Mr Tupa Savea is a 54-year-old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina and mitral valve stenosis.

Mr Tupa Savea is a 54-year-old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina and mitral valve stenosis. Mr Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr Savea is an ex-smoker, tobacco-free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community. On assessment, Mr Savea’s vital signs are PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2 indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has an ST segment elevated myocardial infarction. Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain-free on admission to CCU. Case Study 2: Ms Maureen Smith is a 24-year-old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening and was referred to the local hospital for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant. On assessment, Maureen’s vital signs are PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9oC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders. Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low-density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level measurement. Case Study 3: Mr Ronald Stone is a 47-year-old man who was brought in by ambulance to the emergency department with haematemesis. According to his partner, he vomited a total of 300 mL of fresh blood this morning. He reported that he has been spitting blood-stained sputum for the last few weeks with no associated cough or shortness of breath. For the past 3 days, he has complained of increasing abdominal pain but with no diarrhoea or black stools. Mr Stone tested positive for Hepatitis C virus (HCV) genotype 1A in June 2010. He has cirrhosis and a history of heavy alcohol use, although he no longer drinks. He ceased intravenous drug use 10 years ago, and stills smoke tobacco and marijuana on a daily basis. He used to work with City Rail but has been made redundant 13 months ago and has been unemployed since. He lives with his partner and 2 young children from a previous marriage. On assessment, Mr Stone’s vital signs are PR 112 bpm; RR 24 bpm; BP 105/64mmHg; Temp 37.4 °C; SpO2 94% on room air. He has a body mass index (BMI) of 31.5kg/m2. He is lethargic but orientated to time, place and person. He has a swollen and tight abdomen typical of ascites and bilateral leg oedema. Blood test results show Hb 85 g/L, decreased WBC, platelets and albumin, and a marked increase in both serum ammonia and total bilirubin levels. 6 months ago he underwent an esophagogastroduodenoscopy (EGD) which showed grade 2 oesophageal varices. He is ordered the following medications: Vitamin K 1 mg IV stat, Aldactone 25mg PO TDS, lactulose 15mls PO TDS, and vitamin B12 100mg IV TDS. He is awaiting a CT abdomen scheduled for this afternoon. Questions: 1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family 2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology a. This can be done in the form of a table – each point needs to be appropriately referenced 3. Describe two (2) common classes of drugs used for patients with the identified condition including the physiological effect of each class on the body a. This does not mean specific drugs but rather the class that these drugs belong 4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient 20 total views, 2 views today

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