Bruce is an 82 year old man who lives with

Bruce is an 82 year old man who lives with his wife, 78 year old Agnes, in their own home. They have raised four children, most of whom live within a 45 minute drive of their home. Bruce and Agnes are no longer keen about driving to visit their children and grandchildren but have retained their driver’s licenses and are able to attend local community gatherings/events of their choice, shop, visit friends and medical appointments. Bruce’s early working life was as a farm labourer and shearer. Whilst most of his employment was shearing, he supplemented the income with labouring work included fencing; ploughing, sowing and harvesting assorted grain crops; hay and grain carting; and some stock droving. After purchasing their own home in a small rural town, Bruce was employed at a local stock feed mill for many years. Following several respiratory tract related illnesses Bruce left the stock feed mill and worked as an agriculture assistant at the local high school until he retired. He is not a highly social man, preferring his own company and occasionally that of a few close friends. Agnes maintains an active interest in the community through volunteer work and her involvement in Rotary. Some of her siblings live in the district and she talks with them on a semi-regular basis. She also maintains contact with friends she made during her children’s schooling and sport endeavors. The meet up mostly for a monthly luncheon gathering. In the past Bruce has been a very heavy drinker, consuming at least 8-12 cans of beer each day, and adding two flagons of sherry on weekends. In recent years he has curbed his alcohol intake to three glasses of whiskey per day. He was also a heavy smoker, giving up following a cardiac episode 8 years ago. Since retiring at age 63 years, Bruce has continued his woodworking interests, spending many hours ‘tinkering’ on projects for his family or community organisations. For many years he maintained an extensive vegetable garden orchard and chickens that gave him much pleasure and he enjoyed sharing his crops with neighbours and friends. In the past few years, water restrictions and changes in his health have meant his capacity for planting and maintaining the garden have become increasingly limited. The vegetable garden is now an extended area of grass and weeds for mowing and the fruit trees have fallen into disrepair. Bruce finds this hard to observe and impacts on his mental wellbeing. Bruce’s current medical history reflects his employment history and lifestyle choices. He suffers from a chronic back injury that has restricted his capacity for exercise; chronic obstructive pulmonary disease (COPD); congestive cardiac failure; intermittent angina; type 2 diabetes; and gastric ulcers. He wears glasses for reading and has well-fitting upper and lower dentures. Three months ago he was admitted to hospital with severe abdominal pain. A CT scan revealed an abdominal mass. Bruce is overweight (105 kg) and until the last few months has had a ‘good’ appetite, with a tendency to indulge his love of sweets such as lollies and chocolates, particularly in the evenings. He usually structures his day around taking his frusemide to ensure he has timely access a toilet. Should circumstances not permit, Bruce will omit his frusemide for that day. His comorbid conditions have significantly impacted on his level of activity, which he also finds frustrating. Bruce has consistently opted for conservative management of his various chronic conditions, a decision Agnes has supported. Current medications, as reported by Bruce: • Furosemide, 40mg BD • Potassium chloride, slow release 600mg mane • Magnesium Aspartate 1.65mmol, 2 tabs daily • Anginine PRN • Diltiazem hydrochloride 180 mg once daily • Metformin, 500 mg BD • Pantoprazole 40mg daily • Symbicort Turbohaler 400/12 two inhalations BD • Spiriva 18mcg daily, via handihaler • Ibuprofen, 2 tablets 4-6 times per day • Paracetamol Osteo 665 mg, 2 tablets TDS Bruce presented to his GP last week (5 days ago) feeling unwell, with general lethargy, increased SOBOE with productive cough of frothy sputum, and decreased appetite. At that appointment his vital signs were: T – 37.8 P – 84 RR – 24 BP – 134/88 SpO2 – 92 on RA BGL – 13.2 Weight – 106kg Chest auscultation demonstrated coarse crackles and wheezing throughout most lung fields and clubbing of his fingers and nailbeds were noted. Oedema in both legs was noted to knee level. Chest xray (CXR) and microscopy, culture and sensitivity (MCS) of sputum were not ordered at this time. The GP prescribed Amoxycillin 500mg QID, Prednisolone 25mg daily for 5 days and Ventolin inhaler PRN, for a chest infection. He also increased his frusemide to 80mg mane and added sprinolactone 25 mg BD. Bruce has presented to the local hospital where you work today, with deterioration of his symptoms, and significant SOB. Vital signs on presentation were: T – 39.2 P – 96 RR – 32 BP – 144/98 SpO2 – 88% on RA Pain 7/10 BGL – 6.4 Weight 110kg Bruce was clearly quite distressed, has a persistent productive cough, is restless, and anxious. There is evidence of central cyanosis, his mucous membrane is quite dry, and skin turgor is decreased, but there is evidence of fluid leaking from both legs, which are very swollen. His wife has attended with him, and as Bruce is struggling to speak, has provided much of the information. She advises that his SOB has been worsening over the past 3 days, and he has not been able to lay down at night, so has taken to sleeping in the chair – she indicates this is where he is spending most of his time. They have not been able to make an appointment to see his GP. His appetite is significantly diminished, and even fluid intake is down despite complaining of a dry mouth and feeling very thirsty, due to the shortness of breath. The pain in his back has also escalated, due to spending so much time sitting. He has continued to take his medications as prescribed. CXR was attended, showing pulmonary oedema. ECG was unchanged from previous reports. The VMO has reviewed Bruce, and he has been admitted to the ward, and prescribed the following: IV Furosemide 80mg mane, 40mg midday until review Oxygen via nasal prongs (titrate to SpO2 92%) Salbutamol 5mg and ipratropium 250mcg nebulisers QID Salbutamol 5mg nebulizer PRN Daily weight Fluid balance chart Fluid restriction 1000ml/day Endone, 5mg 6 hourly prn He is to continue his previously prescribed medications, with the exception of the oral Furosemide, and inhalers.Analyse the case study and essay addressing the following points: a. Discuss the pathophysiology of the underlying chronic health condition that has resulted in the acute presentation to the hospital, as identified in the case study. b. Discuss the clinical manifestations relevant to the chronic condition and underlying pathophysiology. you are required to link the disruptions to normal physiology that have resulted in abnormal assessment findings. c. Describe how living with co-morbid conditions create complexity and influence the patient’s capacity for self care. d. Describe how the diagnosis of co-morbid conditions creates complexity and influences patient management for clinicians. e. Identify and prioritise three relevant evidence-based, nurse-initiated interventions that will work to relieve the acute symptoms the patient is experiencing and outline how they will address the underlying pathophysiology. Nursing interventions must be safe, evidence-based and within the registered nurse’s scope of practice.

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."