- 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.
- 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.
- Identify all contributing factors for selected case’s chronic conditions and current health exacerbation.
- Identify all nursing assessments, interventions and strategies for the selected case to effectively manage the chronic condition using a self-management approach.
- Discuss the literature on the nurse’s role in chronic disease self-management.
- Discuss primary and secondary health promotion and education strategies appropriate to the selected case.
1.1.1 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.
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.
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.
- 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
- Pain is 2/10
- Nocturia up to six times per night
1.1.2 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.
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.
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.
- 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
- Pain is 6-8/10 (before taking pain tablets), pain is 4-5/10 (after taking pain tablets)
- Nocturia up to five times per night
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