choose one (1) of the case studies below and answer the associated questions.
The following questions relates to the patient within the first 24 hours since admission to the emergency department (ED):
1. Outline the causes incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words)
a. This can be done in the form of a table each point needs to be appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs belong to.
4. Identify and explain in order of priority the nursing care strategies you as the registered nurse should use within the first 24 hours post admission for this patient(500 words).
Case Study 1: Myocardial infarction with history of stable angina and mitral valve stenosis
Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina
and mitral valve stenosis. Mr Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest
pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr Savea is an ex-
smoker tobacco free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community.
On assessment Mr Saveas vital signs are: PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2
indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has a ST segment elevated myocardial
infarction. Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain free on admission to CCU.
Case Study 2: Cushings Syndrome
Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding abdominal pain and fatigue which has been worsening and was referred to the local hospital
for further investigation. Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old and has experienced multiple exacerbations of RA which have required the use of high dose
corticosteroids. She is currently taking 50mg of prednisolone daily and has been taking this dose since her last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with
metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant.
On assessment Maureens vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9C: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and thefat is mainly distributed
around her abdominal area as well as a hump between her shoulders. Maureens husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test
results show low cortisol and ACTH levels and high levels of low density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon and is currently collecting urine for
a 24-hour cortisol level measurement.
Case Study 3: Decompensated Liver Cirrhosis