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Linda, a 58 year old female, has presented to her General Practitioner (GP) with a persistent, productive cough with dyspnoea on exertion. She has noted that this cough has been present for over three weeks. The GP has suggested that Linda go to hospital and receive further tests for the presenting symptoms. An initial assessment is performed upon Linda’s admission to hospital. She states that her legs are swollen because she has not been able to lie down to sleep and has been sleeping on a chair for the last three weeks. She has an untidy appearance, is not well groomed and is slightly lean for her height, despite reporting recent weight gain.

 

Past medical history includes: asthma, chronic obstructive pulmonary disease (emphysema), hypertension and chronic heart failure. Linda had been smoking two packs of cigarettes a day for 30 years but has cut down to four cigarettes a day for the last two years. She currently lives alone in a unit and has a daughter who lives interstate and calls her once a month. Her vital signs are: Temperature - 37.0 °C, blood pressure- 168/54 mmHg, respiratory rate- 20/min, heart rate – 110 bpm, Sp02 - 92% on room air.

 

After a number of diagnostic tests are performed on Linda, she is diagnosed with primary lung cancer, stage 1. The Resident Medical Officer (RMO) has informed Linda of her diagnosis. Linda has stated, “I cannot believe this is happening to me”.

 

The Nurse has returned to perform regular observations on Linda, and has noticed that she is bent over the bedside table, is very sluggish and looks like she has an increased respiratory rate.

 

1.       Discuss the pathophysiology of each condition in Linda’s past medical history   (2 marks each, 8 marks/250 words)

 

2.       What are the clinical manifestations of chronic heart failure which are evident with Linda’s case?     (1 marks each, 6 marks total/ 175 words)

 

3.       Outline the nursing interventions that should be performed when Linda is found bending over the bedside table and provide appropriate rationales. Note any potential risks or complications related to these interventions if applicable.     (1 mark each, 10 marks total/ 300 words)

 

4.       Provide three (3) nursing diagnoses (and a rationale for each) that can be made in relation to Linda’s physiological and psychosocial health problems. 

    (2 mark each, total 6 marks/ 175 words)

 

5.       Outline the nursing interventions that should be implemented following the diagnoses made in Question 4.    (1 mark each, total 3 marks/150 words)

 

6.       Identity two (2) health support services that Linda may require on admission to the ward and briefly discuss their role.  (1 mark each, total 2 marks/50 words)

 

 

 

Case study 2 (35 marks)

Healthcare

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