Lucy is a 19 year old university student. She has been admitted to hospital with a six (6) day history of lower right quadrant abdominal cramping pain increasing with intensity, diarrhoea with blood, anorexia, fatigue, nausea and episodes of vomiting. Lucy states that she was diagnosed with Crohn’s disease at age 15. She has had two previous hospital admissions for acute exacerbations of Crohn’s disease with clinical manifestations of diarrhoea, abdominal pain and vomiting. Her Crohn’s disease has been managed with a combination of diet, medication and medical monitoring. Remission of her Crohn’s disease was maintained by oral mesalazine (Mesasal). Lucy currently rates her pain as 9/10.
On examination, Lucy was pale, her extremities were cool, and her skin was dry with poor turgor. Her abdomen was distended and tender. A mass was palpable in the lower right abdominal quadrant.
Observations on admission• Blood pressure: 95/60• Pulse rate: 110 beats/minute• Respiratory rate: 22 breaths/minute• Temperature: 37.7C• Sa02: 98% in room air• Weight: 62 kilogramsHeight: 165 cm
• Urinalysis:• specific gravity: 1040• dark coloured urineno other abnormalities note
Initial pathology results• Haemoglobin: 105 g/L (117 – 157 g/L)• Haematocrit: 49% (35 – 47%)• WBC 15000/mm3 ( 3500 – 11000 mm3)• Erythrocyte sedimentation rate (ESR): 28mm/hour (0 – 20 mm/hour)• C-reactive protein (CRP): 30mg/dl (20 mg/dl)Albumin: 28g/L (35 – 50 g/L)
The MO orders the following• fentanyl 75mcg IMI QID PRN• metoclopramide (Maxolon) 10mg IMI TDS• 1000mL 0.9% normal saline over 8 hoursnil by mouth
Lucy was prepared and sent for an urgent colonoscopy, upper barium x-ray and abdominal CT scan. A bowel obstruction at the proximal end of the ascending colon at the ileocecal junction was diagnosed. A balloon dilation of the obstructed colon was attempted, but was unsuccessful. Lucy was scheduled for a surgical resection of the affected proximal ascending colon and end-to-end anastomosis of her colon.
Question 1. 10 marks (250 words)Explain the pathogenesis of Crohn’s disease that has led to the development of Lucy’s obstruction of the proximal ascending colon. Accurately, clearly and comprehensively explains the pathogenesis of Crohn’s disease that has led to the development of Lucy’s obstruction of the proximal ascending colon.
Question 2. 10 marks (250 words)Explain the pathophysiological processes that lead to Lucy’s conscious perception of pain in her lower right abdominal quadrant. Accurately, clearly and comprehensively explains the pathophysiological processes that led to Lucy’s conscious perception of pain in her lower right abdominal quadrant.
Question 3. 5 marks (165 words)Describe the characteristics of the intravenous fluid that was ordered for Lucy, and the specific rationale, related to the details of the case study, for the administration of this intravenous fluid to Lucy. Accurately, clearly and comprehensively describes the characteristics of the intravenous fluid that was ordered for Lucy, and the specific rationale, related to the details of the case study, for the administration of this intravenous fluid to Lucy.
Question 4. 5 marks (165 words)Describe the mechanism of action of fentanyl in relation to its administration to Lucy. Accurately, clearly and comprehensively describes the mechanism of action of fentanyl in relation to its administration to Lucy.
Question 5. 5 marks (165 words)Prioritise the nursing responsibilities and associated rationales related to the administration of fentanyl to Lucy. Accurately, clearly and comprehensively prioritises the nursing responsibilities and associated rationales in relation to the administration of fentanyl to Lucy.
Question 6. 5 marksAcademic Writing Style. Writes in an advanced style exhibiting highly coherent and logical flow of ideas. No errors in spelling, grammar, punctuation or sentence structure.

 

Internal code : MAS2034 Q1 Provide definitions of each of the following – ‘Health’, ‘Illness’ & ‘Disease’. A1 Q2 a) Explain the difference between acute and chronic illness. b) Discuss how you would determine the impact that a chronic health problem has on activities of daily living of a client? A2 a) b) Q3 List 2 clinical manifestations of each condition – Congestive Cardiac Disease, CVA, Type 2 Diabetes, Rheumatoid Arthritis & Breast cancer A3 Q4 Many patients can become confused when health professionals use medical terminology to describe their condition. Explain briefly what the following are using words you would use when talking with your patient. 1. CVA. 2. MI 3. IV therapy 4.Analgesic 5. Anti- emetic A4 Q5 During your preliminary assessment your client tells you they have ‘a touch of sugar”, suffers with ‘piles’ and takes ‘a water tablet’ for ‘the fluid’. What is he referring to? A5 Q6 Thinking holistically, identify 4 actual health issues of a client with Hepatitis C. and list members of the health care team involved in this clients care? A6 Q7 Thinking holistically, identify 2 potential health issues for a client with Type 2 diabetes and describe briefly resources and rehabilitative support services that are available for this client and their family/carers. A7 Q8 Confirm the roles and responsibilities of the members of the emergency response team. A8 Q9 Name and briefly describe the action of 5 drugs commonly stored on the emergency trolley and used in a cardiac emergency A9 Q10 Identify 4 pieces of equipment commonly kept on the emergency trolley A10 Q 11 Define Palliative Care A11 Q12 Identify available resources and support services for a palliative client being discharged home where appropriate with the consent of the client and their significant others. A12 Q13 List 3 common sites where cancer develops. A13 Q14. What is the principle of bed rest? A14 Q15 Describe you management and care of your patient, 20 year old male with a diagnosis of Ulcerative Colitis. He has just returned to your care from Operating Theatre following a Colonoscopy. A 15 Q16 Define Chronic Renal Failure A 16 Q. 17 a) Identify key considerations in regard to cultural and religious issues when caring for clients requiring extended or rehabilitative care. b) Discuss how a client’s dignity and privacy are maintained. c) Write a paragraph on nursing considerations that would be significant to a client, their family/carer/significant other. A 17 Q 18 Discuss the Enrolled nurses role and responsibilities in accordance with professional, legal and organizational requirements. A18 Q19. How, when and to whom would you (EEN) report changes in a client’s condition? A19 Q 20. Scenario Your patient is a 68-year-old Indigenous male, Tom Jones, who presents with a decubitus ulcer on his sacral area and increasing shortness of breath. He has a history of chronic obstructive pulmonary disease. He tells you his current medications are as follows: Ventolin 1ml and Atrovent 1ml – 4 times a day via home nebuliser. Vitamin B tablet x 1 daily. He lives with his partner of 20 years in rented accommodation. He has a son from a previous marriage who lives interstate that he hasn’t seen for 5 years. He doesn’t talk to him on the phone because he can’t hear that well. Tom and his partner, Sally, drink a 2 litre cask of wine each day and both smoke a packet of cigarettes a day between them. They receive the aged pension. Sally mostly does the housework, shopping and cleaning as Tom usually ‘doesn’t feel up to it’. Recently Sally has been ‘out of sorts’ with arthritis in her hands and knees, so they have been eating mostly tinned food as it is easy to prepare. Until now they have both refused services saying “we’ll manage”. Tom admits he is frightened of falling because he tires easily has problems walking steadily and “never know what to grab on to”. Tom required 4 days of bed rest. He was discharged home with services of home care for cleaning, a follow up appointment in wound clinic, a nurse going out to assist with showering and attending wound care and meals on wheels and a GP appointment. On admission (at 10 a.m.) the patient is anxious, appears unkempt and has a pungent body odour. Observations on admission to ward: BP 140/90 Pulse 96 Respiration’s 26 Temperature 38.2c SaO2 91% on room air Urinalysis: Leucocytes ++, Blood + Height: 178cms Weight: 58kgs Peak flow reading: 150 Observations on discharge: BP 130/80 Pulse 86 Respiration’s 20 Temperature 36.2c SaO2 98% on room air Urinalysis: NAD Height: 178cms Weight: 62kgs Peak flow reading: 350 You are required to: 1. Reflecting on your knowledge of the normal anatomy and physiology of the lungs explain the pathophysiological changes related to COPD Answer 2. Based on the information in the scenario briefly discuss Toms actual problems and how they may be impacting on his activities of daily living (assess holistically). Include in your answer Behaviours/life style choices which may have contributed to the development of the chronic illness. Answer 3. Based on the information in the scenario, list 5 potential problems for Tom (assess holistically) Answer 4. A key consideration of how successful outcomes will be for a client and their significant others is the understanding they have of their own illness or condition. As an enrolled nurse how could you confirm the clients understanding or their presenting and underlying conditions Answer 5. Briefly discuss Tom’s observations. Are they within normal range and what do the variations indicate to you. Who do you report the observations to and where do you document your findings. On the documentation paper work provided: record observations on appropriate chart following legal requirements for documentation. Write a legally compliant progress note entry based on the admission. Answer 6. List 5 nursing interventions you could deliver during Tom’s hospitalization based on your assessment. List the members of the health care team who may participate in the development of the care plan. Answer 7. You have identified that Tom needs education on how to use his nebulizer effectively. a) Identify any physical or mental problems that may hinder the communication process with Tom? (b) In your own words, briefly, describe step by step the procedure for using a nebulizer. Answer 8. A key consideration of how successful outcomes will be for a client and their significant others is the understanding they have of their own illness or condition. As an enrolled nurse how could you confirm the clients understanding of their present and underlying conditions? Answer 9. (a) Briefly describe the discharge process (b) Identify 3 community based services that could assist Tom to rehabilitate. (c) Do you require the clients consent to refer to services? (d) What equipment might help this client to remain independent at home? Answer (a) (b) (c) (d) 10. Tom was on bed rest for 4 days. What are the risks/complications of prolonged bed rest and what are the nursing procedures that can be undertaken to prevent them? (Word count 500) Answer 11. What support if any can be offered for Sally as Carer for Tom? Answer 12. Discuss the discharge process and requirements required for Tom to be discharged Answer 13. Complete the designated paper work Patient profile/Discharge check list General observations sheet Peak flow meter chart Progress notes admission entry and discharge entry Discharge notification for patients Patient discharge check list Write a care plan: minimum of 5 nursing diagnosis – goals, interventions, evaluation and rationale. Include one activity of daily living, and remember to consider your clients psychological and social needs and demonstrate respect for your client’s dignity and self-involvement. 31 total views, 2 views today

 

a. Title – Does it accurately describe the article?b. Abstract – Is it representative of the article?c. Introduction – Does it make the purpose of the article clear?d. Statement of the problem – Is the problem properly introduced?e. Purpose of the study – Has the reason for conducting the research been explained?f. Research question(s) – Is/are the research question(s) clearly defined and if not, should they be?g. Theoretical framework – Is the theoretical framework described? If there is not a theoretical framework, should there be?h. Literature review – Is the literature review relevant to the study,comprehensive, and include recent research? Does the literature review support the need for the study?i. Methods – Is the design appropriate for the study? Does the sample fit with the research design and is the size sufficient? Was a data collection instrument needed? How were data collected? Were reliability and validity accounted for?j. Analysis – Is the analytical approach consistent with the study questions and research design?k. Results – Are the results presented clearly in the text, tables and figures? Are the statistics clearly explained?l. Discussion – Are the results explained in relationship to the theoretical framework, research questions, and the significance to nursing?m. Limitations – Are the limitations presented and their implications discussed?n. Conclusion – Are there recommendations for nursing practice, future research, and policymakers?
2. Determine the level and quality of the evidence using a scale (several can be foundin ANA’s Research Toolkit www.nursingworld.org/Research-Toolkit/Appraising-theEvidence)

 

Create a table in which you propose the calculation and graphs you will need to perform to answer the health question you are investigating. Then explain why you chose these calculations to explore your health question.Health Question: To what extent does age influence length of hospital stay for MI patients? From the following Articles:• Gender-specific characteristics of individuals with depressive symptoms and coronary heart disease.Baseline characteristicsComparisons of variables by genderOf the 1951 patients with CHD with depressive symptoms above community norms, 691 (35.4%) were women. In contrast, among patients without depressive symptoms, 395 (26.9%) were women (P < .001). Sample demographic and clinical characteristics of patients with CHD with and without depressive symptoms are compared by gender inTables I and II. Among those with depressive symptoms, compared with men, women were older, more poorly educated, more likely to be single and not working, and more likely to have government-only or no health insurance. Compared with men with depressive symptoms, women with depressive symptoms were less likely to have a history of MI or revascularization by PCI or bypass surgery, or to have attended cardiac rehabilitation programs. Conversely, women with depressive symptoms were more likely to have angina and hypertension than men with depressive symptoms. With few exceptions, gender comparisons of the 2 samples (with and without depressive symptoms) were similar. The only differences between samples with and without depressive symptoms were for history of MI, angina, or cardiac rehabilitation attendance. In the sample without depressive symptoms, there were no gender differences in these clinical characteristics.Table I.Bivariate comparisons of demographic characteristics in men and women with coronary heart disease with and without depressive symptomsVariable Sample without depressive symptoms (N = 1468)________________________________________ Sample with depressive symptoms (N = 1951)________________________________________Male (N = 1073) Female (N = 1129) P Male (N = 1260) Female (N = 691) PMean (SD) Mean (SD) Mean (SD) Mean (SD)Age y 67.4 (10.1) 69.6 (9.8) <.001 65.5 (11.6) 68.3 (11.5) <.001N (%) N (%) OR (95% CI) N (%) N (%) OR (95% CI)High school education or less 299 (27.9) 172 (43.5) 2.00 (1.57-2.54) <.001 438 (34.8) 379 (54.8) 2.28 (1.89-2.76) <.001Single 197 (18.4) 195 (49.4) 4.34 (3.38-5.57) <.001 276 (21.9) 344 (49.8) 3.53 (2.89-4.32) <.001Uninsured or government-only health insurance 494 (46.0) 639 (56.6) 1.39 (1.10-1.75) .006 610 (48.4) 389 (56.3) 1.37 (1.1-1.65) .001Non-Caucasian 96 (8.9) 39 (9.9) 1.12 (.75-1.65) .586 100 (7.9) 58 (8.4) 1.06 (.7-1.49) .723Not working 716 (66.7) 314 (79.5) 1.93 (1.47-2.55) <.001 840 (66.7) 577 (83.5) 2.53 (2.0-3.19) <.001CI, confidence interval; OR, odds ratio; SD, standard deviation.•Gender Differences in Self-Reported Symptoms of Depression among Patients with Acute Coronary Syndrome.Table 1: Comparison of demographic and clinical health characteristics of acute coronary syndrome patients. Variables (n = 789) Women (n = 248) Men (n = 541) P value Age at consent 0.0013∗ M (year) ± SD 62.28 ± 12.03 64.31 ± 12.79 61.35 ± 11.56 Range 28–96 29–96 32–95 BMI 0.2995 M (lb/inch2) ± SD 30.13 ± 6.44 30.53 ± 7.91 29.95 ± 5.64 Range 16.47–58.57 16.47–61.33 18.09–58.57 BDI Score (0–63) < 0.05.