Bob Brown's Case Summary

Nurses must identify and prioritise key issues in presenting patients to determine patient care needs and the implications for nursing practice. This essay discusses Bob Brown, a 63-year-old male, who has presented post fall with a fractured right patella, on which he cannot bear weight, and damage to an existing lower left leg venous ulcer. Bob has a history of hypertension, elevated cholesterol, and poorly controlled type II diabetes. He has recently quit smoking and drinks up to 12 beers on the weekend. He lives a sedentary lifestyle and works long hours in Information Technology. His father died at 65 from an Acute Myocardial Infarction (AMI), and his mother lives next door and requires assistance with Activities of Daily Living (ADL's).
The first priority is damage to Bob’s pre-existing venous ulcer on his left lower leg. Falls can introduce infection and further impair skin integrity in existing leg ulcers, thus increasing the likelihood of secondary infections and associated complications (Doenges, Moorehouse, & Murr, 2014). The second priority is Bob's blood glucose levels. Bob is at risk for unstable blood glucose levels related to poor management of his type II diabetes. An analysis of blood glucose levels provides a method for monitoring the effectiveness of therapy and provides direction for alteration of medications, such as additional regular insulin, allowing treatment for underlying metabolic dysfunction, hyperglycaemia and promotion of wound healing (Doenges, Moorehouse, & Murr, 2014). The third priority is Bob's level of pain related to his leg ulcer and his fractured patella. Level of pain is determined through a patients’ description (Doenges, Moorehouse, & Murr, 2014). A level of pain assessment provides a baseline for assessing improvement and changes after treatment (Doenges, Moorehouse, & Murr,
Bob has a history of hypertension, elevated cholesterol, and poorly controlled type II diabetes, along with a family history of AMI. The implications for nursing practice include assessment of nutritional intake and education on healthy nutrition (Dunning, 2013). Foods that are high in complex carbohydrates and low GI, low in fat, contain protein, low in sugar, low in salt, as well as limiting alcohol intake contribute to a healthy diet (Better Health, 2017; Dunning,