Gordon Deltori Case Study - Nursing Assignment

Case Study:

Mr Gordon Deltori, a 68-year-old male taxi driver presents to the emergency department (ED) at 0900hrs C/O chest pain which began around midnight. Gordon describes the chest pain as a dull, achy radiating to the neck. He states that when he went to bed, he felt tight in the chest and woke up with chest pain which he retrospectively rated 4/10. He now rates his pain as 6/10 but denies SOB or other associated symptoms. Gordon states, “the pain is a lot worse this time” and explains that it was only the 3rd time he has had to use his engine in five months. This time it “did not seem to help”, he laments. He is worried and says don’t know how to look after my family if I didn’t get better”. Gordon’s wife Anna appears obviously distressed. “I don’t know what to do with him…he eats fast food while working and has not exercised in years……he rarely sees the doctor’ and refuses to take medication. He has tried to give up smoking but finds it difficult as he has smoked since he was 14 years old.

His past medical conditions are hypertension for 10 years, atrial fibrillation, osteoarthritis, type 2 diabetes for 5 years. He is on perindopril, apixaban, arginine, metformin, and vitamin D. He does not know the names of his tablets and is vague about why they were prescribed. He wonders if he really needs to keep taking them and he is not sure if they are doing him any good.

Examination data:

General survey: Alert, diaphoretic, anxious, cooperative, well-groomed male. Appears older than stated age.
Vital signs: Temp 37.1 C, HR 120bpm (regular), RR 24, BP 169/90mm Hg.
Peripheral Pulses: All pulses palpable. Dorsalis pedis 1+ bilaterally. All other 2+. 
Precordium: Apical impulse 120bpm regular and strong. S1 and S2 with no murmurs. Visible pulsation with thoracic heave observed.
Neck: Jugular distension and pulsation noted with a patient in a supine position.
Lower extremities: Skin warm and dry, without cyanosis. Even hair distribution. 2+ pitting oedema noted bilaterally, no lesions present.Height: 173cm, Weight: 91kg, BMI =?
 
INSTRUCTIONS:

1. Provide an overview of the patient’s condition and outlining the purpose of the paper.

2. Describe the patient’s presenting problem focusing on the pathophysiological issues.

3. You need to identify all the care priorities of the patient from this scenario and present a comprehensive discussion and justification identifying the first two nursing care priorities within a clinical scenario using the Levitt-Jones’ Clinical Reasoning Cycle. Students are required to provide critical analysis and justification of the care priorities using appropriate literature.

4. Explain the pharmacokinetics of TWO medication that the patient takes.

5. APA citation and referencing system (rephrase sentences; do not copy-paste) and select >10 refereed articles that provide the strongest evidence for your topic.

6. All articles must be ? 7years old.