Chronic Illness

  CASE STUDIES . Case Study 1: George Polaris Mr George Polaris, is a 62-year old Italian man who in" rel="nofollow">initially presented to hospital with in" rel="nofollow">increased shortness of breath, fever and a productive cough. He was first treated for a chest in" rel="nofollow">infection and given IV antibiotics. Over the course of his hospitalisation, George underwent a series of respiratory examin" rel="nofollow">inations/tests and was ultimately diagnosed with chronic obstructive pulmonary disease (COPD). George also has a history of gastro-oesophageal reflux disease (GORD). George was discharged from hospital and is now bein" rel="nofollow">ing followed up at his local GP clin" rel="nofollow">inic. It is 10:00am and you are the Registered Nurse at the clin" rel="nofollow">inic in" rel="nofollow">initially meetin" rel="nofollow">ing with George. He explain" rel="nofollow">ins to you that he had several episodes of shortness of breath and a cough on exertion over the last year but he thought he was just gettin" rel="nofollow">ing old and was not able to work hard any more. Prior to his hospital admission, his shortness of breath was a lot worse. He has also lost several kilograms, and now weighs 65 kg with a height of 178cms. George tells you that he works as a labourer in" rel="nofollow">in the construction in" rel="nofollow">industry and lives with his wife, who works at the local supermarket. He is a smoker who has smoked 20 cigarettes/day sin" rel="nofollow">ince he was 14 years old. George says he does not drin" rel="nofollow">ink and has no known allergies. Current vital signs: Temperature 36.7?C, Blood Pressure 135/88 mmHg, Pulse 100 beats/min" rel="nofollow">in, and Respiratory Rate 22 breaths/min" rel="nofollow">in Current Medications: Salbutamol (Ventolin" rel="nofollow">in)100 micrograms MDI, 2 puffs when required up to 4 times daily Tiotropium (Spiriva) 18 mcg in" rel="nofollow">inhaled by mouth OD Esomeprazole magnesium (Nexium) 40 mg PO OD . . Case Study 2: Anna Lenska . Mrs Anna Lenska is a 68 year old retired woman who, for the past 6 months, has been a client of the Community Health Service for treatment of an ulcer on her right lower leg. She has a history of hypertension and Type 2 diabetes requirin" rel="nofollow">ing oral hypoglycaemics. Anna is widowed, lives alone and has no immediate family. Her neighbour usually takes her to do her shoppin" rel="nofollow">ing. Her leg ulcer has been dressed twice weekly by community Registered Nurses in" rel="nofollow">in accordance with the wound specialist nurse’s in" rel="nofollow">instructions. The leg ulcer is slowly healin" rel="nofollow">ing. It is 7.30am and you, the community Registered Nurse, arrive at Anna’s home for the wound assessment and dressin" rel="nofollow">ing change. Upon arrival, Anna complain" rel="nofollow">ins that she is feelin" rel="nofollow">ing a “bit fain" rel="nofollow">int” and asks you to check her blood sugar level (BSL). The BSL readin" rel="nofollow">ing is 3.5 mmol/L. You follow the recommendations for hypoglycaemia, and Anna begin" rel="nofollow">ins to feel better and her BSL in" rel="nofollow">increases to 6.2mmol/L. On talkin" rel="nofollow">ing with Anna, you discover that she has not been eatin" rel="nofollow">ing well because her neighbour has been away and she has not been able to get out to do the shoppin" rel="nofollow">ing. She has been wearin" rel="nofollow">ing an old pair of closed toe shoes as her other more comfortable shoes had become too broken down to wear. She also says she sometimes forgets to take her medications. Current vital signs: Temperature 36.5?C, Blood Pressure 160/90 mmHg, Pulse 84 beats/min" rel="nofollow">in, and Respiratory Rate 15 breaths/min" rel="nofollow">in Current medications: Metformin" rel="nofollow">in 1g PO daily Metoprolol 25mg PO BD