In addressing this case study I required to follow the underneath structure: o Introduction (150 words). Present a short patient history. This history should demonstrate the complexities of the patient. The patient problems are expected to provide you with an opportunity to demonstrate under the following assignment headings how you address issues in your selected area of nursing practice using sound clinical judgement, critical analysis and planning to ensure the best patient outcome. o Signs and/or symptoms (750 words). Identify three pertinent signs and/or symptoms which you believe contribute to the patients key issues or problems remember that there will be interrelationships between signs/symptoms because of comorbid chronic diseases. You are required to use current literature to justify why these signs and symptoms were of particular significance in this instance and how they contributed to (or allowed the identification of) the key patient issues or problems. o Complexity of care (2,000 words). Drawing from the key principles found in the conceptual model of the role of complexity in the care of patients with multiple chronic conditions (see below and Grembowski et al. 2014), examine high priority needs of the patient and the services required. Draw on research evidence, ensure nursing aspects are clearly identified as well as the collaborative services needed (i.e. involve other members of the interdisciplinary team). Consider the input of an advance practice nurse-led service (e.g. nurse practitioner or clinical nurse consultant) for this patient. o Conclusion (100 words). Concluding remarks which reflect on models/frameworks currently in use in your practice environment and how this complexity model might inform your future practice. patient scenario Mr M, a 73-year-old man, was admitted to the medical ward of a hospital in your country with complaints of increasing dyspnoea on exertion. He has type II diabetes, cardiovascular disease, and chronic kidney disease. Mr M is a retired engineer who lives with his wife in an apartment on the fourth floor (no lifts in the building) and he is normally able to attend to activities of daily living, cooking, cleaning and shopping. He has two adult children who live nearby. Subjective data ? Had a myocardial infarction at 68 years of age ? Has experienced increasing dyspnoea, frequent cough, and oedema in the legs over the last 5 weeks ? Has to sleep with head elevated on three pillows Objective data ? In some respiratory distress, use of accessory muscles, respiratory rate 34 breaths/min ? Heart murmur ? Skin cool and diaphoretic ? Venous leg ulcer on left ankle ? Bloated abdomen Physical examination ? Pulse full and bounding: 102 bpm, blood pressure: 162/106 mmHg, O2 saturation: 88% (room air) ? Temperature: 36.8oC ? Urinalysis: protein++++; pH 6.8; SG 1.020; blood, glucose & ketonesnil Diagnostic studies ? Serum: K 6.3 mmol/L; HCO3 15 mmol/L; Urea 22.7 mmol/L; Creatinine 390 ?mmol/L; eGFR 12 mL/min/1.73m2 ; Hb 98 g/L; HbA1C 7.5%. ? Chest X-ray result: left ventricular hypertrophy; fluid in lower lung fields ? ECG: normal sinus rhythm Collaborative care ? Frusemide 250 mg BD ? Peridopril 8 mg daily ? Lercanidipine 10mg daily ? Atorvastatin 10mg daily ? Calcium carbonate 600mg TDS ? Calcitriol 0.5?g daily ? Lispro 25% 12 units BD ? Oxygen 6 L/min via Hudson mask ? Daily weight ? Renal diabetic diet and 1,500ml fluid restriction ? Referral to vascular surgeon for arteriovenous fistula formation and to the nurse led pre-dialysis multidisciplinary clinic.
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