Unstable ischaemic heart disease

Mr. Jack Charles owns and manages a Market Garden mainly producing celery and herbs. He has hypercholesterolemia managed with Lipitor 40mg nocte. He and his son “Thomas” share this business together. Thomas has a wife and three young children aged 2, 4 and 6.

Mr. Jack Charles is a 78-year-old type 2 diabetic. He was first diagnosed in 1999 with hypertension then 2 years later as a type 2 diabetic. His wife Gladys has been managing his diet and medications until she died in 2010., his hypertension is managed with Aldomet 50mg daily, and his type 2 diabetes is managed with diet and Metformin 500mg slow release BD. He has been struggling to manage his health and work on the Farm.

Mr. Charles was admitted to a Private Hospital 65 days ago with unstable ischaemic heart disease. On admission, his BGL was 20 mmol/litre and he had polyuria, polydipsia and polyphagia. He required emergency Quadruple Coronary Artery Bypass Grafts (CABGs)that were complicated post-operatively by a Right Cerebrovascular Accident (RCVA).

 

After ten (10) days he was transferred to a Private Rehabilitation Centre to receive specialized post-stroke management. He has L leg weakness, L arm weakness and dysphasia as a result of his ischaemic stroke.

Medications in Rehabilitation 

Hypertension is now managed by Captopril 50mg TDS

Diabetes is now managed by TDS Actrapid Insulin 10 units

Hypercholesterolaemia us managed by Lipitor 80mg

Clexane 80mg BD subcutaneously

He will require Oral warfarin on discharge, dosage to be determined.

 

Q1.2  Seek information from Mr. Charles, and as appropriate, with family or carer to confirm their understanding of the condition and its impact.

What question/s would you ask Mr. Charles and his son “Thomas “to determine if they have an understanding of one of Mr. Charles’ chronic health conditions and its impact on their lives and activities of daily living?

 

Q1.3  In the Post Stroke Rehabilitation Program,

identify the current treatments given by teach of the following members of  the interdisciplinary health team

Medical Doctor, Nurse, Physiotherapist, Occupational Therapist, Speech Therapist

to Mr. Charles in rehab and on discharge.

 

Q1.4   Identify community-based care services that are available for Mr. Charles with a need for restorative or rehabilitation care.

 

 

Q1.5  Actively involve Mr Charles in the development of strategies to self-manage his condition. Describe the strategies, or design a program to help teach Mr Charles how to self-manage his Type 1 Diabetes and the introduction of insulin therapy.

Please make reference to:

  • Sugar free diet
  • The importance of BGL’s

The storage of insulin

 

Q2.1  Identify current contribution of other agencies and professionals in supporting Mr Charles. For the following agencies and professionals, determine their contribution in providing care for Mr Charles in hospital, or following discharge.

Please make reference to the following:

  • GP
  • Pharmacist
  • Centrelink
  • RDNS
  • Physiotherapy
  • Hydrotherapy
  • Diabetic nurse educator
  • Wound care nurse
  • Q2.2   Identify the level and type of contribution and support made by family or carer.
  • Q2.3   As a nurse, identify four (4) situations you will communicate with allied health professionals to describe Mr Charles progress.  Provide an example for each situation of how and what is communicated.
  •  Q2.4   Respond to variations in Mr Charles needs in the context of a coordinated service approach. Mr Charles is very sad and writes: “I can’t live like this.  I just want to die- and I know how to do it.”  As a nurse, how will you respond and what members of the health care team will you contact to help deal with this situation?

Q2.5 After consultation with the Endocrinologist and Diabetic Nurse Educator, Mr Charles has been told he will need to manage his insulin injections to help control his Type 1 Diabetes.  How will you as a nurse, educate and evaluate Mr Charles understanding of his diabetes and new management regime? Please make reference to the following:

  • Sugar free diet
  • Checking of BGL
  • Storage of insulin
  • Injection of insulin