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
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
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.
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
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
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).
Writing audits that Indian managing an account framework comprise of a bigger structure on of money related foundations, Commercial banks, outside monetary organizations. These auxiliary changes of Indian back framework can be partitioned into three sections. To start with, the post freedom period (1947-1968). The Reserve bank of India, performed part as a director and controller of fund framework. RBI, ruled over every one of the types of back controls in India. In this time RBI, dealt with money related solidness, credit control, and direction of financing costs and development managing an account structure. The second money related suppression, period <1969 to 1990> the development initiated with the nationalization of banks. This nationalization of business banks infers the base for changes in fund and managing an account framework. The outcome into loan fee control and credit software engineers store and managing an account working strategies and so forth. The third time frame known as money related change and advancement period. Begun in mid 90's. In that period administration of India will probably more changed. The three advisory group in 1985, vagual in 1987 and the Narasimham council 1991. The most compelling suggestions made by the board of Narasimham in regards to advancement, combination and privatization in keeping money framework. Also, the legislature of India began a budgetary change period with the monetary part progression program. The primary points of monetary progression program is to direct the rates of premium, money stores and execution budgetary framework comprise of monetary foundation stocks trades and banks. It influences progression to program improve the significance of keeping money part and make it more proficient and aggressive. The globalization, deregularisation and privatization framework accentuated on Washington accord. These leads nation to shortsighted method for changing framework by working of market and state possessed establishment's rebuilding. The advancement program rolled out improvements inner economy. It rehashed more aggressive and profitable in shorter period. The liberal loan costs and hold breaking points of banks came about into steady and sound acquiring and loaning market and fiscal approach of government. The bank requires to keep certain measure of stores to evade too vulnerability a future because of aggressive market another component of managing an account changes is adjustment, non performing advance, which oppressive for banks are recapitalized and require standard workplace a standout amongst the best part is modification of state possessed banks into private division banks. Under the administration controls state claimed banks prescribes to offer out its open bit to private division and devour people in general property in other monetary task which needs more finances and these assets are taken from the privatization of state possessed banks. Under the Nationalization demonstration 1969, the biggest banks were nationalized with the point of increment out in the open stores. The explanation for the nationalization of banks to develop the economy and bank arrange extension. The administration of India requires upgrading the economy and serving to earlier zones. In 1980, more six banks were nationalized included into open offer in banks to continue arriving to monasteries' regions. It was material to control on managing an account framework and came about into increment in need zone landing and five year designs of Indian Government. In addition, these transformed into wastefulness in keeping money framework as opposed to giving equivalent circulation of assets. Expansion managing an account framework confronted issues in 1980s these are the time of unrewarding quality and wastefulness and in mid 80s makes more confinements on returns and capital and stores. These leads banks to the impossible execution gauges. As say over the 1991 Narasimham council provides food an affecting thought on managing an account area changes which romanticized on loan cost deregulation, credit administrations and section of new counts on Indian market private and also outside banks. Prior to the panel, financing costs were medium of backup between various parts of economy. Deregulation of loan costs was significant piece of making changes that offered development to monetary investment funds and enhance authoritative back framework. On alternate hands board suggested add up to progression on stores rates. In 2004 RBI set rates for the funds and NRI stores rates rest of alternate stores banks are allowed to exact their rates. The last real proposal of board of trustees was on section of new banks in Indian market. Before it was a constrained specialist to the banks to do with loan fees and stores, there were absolutely confinements for new banks section. Because of liberal perspective of new banks section in Indian market seven private and twenty remote banks began their tasks in India after 1990. According to RBI (2004), the liberal part of new banks passage enhanced the nature of activity, hazard administration, innovative changes and rivalry. Likewise, before 1990 open segment bank twisted market framework by its non benefit and wasteful administration. To recoup the dependability in advertise Government infuse more subsidizes in 1993 and 1999 to sell the administration and contributors bear loses through open part banks. In 1995 SBI act confined incomplete privatization of open segment banks and SBI was the main bank to get subsidizes in type of value and wind up private segment bank. Regardless of incomplete privatization Government choose to expand the private holding up to 49 rate and to control managing an account framework arrangement was made for an open specialist to control regulatory methodologies after every one of the progressions have been made the Indian keeping money area covers a few changes and investigate the change impact. In the event of privatization of Indian banks there are just financing costs, credit control and stores rates to know the adjustments in economy are increment in reserve funds. It predicts the evacuation of store strategy in heating will prompt increment in capital accessibility these can roll out improvements in private segment capital development. The loan costs make change shapes the settled store rates, loaning rates are expanded and relentlessly decrease in 1990 which impact on the present market. The Repressioninst arrangement diminishment enhances the hazard administration of banks it means that liquidity. The advancement regarded as an instrument of money related approach renewal of credit rates and statutory loaning rates the division of two rates in least and most extreme can continuously impact the severe of fiscal strategy. As the progression program meant to make banks more effective and gainful to make the productivity out of managing an account segment in view of specialized effectiveness, scale and degree proficiency called parametric and non parametric proficiency. The parametric strategies considered keeping money returns and information like creation and benefit, cost, income to know how successful bank is performing. In Indian conventional economy expected to lift the keeping money segment through mechanical changes, worldwide market, monetary weight and bank emergency compelled to change in method for working together in customary way. It helps in increment in rivalry at neighborhood advertise by expulsion of loan costs on current record, store rates. More rivalry upgraded the administration of banks in free administrations, capital development and mergers. The Indian economy faces different difficulties because of privatization. To begin with, the administration unfit to consider the running of nationalized banks amid 1997-1998 emergencies. In this period government can't weight the security holders to uncover their holding and these makes issues in transaction of outside bank accomplices and for obligation pardoning issues. In spite of the fact that state possessed banks serves subjective and respectable assignment in managing an account part. In India, state possessed banks just work on remote territories like provincial and urban saving money. On the other hand some credit associations and money related foundation likewise appears, in remote territories state claimed banks support little and medium endeavors by loaning developers, in emergency time state possessed banks has snappy time to bargain. The process duration is speedier than private banks some time absence of nearby framework for fund, government association just is the best approach to get hands. These are the way state claimed serves open and make quality administration against less return against benefit. Privatization Experience and Issues The privatization as of late, the best approach to offer out a few states to some monetary establishments remote association. Other way government specifically pitch its parts to open in type of value in securities exchange. These technique may be valuable to nations state possessed banks since absence of supervision of bank administration, something else is to straightforward tasks previously it privatized, in view of they have to know the what they are purchasing. The awful factor amid privatization was bank commercialization and accumulation of credits. Globalization propose the more powerful consummation mostly nationalize banks along these lines moved to completely privatized in brief period for operational productivity later on the issue emerge on holding some offer for state. The offer of state in private banks infers the forces to impact the basic leadership and systems of banks. The way tolerating a state possession improves as an alternative. Mergers and combination and productivity The saving money framework comprises of different foundations in estimate, possession, focused gainfulness, structure and innovation. The connection amongst productivity and size of bank is relative, more modest number in having misfortune making establishment and ale association has extremely advantage over little association like profit for capital. However, littler banks have great effectiveness in work while expansive association. Above state bank combination is new wonder for rivalry because of section of outside banks, privatization and deregulisation. Emergencies deregulisation and globalization causes increment in the outside banks in economy, there is no uncertainty t>GET ANSWER