Case Study | Cheap Nursing Papers

Case Study

Case Study

Case Study Scenario

Luna Sorian is a 48-year-old woman with alcohol-induced cardiomyopathy. Her most recent left ventricular ejection fraction (LVEF) is 20%. Luna’s daily activities are limited by dyspnea and fatigue. Luna’s medications include:

  • Lisinopril 20 mg/day
  • Furosemide 40 mg twice daily
  • Carvedilol 12.5 mg twice daily
  • Spironolactone 25 mg/day
  • Digoxin 0.125 mg/day

Luna has been stable on these doses for the past month. Her most recent laboratory results include:

  • Sodium (Na) 140 mEq/L
  • Potassium (K) 4.0 mEq/L
  • Chloride 105 mEq/L
  • Bicarbonate 26 mEq/L
  • Blood urea nitrogen (BUN) 12 mg/dL
  • Serum creatinine (SCr) 0.8 mg/dL
  • Glucose 98 mg/dL
  • Calcium 9.0 mg/dL
  • Phosphorus 2.8 mg/dL
  • Magnesium 2.0 mEq/L
  • Digoxin 0.7 ng/mL

Luna’s vital signs today include blood pressure (BP) of 112/70 mm Hg and heart rate (HR) at 68 beats/minute (bpm). Her lung examination is clear.

Assignment Instructions

After carefully reading the scenario, respond to the following two-part assignment:

Part A: Of the following options provided, explain which is the best approach for maximizing the management of Luna’s heart failure (HF), and why the others would not be an ideal therapeutic change at this time. Please use the textbook, along with appropriate clinical guidelines for heart failure, and/or primary literature articles as needed to formulate your response.

  • Increase Carvedilol to 25 mg twice daily
  • Increase Lisinopril to 40 mg/day
  • Increase Spironolactone to 50 mg/day
  • Increase Digoxin to 0.25 mg/day

Part B: Luna’s therapy is optimized based on your recommendation for Part A. Her case illustrates an important distinction between medication selection and dosing for heart failure and other cardiac conditions. Explain the major differences when choosing and titrating doses in HF versus hypertension.

Assignment Requirements

  • APA formatting: required for references.
  • Page length: each question is a 1-2 paragraph response (concise yet thorough) on one Word document.
  • References: use sources no older than five years (if not using the textbook); cite when appropriate. Include a references list.

To view the assignment rubric for this course, please go to My Grades in your course menu. Locate the assignment in the list and select View Rubric.

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case study

Assessment Task 2 –Case Study Weighting: 40%
Word count: 1600 words (every question has a specific word count, which must be adhered to) Instructions:

  • Students are to choose one (1) of the case studies below and answer the associated questions. The assignment is to be presented in a question/answer format not as an essay (i.e. no introduction or conclusion).
  • Each answer has a word limit (1600 in total); each answer must be supported with citations.
  • A Reference List must be provided at the end of the assignment.
  • Please refer to the marking guide available in the unit outline for further information. 
** The following questions must be answered for your chosen case study ** The following questions relates to the patient within the first 24 hours:
    1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)
    2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words)
    3. This can be done in the form of a table – each point needs to be appropriately referenced
    4. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)
    5. This does not mean specific drugs but rather the class that these drugs belong to.
    6. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).



Case Study 1

Mrs Sharon McKenzie is a 77 year old female who has presented to the emergency department with increasing shortness of breath, swollen ankles, mild nausea and dizziness. She has a past history of MI at age 65. During your assessment Mrs McKenzie reports the shortness of breath has been ongoing for the last 7 days, and worsens when she does her gardening and goes for a walk with her husband.

On examination her blood pressure was 170/110 mmHg, HR 54 bpm, respiratory rate of 30 bpm with inspiratory crackles at both lung bases, and Sp02 at 92% on RA. Her fingers are cool to touch with a capillary refill of 1-2 seconds. Mrs McKenzie states that this is normal and she always has to wear bed socks as Mr McKenzie complains about her cold feet.

Her current medications include: digoxin 250mcg daily, frusemide 40mg BD, enalapril 5mg daily, warfarin 4mg daily but she sometimes forgets to take all of her medications.

The following blood tests were ordered: a full blood count (FBC), urea electrolytes and creatinine (UEC), liver function tests (LFT), digoxin test, CK and Troponin. Her potassium level is 2.5mmol/L.

Mrs McKenzie also has an ECG which showed sinus bradycardia, and a chest x-ray showing cardiac enlargement and lower-lobe infiltrates.

Impression: Congestive cardiac failure



Case Study 2

Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was referred to the local hospital for further investigation.

Maureen was diagnosed with rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple exacerbations of RA which have required the use of high dose corticosteroids. She is currently taking 50mg of prednisolone daily, and has been taking this dose since her last exacerbation 2 months ago.

Maureen also has type 2 diabetes which is managed with metformin. She is currently studying nursing at university and works part-time at the local pizza restaurant.

On assessment, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg; Temp 36.9oC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the fat is mainly distributed around her abdominal area, as well as a hump between her shoulders.

Maureen’s husband notes that her face has become more round over the past few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH levels, and high levels of low density lipoprotein cholesterol. She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level measurement.

Impression: Cushing’s syndrome


Case study 3

Mr Nathan James is a 48 year old male who was admitted to the high dependency unit for investigation of jaundice and ascites. He is an interstate truck driver and is married with 2 children. Mr James is a current smoker and known to consume 2 of beer per day. He has a previous (15 years ago) history of recreational drug use and was diagnosed with Hepatitis C 10 years ago.

On assessment:

Mr James is lethargic but orientated to time, place and person and slightly irritable. He is slightly tachypnoeic with moderate use of accessory muscles. His wife reported that Mr James has been spitting blood stained sputum for the last few weeks with no associated cough or shortness of breath. Mr James reports that he has lost 9 kilos in weight which he attributed simply to a lack of appetite. No changes were reported with his urine output. On examination his sclera is mildly jaundiced and has some “unexplained” bruises on his arms and legs. His abdomen is tight and distended and pitting oedema noted on his ankles.

Observations: BP: 115/60mmHg, HR: 110 bpm, RR: 24 bpm, SpO2: 88% on RA, 95% on 6L via Hudson Mask, Temp: 37.8C

Impression: Liver Cirrhosis


Laboratory Findings:

Result  Normal Values 
RBC 4.0 million/mm3 2.6 to 5.9 million/mm3
WBC 3500/mm3 4300 to 10800/mm3
Platelets 75000/mm3  150000 to 350000/mm3 
Serum Ammonia 110 μm/dl 35 to 65 μm/dl
Total Bilirubin 4.9 mcg/dl  0.1 to 1.0 mcg/dl 
Sodium 150 mEq/L 135 to 145 mEq/L
Potassium 3.4 mEq/L 3.7 to 5.5 mEq/L
Haemoglobin 85 g/L 120-170 g/L
Albumin 24 g/L 35-50 g/L
Liver Enzymes  Slightly elevated
BUN 22 mg/dl 7-18 mg/dl
Creatinine 154 ml/min 88 to 137 ml/min


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