Case Study 1
Mrs Sharon McKenzie is a 77 year old female who has presented to the emergency
department with increasing shortness of breath, swollen ankles, mild nausea and
dizziness. She has a past history of MI at age 65. During your assessment Mrs McKenzie
reports the shortness of breath has been ongoing for the last 7 days, and worsens when
she does her gardening and goes for a walk with her husband.
On examination her blood pressure was 170/110 mmHg, HR 54 bpm, respiratory rate of
30 bpm with inspiratory crackles at both lung bases, and Sp02 at 92% on RA. Her fingers
are cool to touch with a capillary refill of 1-2 seconds. Mrs McKenzie states that this is
normal and she always has to wear bed socks as Mr McKenzie complains about her cold
feet.
Her current medications include: digoxin 250mcg daily, frusemide 40mg BD, enalapril 5mg
daily, warfarin 4mg daily but she sometimes forgets to take all of her medications.
The following blood tests were ordered: a full blood count (FBC), urea electrolytes and
creatinine (UEC), liver function tests (LFT), digoxin test, CK and Troponin. Her potassium
level is 2.5mmol/L.
Mrs McKenzie also has an ECG which showed
Case Study 2
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, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp
36.9ºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is
mainly distributed around her abdominal area, as well as a hump between her shoulders.
Maureen’s 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.
Impression: Cushing’s syndrome
3
Case study 3
Mr Nathan James is a 48 year old male who was admitted to the high dependency unit for
investigation of jaundice and ascites. He is an interstate truck driver and is married with 2
children. Mr James is a current smoker and known to consume 2 of beer per day. He has a
previous (15 years ago) history of recreational drug use and was diagnosed with Hepatitis C
10 years ago.
On assessment:
Mr James is lethargic but orientated to time, place and person and slightly irritable. He is
slightly tachypnoeic with moderate use of accessory muscles. His wife reported that Mr
James has been spitting blood stained sputum for the last few weeks with no associated
cough or shortness of breath. Mr James reports that he has lost 9 kilos in weight which he
attributed simply to a lack of appetite. No changes were reported with his urine output. On
examination his sclera is mildly jaundiced and has some “unexplained” bruises on his arms
and legs. His abdomen is tight and distended and pitting oedema noted on his ankles.
Observations: BP: 115/60mmHg, HR: 110 bpm, RR: 24 bpm, SpO2: 88% on RA, 95% on 6L via
Hudson Mask, Temp: 37.8C
Impression: Liver Cirrhosis
Laboratory Findings:
Result Normal Values
RBC 4.0 million/mm3 2.6 to 5.9 million/mm3
WBC 3500/mm3 4300 to 10800/mm3
Platelets 75000/mm3 150000 to 350000/mm3
Serum Ammonia 110 µm/dl 35 to 65 µm/dl
Total Bilirubin 4.9 mcg/dl 0.1 to 1.0 mcg/dl
Sodium 150 mEq/L 135 to 145 mEq/L
Potassium 3.4 mEq/L 3.7 to 5.5 mEq/L
Haemoglobin 85 g/L 120-170 g/L
Albumin 24 g/L 35-50 g/L
Liver Enzymes Slightly elevated
BUN 22 mg/dl 7-18 mg/dl
Creatinine 154 ml/min 88 to 137 ml/min
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).
