Nursing Diagnosis and Health Professional Literature - James Ruru Case Study - Health Assignment Help

Assignment Task :

Learning Outcomes :
This assessment will assess the following learning outcomes and will contribute 50% to your final grade:
1. Manage the nursing care needs of health consumers experiencing acute and/or complex illnesses, including palliative care
2. Interpret specific diagnostic tests

Task:

Select one of the case studies provided. You will then be required to demonstrate your ability to think critically, apply clinical reasoning and articulate your understanding of the underlying pathophysiology as they relate to the presenting signs and symptoms, potential complications, and your health consumers lived experience of this acute event. It is expected that you will make links to the diagnostic data provided to you in the profile selected.
 

1) Identify one nursing diagnosis that is an immediate priority for the nursing care of your chosen patient and discuss the rationale for the selection of this nursing priority using current health professional literature.
2) Identify one SMART goal that relates to achieving the expected health consumer outcome and discuss the rationale for the selection of this goal using current health professional literature.
3) Identify and discuss the rationale for the selection of six nursing interventions that you consider to be priorities in achieving the expected health consumer outcome.

Case study 1: Max Johnston

Max Johnston, 59 years old, is Principal of an 800-pupil Secondary School and finds his job very stressful. Max is married & has 3 adult children and 4 grandchildren living in different parts of New Zealand and Australia. He has at least weekly phone contact with his children and grandchildren. He has limited time for exercise but enjoys trout fishing, playing occasional rounds of golf, and watching motor racing on TV during weekends & holidays. Max drinks approximately 18 standard drinks/week and smokes 20 cigarettes/day.
 

Family medical history
• Max’s father was diagnosed with hypertension, hypercholesterolaemia, Type II diabetes and died aged 63 years following a haemorrhagic stroke.
• Max’s mother, aged 81 years currently experiences stable angina which is well controlled with GTN spray PRN. She also had glaucoma and mild osteoarthristis in both hips.
• Max’s older brother, 61 years old, was diagnosed with Type II diabetes 6 years ago.
 

Past medical history
• Childhood illnesses: Measles, mumps & chickenpox + # radius & ulnar age 8 years.
• Routine life insurance health assessment age 39 years: Blood pressure 155/95, random blood glucose9.5mmol. Advised to watch diet, exercise regularly & visit GP to monitor regularly.
• Five years ago, age 54 years, blood pressure 168/98, random blood glucose 11.7 and ruddy complexion. He reported feeling stressed and tired constantly. Further testing revealed: HbA1c 56mmol/mol, body mass index 34 (height 175cm & weight 97.5kg), total blood cholesterol 6.9 mmol/L, LDL 4.7 mmol/L, HDL 0.8 mmol/L. His GP commenced Max on Accupril 20mg BD for hypertension, Cartia 100mg mane for cardiovascular protection, Metformin 500mg BD for blood glucose control, and after an ineffective attempt to reduce serum cholesterol with a diet and exercise regime, Atorvastatin 40mg nocte.
• For 2 or 3 months Max has been unusually thirsty, is constantly feeling tired and is experiencing unexplained weight loss.
• Has reported several episodes of indigestion after meals, “tightness” across anterior chest and breathlessness on exertion unrelieved by antacids and paracetamol but mostly relieved by rest over the last 2 or 3 weeks.

Case study 2: James Ruru
James Ruru is a 68 year old man diagnosed with prostate cancer 8 years ago. At that time he underwent prostatectomy and radiotherapy which left him with urinary incontinence controlled with continence products. His regular follow ups and PSA assessments revealed that he developed metastatic disease 2 years ago. Metastatic tumours where located in his lung and right 4th rib (posterior). James refused orchidectomy and hormone therapy and subsequently had 3 courses of immunotherapy. Has been instigated but at this time is considered palliative rather than curative. He is married with 3 adult children and 4 grandchildren living locally. He enjoys being with family and fishing. He is an ex-smoker with a 50 pack year history. He stopped smoking when originally diagnosed with prostate cancer.

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