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3000 word care study outlining aspects of care to be delivered to an individual living with an ongoing condition based on a selection of given scenarios (see module guide). There should be a focus on discussing the nature of their illness, including, an outline of its biopsychosocial effects on the service user, key therapeutic interventions to be given, making reference to supporting research evidence. - you should select 2 or 3 interventions for deeper contemplation. It should emphasise the holistic nature of health and illness, consider the role of the service use in the self management of their condition and contemplate the educative and coaching components of the nursing role in helping service users become more independent. 100%
Scenario on which to base the Critical Analysis of a patient pathway (please choose one)
Scenario 1
Clare is a 54 years old Caucasian lady who visited her General Practitioner (GP) with a complaint of headaches and blurred vision for about 4 weeks. She is a full time Market Research Manager and is married with four children ranging from seven to eighteen years of age. Her husband works away from home, hence Claire is the main carer for her children on a day to day basis. She leads a very stressful life but was previously fit and healthy, and had not visited her doctor for almost four years. The reason for her visit then was for the treatment of Reactive Depression following the death of her father 4 years ago.
Clare’s initial health check, revealed that she was in the obese category, with a body mass index (BMI) of 34.46. As part of the assessment, her blood pressure was monitored and was recorded as 172/119 mmHg. She was sent home with an electronic sphygmomanometer to record her blood pressure three times daily over a one week period. The average values which were obtained over the rest of the week was 159/92mmHg and this assisted the doctor in confirming a diagnosis of Stage 1 hypertension. She was subsequently commenced on a daily dose of the antihypertensive medication Ramipril 2.5mgs once daily at night time and referred to the practice nurse for lifestyle modification advice.
Scenario 2
Katie is an 18 year old student, who has recently moved away from home to undertake a Primary Teaching degree at University. Now living in University accommodation, Katie has been enjoying her newly found freedom and is engaging in an active social life with her co students, although describes her course as being stressful.
Katie attended her GP surgery as she had begun to feel concerned about experiencing episodes of breathlessness, especially at night-time, when she described her symptoms as “waking suddenly fighting for breath”. She informed her GP that this has been a pattern that has continued over a period of approximately two months.
Katie lives with three other students in her university accommodation. She describes being away from home as difficult but has made some good friends and is enjoying an active social life. Previously a non-smoker, Katie now states that she smokes the occasional cigarette when out during an evening, but never more than two or three in total. Katie has no previous health complaints. Her baseline observations of pulse, blood pressure and respirations were all normal when examined in the clinic. As part of Katie’s assessment, her GP requested that Katie self-monitor her peak flow recordings for a fortnight before returning with her readings. When she returned to surgery, the GP established a diurnal variability of the peak expiratory flow rate (PEFR) that was greater than 20% on several days of each week she self-monitored.
The GP diagnosed Katie as having developed mild asthma and prescribed her a Salbutamol inhaler, 1-2 puffs up to four times a day. He also referred her to the asthma nurse for more advice about self-management of her asthma and lifestyle modifications .
Scenario 3
Ramesh is a 49 year old man, originally from Pakistan, but who has lived in the UK since he was seven years of age. He visited his GP complaining of increasing and unexplained lethargy and tiredness which he felt had been getting worse over the period of about four months. He also reported experiencing blurred vision.
Ramesh is a full time taxi driver, working up to 12 hours a day, 7 days a week. He is married to Gaugan and has two teenage boys. His wife does not work presently and Ramesh is the main breadwinner in the family. He has little time for leisure and admits to not taking regular exercise. He states that until quite recently he considered himself fit and healthy.
Ramesh’s initial health check by the GP revealed that at 1:70cm in height and 105.4kgs in weight, Ramesh had a body mass index ( BMI) of 36.4. During his consultation Ramesh disclosed that despite feeling very tired and lethargic , he found it difficult to sleep as he needed to pass urine several times during the night, He also advised the doctor that he occasionally experienced pins and needle type sensations in his right foot.
A capillary blood glucose assessment was undertaken which revealed a glucose level of 17.2m/mols glucose. Subsequent random glucose, fasting glucose and HbA1c tests led to a diagnosis of type 2 diabetes mellitus being confirmed.
The GP commenced Ramesh on 500mgs of Metformin orally TDS and referred him to the Diabetes Specialist Nurse for more advice about self-management of his Diabetes and lifestyle modifications.

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