Care of the Ill Adult - Essay Example

Care for the ill Adult Introduction. Holistic nursing involves the health care practise that focuses on healing the body. It entails the identification of a patient’s health care needs, which can be either actual or potential (Amato, 2006). It is worth noting that providing a holistic assessment to the patient during admission to the ward is one of the fundamental requirements of nursing. This is because, through holistic nursing, it becomes possible to ensure that unity of the body, mind, spirit, emotion, and the environment becomes guaranteed. This implies that nurses, who strive to offer holistic assessment, need to consider all the needs of every patient irrespective of the reason behind their encounter. According to Dossey (2005), patient’s needs have the highest probability of being known and eventually diagnosed when holistic assessment is employed. This, thus, means that a patient, who receives a holistic care, stands to recover with a quicker rate as compared to a patient receiving non-holistic care given that true needs of a patient are easily identified. This happens, in cases where a patient is provided with an opportunity to think and expound on what care he or she requires. Through this, the patient can work in harmony with the care givers in finding the appropriate methods to achieve set goals. There are various factors that have to be examined in a holistic assessment, which, certainly are the primary cause of the current illness, as well as act as measures taken by the patient in managing the illness and the patient’s medical history. Factors that ought to be put under consideration are the patient’s social history and the perception of illness exhibited by the patient. With a view to discus nursing interventions for a range of conditions invented from a patient scenario, this paper explores the case of Rosie who is a patient admitted to hospital for a total thyroidectomy with type 2 diabetes. In this regard, there are five conditions to be explored including the patient's assessment during the ward admission, medical condition, post operative care, discharge details, as well as immediate care of the patient in the community. Communication. In assessing the communication skills of Rosie, the nurse shall consider investigating nonverbal communication of the patient. Through this, the nurse will work towards reducing the patient’s anxiety by allowing the patient to express fears. In this regard, the nurse shall provide an explanation of all procedures, and then link them up to the relevance of healing anxiety. In order to achieve this, the nurse shall consider the overproduction of catecholamine and cortisol occurring in response to stress and could posses the healing effect of the wound because of alteration in the tissue and immune system. Additionally, the nurse will also encourage questions and inputs of encouragement from the husband with due consent of the family members. Pre-op. In line with this, the nurse shall work towards providing orientation to the ward, giving out information to the patient, investigating allergies, providing baseline observations, urinalysis, Capillary blood glucose monitoring, carrying out blood tests, providing the patient with medication, as well as managing anxiety and fears of the patient. Additionally, the nurse will provide the patient adequate emotional support, while considering issues including the Braden score, allergies such as drugs, history of DVT, iodine latex, tape, Patient ID bands, and the Nil by mouth for a given recommended time. Post operative care of Rosie after the Thyroidectomy. Airway and Breathing management. In order to manage the breathing and airway conditions for Rosie, the effects of anaesthesia, rate of respiration, the depth of respiration, as well as the breathing work shall closely be monitored by the nurse. Moreover, the breathing sound of Rosie shall be auscultated while noting the existence of rhonchi (Beldi, 2004). As if not enough, the nurse shall be required to assess Rosie’s dyspnoea, cyanosis, as well as her stridor along with her voice quality. Following the doctor’s set of instructions, Rosie shall be assisted in the repositioning, exercises of deep breathing and coughing. In order to manage the blood circulation, the nurse shall with the direction of the doctor, shall work towards checking and managing haemorrhage risk and the decrease in blood pressure. The assessment process shall not be complete unless the nurse manages other conditions including hydration, nutrition, vomiting, and nausea as shall be indicated by Rosie. This process shall be summed up with closely monitoring the bleeding visual signs and the infection risk. Graves disease. This is a disorder of the autoimmune that results following a thyroid gland’s overactivity. In this case, the Thyroid gland releases thyroxine hormones (T4) and the triodothyronine (T3) that takes charge of the metabolism of the body. This happens when an individual’s body produces high amounts of thyroid hormone thereby causing the individual to experience hyperthyroidism. In essence, graves disease occurs following abnormalities in the immune system that ends up causing the thyroid gland give out excess thyroid hormone. There are various symptoms of the graves disease. A few among them include breast enlargement, anxiety, difficulty in concentrating, double vision, Eyeballs that may stick out, eye tearing and irritation, goitre, insomnia, heat intolerance, as well as increased appetite, which work to cause the weakening of the muscles and fatigue. The hypothyroidism or the hyperthyroidism like any other condition can be diagnosed through the process of conducting a test on thyroid hormone level in the blood. This often involves measuring thyroxin hormone produced by thyroid glands, as well as thyroid levels of the stimulating hormones produced by the pituitary glands. More often than not, High TSH quantities circulate in the body as an indication that one is a hypothyroid. This happens when the body overproduces the thyroid hormone (Bhattacharyya, 2002). On the contrary, for hyperthyroidism, the amount of thyroid hormone increases when there are minimal TSH in circulation. This means that in order to identify the causes of hyperthyroidism, the doctor makes use of radioactive iodine uptake test in tracking the amounts of iodine in the thyroid glands. This is a test that involves swallowing small amounts of radioactive iodine in capsule form. After a certain period of time, an instrument is placed on an individual's neck in helping measure the quantity of radioactive iodide in the thyroid. Positive results allow the doctor to conduct a scan using an exceptional film that creates a picture of the location of radioactive iodine in the body. It is after making a correct diagnosis that the doctor would treat the condition using the lithium drug dose or any other appropriate drug. Unlike the Graves ’ disease, which is characterized by over production of excess thyroid hormone, the toxic adenomas, thyroid glands develop nodules that produce thyroid hormones that work to upset the chemical composition of the body. In this case, the subacute thyroiditis causes thyroid inflammation making them leak the extra hormone. This leads to a condition in which there is a temporal hyperthyroidism lasting for few months. The hyperthyroidism condition, on the other hand, is caused by Hashimoto’s thyroiditis (Anderson, 2003). As an autoimmune disorder, the thyroid tissues are often attacked by the body causing it to stop producing the hormone. The thyroid glands removal may, as well cause hyperthyroidism. This happens when it is either surgically removed or destroyed through a chemical process. The use of lithium drug following an excessive exposure to iodine has also been found to cause hyperthyroidism. For the cases where an individual gets exposed to Sinus and cold medicine, the amiodarone or contrast dye that is often provided before an x-ray scan, it becomes apparent that one becomes subjected to iodine. It is worth noting that given that the thyroid is the core controller of metabolism, its malfunctioning affects all aspects of an individual health. In particular, this includes depression, weight and levels of energy, and if it is undiagnosed as required, thyroid gland disorders increase other risks. This cut across anxiety, infertility, obesity, depression, hair loss, heart diseases, sexual disfunctioning, alongside a host of health symptoms. The notable signs and symptoms of thyroid disorders include the Tendonitis problem or joint and muscle pains, skin or hair changes, neck enlargement, bowel problems, fertility disorders and irregularities in the menstrual (Baloch, 2002). Type 2 diabetes. Type 2 diabetes is one of the chronic diseases with imbalances that are considered as being systematic psych-neuro-immuno-endocrine. Such imbalances are responsible for altering insulin and sugars in the blood with systematic inflammation cascade markers. Failure to identify the imbalances in a timely manner results into a damage that might be irreversible. In line with Rosie’s case, her holistic assessment involves the detection of the signs of warning that can result into type 2 Diabetes. Diabetes is one of the known chronic diseases that occur following the failure of a pancreas to provide sufficient insulin (Burkey, 2001). A condition where a body fails to utilize well insulin produced can also lead to Diabetes. Hyperglycaemia, on the other hand, occurs due to the effect of diabetes whose level is uncontrolled of which if sustained over time, it results into damaging a number various body systems including the body nerves, as well as the vessels of the blood (Cheng, 2010). In a more practical approach, the pathophysiology of type 2 diabetes is often characterised by insulin peripheral resistance, regulation of the release of the impaired hepatic glucose the reduction of the function of the B cell function, along with the failure of the B cell. Research has indicated that this type of diabetes starts with the resistance of insulin, a situation whereby fat, muscles and liver cells becomes incapacitated to make use of insulin. This condition, basing on research, develops whenever the receptors on cells that work to respond to the action of insulin fails to be stimulated (insulin resistance). In certain case, it may occur following a condition of insufficient insulin or for conditions where the insulin is at an abnormal level leading to failure to be efficient. There are various symptoms associated with diabetes. Among them include tiredness, passing excess urine, increased thirst, sudden loss of weight, a slow process of the wound and cut healing, as well as a blurred vision. The warning signs that individual need to be privy to include, hypoglycaemia, severe myocardial infarction, chronic hyperglycemia, stroke, coma, diabetic retinopathy, diabetic nephropathy, fatty liver, diabetic gastropathy, central neuropathy, and the insufficiency in the vascular peripheral (Braverman, 2001). The effective assessment involves the application of the Functional Medicine Approach to patients. This approach covers the entire spectrum of issues. The approach provides an assessment of Rosie’s physiology of the pathology mechanism, the biochemistry, energetic, spiritual, and structure aspects, with an intention of discovering everything that can take part to a permanent or partial blood sugar elevation. In line with the objective of the holistic assessment, this would entail hindering the possibilities that can unleash the insulin and blood sugar problems in the future (Braverman, 2001). In this regard, the assessment shall focus on factors, which may in conjunction or alone be responsible for the disease. This means that the assessment involve investigating factors such as lifestyle, environmental changes, and genetic factors. More often than not, these factors end up playing a significant role in developing Type 2 Diabetes in an individual’s life given that one trigger can evoke the process of diabetes. With the use of the tools of assessment, it becomes possible to find the required information from the clinical history of Rosie. In this respect, the instrument uses are fundamental in identifying the antecedents that predisposed Rosie to develop the disease, the problems that evoked the imbalance, and the cause of the symptoms experienced by Rosie. Further assessment of Rosie’s condition shall include routine testing like Spirometry, ultrasound, EKG, and chest imagery (Anderson, 2003). Moreover, carrying out analysis of bio impedance is an important process that helps in evaluating the metabolic rate of Rosie. The important part of this process is to do with establishing whether Rosie’s diet was right for her type of diabetes, and would help highlight her real body fat level and lean mass. Conducting a laboratory test would help in verifying the markers that are related to the syndrome of metabolism. These include the function of the thyroid, the levels of vitamin D, and the released insulin (Braverman, 2001). In this case, the device for the biofeedback shall be of use especially in evaluating the existence of the allergens of food which can motivate inflammation or the existence of different inflammation. Nursing implications. In this respect, a nurse would look for Hypoglycaemia, which may make the patient be nervous, shaky, dizzy, confused, headache, hunger, cold, clammy skin, fast heartbeat and irritability, drowsy, fitting, coma. Hyperglycaemia may also make a patient weak, tired, increased thirst, appetite that is reduced, frequent urination, itchy skin, blurry vision, breath smell of fructose. Aim. The prime aim of the assessment would be to optimize the control of pain, to facilitate an early return to normal drinking and eating, and return to the normal regime of diabetes. Additionally, the assessment will ensure the control and maintenance of glycaemic and the electrolyte fluid balance and avoid the iatrogenic injury. Action plan. The nurse would give a chance to the patient to manage and control their diabetes, monitor fluid and electrolyte balance, and treat the post operative vomiting and nausea. Airway management. In many cases, the airway potential could be compromised especially in the post-operative immediate periods. This is due to the continuing of anaesthetics and analgesia used during the surgery (Braverman, 2001). Therefore, patient would be well positioned to maintain the airway and reduce the risk of aspiration should she vomit. Use semi fowler position. Airway checked for patency by asking her to speak, monitor her level of consciousness and listen for increased respiratory noises such as snoring or stridor. The conditions of dressing will equally be monitored and the region below her neck checked for drainage. Breathing management Additionally, the rate of respiratory should be monitored on a regular basis at every 15 minutes for the first hour post-surgery, then at 30 minute intervals for the next 2 hours and then at an interval that is hourly for the following four hours. The normal respiratory rate for an adult is between 1 2 and 20 breaths per minute. A fast rate of respiration (Tachypnoea) could show out that she was in pain hence measures to control pain would be taken. Tachypnoea may also be an early sign of hypovolaemia as her respiratory rate increases to compensate for the reduced ability of low circulating blood volume to deliver oxygen to the cells. A low respiratory rate may happen due to opioid analgesia. Oxygen therapy used for 24 hours post-op to encourage the passage of remaining anaesthetic gases across the alveolar membrane. Oxygen therapy should be prescribed and delivered only at the prescribed rate. Oxygen saturation should be monitored via an oxygen saturation probe. The normal value is above 95%. All these would help Rosie in managing her airway and respiration. Circulation. The nurse would frequently observe the posterior and anterior dressings of the patient since in many situations blood will accumulate in these areas. The monitoring of care would consist of a comparison of the changes after the first assessment from a post-anaesthetic ward of recovery. This is because of the risk of post-op hypervolemia, and haemorrhage from the losing other body fluids. The surgery stress brings about the risk of the instability haemodynamic in the immediate post-op duration (Bhattacharyya, 2002). Therefore, close observation of the main parameters of haemodynamic is crucial. These are heart rate, blood pressure, urine output and body temperature. These parameters would be observed at a similar time to the respiratory observations. Considering human beings, the normal range for ones heart rate is between sixty and one hundred beats per minute. Whenever the heart rate moves below 60 BPM, one would be said to have hypoxia. If the heart rate is higher than 100BPM, one may have pain, pyrexia, or psychological stress. In other situations, this could be a hypervolemia signs and indicators of the stage of compensation. An individual with a normal blood pressure is one whose blood pressure range lies between 100 – 140 systolic and 79 and 90 diastolic. This is normally compared to the patient’s pro-operation and baseline recordings. Prolonged refill of the Capillary is another sign of hypervolemia. A refill Capillary test provides an indication of the peripheral extent of vasoconstriction. This test is normally performed through the application of pressure to a toe or finger for approximately 5 seconds and noting down the duration taken to come back to the area (De Felice, 2004). Whenever the patient is correctly perfused, it may take three seconds for the blood to return. A Capillary refill that is prolonged is symptoms of high vasoconstriction. The different observations would be recorded and the drainage volumes, colour, consistency, and the equipment's drainage functional status (Beldi, 2004). The drain sanction would be used to avoid the blood accumulation and serum following the surgery, The dressing of the neck would be monitored for comfort and fit changes with the inspection of the edge of dressing in order to detect the possibility of the welling of the neck. A circumference change of the neck may display the establishment of haematoma. Rosie’s vital signs would be observed including tachycardia and hypotension detection since this is an indication of haemorrhage. Other signs of warning include distress in respiration, pain in the neck, pressure in the cervical, blood drainage increase, and dysphagia. Pain management. Rosie’s non verbal and verbal reports of pain would be assessed noting the location, duration, and the intensity of pain. Rosie would be placed in a semi-Fowler position, and her head would be supported with sand bags or pillows that are small (Davies, 2008). This implies that her head would be placed in a torso and head at an angle of 30-45 degrees. Her neck and head would be maintained in a position that is neutral and be supported during the changes in position. Rosie would be instructed to use her hands in stopping her neck during movement and avoid the neck hyperextention (Baloch, 2002). The items that would be frequently needed and the call bell would be kept within an easy reach for Rosie. She would also be given liquids that are cool or foods that are soft like ice cream or lollies. She would be encouraged to use different methods of relaxing. This care will help her to reduce fear. Fear for any patient after surgery will increase catecholamines, change the vital signs and affect the anesthesia, surgery and the post operative smooth recovery of the body (Beldi, 2004). Opoids are normally used in treating chronic pain. Despite its relevance in reducing chronic pain, the prolonged utility of opoids could result into side effects such as tolerance, hormonal effects, hyperralgesia, and immunosuppression. For example, tolerance involves the loss of the potency of analgesic resulting into an increased dosage requirement and a reduction of its effectiveness for a long period (Bononi, 2010). Psychological care. Rosie shall obtain psychological care from a qualified psychologist. This care would help to manage Rosie’s emotional factors that could worsen her surgery condition. The care shall be essential for her given that it shall enable work as a healing support through healing imagery, relaxation, and expression of emotions. Conclusion. Common health problem encountered by many people in the world can be avoided through ensuring that people get appropriate information about their causes, symptoms and remedies. Certainly, Thyroid disorder is one of the health problems that could be avoided. It is a disease associated with thyroid glands and thyroid hormones. As outlined in the discussion, the two main categories of thyroid disorders are hypothyroidism and hyperthyroidism. This grouping is based on the either the decrease or increase in thyroid hormone serum. It has been found that Thyroid gland has an influence on virtually all the metabolic processes in human bodies. Its effect and functionality is based on its ability to produce the hormone thyroxin. Notably, the common problems associated with thyroid disorders entail the abnormal over-production of thyroid hormone, which often lead to hyperthyroidism condition (Baloch, 2002). Production of insufficient hormone, on the other hand, leads to a condition known as hypothyroidism. Although the conditions are uncomfortable and unpleasant, if well diagnosed, thyroid disorders can easily be treated and managed. The hyperthyroidism condition occurs because of various risk factors. These include the Graves ’ disease, the toxic adenomas, the sebacute thyroiditis and the malfunctioning pituitary gland or the cancerous thyroid gland growth. In line with this discussion, it is clear that the vulnerability of humans to diseases necessitates people to consider regular medical checkups. It is true that, with the right information, most diseases, including the PID, the thyroid diseases, and the testicular diseases among others can be prevented (Chong, 2010). Increased research in the medical field has lead to discoveries of many diseases, and it is through learning that we get to know about the possible diagnoses, symptoms and treatments of such diseases. It is, therefore, upon individual efforts that we shall all stay safe against the diseases. References Amato, M., 2006. Endocrine disorders in paediatric-onset Langerhans cell histiocytosis. Hormone and Metabolic Research. 38, 11, 746-751. Anderson, C.,2003. Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves’ disease. Journal of the American Academy of Dermatology. 48, 6, 970-972. Baloch, Z., 2002. Pathology of the thyroid gland. 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