PathoPhysiology -Pharmacological and Non-Pharmacological Management - Nursing Assessment Answer

Nursing Assessment

• Discuss the incidence of the chosen complication, and address the questions:

o What is the likelihood of Mr Joni experiencing this complication?
o What evidence suggests this?

• Discuss the pathophysiology of the chosen complication, and address the question:

o What are the consequences of this complication for Mr Joni?

• In consultation with Mr Joni, set two goals for him to reduce his risk of developing the complication?
• Identify interventions to achieve the above goals. The interventions should:

o be both nursing and patient based
o consider both pharmacological and non-pharmacological management
o recognise strategies to empower and education Mr Joni to take initiative to alter his lifestyle factors.
NOTE: The below steps 7 and 8 are NOT required as part of your assessment. You can choose to include this information as part of your conclusion, however, it is NOT mandatory/required for this task.
Steps 7 and 8 - Evaluation and Reflection (OPTIONAL)

•  Consider what strategies/aspects would determine that the patient and nurse interventions have been successful or effective for Mr Joni?
•  Include your conclusion here, and part of that should include an overall statement of what have you learned from doing this presentation on this patiet

Case study :
Mr Tomasi Joni is a 56 year old male of Fijian background, who currently lives with his wife (Theresa) and three children (ages 14, 17 and 18 ) in the Inner West City of Melbourne.

He recently presented to his GP clinic for his annual health check.  Following the review of his laboratory tests and assessment results, the GP was concerned that Mr Joni was at risk of developing multiple health complications. He has since been referred to you, the practice nurse, for a care plan to reduce his risk of these Complications and improve his overall health. 
 
Mr Joni works full time as a mechanical engineer and is currently averaging 50 hours/week which means he needs to work on most weekends.  He has always been socially active within his Church community, but due to his increased working hours this has restricted his ability to attend mass and contribute to his community. He states that he needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”.  Mr Joni states that he tries to exercise when he has time and walks to the train station every day to get to work, which is 8 minutes each way. He also goes bowling with his friends every Thursday night and then enjoys a pub dinner afterwards with a “couple of beers”.  He smokes 1 pack of cigarettes a week but this can increase if work becomes “too stressful”. 
As Theresa also works full time, they do not have a lot of time to cook. Therefore, the family eat takeaway 3 times/week and then go to his parent’s house for dinner the rest of the week.
Mr Joni has a history of hypertension, gout and had an AMI in 2016. He has moderate Obstructive Sleep Apnoea (OSA) and requires CPAP for overnight sleep.
 
Family history
Father has hyperlipidemia and had a stroke in 2015.
Mother had breast cancer in 2012 and is in remission currently.
 
Medications
Metoprolol 100mg daily
Aspirin 100mg daily
Allopurinol 500mg daily 
 
Current vital observations:
BP 142/96mmHg
HR 96bpm
RR 22 bpm
SpO2 96% on RA
T 36.7C
 
Health assessment findings:
Height 1.7m, Weight 93kg, excess abdominal fat evident. Waist circumference 104cm
Total cholesterol level - 9.2mmol/L
Fasting BGL - 9.6mmol/L 

Albumin-to-Creatinine Ratio (Urine ACR) - 10 mg/mmol

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