Scenario John John Explained for Students (Easy Guide)
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Original Question
Scenario 1 – John Doe John Doe is a 78-year-old man who lived in supported accommodation until his physical condition deteriorated and he was admitted to your ward for assessment and potential aged care placement. Past History – Heart Failure (left-sided) Medications – Aspirin, Perindopril, Lasix. Assessment – Alert and orientated Nil complaints of pain Slightly cool to touch and pale Increased lethargy. Peripheral refill is less than 3 seconds for capillary beds on fingertips but 5 seconds to toes Oedema present to lower limbs Dorsalis pedis and posterior tibial pulses are absent Chest appearance normal Shortness of breath on exertion Persistent productive cough Vital signs: BP 110/61 HR 90 RR 22 O2 Saturation 95% Temp 36.6. Q1 a. Define left-sided heart failure b. List four (4) common signs and symptoms of left-sided heart failure (A “sign” is something you can see/hear/measure, a “symptom” is something the patient describes – be careful not to use medical diagnoses as a S/S) c. Describe the pathophysiology of each of your 4 listed signs and symptoms (Remember “pathophysiology” is how the disease affects the function i.e., due to severe dehydration, blood volume is reduced and therefore blood pressure) Q2 Why does left sided heart failure often lead to right sided heart failure? Q3 After completing the respiratory assessment, explain what you heard and the cause of this sound. Q4 Describe why the patient is experiencing SOBOE (include in your answer why SOB doesn’t occur when he is resting)? (Think about which tissue group is used more with movement, what the tissue requires for this movement, and how meeting that requirement is impaired) Q5 Explain the pathophysiology that is causing oedema in John’s ankles. Q6 Explain why an absent dorsalis pedis and tibial pulse is significant, and what it may be an indication of? Q7 This patient was prescribed an increase in Furosemide (Lasix) to 80 mg Daily. Using your Harvard’s Nursing Guide to Drugs, look up this medication and… a. Discuss why this medication will benefit the patient b. Identify potential interactions (side effects) that may occur between the diuretic drug Furosemide and the ACE inhibitor (Perindopril) John is also taking Q8 A nursing intervention for this patient includes a daily weigh. a. What does this intervention aim to monitor and evaluate for this patient? b. What could be the likely factors that could cause an increase of 1kg? Q9 Develop two (2) nursing diagnoses for this patient. For each diagnosis develop two (2) nursing interventions and appropriate rationales for each.
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