Jasmin Dowton Case Study - Pharmacological Management - Nursing Assignment Help

Assignment Task:

Case study:

Jasmin Dowton is a 68-year-old Caucasian female with a history of hypertension, hyperlipidaemia, and coronary artery disease (CAD). She suffered a non-ST elevation myocardial infarction (NSTEMI) 4 years ago and underwent a percutaneous coronary intervention (PCI) with stent placement in the left anterior descending artery (LAD). She smoked 30 cigarettes per day for 40 years, quitting after her NSTEMI. She has been overweight most of her life and does not exercise regularly. She informs medical staff that she has gained 5 kg over the last 3-4 weeks and is currently weighing 80 kg. Her height is 163cm. Jasmin's current medication regimen includes aspirin 100mg mane, ezetimibe/simvastatin 10/40 mg nocte, indapamide 2.5mg mane, and losartan 50mg bd. 

Jasmin has presented to the emergency department (ED) with fatigue and shortness of breath. She has difficulty sleeping at night and wakes up feeling like she is drowning. She has developed a wheeze and cough and has just begun to cough up a small amount of blood-tinged frothy sputum. She has trouble carrying out normal routine tasks such as meal preparation and hygiene cares. She states, ‘I just get so short of breath!’ Baseline vital signs: 

• T 37.1oC 

• BP 160/90 mmHg 

• Pulse weak and thready, irregular, 105 bpm. 

• Respiratory rate: 25 breaths per minute. Use of accessory muscles noted. 

• SpO2: 89% on room air 

Jasmin has a provisional medical diagnosis of acute decompensated heart failure. 

Her initial medical management orders in ED include: 

• Insert a peripheral intravenous cannula (PIVC) 

• Commencing continuous cardiac monitoring 

• Commencing a fluid restriction of 1.5L per day 

• For chest X-ray, 12-lead electrocardiogram, FBC, U&Es, serum troponin and BNP levels 

• For frusemide 20 mg IV stat 

• Admit Jasmin to the Coronary Care Unit (CCU) 

You are a second year nursing student completing a three-week placement in the CCU. Toni, the registered nurse (RN) you are partnered with today and yourself receive handover from the ED RN. During the handover, the ED RN informs Toni and yourself that the medical staff ordered a glyceryl trinitrate (GTN) infusion of 10 microg/min just as they were commencing their transfer to CCU so she hadn’t yet had a chance to prepare the GTN infusion. Upon handover, RN Toni requests that you introduce yourself to Jasmin and begin to plan her care while she goes and gathers the medication and equipment required to commence the GTN infusion. 

While settling in Jasmin, you infer from the information received from handover and your assessment of Jasmin that she is experiencing impaired gaseous exchange related to increased preload and alveolar–capillary membrane changes as evidenced by fatigue, dyspnoea, tachypnoea, pink frothy sputum, SpO2 89% on room air and patient’s statement, ‘I get so short of breath’.

Task: 

In the table provided develop one person-centred goal for the nursing problem identified. Ensure your goal is written in SMART (Specific, measurable, achievable, relevant and time limited) format. Identify two nursing interventions for your goal before completing the medication calculation and describing the precautions that are needed when administering the GTN infusion. 

The next part of this task is to describe how Jasmin’s clinical manifestations have led to the provisional medical diagnosis and subsequent nursing problem statement. In this description, you also need to explain the rationale for the collaborative and nursing interventions carried out for Jasmin so far. This discussion needs to include: 

o The pathophysiology behind Jasmin’s current presenting condition. 

o Pharmacodynamics and benefits of the pharmacological management you are administering 

o How the nursing interventions you have chosen will assist Jasmin to meet the formulated goal statement. 

o Links to one of the NSQHS Standards (Australian Commission on Safety and Quality in Health Care, 2017). This link should include some background about the selected standard and include a statement about how your care has met this standard. 

The discussion is to be supported by high-quality evidence-based literature. 

PART B: (700 words) 

Jasmin is beginning to respond to treatment and her dyspnoea has eased. You are now able to further assess Jasmin to gather additional data to assist in developing a plan of care. RN Toni has asked that you: 

• Identify a nursing problem specific to Janet’s situation and develop a plan of care. You must select a PRIORITY problem that can be actual or potential. 

• Develop one person-centred goal for the nursing problem identified. Ensure your goal is written in SMART (Specific, measurable, achievable, relevant and time limited) format. 

• Identify two nursing interventions for your goal. 

• You are then required to write a rationale for the problem, goal and interventions. The justification will be a detailed discussion based on the problem you have identified and the nursing interventions that you have chosen to achieve the goal you have set. Justify your nursing interventions based on cues, pathophysiology and/or pharmacology where appropriate. Within the rationale, you also need to demonstrate how this knowledge and action assists you to meet the Registered nurse standards for practice (NMBA, 2016). The discussion is to be supported with high-quality evidence-based literature.

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