NURBN-2012 - Deependra Sidhu Case Study - Nursing Assignment Help

Assignment Task

Scenario
Deependra Sidhu (preferred name of “Deep”) is a 68 year old male of Indian descent. He immigrated to Melbourne at the age of 18. He became an Australian citizen at the age of 28.
Past medical history
Myocardial infarction (MI) 2017
Stable Angina
Hypertension
Hypercholesteremia
Type 2 Diabetes Mellitus (currently diet controlled, diagnosed 2016)
Current Medications
Aspirin 100mg mane
Atenolol 25mg mane
Furosemide 40 mg mane
Pravastatin 40mg oral nocte (bedtime)
GTN spray 1 – 2 sprays S/L PRN
Sildenafil (Viagra) 50mg prn

Social history
Deep tells you that he is trying to lose a bit of weight by having soup for lunch, he is particularly fond of hot and sour soup. His wife has bought him lunch and dinner every day he has been admitted. Deep has a very supportive family but they are currently studying. Deep works 3 days a week and would like to retire soon but “needs to support my family first”. He confides in you that he doesn’t like the side effects (“makes me go to the toilet too much”) of the Lasix tablet and sometimes doesn’t take it.
History of presenting complaint
Deep has called for help after waking up at 2am feeling breathless with pain in his chest (8/10 pain score). You sit him up in the bed and perform a set of observations while asking for assistance.
Your buddy nurse comes to assist and asks you to perform and ECG and prepare to take a troponin T and MKMB blood test. You prepare to give Deep GTN S/L as per the wards chest pain management. Your buddy nurse says to double check his PRN and OTC medication. You ask Deep if he has taken any medication in the last day, apart from his prescribed medication (Aspirin, Atenolol, Furosemide, Pravastatin). Deep says he has not and you administer the medication at 02:40 after performing your first set of observations.
Observations at 02:35
HR 90, regular
BP 145/85
Skin – sweaty and pale, RR 26, regular
SpO2 94% RA
Temp. 36.7oC
Oedematous legs, moderate pitting oedema (2+)

Question 1 Your buddy nurse asks for an ECG. Explain the rationale for the ECG request (5 marks). Why would the nurse also ask you to prepare for a blood test? (2 marks) Why do both ECG and a blood test?

Question 2 The medical team confirm the diagnosis of heart failure. Describe the pathophysiology of heart failure with reference to causes, progression and outcomes (15 marks). Include links to how heart failure has progressed for Deep.

Question 3 Appendix 1 is an ECG that was taken while Deep was experiencing shortness of breath. Systematically analyse the ECG, commenting on the: - Rhythm - Rate - Presence and regularity of p waves - ST segment What is your interpretation of this ECG?

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