CHAPTER I

THE PROBLEM AND ITS SETTING

Introduction
Intensive Nursing Practicum is the application of the
theories, principles and concepts of clinical nursing
practice to groups of clients in varied settings to refine
nursing skills in different basic nursing services
including community. Emphasis is placed on integrating the
multiple roles of professional nursing as vehicle to
enhanced critical thinking and communication skills. The
placement are 4
th
year, 2
nd
semester. The course objectives
first apply the nursing with varied conditions and the
community. It includes the assessment of the client's total
condition and resources, formulate nursing diagnosis based
on the data gathered, develop a plan of care for
individual, family and community, implement plan of care,
applying appropriate interventions, evaluate outcome of
care. Second is to demonstrate competencies of a beginning
staff nurse , head nurse, researcher and leader. Third is
observation of bioethical principles, core values and
standards of nursing care. And promotes personal and
professional
growth(http://www.uic.edu/ucat/courses/NUPR.htm).
An enlarged heart is medically known as cardiomegaly.
Cardiomegaly can be caused by a number of different
conditions, including diseases of the heart muscle or heart
valves, high blood pressure. Arrhythmias and pulmonary
hypertension. Cardiomegaly can also sometimes accompany
longstanding anemia and thyroid diseases, among other
conditions. Infiltrate diseases of the heart, for
example,in which abnormal proteins (amyloidosis) or excess
iron (hemochromatosis) accumulate within the tissues of the
heart, can also cause an enlargement of the heart.
Infections, nuritional deficiencies, toxins (such as
alcohol or drugs), and some medications have been
associated with cardiomegaly. In some situations (for
example, pregnancy) there can be a temporary increased
demand on the heart, resulting in some temporary
enlargement.
It is important to remember that an enlarged heart is
not a disease itself but a physical sign that can accompany
many diseases and conditions. Treatment and prognosis are
dependent upon the underlying cause (Fauci,2008).


General Objective
To develop a deep understanding of the disease to
render effective management to client thus preventing
complications.
Specific Objectives
To identify the client's status through physical
assessment as well as her lifestyle, environment, etc. Also
to prioritize the client's problem regarding the control of
the disease. Educating the client regarding the disease,
its management and care and prevention of complications.
As a student nurse, I will be able to enhance the
understanding about the disease including its
pathophysiology, risk factors, and management. Also to be
able to promote and improve the client's health status.






Client's Profile
Name :.M
Address :# 157 Marcos Village, Palayan
City
Age :53 y/o
Gender :Female
Birthday :une 28,1958

Civil Status :Widow
Religion :Catholic
Educational Attainment :College Graduate
Assessment
Past Medical History
According to the client, she had mild stroke in 1993
and was confined in Philippine General Hospital for 3
weeks. In 1997, she was feeling dizzy until she collapsed
but she didn't pay attention to her condition until she
became hypertensive. In 2004 she had her first check up and
found out her condition. She was confined in Chinese
Medical Hospital due to cardiovascular disorder
specifically 2 blockages to the heart vessels and underwent
cardiac catheterization.
amily History of Illness



Present History of Illness
According to the client, she experience fatigue and
dizziness sometimes. She is also hypertensive until now but
is taking different medications for maintenance of her
condition such as Jlmezar (Jlmesartan Meboxomil) one tab
per day, Clotiz (Clopidogrel Bisulfate) 75 mg once a day,
Isordil (Isosorbide dinitrate) 5 mg as necessary, astromed
(aspirin) 100 mg once a day, Artovastatin 20 mg once at
bedtime, Myodial (Amodarone Hydrochloride) 200 mg once a
day and Carvidon Mr (Trimetazidine Hcl) 35 mg twice a day.
She also smokes three to five sticks in a day.
Nutrition and Metabolic Pattern
The client usually eat bread and a cup of coffee for
breakfast and a cup of rice with vegetables and fish for
lunch and dinner. She usually consumes four glasses of
water in a day and fie to six cups of coffee and juice in a
day. She was advised to avoid fatty an dsalty foods by her
physician and she has no problems with ability to eat.
Elimination Pattern
She usually defecates once a day with soft, brown and
well formed stool. She urinates five to six times a day
with yellow amber and clear urine.
Activity and Exercise Pattern
She performs light activities and exercise when she
doesn't feel weakness in her body. She was advised not to
perform physical exertion by her physician.
Cardiovascular
The client has an irregular pulse of sixty five beats
per minute and blood pressure of 160/110 mmhg.
Sleep and Rest Pattern
She usually sleeps a maximum of three hours per night
and also experience difficulty of sleeping sometimes due to
stress. Her physician prescribed Valium (Diazepam) which is
a tranquilizer to relieve her difficulty in sleeping.

Table 1.Vital Signs
The table below shows the vital signs of the client during
home visits.

Weight and Height
The client weighs 54 kilograms and her height is five
feet.
Body Mass Index
BMI = weight (kg)
Height (m)
BMI = 53 kg
2.32 m
BMI = 22.84
Date Blood
pressure
Temperature Pulse rate Respiratory
rate
December
5,2011

December
6,2011
160/110
36.5
65 bpm 22 cpm
December
7,2011

December
8,2011

December
9,2011

The client's body mass index is 22.84 which falls
under normal.
Table 2. Summary presentation of Client's Assessment
Body Parts Assessment indings
Skull Round, normal
symmetrical
Normal
hair Hair evenly
distributed
Normal
Scalp No signs of nits
and flakes
Normal
Face Symmetrical
structures, no
involuntary
movement, wrinkled
Normal
Eyes No protruding Normal
Visual field Can see far
objectives
Normal
Ears Skin color is same
to the face,
symmetrical,
flexible
Normal
Hearing No discharge, can Normal
hear normal, can
response to a
normal voice
Nose Symmetrical, no
discharge, no
flaring
Normal
Tongue Moist, no lesion,
no lumps or
nodules
Normal
Neck No palpable mass,
no tenderness
Normal
Breast
Thorax
Abdomen
Upper Extremities No deformities,
complete # of
digits, no lesions
Normal
Lower Extremities No deformities,
complete # of
digits, no lesions
Normal
Nails