Chronic Illness

Chronic Illness

CASE STUDIES
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Case Study 1: George Polaris

Mr George Polaris, is a 62-year old Italian man who initially presented to hospital with increased shortness of breath, fever and a productive cough. He was first treated for a chest infection and given IV antibiotics. Over the course of his hospitalisation, George underwent a series of respiratory examinations/tests and was ultimately diagnosed with chronic obstructive pulmonary disease (COPD). George also has a history of gastro-oesophageal reflux disease (GORD).
George was discharged from hospital and is now being followed up at his local GP clinic. It is 10:00am and you are the Registered Nurse at the clinic initially meeting with George.
He explains to you that he had several episodes of shortness of breath and a cough on exertion over the last year but he thought he was just getting old and was not able to work hard any more. Prior to his hospital admission, his shortness of breath was a lot worse. He has also lost several kilograms, and now weighs 65 kg with a height of 178cms.
George tells you that he works as a labourer in the construction industry and lives with his wife, who works at the local supermarket. He is a smoker who has smoked 20 cigarettes/day since he was 14 years old. George says he does not drink and has no known allergies.
Current vital signs:
Temperature 36.7?C, Blood Pressure 135/88 mmHg, Pulse 100 beats/min, and Respiratory Rate 22 breaths/min
Current Medications:
Salbutamol (Ventolin)100 micrograms MDI, 2 puffs when required up to 4 times daily
Tiotropium (Spiriva) 18 mcg inhaled by mouth OD
Esomeprazole magnesium (Nexium) 40 mg PO OD
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Case Study 2: Anna Lenska
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Mrs Anna Lenska is a 68 year old retired woman who, for the past 6 months, has been a client of the Community Health Service for treatment of an ulcer on her right lower leg. She has a history of hypertension and Type 2 diabetes requiring oral hypoglycaemics.
Anna is widowed, lives alone and has no immediate family. Her neighbour usually takes her to do her shopping. Her leg ulcer has been dressed twice weekly by community Registered Nurses in accordance with the wound specialist nurse’s instructions. The leg ulcer is slowly healing.
It is 7.30am and you, the community Registered Nurse, arrive at Anna’s home for the wound assessment and dressing change. Upon arrival, Anna complains that she is feeling a “bit faint” and asks you to check her blood sugar level (BSL). The BSL reading is 3.5 mmol/L. You follow the recommendations for hypoglycaemia, and Anna begins to feel better and her BSL increases to 6.2mmol/L.
On talking with Anna, you discover that she has not been eating well because her neighbour has been away and she has not been able to get out to do the shopping. She has been wearing an old pair of closed toe shoes as her other more comfortable shoes had become too broken down to wear. She also says she sometimes forgets to take her medications.
Current vital signs:
Temperature 36.5?C, Blood Pressure 160/90 mmHg, Pulse 84 beats/min, and Respiratory Rate 15 breaths/min
Current medications:
Metformin 1g PO daily
Metoprolol 25mg PO BD