Health Alterations and Nursing - Case Study Example

NSB423 HEALTH ALTERATIONS AND NURSING 2 SUPPLEMENTARY ASSESSMENT SEMESTER Number: Q1. Amy is a 3 year old child seen by the Nurse Practitioner at the clinic for a urinary tract infection. Her mother tells you that Amy has bowel movements every 3-4 days. They are usually large, hard formed and sometimes Amy has trouble evacuating the stool. When Amy is asked if it hurts when she does a wee she replies, «yes it does and I cry” “I don’t want to go to the toilet but my mum makes me”. Mum states Amy has had a couple of wet beds over the past couple of days and has not been eating or drinking very much. Amy is also not as active as usual. A teaching session is planned to be undertaken with Amy & her mum on prevention of constipation. a). Discuss the anatomical/physiological reasoning for the link between Urinary Tract Infection and constipation b) Discuss the teaching strategies you would include in the teaching plan for Amy and her mum. DO NOT include content of the teaching session. Q2. Maria Poulos, a 40-year-old woman with two children, consulted her doctor about experiencing menorrhagia and occasionally metrorrhagia for the past 5 months. She was diagnosed with leiomyomas and a total abdominal hysterectomy was recommended. Maria was initially reluctant about surgery She states she does not want more children She is concerned that she may have uterine cancer Maria has several large, firm masses in the body of the uterus thought to be leiomyomas Physical examination otherwise normal Maria underwent a total abdominal hysterectomy and she is just back in the ward post operatively. Post Operative orders are as follows: Indwelling urinary catheter (IDC) Intravenous Therapy – 1L N/Saline 12 hourly Wound drain and wound to remain intact until reviewed by Dr Full-length elastic compression gradient stockings in situ What are the three (3) priority immediate nursing Interventions you would carry out on her return to the ward and why (rationales)? Q3. Mr Graham is a 55-year-old man admitted with a diagnosis of cirrhosis of the liver and is to have an abdominal paracentesis for ascites. Has had cirrhosis for 12 years Acknowledges that he had been drinking heavily for 20 years but has been sober for the past 2 years Complains of anorexia, nausea and abdominal discomfort Is thin and malnourished Has ascites Has jaundice of sclera and skin Has 4+ pitting oedema of the lower extremities Liver and spleen are palpable Total bilirubin: 257 µmol/L Serum ammonia: 122 µmol/L AST: 154 U/L ALT: 169 U//L a) Discuss the pathophysiology of Cirrhosis of the Liver and Ascites. b) Mr Graham is being closely observed for the possibility of gastrointestinal bleeding. Why is this considered a possible complication? Q4. Sally Smith, aged 14 yrs, has been admitted for review of her diabetes. Sally’s diabetes has been rather uncontrolled lately and her parents are extremely worried. She is now on insulin TDS and her diabetes appears to be more controlled. You are on night shift and are doing a round of checking the patients - you check Sally and find her unresponsive, cold & clammy. Identify the Diabetes complication that you suspect is occurring and outline the priority care you would give Sally in this emergency situation. Q5. Tara Smith aged four (4) years had a fall off the monkey bars at her day care centre. She fell on her outstretched arm which resulted in a Greenstick fracture of her distal R) radius. She is to have a synthetic cast applied to her forearm for 3-4 weeks. Briefly discuss the cast care that Tara and her mum must undertake. SSh Q6. Tate Brown aged 3 years has atopic eczema. He has been getting increased episodes over the past few months and his mother is finding it difficult to deal with. Briefly outline nursing interventions that can assist Tate’s mother to stop the itch-scratch cycle and decrease episodes of eczema? Q7. Bob Jackson, a 76-year-old man, was admitted to the hospital with pain while at rest and a non-healing ulcer of the big toe on the right foot. He has a history of: myocardial infarction stroke hypertension arthritis diabetes mellitus Type 1 - been using insulin for 30 years a smoking history of 45 pack-years Bob underwent a left femoral–popliteal bypass graft 5 years ago and is complaining of intense right foot pain for past 6 weeks. He states “I sleep in the recliner with my right leg hanging down to get some relief from the pain”. On assessment he has: a diminished right femoral pulse with no palpable pulses below that level a small necrotic ulcer on the tip of the right big toe thickened toenails; shiny, thin skin on the legs; and hair is absent on both feet Bob is to go to the operating theater to have a Right Femoro-Popliteal Bypass Graft tomorrow am. a) Briefly discuss the pathophysiology of intermittent Claudication. b). Discuss the nursing interventions for pre operative preparation for Bob REFERENCE LIST American Academy of Orthopedic Surgeons, Care of Casts and Splints. Web. (n.d), Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00095, 2011. Hiatt, W. R. Pathophysiology of Intermittent Claudication in Peripheral Arterial Disease. Cardiology Rounds, 10(1), 2006. Print. Juravinski Cancer Centre. Recovering from total abdominal hysterectomy - bilateral salpingo-oophorectomy, and pelvic node dissection. Ontario, Ca: Hamilton Health Services. 2010. Print. Kliegman, R. M., Stanton, B. M. D., St. Geme, J., Schor, N., & Behrman, R. E. Nelson’s Textbook of Pediatrics. (19th ed.). Amsterdam: Elsevier, 2010. Print. Kumar, V., Sbbas, A. K., Fausto, N., & Aster, J. C. Robbins and Cotran Pathologic Basis of Disease. (8th ed.). Amsterdam: Elsevier, 2010. Print. Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., & Loscalzo, J. Harrisons Principles of Internal Medicine. (18th ed.). New York: McGraw-Hill, 2012. Print. Nurse’s Rapid Reference. Philadelphia: Lippincott, Williams and Wilkins, 2009. Print. Read More