Clare Giardini and Freddie Hankin Case Study – Medical Science Assignment Help

Assignment Task

Task

Clare Giardini and Freddie Hankin Case Study
 

Instructions

1. Select a case from the options below
2. You are the registered nurse working in the medical ward and are preparing selected cases for discharge from the hospital into the care of a chronic care nurse manager working in primary health care (including home care). Discuss the following to demonstrate your understanding of selected case’s ongoing care.
3. *ISBAR to be used for clinical handover from hospital to community setting
4. Follows requirements for referencing (APA 7th Edition), (intext citation) and 10 scholarly references within the past 5-7 years. 

USE ISBAR FOLLOWING PATTERN

INTRO: Who you are and why are you communicating with the Chronic Care nurse manager in primary health care? Who is the patient – provide all of his/her demographic data, his/her support person in the community and the social history.

Situation:Identify all data that is relevant to complete a comprehensive nursing assessment for the selected chronic condition/s and prioritize current care needs specific to his/her presentation as part of the nursing assessment. What is happening now- is he/she stable following period in hospital. What did you and the multidisciplinary team to do to improve the situation of the patient and what needs to be done to maintain/improve current presentation. Provide all subjective and objective data

Background:Identify all contributing factors for selected case’s chronic conditions and current health exacerbation. Identify their chronic condition and what happens when chronic conditions are not well manage as per the literature. What are the issues that let up to this situation? What were the contributing factors for their current heath exacerbation? (Case 1- has osteoarthritis, diabetes and hypertension and atrial fibrillation – has a history of missing her local GP appointments and runs out of her medications.)

Assessment:Form your assessment, what do you believe is the problem here? (Both cases need support with self-management- they require coordination of their care by a community RN- Think about the requires resources how to keep stable in the community and how to improve their health.)

Recommendations:Effectively identifies all nursing assessment, intervention and strategies for the selected case to effectively manage his/her chronic condition using a self-management approach. Self-management support should include disease education, treatment (medication adherence) and what to do when unwell. Develop an action plan  recommend nursing visits every organising/picking up Webster/blister packs, escort to GP appointments. Diet advice, exercise, breathing strategies, symptoms and pain management including fatigue, improving the quality of life- aim for setting goal, self-management and independence, and family and carers support-support strategies, resources available, support groups information. 

Discuss the literature on the nurse’s role in chronic disease self-management.(A key element of the nurses role is recognising, preventing and mangeing any deterioration while promoting greather functional ability for older people. This approach support the health and wellbeing of the older persons and prevents inappropriate or avoidable hospitalisations or early entry into residential care.)

Discuss primary and secondary health promotion and education strategies appropriate to the selected case. (Apply current and relevant data when discussing primary and secondary health promotions and education strategies appropriate to the selected case. Why a primary and secondary health promotion and education strategies appropriate to the selected cases and what would likely happen without these strategies in place). 
Conclusion.

Case Study 1
Clare Giardini is a 70-year old women, who frequently presents to both her local General practitioner and also the local emergency department. In the last three months she has presented to the local hospital with shortness of breath six times. On occasion she misses her local GP appointments and runs out of her medications whilst waiting for her pension.

Social History
She lives happily on her own and has two adult children who live several hours away. Clare’s husband passed away over five years ago from complication of his diabetes and cardiac disease and she cared for him during his last few years. Clare lives in town in government housing and she enjoys knitting and playing with her pet cats. Clare grew up in her local town and has never left in her 70-years she has many friends that she meets at the local club for lunch twice a week.

Medical History
Clare has a history of osteoarthritis, non-insulin dependent diabetes and hypertension. A recent echocardiogram showed systolic dysfunction and a poor left ventricular ejection fraction, and she is noted to have chronic controlled atrial fibrillation.

Medications
• Metformin 
• Paracetamol
• Diclofenac
• Quinapril
• Furosemide

Objective data
• Temperature 36.8
• Radial pulse 91 beats per minute and irregular
• BP 112/65 mmHg 
• Cardiac system S1 and S2, present, no murmurs
• Respiration rate: 22 breaths per minute and shallow, SpO2 94%
• Lung sounds: crackles in both bases
• BGL: 8 mmol/L
• HbA1C: 75mmol/mol

Subjective data
• Pain is 2/10
• Fatigue
• Orthopnea
• Nocturia up to six times per night

Case Study 2
Freddie Hankin is a 69 year old Australian Indigenous man who lives in regional NSW. He was diagnosed with Stage III lung cancer one year ago. In last two month, he has presented to the local hospital with symptoms of pain and dyspnea three times. Freddie says he is afraid his condition is deteriorating. 

Social History
He lives with his wife (Annie) (both self-funded retirees) and his young grandchildren for whom he and Annie have been providing care. He enjoys gardening and playing with his dog. He and Annie bring his young grandchildren to child care twice a week. He and Annie will use this time to meet their friends in the local restaurant. 

Medical History
Freddie has a history of hypertension and benign prostatic hyperplasia (BPH). He also suffered from emphysema two years ago. He takes regular treatment for his hypertension and pain. 

Medications
• Amlodipine 
• Verapamil
• Paracetamol
• Tramadol
• Oxycodone 

Objective data
• Temperature 36.5
• Radial pulse 85 beats per minute and regular
• BP 160/95 mmHg 
• Respiration rate: 22 breaths per minute, 26 breaths per minute when he is in pain, SpO2 97%
• Lung sounds: whistling noise while breathing 

Subjective data
• Pain is 6-8/10 (before taking pain tablets), pain is 4-5/10 (after taking pain tablets)
• Fatigue
• Orthopnea
• Nocturia up to five times per night

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