Essay Bill McDonald Case Study – Nursing Assignment Help

Assignment Task:

Assessment Tasks 

During the semester, you will engage in an assignment, vsim online and clinical skill performance assessment and a written examination. The assessment tasks are designed to assist you in meeting each of the course learning objectives and are described as follows: 

Laboratory Attendance (HURDLE) 

You are required to attend ALL six skills laboratory sessions and a class roll will be kept. You will need to provide a medical certificate to the course coordinator, for any non-attendance at skills laboratory sessions. You are expected to complete the pre-reading, questions, exercises or worksheets related to each session. These will not be collected or assessed, however, the content will form the focus of discussion and class participation in the skills laboratories and will be examinable. Failure to attend all lab session without evidence will result in an NH fail Case Study Assignment (25%) 

Details of the task: 

Case Bill McDonald is a 75-year-old male patient who was previously diagnosed with type 2 diabetes. He has smoked one pack per day of cigarettes for 35 years and has a history of heavy alcohol use but quit both after he was diagnosed with diabetes 1 year ago. 

He was started on metformin 500 mg oral twice daily, was increased to 1000 mg twice daily 6 months ago. His latest HbA1c level is 7.2 %. Morning fasting glucose in the past week ranging from 4.5 to 7 mmol/L, however his glucose control has been unstable, fluctuating over the last 3 months. 

Bill’s mother had diabetes and died of heart failure at age 65 years. Bill is running a juice bar and loves fresh fruits, especially banana. He has a sedentary lifestyle. 

A week ago, he presented for a regular GP visit and was noted to have a blood pressure of 170/100 mmHg, he was asymptomatic, with no headache, dizziness or blurred vision, but reported his eyes to get tired easily. 

On examination, he is 175 cm tall, the weight of 123 Kg (from 156 kg two years ago), had regular resting pulse rate at 82 /min, respiratory rate 18, temperature 37. The review of physical systems was unremarkable. No skin or nail lesions were noted but there was pitting oedema in both lower legs. 

Urine analysis revealed an increased level of protein (4+). A blood test showed an increased level of urea (25 mg/dl) and serum albumin (6.1 mg/dl) and decreased Estimated Glomerular Filtration Rate. A 24-hour urine test revealed higher than normal rate of urinary albumin excretion. 

Question set A:

Analyse the case and respond to below two questions in the essay 

• Discuss the pathophysiology of type 2 diabetes as it relates to the chronic symptoms the patient is experiencing. 

• Analyse the potential management approaches (medical and nursing) for a hypertensive diabetic patient. 

One week after visiting the GP, Bill presented to the emergency department alone with a 24 hour history of nausea, vomiting, and severe right lower quadrant abdominal pain with radiation over his periumbilical area. He stated to the doctor that he had had similar pain over the last week but not as bad as it was now. Following assessment and investigation, Bill was diagnosed as having acute appendicitis and is scheduled for laparoscopic appendectomy in theatre in 4 hours. 

On examination, Bill is 175 cm tall, the weight of 120 Kg. His temperature is 37.5 ; 25 breaths/min, pulse 115/min. BP 140/95mmHg. The review of systems shows clear lung and heart sounds. His blood glucose is 5.0 mmol/L. Bill was conscious but anxious. 

Question set B 

Analyse the case and respond to below one question in the essay 

• Explore the nursing considerations and strategies involved in the management of Bill, prior, during and after the acute surgical operation. 

Bill returned home after a five day stay in the hospital. Although he has slowly recovered from the above ED visit and operation, he has been feeling fatigued for the past few days and become increasingly depressed about his health status. He started drinking two large glasses of red wine on most evenings for two weeks since he was discharged. 

One night, Bill was fast asleep when he experienced a sudden onset of epigastric pain at 2 am. He thought it was heartburn due to what he had eaten for dinner, but when he woke up at 5 am, the pain had not subsided and started to intensify and radiate into his jaw and left shoulder. Bill drove himself to the Emergency Department. 

On arrival at the ED, Bill reported 9/10 crushing pain in his chest, nausea, and diaphoresis. A 12- lead ECG was taken (see below ECG strip). Blood work revealed increased level of Cardiac Troponin T (cTnT) and Creatine Kinase – MB (CK – MB). 

Question set C

Analyse the case and respond to all below two questions in the essay 

• Discuss the pathophysiology of the acute cardiac event Bill is experiencing. 

• Analyse the immediate management approaches (medical and nursing) for Bill with an acute cardiac condition.