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).
Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell.
In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.
God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.
Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.
To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.
Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.
Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.
Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.