Instruction
- You will receive a Satisfactory (S) or Not Yet Satisfactory (NYS) result for this assessment.
- The assessment criteria are stipulated on the rubric to help guide you in this assessment.
- There are three case studies, each representing a different person with a different condition (i.e.: Congestive Cardiac Failure (CCF), Chronic Obstructive Pulmonary Disease (COPD) and Parkinson’s disease respectively).
- Each of these case studies will be the focus of learning in the classroom, you will be provided with simulated activities using industry documentation to enhance your learning for each of these three case studies.
- This assessment provides students with the opportunity to work collaboratively in the classroom to help prepare them for the advantages and pitfalls of collaborative work on the job. Working collaboratively means that you can draw upon the strengths of all group members i.e. one student may be stronger in critical thinking skills and another may excel in organisational skills. By working in groups, students learn from each other while they complete assigned tasks. However, you must be careful when submitting your individual assignment that you submit your own work and do not plagiarise (refer to the Plagiarism & Cheating Policy).
- Read the given scenarios carefully and provide your response in the given space.
- You must attempt to answer all questions to demonstrate competency in this unit.
Ensure you answer each part of the question with the required amount of detail.
Scenario – 1: Mr John Doe (CCF)
John Doe is a 78-year-old man who lived in a supported accommodation house until his physical condition deteriorated requiring hospitalisation in 2009.
John spent several weeks as an inpatient in the sub-acute wards whilst waiting for an aged care assessment for high level care. During this admission, John had many nocturnal hypoglycaemic episodes.
John was admitted to a high level residential aged care facility for permanent care in 2009 due to his self-care deficit. He continued to have many nocturnal hypoglycaemic episodes as well as many during the day as he refused to eat meals and monitor his diabetes correctly.
John has a history of:
Congestive Cardiac Failure (CCF)
•Type 2 diabetes mellitus, he is now insulin requiring, the diabetes is classed as “brittle”.
•Bilateral pleural effusions
•Gastro esophageal reflux disease (GORD)
•Anaemia
•Hypothyroidism
•Alcohol abuse
•Aortic stenosis
•History of bilateral lower lobe and mid right lobe pneumonia
•Peripheral neuropathy
•Pancreatitis.
John’s medications include:
•Gemfibrozil
•Creon
•Thyroxine
•Aspirin
•Levemir
•Novorapid
•Actrapid
•Metamucil
•Perindopril
•Cholecalciferol
•Pantoprazole
Physical appearance:
•Average height – 172 cm.
•He has good color tones, pink complexion.
•He weighs 78 kg – gained 2.5kg since admission
•BMI – 28
Cardiovascular system:
•Skin on hands pick, warm and intact, no indication of cyanosis.
•Peripheral refill is under three seconds for the capillary beds in finger tips.
•Good skin turgor.
•Nails are clean, pink and dry with no indications of other disease processes.
•Left and right radial pulse rate and rhythm on the day of examination are both within normal range.
•John refused palpation of the femoral pulse.
•Unable to auscultate or palpate blood pressure, which is not unusual, GP has difficulty in finding the BP.
•No scars or pigmentation changes are present on face.
•Pale conjunctiva on examination, which is an indicator of anaemia. This is explained in the results of last full blood examination; indicating slight anaemia (may be related to constant blood noses where large clots are being passed mostly at night or in the morning shower). This is still under investigation at present.
•John’s mouth is pink, moist and very clean, tongue is also pink moist and clean.
•Chest shape form the anterior is symmetrical, no deformities. No scars present.
•There is an audible murmur between S1 and S2 when heart sound auscultated.
•John’s jugular vein pressure (JVP) is 5 cm, unable to visualise the carotid pulse.
•JVP alters when abdominal pressure is applied; it flickers more times during this examination. This strongly indicative of abnormalities to the ventricle.
•The results from the echocardiogram show physical changes to the heart.
•Notes state there is a grade one impairment of the left ventricle.
•He also has both mitral and tricuspid valve regurgitation as well as severe aortic stenosis.
•These are audible on auscultation.
•No oedema present to sacral area or to lower limbs.
•Both the pedal and dorsal pulses were unable to be palpated.
•Skin to lower legs is shiny, pale and there is sparse hair growth.
•Feet and toes are pale and cool to touch.
•Peripheral refill to toes is five seconds, indicating changes to perfusion of the feet, still able to feel touch to feet, nil complaints of pain.
Respiratory system:
•The chest appearance is normal, both sides look symmetrical and respiration rate at rest is eighteen breaths per minute.
•No sign of dyspnoea.
•No accessory muscles used to breathe.
•No cough present and his trachea is midline.
•Respirations are normal 18 breaths per minute
•No clubbing to fingers
•Fingers are clean dry and pink in colour there is no wasting present.
•Dupuytren’s contractures present to both hands.
•Pulse rate and rhythm is regular 80 beats per minute.
•Sclera is clear in both eyes.
•Mouth is clean pink and moist, and no hoarseness or alterations to voice are audible.
Gastrointestinal system:
•On visual examination there are no obvious deformities, scars of pigmentation changes.
•No wasting or jaundice noted.
•Obvious layers of adipose tissue to the abdomen on visual examination.
•The abdomen looks normal, no scars or pigmentation changes, there is an obvious large layer of adipose tissue on the abdomen, no distension noted.
•Visually there are no prominent veins, bruising or masses.
•Unable to palpate any organs due to the amount of adipose tissue present on the abdomen.
•Unable to percuss any of the organs for the same reason, the sound is the same dull sound across the entire abdomen.
•Auscultation of the bowel was normal, bowel sound present with normal sounds and amount.
•No audible sounds auscultated over the general region of the liver and kidneys.
•John stated that he experienced intermittent upper epigastric pain.
•Repetitive episodes of vomiting and nausea.
•Abdominal x-rays show increased faecal loading, no obstruction
•Refused groin examination.
•No oedema or bruising present to his legs.
•Biochemistry shows a small discrepancy in his potassium and bicarbonate levels.
•Other biochemistry markers are within normal ranges
•HbA1c is 7.3 mmol/l; indicating fair control.
Muscular Skeletal System:
•Skin is pink, slightly cool to touch and symmetrical when compared side by side.
•No nodules on fingers.
•John denies pain in joints or muscles.
•Nails are clean, dry, and pink with white nail tips.
•No ridging or pitting present
•There is small round scars on the right middle and ring phalanges.
•The scars are from blisters that rise for no known reason, burst, ulcerate then heal; this condition is called Diabetic bullae and is common to the fingers.
•Dupuytren’s contractiures on palmar surface to both hands
•The right hand is significantly more affected than the left hand.
Neurological System:
•Cognition:
•Good cognition and communication skills.
•Able to understand and follow directions for the nervous system assessment.
•Cognitive function test score of ten out of ten.
•Psychogeriatric Assessment Score (PAS) is two indicating minimal impairment
•Cornell Scale for depression completed with a zero score.
•Like his own company and spends most of his time in his room reading, watching TV and spending time with the facility cat.
•Able to undertake his own activities of daily living.
•Able to shower, dress, groom, toilet and eat with minimal assistance.
•Denies experiencing any dizziness or seizures.
•No visual tremor.
•No muscle weakness.
•No swallowing difficulties or speech changes.
•Problematic issue with hypoglycaemia.
•Blood glucose levels drop rapidly and without symptoms, most of the time.
Deterioration of medical condition:
•Over a period of several weeks John Doe’s condition changed.
•Increased lethargy
•Increased shortness of breath on exertion
•Complaints of dizziness
•Increased nausea and vomiting
•Disinterest in food
•Oedema to ankles present
•Chest tightness
•Dry cough
•Nocturia
•Altered blood glucose levels – increased hypoglycaemia
Vital signs:
•BP 114/61
•Pulse 76
•Respirations 18
•Temperature 36.6
•O2 saturations RA 97%
•Height 172cm
•Weight 78kg
Medication changes:
•Lasix 80mg daily PO
Conservative medical treatment:
•Due to current multiple co-morbidities John Doe was not considered to be a candidate for valve replacement surgery.
•Palliative approach to care was undertaken.
Qs
1 Define CCF
Congestive cardiac failure refers to a chronic health condition characterised with fluid build-up around the heart that eventually impairs its pumping mechanism. The incapability of the heart to effectively pump the required amount of blood leads to peripheral or pulmonary oedema.
2 Describe the pathophysiology of CCF
Congestive cardiac failure is a condition that is caused by many abnormalities such as a decreased efficiency of heart muscle, pressure and volume overload, primary or excessive peripheral demands like a high output failure. These are caused by various conditions like hypertension, myocardial infarction, and amyloidosis. These conditions gradually augments the workload that will bring about modifications to the heart. In a usual heart failure, the cardiac muscle has decreased contractility, which in turn produces a decline in cardiac output that becomes insufficient to address peripheral demands of the body.
3 Describe the ageing process on the cardiovascular system.
