1. It is likely that Tom’s symptoms are being caused by problems with which body system?
Symptoms such as crushing chest pain, edema to feet and ankles and shortness of breath is associated with the cardiovascular system.
2. Explain the likely pathophysiology of Tom’s chest pain and the swelling to his feet and ankles.
The likely pathophysiology of Tom’s symptoms are
3. What diagnostic procedures could confirm his condition?
4. What is the purpose of each of the above named diagnostic procedures?
“Electrocardiogram (ECG): is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it contracts.”
Echocardiogram:
Chest X-ray:
(Better Heath 2015)
5. What health professionals will this client need to access for his condition (name at least 3)? What services would each provide?
Health professionals that Tom will need to access include Cardiologists, General Practicitioners (GP), Dieticians, Exercise Physiologists, Heart Failure Nurse, Occupational therapists, Pharmacists and Physiotherapists.
Cardiologist:
1. According to the given symptoms, it can be said that the associated disorder is related to congestive heart failure. The problem is concerned with heart.
2. The pain in heart is because of reduced blood flow to the heart muscles and narrowing of the arteries, which supply less nutrient and oxygen to heart. Swelling of feet and ankle, is because of less supply to kidney, which leads to fluid and water retention. This is also known as edema.
3. Condition which causes heart failure such as angina, coronary artery disease, diabetes, high BP, heart valve disease. Smoking and drinking habit also promotes the complication. Notably the type of medication on the daily routine of individual is also responsible for the same. Diagnosis like blood test, Natriuretic peptide (B-type) test, ECG, chest X-ray and cardiac catheterization can be helpful in identification.
4. Electrocardiogram (ECG): is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it contracts.
Echocardiogram: Ultrasound test, which helps in reveal the movement, function and structural defect in heart.
Chest X-ray: this helps in showing the size of heart, in case fluid there is fluid retention near heart and lungs.
5. Health professionals that Tom will need to access include Cardiologists, General Practicitioners (GP), Dieticians, Exercise Physiologists, Heart Failure Nurse and pharmacist.
Cardiologist: will help in identification of any specific deformity or malfunctioning in the heart region, which is responsible for the said disease.
Dieticians, Exercise Physiologists: will help in advising for balanced and healthy diet. Similarly, exercise physiologists will help in regulating exercise and activeness of body.
Heart Failure Nurse: is specialized for the treatment regime, medication plan and educating Tom regarding the condition, measure and self-care for the health restoration.
References:
MCMURRAY, J. J., ADAMOPOULOS, S., ANKER, S. D., AURICCHIO, A., BÖHM, M., DICKSTEIN, K., … & BEN LAMIN, H. A. 2012. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.
Mary is a 56 year old woman who has recently been diagnosed with type 2 diabetes. She is morbidly obese and has a body mass index (BMI) of 35. She is visiting a community health clinic for assessment and education for her newly diagnosed condition.
1. Explain 5 potential health issues Mary faces as a result of her obesity?
2. Name two (2) external and (2) internal factors that could be affecting Mary’s health status?
3. What health professionals and allied health staff may be involved in the care of this client? Explain the role of each?
4. What type of health education should nurses give this client to assist her with controlling her condition?
1. High blood pressure, as there is high deposition of LDL (low density lipid) which causes interruption in blood flow and corresponding increase in the blood pressure.
Arthrosclerosis – deposition of fat in the arteries which leads to insufficient supply of nutrient and oxygen to body parts
Edema and swelling, which is because of poor blood supply to kidney and hence the body part will be swelling because of fluid retention.
Fatigue is one of the common complication that will resist Mary is routine activity and work.
Poor blood circulation may also leads to nerve damage, increased prone to skin infection and retinopathy.
2. External factor include (i) high intake of calorie food including junk food and fats, (ii) lack of physical activity and exercise. Internal factor is (i) deposition of fats in body parts, which leads to increase in blood pressure and LDL content. (ii) fatigue is the caused by high blood pressure and insufficient oxygen supply to body parts.
3. General Practicitioners (GP), Dieticians, Exercise Physiologists, Nurse and pharmacist.
General Practicitioners (GP): will help in diagnositic and measurement of relevant parameters, for example blood test.
Dieticians, Exercise Physiologists: will help in advising for balanced and healthy diet. Similarly, exercise physiologists will help in regulating exercise and activeness of body
Nurse: will guide for treatment regime, medication plan and educating Mary regarding the condition, measure and self-care for the health restoration
Pharmacist: will help in medication and its corresponding management information.
4. The health education in this concern should be primarily reflected in concern to food regulation and control. This will not only restrict the uncontrolled intake of calories, but will also ensure avoiding of junk food. Similarly, it is important to advocate and motivate for physical exercise and work. Last but not the least is the education regarding medication management. These education should thus reflect the self-management criteria for avoiding future complication and also for the restoration of healthy state.
References:
TCHERNOF, A., & DESPRÉS, J. P. 2013. Pathophysiology of human visceral obesity: an update. Physiological reviews, 93(1), 359-404.
LEBOVITZ, H. E. 2013. Metabolic Surgery for Type 2 Diabetes with BMI< 35 kg/m2. Obesity surgery, 23(6), 800-808.
A 40 year old male has presented with unstable blood glucose readings which are secondary to his type 1 diabetes.
1. Explain the long term complications that may occur if this patient’s disease progresses?
2. Name 5 specific health care professionals that may be involved in the long term care of a client with type 1 diabetes and briefly explain the role of each?
3. Explain the services and therapies that would be provided as part of long term community care for this client?
Answers:
1. Damage to body part such as liver, kidney, eyes, heart are the prime concern of such complication. This also leads to hardening of atherosclerosis of large arteries, which are causative reason for heart attack and stroke. Other complication include ketoacidosis where is the combination of dehydration and excess glucose state in body. It is important to mention that ketoacidosis is a life threatening condition, if left untreated.
2. General Practicitioners (GP), Exercise Physiologists, Dieticians, Nurse and pharmacist.
It is important to mention that the name of the professionals involved is same in all the case, whereas their role is specific regarding the intervention, implementation and monitoring of the condition.
General Practicitioners (GP): will help in diagnositic and measurement of relevant parameters, for example blood test.
Dieticians, Exercise Physiologists: will help in advising for balanced and healthy diet. Similarly, exercise physiologists will help in regulating exercise and activeness of body
Nurse: will guide for treatment regime, medication plan and educating Mary regarding the condition, measure and self-care for the health restoration
Pharmacist: will help in medication and its corresponding management information such as metformin.
3. The services include the management and motivation for physical activity and diet regulation. The emotional state and the depression state of the client should also be monitored in the long run. Notably the disability state that might occur as a result of chronic disease state should be addressed specifically with the attention towards the medication and appropriate treatment plan for concerned type I diabetes. Careful and effective monitoring of the disease will lead to prevention of organ damage and failure and will also ensure the progress in health state with time.
References:
de BOER, I. H., RUE, T. C., CLEARY, P. A., LACHIN, J. M., MOLITCH, M. E., STEFFES, M. W., … & BRUNZELL, J. D. 2011. Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort. Archives of internal medicine, 171(5), 412-420.
A 24 year old male presents at the emergency department following a motor vehicle accident (MVA). He had an elevated blood alcohol reading and appears to be intoxicated. The client suffered a blow to the forehead in the accident. He is reported to have lost consciousness at the scene. On admission he is incoherent and aggressive.
What internal factors are likely to be affecting the client’s physical condition?
What external factors have contributed to this client’s condition?
If the client’s level of consciousness declines 6 hours after admission, what may be their diagnosis? When responding, consider the onset, peak and duration of alcohol in the system and factor in your knowledge of brain injuries?
What specific diagnostic tests would be required for this client?
Name two specific health care professionals who would be involved in the care of a client with an acute head injury and briefly explain the role of each?
1. Internal factors include the brain shock due to sudden trauma. This trauma is also severing in the present case as because it is under the hallucination effect of alcohol. Other than this with occurrence of the accident and the immediate reflex, there would be severe blood loss, which made the client unconscious owing to reduction it the blood pressure.
2. External factor is the accident, which leads to severe blood loss and corresponding exposure to dust and pathogenic microbes at the sight of incident. Other than this the transportation of the client from the sight of accident to the hospital emergency ward is the another factor, which leads negative impact over the physiological state. Lastly the conditions and facilities such as availability of health care professionals, immediate surgical instruments, oxygen supply are considered within the scope of external factors.
3. The loss of consciousness in client condition is related to the fall in blood pressure and loss of nervous sensation. Moreover, the alcohol level present in blood might cause severe damage to brain parts. This is attributed to the clogging of small blood vessels in the brain parts. The diagnosis should be done for the debris and blood clot in the blood. The primary notation for the physician is to administer warfarin IV and analgesic such as diazepam. Subsequently the wound and injuries are needed to be dressed along with applying sufficient antibiotics. The maintenance of cardiac functioning and blood pressure should be compensated with the oxygen mask supply and the pressure balance should be monitored.
Along with these treatment regime and medication management, it is also essential to maintain the records and inform the higher authority in order to comply with the ethical and legislative concerns.
4. Blood test is the first diagnostic test for the measurement and assumption of alcohol content in blood. The signs of intoxication should be assessed with the help of bloodshot eyes, lack of coordination. Another test is the measurement of blood pressure, heart rate, respiratory rate.
5. Two specific health care general physician, emergency ward nurse.
Surgeon: The role of surgeon is to follow the diagnostic measure and assess the complication related to blood pressure, heart rate, coordination and eye movement.
Emergency Ward Nurse: the professional responsibility is attributed to management and dressing of wound, oxygen supply, warfarin administration and taking care of the posture.
References:
STÜBIG, T., PETRI, M., ZECKEY, C., BRAND, S., MÜLLER, C., OTTE, D., … & HAASPER, C. 2012. Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality. Alcohol, 46(7), 681-686.
A 79 year old Chinese Buddhist woman has been admitted for palliative care in a respite facility. She has requested that no opiates be given to her as she wishes to die without pharmacological intervention.
1. Referring to the competency standards for Enrolled Nurses, explain the ethical issues that would need to be considered when caring for this client?
2. This client appears to be in increasing pain, and the Enrolled Nurses caring for her understand the importance of her request to have a medication free death, yet they are upset by her discomfort. What are the responsibilities of an Enrolled Nurse in this situation, and who could they seek advice from?
3. What non pharmacological treatment could be provided as pain relief?
1. The concerned lady is probably at the last stage, it is hence the palliative care workers are needed to give value to the belief and values of patient. The respective care in conjunction to environment of care, dietary care, and emotional states should be taken care in this conjunction. Other than this, it is necessary to make arrangement of the family members and carer if any, so that she can talk and express any of the feelings, if necessary. It is the responsibility of palliative care member to take consent for every intervention, and necessary measures. Other care related facilities such as regular checkup of physiological conditions should be monitored effectively and made appropriate records.
2. With respect to given consent of the patient, it is necessary to abide the ethical concerns by valuing the belief of client. To the next, it is more important for the nurse to make consultancy with other health care professionals and nursing leaders regarding the next approach. Use of appropriate wordings and touch should be provided to the client, so as to calm the situation and pave empathy to the situation. It is more important to access, if the pain is because of any condition or posture. Such problems should be addressed and rectified for the comfort of client.
3. The pharmacological treatment should be in accordance to WHO ladder approach.
Step 1 – Mild pain (score 1-3), where nonopoid analgesics are thought for the medication.
Step 2 – Moderate pain (score 4-6), where the use of weak opiods or combination of opiods with nonopioids are used.
Step 3 – where the pain level is higher (score 7-10) and hence strong opoids are necessary for the medication.
References:
BULLEN, T., MAHER, K., ROSENBERG, J. P., & SMITH, B. 2014. Establishing research in a palliative care clinical setting: perceived barriers and implemented strategies. Applied Nursing Research, 27(1), 78-83.
GLARE, P. 2011. Choice of opioids and the WHO ladder. Journal of pediatric hematology/oncology, 33, S6-S11.
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