NUR20006 - Managing Chronic Care Assignment 2 - Case Study

Individual Written Case Study

[LO 1] - Discuss the holistic approach required to care for individuals and families in relation to chronic health conditions

[LO 2] - Apply knowledge of the underlying pathophysiology and clinical manifestations of selected chronic conditions

[LO 3] - Conduct a comprehensive and systematic nursing assessment for individual with a chronic conditions and/or co-morbidities

[LO 4] - Utilise an evidence based framework to develop a plan of comprehensive, safe and effective nursing care to achieve identified health outcomes

Case Study - Isbar Handover

Kasun Perera, 61-year-old Sri Lankan male (DOB – 03/01/1962)

Kasun has been admitted to the surgical ward today via ED with ongoing pain in both legs, which increases when walking. He also has a non-healing ulcer on his left foot.

Medical history of AMI, CVA with no residual deficits, HT, Type II Diabetes Mellitus, cigarette smoker for 40 years and requiring oral hypoglycaemic agents for 30 years.

Socially, Kasun has lived in Australia for 30 years and lives at home with his wife Asheni, who is also a cigarette smoker. Kasun and Asheni have three adult children who do not live at home.

CNS: Alert, orientated to time, place and person. PEARL 2+. Complaining of 7/10 pain in left foot/leg that worsens on ambulation

CVS: BP 148/95mmHg, HR 90bpm irregular. Left foot - cool, pale and mottled in colour and has reduced sensation. Right foot – cool but warmer than left foot, pale and has reduced sensation.

CVS: BP 148/95mmHg, HR 90bpm irregular. Left foot - cool, pale and mottled in colour and has reduced sensation. Right foot – cool but warmer than left foot, pale and has reduced sensation. Peripheral pulses difficult to palpate – left leg femoral and popliteal pulses present, dorsalis pedis absent and right leg pulses all present but weak. Capillary refill > 4 secs to both legs

RESP: RR 20b/min, SpO2 95% on R/A. Scattered expiratory wheezes bilaterally on lung auscultation with mild increase WOB

RENAL: voiding in a bottle. Awaiting E&U results

GIT: abdo soft and non-tender on palpation. Tolerating small amounts of diet and fluids well. BO yesterday.

METABOLIC: Temp 36.6°C, BSL – 10.8mmol/L

INTEG: left foot ulcer present 2cms x 2cms with dark eschar covering the wound. Both legs have thin, shiny skin with no hair evident. Nil other wounds/pressure areas evident.

MSK: ambulant with supervision; currently very painful to walk and has intermittent ‘pins and needles’ in feet.

INTEG: left foot ulcer present 2cms x 2cms with dark eschar covering the wound. Both legs have thin, shiny skin with no hair evident. Nil other wounds/pressure areas evident.

MSK: ambulant with supervision; currently very painful to walk and has intermittent ‘pins and needles’ in feet.

SOCIAL: wife aware of admission today and will return this evening to visit again

Kasun is planned to have investigations into the peripheral circulation of both legs by the Vascular Team.

Kasun requires referrals to multiple members of the allied health team including the dietician, diabetes nurse educator, physiotherapy and occupational therapy.

Step-by-Step Academic Mentor Guidance

The academic mentor guided the student through a structured process to address each requirement:

1. Understanding the Case (Patient Background Review)

   • Mentor explained how to extract key health information from the case (medical history, social background, and presenting symptoms).

   • Encouraged the student to connect lifestyle factors (smoking, diabetes) to Kasun’s current complications (non-healing ulcer, leg pain).

2. Linking to Pathophysiology (LO2)

   • Mentor helped the student map the clinical manifestations (pain, poor circulation, ulcer, reduced sensation) to underlying conditions like peripheral vascular disease and diabetes.

   • Guided the use of scholarly references to explain how poor circulation and neuropathy impair healing.

3. Holistic Care Approach (LO1)

   • Mentor emphasized including psychological and social dimensions , not just physical.

   • Student was guided to consider Kasun’s wife (also a smoker) and the role of family support in chronic illness management.

4. Systematic Nursing Assessment (LO3)

   • Mentor introduced frameworks such as ISBAR handover and systematic head-to-toe assessment.

   • Guided the student in organizing findings into body systems (CNS, CVS, RESP, GIT, MSK, Integumentary, Social).

5. Developing Evidence-Based Care Plan (LO4)

   • Mentor explained how to use nursing process (Assessment → Diagnosis → Planning → Implementation → Evaluation).

   • Assisted in drafting a comprehensive care plan addressing pain management, wound care, blood sugar control, smoking cessation, and referrals to allied health professionals (dietician, physiotherapist, diabetes educator).

6. Structuring the Case Study

   • Mentor guided the student in maintaining academic tone, using references, and ensuring logical flow:
     • Introduction → Patient background → Pathophysiology → Nursing assessment → Care plan → Conclusion.

Final Outcome & Learning Achievements

Through the guided process:

• The student produced a structured, evidence-based case study that addressed all four learning objectives.
• The care plan included multidisciplinary interventions, reflecting the holistic care approach.
• The outcome demonstrated an ability to link clinical manifestations with pathophysiology and integrate them into a systematic nursing assessment.
• The student learned to apply an evidence-based nursing framework in developing a practical care plan tailored to Kasun’s condition.
• Overall, the exercise reinforced critical thinking, clinical reasoning, and academic writing skills required for professional nursing practice.

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