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jansportz
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Fri Apr 08, 2011 3:04 pm
Last edited Apr 08, 2011, 03:10 pm
Update #1
Im in second year of nursing. Maybe you could help out! Here is the case scenario, Mr Belami is admitted to hospital yesterday morning - scheduled for left hip replacement this afternoon. He has reported having an episode of chest pain yesterday morning prior coming to hospital. It was relieved by resting. He suffers from shortness of breath on exertion He has reduced his cigarette smoking (30 per day) since being diagnosed with angina, now smokes 10 per day. Mr Belami complains of central chest pain and is rubbing his sternum and looks distressed. Now the preceptor asks you to make a problem list for Mr Belami. You identify these problems; Impaired gas exchange Ineffective breathing pattern Altered cardiopulmonary tissue perfusion Pain Activity intolerance Altered health maintenance Potential impaired skin integrity Anxiety Altered role performance Potential altered parenting Here is the Question: From the list of identified problems in the case study please choose the patient's 3 most critical problems?
modified: Friday 08 April 2011 3:24:57 pm - jansportz
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sidak
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Apr 12, 2011, 09:44 pm
I think the order should be
pain
altered cardiopulmonary tissue perfusion
ineffective breathing pattern
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megan08
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Apr 13, 2011, 12:15 am
Hi I was thinking 1) pain, 2) anxiety, 3) ineffective breathing pattern. How I am looking at it is, if we can reduce the level of pain the patient is experiencing then hopefully the patient's anxiety will also decrease. We all know that if we are in pain then our anxiety automatically escalates and the sympathetic nervous system takes over as a way of coping with the stress, increasing heart rate which will exacerbate the chest pain even more and increasing respiratory rate causing hyperventilation or an impaired breathing pattern. so basically fix the pain then then patient will be less anxious, if the patient is less anxious then they will be able to breathe more effectively and more calmly, if they can breathe more effectively then there will be improved gas exchange and hence better tissue perfusion and less chance of impaired skin integrity and so on and so on down the list. Does this help at all? I'd love to know what others think, it's a good scenario! Megan
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jansportz
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Apr 13, 2011, 04:50 pm
@sidak thanks! @megan08 hey thanks, yeah ur answer does help. I chose Pain and Anxiety as in order but im unsure for the third problem. Cheers, Homer
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Ally-Syn
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Apr 27, 2011, 10:20 pm
Hey! I'm doing this assignment too!! haha I'm so confused about what to choose also... Pain is for sure, reducing pain reduces anxiety which hopefully reduces innefective breathing pattern altered cardiopulmonary is my second choice, because you'll be needing to keep their 02 levels up for all the breathing issues... (also will reduce anxiety and chest pain) and i'm not sure what my third should be... when you fix one generally you fix the others the same way... and all the other problems should decrease with those two done...
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jansportz
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Apr 28, 2011, 02:19 pm
@Ally-Sin Are you a VU second year nurse student too?lol ive asked some few other student n they chose Pain, Anxiety, and Altered cardiopulmonary tissue perfusion. so my first is pain n anxiety -we can reduce pain while anxiety is reducing too at the same time because these are an immediate priority. then third is altered cardiopulmonary tissue perfusion n YES u were rite u need to maintain the oxygen level up!
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Ally-Syn
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Apr 29, 2011, 10:20 pm
Yep I am!!! I chose those three... anxiety can lead to angina :) go team
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Koukla
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Apr 30, 2011, 01:35 pm
Am really stumped with this one... I've picked my three major issues 1. Altered Cardiopulmonary Tissue Perfusion 2. Pain 3. Anxiety But don't really know where to start in the describing the underpinning pathophysiology of each problem. I find that for example altered cardiopulmonary tissue perfusion, how far should we go into to it. Have looked at numerous text and online and just find that it may go way to far into detail but is that what is required or not? I'm sure nurses on the job are more interested in care plans for actually relieving symptoms than the detailed explanation of gas exchange between cells. I'm at a dead loss as to where to start, this particular question????
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jansportz
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Apr 30, 2011, 02:17 pm
Last edited Apr 30, 2011, 02:17 pm
update #1
@Koula use LeMone Medical-Surgical book they mention about the pathophysiology of cardiopulmonary tissue perfusion. i think altered cardiopulmonary (heart and lungs in my knowledge lol) is when there is not enough blood with O2 flowing in coronary arteries or blood vessels of the heart n same thing with lungs which is located in alveoli! use the pathophysiology book n it might help also! i find it very easy to answers the care plans than question 1 & 2! Sorry i cant help much
modified: Saturday 30 April 2011 2:21:38 pm - jansportz
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Koukla
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Apr 30, 2011, 03:09 pm
Thanks Jansportz, have looked at that many text books and internet articles, I'm overloaded and getting in a bit of a state. Will go over Lemone as you suggested (have a cuppa and settle down a bit), as I think the problem is I'm going a bit too much into detail. Essentially, I don't want to just reinterate what is in the text books i want to show that I have the capacity to critically think through the issues and decide what is the best course of action for the patient. Thanks again :)
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Koukla
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Apr 30, 2011, 03:12 pm
Hey Jansportz, you are right the care plans are a breeze compared with the first couple of questions lol :)
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