack of sleep, endocrine disruption (like food that interferes with lipid metabolism) and genetic conditions (like a faulty FTO gene or family history) might have contributed to the excess increase in weight in the patient (Healthdirect.gov.au. 2017). This condition is dangerous for the patient as it aggravates the chances of type 2 diabetes, cardiac disease, hypertension, arthritis, stroke and sleep apnea (Esser et al. 2014). The effects on health can be due to an increased mass of fat (causing arthritis, sleep apnea) or increase in the number of fat cells that can cause insulin resistance, proinflammatory and prothrombotic states. Since the patient was already obese, it can be concluded that diabetes, hypertension, fatty liver and back pain could have been a clinical repercussion. An effective approach would be a change in diet, and usage of laxatives like Docusate (50mg x2) and Sennoside (8mg), twice a day. Reducing the reward value for food is a good strategy to reduce weight (Hiesler. 2016). Side effects of Docusate include rectal bleeding/ irritation, rashes around rectum, diarrhea, stomach cramps, constipation, and allergic reaction. Sennoside administration can also lead to nausea, vomiting, diarrhea, weakness, muscle cramp, dizziness, cardiac arrhythmia, decreased urine output, mood changes and allergic reactions. Therefore, there is a need to check for drug interactions for both the medications, before administering them to the patient (Drugs.com. 2017). The patient also reported signs of deconditioning that might have occurred due to lack of physical activity or due to disuse of body parts, and can have severe effect in older patients (Narici. 2017). A sedentary lifestyle or complete bed or chair rest during an illness might have contributed to this condition in the patient. Deconditioning is characterized by a decline in muscle tone, mass and strength. Aging can result in a reduction in the number of muscle fibers, and thus a loss of the bulk. Additionally, disuse of muscles can have similar effects on muscle strength and mass. Since the patient was completely bed ridden, it seemed possible that it resulted in her deconditioning due to the lack of use of her legs. An exercise plan should be formulated with the help of a physical therapist that would keep the patient in good spirits. Investigation Investigations on the patients medical condition revealed the following problems: she developed cellulitis on the right leg, and a subsequent septicemia. It can be attributed to the slowed healing of wounds typical in diabetes. Nurses play an essential role in conducting assessments and identifying worsening conditions in a patient. However, evidences suggest that they often miss reporting patients exacerbating conditions due to delayed management that leads to adverse consequences (Chua et al. 2013). Strict monitoring of her blood pressure was required to reduce health complications. If her increased blood pressure was left uncontrolled several complications such as, transient ischemic attacks, dementia, cognitive impairment, kidney failure, heart failure might have occurred. Therefore, her blood pressure was continuously checked. She also developed chest infection which can be related to the fluid buildup and edema caused by diabetes. She was consequently administered antibiotics v ia intravenous channel. However, her condition became worse, and she developed acute kidney infection, due to the systemic spread of the disease. A positive urine test for AMPC indicated the presence of urine infection in the patient. There was a need to periodically monitor her blood glucose levels before and after meals as this would provide an accurate representation of her glycemic index. This should be strictly monitored unless the levels get normalized. Significant associations exist between cardiovascular complications and high glycemic index. Therefore, there is a need to control her blood sugar levels in order to reduce predisposition to further complications. An X-ray analysis showed the presence of chest infection in the patient. Her lung infection seemed to have quickly worsened, and she even faced respiratory failures, twice, while in the intensive care unit. Because of these multiple complications, she was put to complete bed rest, and it result in a significant deconditioning of her muscles strength and tone. The patient was considered for an ACAT assessment. This aged care assessment team provided her assistance as she was obsess and was unable to move (Boltz et al. 2016). ACAT assessment showed that the patient was no longer able to stand transfer, and hence she needed more care than what can be provided at home. Sling assistance for bed transfers, and 2-3 assists were provided. Reccomendation Firstly, the patient requires a round the clocknursing supervision or a permanent residential care. Both physical and social health care must be provided to the patient in order to help her achieve optimal health and wellbeing. Secondly, her diet should be properly formulated to ensure prevent excess calorie intake. Thirdly, it is also important to address the effect of the diseases on her mental health condition. Her medical history of depression and anxiety predisposes her of acute mental stress, which can adversely affect the treatment outcome. It can therefore be suggested that she be administered 4 tablets of Doxepin (50mg) or 1 tablet of Duloxetine (30mg), daily to manage depression (Werner and Covenas. 2017). Furthermore, social healthcare workers should be involved in providing long term care, and to assist the primary caregiver (patients son). As it is understood, that the patient might be on prolonged bed rest, with only the minimal movement, regular checkups are needed to ensure she does not suffer from bed sores, muscle fatigue and further deconditioning. Additional recommendations can a psychological counseling or evaluation would be helpful for the patient to deal with her condition. Since a comprehensive care might not be feasible in the house, she was recommended to opt for permanent residential care. Reflection Working as a nurse involves a list of responsibilities like observing behavior of patients; coordination between the healthcare professionals; creating and evaluating care plan; emotional and psychological support; analyze patients symptoms and taking any action needed for recovery; maintain report, medical history, and change in condition; administering or changing medication; checking the stock of medicine, to ensure it does not run out; maintain safe and hygienic environment; researching effectivenursing practices; providing emergency care; discussion of treatment plan with doctors or healthcare professionals; providing guidelines disease prevention and health maintenance (Nursing and Midwifery Board of Australia Policies. 2017). Feedbacks are essential tools for developing competencies in the field of evidence based nursing (Boltz, Capezuti, Fulmer and Zwicker. 2016). The feedback by my PEP facilitator during my VIVA VOCE placement suggested that I had demonstrated sufficient knowledge on the case scenario that was presented. I was able to identify the gaps that were associated with the pathophysiology of the several complications presented by the patient. However, my placement facilitator suggested that there was lack of cohesion in my VIVA VOCE assessment. Moreover, I did not demonstrate adequate flow of information during the assessment. My facilitator suggested that I had demonstrated great efforts to present the case. I felt that registered nurses should provide frequent feedbacks to the nursing students to help them develop their nursing practice. The substandard 1.2 of the Nursing and Midwifery Board of Australia(NMBA) (2016, p. 3) points out that nurses are supposed to critically think and analyse the nursing practice. Furthermore, the sub standard 3.5 states that a nurse should maintain the practice capability to ensure continuous professional development. Using the reflection provided, I will implement a better strategy in analyzing and writing the article. I will follow the protocols and marking criterion, create a mental checklist, and work towards achieving my objective. Utilizing the knowledge gathered from the feedback, and the learning processes, allowed me to better understand the subject and national standards. Thus, the clinical placement and VIVA VOCE assessment helped me enhance my clinical skills. References: Ahmad, F.S., Ning, H., Rich, J.D., Yancy, C.W., Lloyd-Jones, D.M. and Wilkins, J.T., 2016. Hypertension, obesity, diabetes, and heart failurefree survival: the Cardiovascular Disease Lifetime Risk Pooling Project.JACC: Heart Failure,4(12), pp.911-919. Andrade, J., Khairy, P., Dobrev, D. and Nattel, S., 2014. The clinical profile and pathophysiology of atrial fibrillation.Circulation research,114(9), pp.1453-1468. Boltz, M., Capezuti, E., Fulmer, T.T. and Zwicker, D. eds., 2016.Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company. Bonde, A.N., Lip, G.Y., Kamper, A.L., Hansen, P.R., Lamberts, M., Hommel, K., Hansen, M.L., Gislason, G.H., Torp-Pedersen, C. and Olesen, J.B., 2014. Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease: a nationwide observational cohort study.Journal of the American College of Cardiology,64(23), pp.2471-2482. Chua, W.L., Mackey, S., Ng, E.K.C. and Liaw, S.Y., 2013. Front line nurses' experiences with deteriorating ward patients: a qualitative study.International nursing review,60(4), pp.501-509. Diabetesaustralia.com.au. (2017).Type 2 diabetes. [online] Available at: https://www.diabetesaustralia.com.au/type-2-diabetes [Accessed 18 Nov. 2017]. Diabetes-mellitus-info.com. (2017).Fainting diabetes. [online] Available at: https://diabetes-mellitus-info.com/fainting-in-diabetes [Accessed 18 Nov. 2017]. Drugs.com. (2017).Amiodarone Side Effects in Detail - Drugs.com. [online] Available at: https://www.drugs.com/sfx/amiodarone-side-effects.html [Accessed 18 Nov. 2017]. Drugs.com. (2017).Docusate Side Effects in Detail - Drugs.com. [online] Available at: https://www.drugs.com/sfx/docusate-side-effects.html [Accessed 18 Nov. 2017]. Drugs.com. (2017).Senna Side Effects in Detail - Drugs.com. [online] Available at: https://www.drugs.com/sfx/senna-side-effects.html [Accessed 18 Nov. 2017]. Esser, N., Legrand-Poels, S., Piette, J., Scheen, A.J. and Paquot, N., 2014. Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes.Diabetes research and clinical practice,105(2), pp.141-150. Flores-Mireles, A.L., Walker, J.N., Caparon, M. and Hultgren, S.J., 2015. Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nature reviews microbiology,13(5), pp.269-284. Healthdirect.gov.au. (2017).Obesity symptoms. [online] Available at: https://www.healthdirect.gov.au/obesity-symptoms [Accessed 18 Nov. 2017]. Heart.org. (2017).What are the Symptoms of Atrial Fibrillation (AFib or AF)?. [online] Available at: https://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-are-the-Symptoms-of-Atrial-Fibrillation-AFib-or-AF_UCM_423777_Article.jsp#.WhBHCkqWbIU [Accessed 18 Nov. 2017]. Heisler, L., 2016. Obesity medication reduces the reward value of food. January, C.T., Wann, L.S., Alpert, J.S., Calkins, H., Cleveland, J.C., Cigarroa, J.E., Conti, J.B., Ellinor, P.T., Ezekowitz, M.D., Field, M.E. and Murray, K.T., 2014. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation, pp.CIR-0000000000000041. Kirk, J.K., Arcury, T.A., Ip, E., Bell, R.A., Saldana, S., Nguyen, H.T. and Quandt, S.A., 2015. Diabetes symptoms and self-management behaviors in rural older adults.Diabetes research and clinical practice,107(1), pp.54-60. Mandal, A. (2017).Diabetes Mellitus Type 2 Pathophysiology. [online] News-Medical.net. Available at: https://www.news-medical.net/health/Diabetes-Mellitus-Type-2-Pathophysiology.aspx [Accessed 18 Nov. 2017]. Matsuda, M. and Shimomura, I., 2013. Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer.Obesity research clinical practice,7(5), pp.e330-e341. Mujeeb, M.M. and Mutha, A.S., 2015. Type 2 Diabetes, Metformin, Glimepiride, Repaglinide.Comparative Efficacy And Safety Of Metformin Alone And In Combination With Glimepiride Or Repaglinide In Type-2 Diabetes Patients., (2). Narici, M.V., 2017. Neuromuscular deconditioning with disuse: should we live more on our nerves?.The Journal of Physiology. ncbi.nlm.nih.gov. (2017).The pathophysiology of hypertension. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120075/ [Accessed 18 Nov. 2017]. Nursing and Midwifery Board of Australia - Policies (2017).[online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Policies.aspx [Accessed 18 Nov. 2017]. Perros, F., Ranchoux, B., Izikki, M., Bentebbal, S., Happ, C., Antigny, F., Jourdon, P., Dorfmller, P., Lecerf, F., Fadel, E. and Simonneau, G., 2015. Nebivolol for improving endothelial dysfunction, pulmonary vascular remodeling, and right heart function in pulmonary hypertension.Journal of the American College of Cardiology,65(7), pp.668-680. PubMed Health. (2017).Hypertension - National Library of Medicine - PubMed Health. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024199/ [Accessed 18 Nov. 2017]. Roy, D., Talajic, M., Dorian, P., Connolly, S., Eisenberg, M.J., Green, M., Kus, T., Lambert, J., Dubuc, M., Gagn, P. and Nattel, S., 2000. Amiodarone to prevent recurrence of atrial fibrillation.New England Journal of Medicine,342(13), pp.913-920. Tamargo, J., Segura, J. and Ruilope, L.M., 2014. Diuretics in the treatment of hypertension. Part 2: loop diuretics and potassium-sparing agents.Expert opinion on pharmacotherapy,15(5), pp.605-621. Velasco, A., Solow, E., Price, A., Wang, Z., Arbique, D., Arbique, G., Adams-Huet, B., Schwedhelm, E., Lindner, J.R. and Vongpatanasin, W., 2016. Differential effects of nebivolol vs. metoprolol on microvascular function in hypertensive humans.American Journal of Physiology-Heart and Circulatory Physiology,311(1), pp.H118-H124. Werner, F.M. and Covenas, R., 2017. Three Cases of Major Depression: Differen t Pharmacological Antidepressant Options.J Cytol Histol,8, p.457. World Health Organization (WHO, 2017. Obesity and Overweight factsheet from the WHO.Health.