CASE STUDY
Case study 1
Introduction
According to the world health organization, the number one cause of death globally is cardiovascular diseases. The most prominent cardiovascular disease is myocardial infarction which is also known as heart attack(World Health Organization, 2012). Myocardial infarction can be recognized by its clinical manifestations, including the use of electrocardiogram (ECG) findings, biochemical markers elevation of myocardial necrosis and imaging (Daubert& Jeremias, 2010).
Management of Myocardial Infarction in the first twenty-four hours
When a person experiences myocardial infarction, the flow of blood in the coronary artery is usually obstructed leading to ischemia of the tissues of the heart tissue(Tortora& Defrickson, 2013). In acute myocardial infarction, the causative agent is thrombi (Reed, Rossi, & Cannon, 2017). The thrombus is formed when the conditions in the blood vessels that surround the cardiac muscles induce platelets adhesion or if there is slowed the flow of blood which causes accumulation of the clotting factors (Tortora & Defrickson, 2013). An antiplatelet drug should be administered to Hellen May immediately to break the blood clots. The recommended dose is 300mg of Aspirin (Reed et al., 2017). Aspirin is rapidly absorbed in the ileum and stomach and enters the circulation quickly and prevents the synthesis of thromboxane A2 which is a potent vasoconstrictor and an inducer of platelet aggregation(Vane & Botting, 2003; Warkentin, 2012). The nurse should make the patient aware of these side effects, and the patient should be carefully monitored and be made aware of these effects (Sostres & Lanas, 2015). However, if there is an elevation of the cardiac markers Troponin, the drug clopidogrel 75 mg OD will be administered to the patient(Agewall, Giannitsis, Jernberg, & Katus, 2011).
The levels of troponin should be observed in the patient’s blood. Routine high sensitivity test of troponin is crucial to rule out myocardial infarction (Wise, 2016). In patients with negative cardiac markers within the six hours of the pain onset, another sample for measurement should be drawn- within the 6 to 12 hour time frame (Braunwald et al., 2001). Troponin is a regulatory protein which controls the ability of the cardiac muscle to contract (Tortora&Defrickson, 2013).
Patients diagnosed with myocardial infarction, pain relief should be a priority, and hence analgesics should be administered quicky. While in the first instance it can be achieved by applying glyceryltrinitrate spray, opioid such as morphine, pethidine should also be offered, and it can be administered through intravenous route to allow rapid action. However, the oral morphine should not be given because of the of the fast metabolism by the liver in patients with myocardial infarction (Greenstein, 2012). Before administering morphine, it is crucial for the patients to be made aware of the potential side effects. The most common side the related to morphine is respiratory depression (Cox, 2010).
Because the cause of myocardial infarction is the formation of thrombi, it is vital to prevent coagulation of blood following myocardial infarction. Heparin which is a low molecular anticoagulant drug is recommended when beginning anticoagulant therapy to prevent thrombi formation.
Case study 2
Introduction
Bronchopneumonia is a condition that affects millions of peoples around the world annually. It is a condition that occurs as a result of the swelling or the inflammation of the bronchioles. Although it is quite similar to ordinary pneumonia, this condition can be acute and may require more aggressive treatment with antibiotics. The infection is bilateral, and it may affect multiple or single lobes. The situation presents with typical symptoms and signs such as chills, chest pain, cough, fatigue, and fever. Patients who are diagnosed with bronchopneumonia may present with a productive cough which, relief yellow or blood-streaked mucus(Sykes, 2013).
Bacteria are the causative organism, and the conditions arise when the bacteria gain access to the lungs. The most common forms of bacteria associated which bronchial pneumonia is the Pseudomonas aeruginosa and Staphylococcus aureus(Sykes, 2013). Whenever this species of bacteria infect the pulmonary lobes, the mucus which is produced by the lungs occupies the alveolar sacs. It results in consolidation which occurs when the airspace is reduced because of the mucus buildup inside the lungs. The reduction in air spaces leads to difficulties in respiration which causes shortness and shallow (labored breathing). The risk factors for the development of bronchopneumonia are advanced age of over 65 years, history of long-term ailments and low immunity. As in the case of Thomas Butler, he presented to the general practitioner with all signs suggestive of bronchopneumonia, he had a productive cough and raised complains of chest pain, lethargy and labored breathing. He also happened to fall in the category of the at-risk persons because he was at an advanced age of 72-years old.
Commencing antibiotic therapy is the primary mode of treatment in a patient’s diagnosed with bacterial bronchopneumonia. The objective of antibiotic therapy is to reduce morbidity, eradicate infection and prevent complication. Intravenous Benzyl penicillin five mega units will be administered 6hourly to Mr. Butler. The mechanism of action of Resets each is by inhibiting the synthesis of bacterial cell wall thus causing cell death(Bayles, 2000). Therefore with the bactericidal effects of this drug, there will be reduced inflammatory processes and less production of mucous and hence improved breathing(Bayles, 2000).
Mr. Butler will also benefit from inhaling bronchodilators which can be administered using a nebulizer. Nebulization with salbutamol will be vital because it will aid in the stimulation of beta-agonist receptors in the lungs which will help in the relaxation of bronchial smooth muscle thus relieving bronchospasms which may have been caused by the inflammatory process(Lenney& Evans, 1986).
Mr. Butler presented with labored and shortness of breathing hence supplemental oxygen via a nasal cannula becomes necessary which will be vital in preventing Mr. Butler from going into a state of hypoxia as a result of reduced oxygen intake. Many patients who present with broncho-pneumonia have fluid volume depletion, and hence Mr. Butler will benefit from intravenous crystalloid such as Normal saline alternated with 5% dextrose to prevent tachycardia or hypotension although care should employ to avoid fluid volume overload.
Qualitative Research Critique
Introduction
It is vital for an individual to acquire necessary skills for synthesizing and critiquing information. This expertise in critical analysis and information synthesis enables nurses to differentiate between practice and theory in nursing. The author of this article critically analyzes a research paper ‘Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality(Berg et al., 2013).’ The task of research critiquing will follow Caldwell et al. (2005) critiquing tool(Caldwell, Henshaw and Taylor, 2005).
Title: The title of a research study should be concise and informative. It should shed light on the research approach and be specific about the content to be handled(Rayner, 2005). In the opinion of the reader, the title of the research article is brief and seems to give adequate information about the primary subject of the study. The imagination of the reader is captured by the title thus warranting further reading. However, the title does not include the research approach although it comprised the study population. Therefore it is quite difficult for the reader to determine the study method which was employed at first glance. The reader infers that the investigators used a standard format in drafting the research title article but should consider including the study method used in the title of the article. The authors of the research paper are credible because they work with organizations which care for patients with cardiac conditions.
Abstract: Abstract is an integral component of a research article. It should have an objective/hypothesis of the study, statement of the problem, a brief report of significant findings, research methodology outline, and sample population details. The survey by had an abstract. In the opinion of the reader, the abstract is distinctive, thus making it an excellent summary of the study. The researcher highlighted the objectives of the study in the abstract in an easily noticeable way. The study design, sample population, significant findings, conclusion as well as keywords were included in the study. Then reader’s feels that the abstract of the study was done correctly because it contained all the information that requires appearing in an abstract.
Introduction and Background information: It is vital for an introduction of the research article to identify the problem and state the reasons for the problem and state limitations if available. It is commendable that the researchers presented the research problem early when they were describing the background information of the study. The reasons and rationale for conducting the survey were well articulated and were convincing to merit the investigators to do the study. It is appropriate for a research problem to be identified early in an investigation because it gives the reader the advantage of knowing the problem right away. The researchers identified lack of knowledge about patient’s experiences after heart surgery as the main reason for conducting the study. The rationale by the researcher was that the information collected would aid in the development of clinical guidelines. However, the reader feels that the investigators should also mention how their study will apply to patients who may require home-based care. The investigators should also have stated that the information
