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Apr 27, 2023


The present case of Aron depicts the onset of atrial fibrillation. The rhythm of the heart or the heartbeat is depictive of the normal functioning of the heart. Heart arrhythmia depicts an irregular heartbeat or rhythm. This arises due to the insufficiency of the electrical signals managing the heartbeat. These are the result of the insufficiency of the heart to pump blood effectively. Different types of heart arrhythmia occur depending on the speed of the heart these can be tachycardia and bradycardia. Tachycardia depicts the increase in the heartbeat i.e. more than 100 beats per minute (American Heart Association, 2023). The rhythm depicted by the electrocardiogram (ECG) of the Aron shows an irregular heartbeat with a pulse rate of 90 beats per minute, which is more towards the higher side of the normal range. His ECG showed flutter waves, also known as f waves, which showed that atrial fibrillation was present (AF). Also, he was displaying AF-related signs including palpitations, tightness in the chest, and dizziness. Hypertension and a poor diet are two lifestyle variables that may contribute to the development of AF. In the present scenario, Aron reported incidences of stress due to work and having a poor dietary lifestyle which can be the probable variables that lead to the existence of this condition. Hypertension and the presence of AF have long been linked. This results in the atrial remodeling that serves as the basis for AF (Nalliah et al., 2018). Electrical activity in the atria is disordered, producing erratic impulses that interfere with the SA node`s steady rhythm. A quick and erratic ventricular response could result from this. The structural alterations in the heart caused by chronic stress, such as fibrosis, can act as a substrate for the emergence of atrial fibrillation (AF). Atrial remodeling and electrical instability can also be caused by stress-induced inflammation and oxidative stress, which heightens the risk of AF (Chen & Ma, 2021).


Considering the case of Aron, the primary responsibility will be the regulation and monitoring of the cardiovascular status. Blood pressure (BP) management could be one possible intervention. His BP was 126/85mmHg, which is divergent from the normal range of 120/80mmHg (National Health Service, 2022). As he was hypertensive and displayed elevated levels of BP, continued assessment of factors leading to the elevation in the levels of BP should be a priority of the nurse. Management of preexisting hypertension, pain, and nausea needs to be monitored (Thomas & Amatangelo, 2019). He was also given atenolol and ramipril as possible medications to control his blood pressure within the normal range. Atenolol is used to treat incidences of chest pain and is used to control the increment in BP levels (MedlinePlus (.gov), 2017). Being a registered nurse (RN), one needs to encourage Aron to adopt lifestyle changes such as meditation and following a healthy diet to bring about a decline in his BP levels. Management of the cardiac status and vital signs monitoring is an important nursing intervention that nurses should take care of (Nesheiwat et al., 2021). The nurses should monitor the change in pulse rates or palpate pulses. While doing so the changes in heart rhythm can be visualized which aids in seeing the signs of arrhythmia.


A Multidisciplinary (MDT) approach to managing and handling patients is receiving extensive importance. The objective of the MDT is to provide patient-centered care and meet the needs of the patient and provide integrated care to the patient. The MDT teams integrate professionals from diverse backgrounds to collaborate and work towards attaining a single goal (Social Care Institute for Excellence, 2023). In the scenario of Aron, the cardiologist, and dietician are the core members of the MDT that can aid in providing quality care to him. Since he had AF so a cardiologist will be the most appropriate member of the MDT that assists in the management of his condition. Cardiologist is a specialist who deals with heart ailments. They assist in diagnosis and determining the medical management of the patient with AF. They help in prescribing medications for the current condition and procedures to manage the normal rhythm of the heart. In the present scenario also to lower the levels of BP, medications are prescribed like atenolol and atorvastatin. Dietician could be another possible member that could assist Aron to maintain a healthy weight. Dietician assists in the management of dietary habits according to the dietary needs of the patients (British Heart Foundation, n.d.). In the present case, he was having irregular dietary habits which lead to an increase in his weight to 95 kg. So a dietician would assist him in lowering his weight as being overweight increases the risks of heart failure.


Case Study 2


The present case study discusses Tyson, who was brought to the emergency department due to the incidence of recurrent vomiting. On secondary assessment, his vital signs were all within the normal range. After pathological examination, it was depicted that he had high levels of ketones and glucose in his urine and his urine was pale. Also after the examination, it was found that his blood glucose levels were 35mmol/L which is far high from the normal range and his bicarbonate content was 12 mEq/L which is relatively low from the prescribed normal range. After evaluating the result it can be predicted that he may be suffering from diabetic ketoacidosis. Increased ketone content is a result of insufficiency of the body to attain enough glucose which causes the body to break down fat to meet the energy requirement (American Diabetic Association, 2019). This occurs commonly in the case of diabetic ketoacidosis (DKA). Since he was experiencing episodes of vomiting and was in a state of confusion which can be depictive of early signs of diabetes. He may be experiencing a severe hyperglycemic-like condition which led to an increase in his glucose content. Insufficiency of insulin causes an increase in glucose levels that leads to the development of diabetic conditions (Diabetes UK, 2023). According to the results obtained, he was showing extremely high levels of glucose which causes excessive loss of glucose in urine and since the glucose was insufficient reaching cells, it caused the fat of the body to breakdown and which in turn caused excessive ketone bodies in the urine which lead to DKA (Centers for Disease Control and Prevention, 2022).


Considering the case of Tyson, the primary focus needs to be lowering the levels of glucose. Blood sugar management is one of the most imperative interventions that assist in keeping a check on the sugar contents of an individual with DKA (Ghimire et al., 2022). Insulin level management is imperative in the cases of DKA. A fixed rate of intravenous insulin needs to be provided either in the form of an injection or via a pump (Association of British Clinical Diabetologists, 2022). Insulin management is imperative as it promotes the uptake of glucose via tissues and enhances the process of gluconeogenesis and lowers the incidences of ketogenesis. Maintaining accurate levels of ketones is also an essential intervention. Acidosis results in affecting varied organs. Reducing the levels of ketones in the urine is imperative to restore the normal functioning of the body. Ketones cause the release of acetoacetate and acetone which are used as a source of energy by the various organs of the body in deficient glucose and can be hazardous owing to their acidic nature. Monitoring the levels of ketone to below 0.6mmol/L is extremely crucial (Dhillon & Gupta, 2022). Monitoring routinely the levels of ketones is crucial to provide relief to the condition of Tyson.


DKA is a medical condition that may become life-threatening if left untreated as it is often associated with extremely high levels of glucose. The accurate management of such cases requires appropriate examination of the vitals and evaluation of the factors causing the condition. Physicians are crucial members of the MDT that are involved actively in the management and regulation of cases of DKA. Physicians aid in determining the accurate levels of blood glucose and reducing the ketone levels and determining the procedures required to bring relief to the patient. Since Tyson was showing a trend of rapid weight decline, a dietician can be another member that could assist him with his condition. Dieticians can aid by providing food chards and a dietary routine for the management of normal levels of nutritional requirements (Steinke et al., 2017)


Case study 3


The present case study encircles Cheryl who shows the clinical presentation of gastrointestinal disease. She also presented the case of hematemesis or blood vomiting which may be indicative that she was experiencing internal bleeding in the gastrointestinal tract. She was depicting tenderness in the upper right quadrant and bowel sounds which indicate that she may be suffering from gallbladder issues, more precisely cholecystitis. This condition is characterized by swelling of the gall bladder and the gallstones resist the flow of bile. She was experiencing continuous episodes of pain and her pain in the upper abdomen was elevated. The pain she was experiencing may be due to the hindrance in the drainage of bile from the gall bladder which causes episodes of extreme pain in the upper abdomen (Sigmon et al., 2022). She also reported incidences of blood vomit that can indicate bleeding in internal organs and can indicate bleeding in the biliary tract or hemobilia and this condition can be fatal (Chang et al., 2022). She was sweating excessively which is an indicative symptom of the existence of cholecystitis (National Health Services Inform, 2023).


Considering the case of Cheryl the primary management strategy would be a reduction in her abdomen pain. Assessment of abdominal pain is an important nursing intervention (Jones et al., 2017). In the present case, she was experiencing pain in the upper right quadrant and hence the physical assessment for the symptoms of pain needs to be there. In cases of recurrent acute pain, the nurse should contact the healthcare professional to cause relief the pain. Monitoring the signs of internal bleeding and vomiting could be another possible nursing intervention that can be effective in this case of Cheryl. Increased levels of vomiting can make the body deficient in essential nutrients like sodium and potassium. Internal bleeding can occur due to increased obstruction in bile flow which requires immediate medical attention to reduce the condition from becoming fatal. Nurses play a critical role while monitoring the patients, assessing their progress, and hence seeing for the symptoms that may worsen the condition.


A member of MDT the role of the nurses would be to coordinate and collaborate with different professionals to integrate care for diseased individuals. The physician is the critical member of the MDT who is authorized to manage the overall care of the patients. In the present case, the physician can regulate the diagnostic procedures aiming at providing relief to her. The physician can prescribe medication for the pain relief that she was experiencing, regulate the imaging procedures to determine the severity of the condition, and determine the overall care plan for her. Another imperative member that may assist Cheryl can be a dietician. A dietician is a person who regulates dietary changes to improve the quality of life of the patients. The dietician can educate the patient and also form a specific diet aiming at promoting the health of the patient. In the present scenario, Cheryl was consuming alcohol extensively which had impacted her quality of life. So a dietician can assist her in causing changes in her drinking habits by educating her and can incline her towards a better lifestyle.


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