BNURS20 Nursing

Briefly describe the key difference between deep vein thrombosis and venous thromboembolism (in 30 – 60 words).Briefly describe four (4) common symptoms of a bone fracture.Briefly describe the key difference between greenstick and impacted fractures.list three (3) key principles of surgical nursing.Briefly describe the key difference between elective surgery and emergency surgery.Briefly describe the key difference between general, local and epidural anaesthesia.

The following table identifies examples of acute disease states and illnesses requiring complex nursing interventions. Complete the table defining each of these acute health problems and provide three (3) specific clinical manifestations of each of these conditions.

 Briefly describe the characteristics of acute pain (in 60 – 90 words).

Acute pain lasts typically a particular amount of time like no longer than six months, fading as whatever caused the pain is resolved or healed. Also, it generally comes suddenly and has a precise cause, typically from tissue damage, swelling or disease and it is sharp in quality (Griffioen et al., 2017).

3. Briefly describe the critical difference between deep vein thrombosis and venous thromboembolism (in 30 – 60 words).

Venous thromboembolism is a disease that consists of deep vein thrombosis together with pulmonary embolism while deep vein thrombosis is a blood clot in a deep vein generally in the legs. The symptoms of deep vein thrombosis are a feeling of warmth in the affected limb, pain and red or discoloured skin on the leg while the signs of venous thromboembolism are dyspnea and breathlessness (Galanaud et al., 2014).

4. Briefly describe four (4) common symptoms of a bone fracture.

Pain in the harmed region that becomes worse when the region is shifted or pressure is applied. Proliferation or bruising over the bone, deformity of an arm or a leg and difficult moving (Gómez-Barrena, Rosset, Lozano, Stanovici, Ermthaller and Gerbhard, 2015).

5. Briefly describe the key difference between greenstick and impacted fractures (in 40 – 70 words).

Greenstick fracture is a fracture in a young, soft bone in which the bone partly fractures on one side but does not break entirely since the rest of the bone can bend while an impacted fracture is when the split bone ends are fastened together by the force of injury (Atalar, Eren, Uluda? and Demirhan, 2014). Impacted fracture needs surgery since the bone should be de-compacted and re-assembled but a greenstick fracture can be straightened manually for it to heal correctly (Kareem, Raza, Kontojannis, Nimer and Tsang, 2018).

6. List three (3) key principles of surgical nursing.

The fundamental principles include multiple skills which allow working flexibly in preoperative evaluations, theatre, wards along with recovery environments. Management of high turnover of patients and the provision of proactive attention during the postoperative period. Finally, the ability to manage a wide range of surgeries across a diverse range of surgical specialties.

7. Briefly describe the key difference between elective surgery and emergency surgery (in 70 – 100 words).

Elective surgery is a procedure which is scheduled in advance since it does not involve a surgical emergency while emergency procedure is an operation that must be done immediately or a person might die. Elective surgery is chosen to be done like plastic surgery, but emergency surgery is performed to save the life (Matsuda et al., 2015).

8. Briefly describe the key difference between general, local and epidural anaesthesia (in 50 – 80 words).

General anaesthesia is an injection which places the whole body into a condition of unconsciousness, and local anaesthesia is the injection of a local anaesthetic around the significant nerves to block the pain from a vast region of the body. On the other hand, epidural anaesthesia is an injection administered in the lower back region using a special needle inserted amidst the vertebrae of the spinal column into the epidural space about the spine (Mergeay, Verster, Van Aken and Vercauteren, 2015). General anaesthesia numbs the entire body; local anaesthesia numbs a more substantial part of the body while epidural anaesthesia numbs just a small region of the tissue.

9. Briefly describe the key difference between spinal anaesthesia and a peripheral nerve block (in 50 – 80 words).

Spinal anesthesia is a type of local anesthesia with injection of an anesthetic drug into the subarachnoid cerebrospinal fluid space while peripheral nerve block is a kind of regional anaesthesia involving injection of anaesthetic near a particular nerve to block sensations of pain from a specific region of the body (Johnston, Stafford, McKinney, Deyermond and Dane, 2016). Peripheral nerve blocks are widely utilized for surgical anaesthesia and postoperative and nonsurgical analgesia for a variety of upper extremity procedures while spinal anaesthesia is frequently utilized for anaesthesia and analgesia for a variety of lower extremity, lower abdominal, perineal along with pelvic surgeries.

10. Define the following surgical interventions and briefly describe the surgical procedures involved in each of them.
11. Open reduction (in 40 – 70 words)

 Is a kind of surgery used to fix broken bones. The orthopaedic surgeon repositions the broken bones to replace their normal alignment or fracture reduction and then internal fixation of bones which entail different kinds of implants to hold the broken bones together and give reasonable stability during the process of healing.

1. Amputation (in 50 – 80 words)

It is the displacement of a limb by trauma, surgery or medical illness performed by a surgeon. The procedure starts by removing the diseased tissue and any crushed bone; the rough areas are smoothened, blood vessels along with nerves are sealed off then muscles are cut and shaped so that the stump or the end of the limp will be able to have an artificial limb connected to it.

1. Total hip replacement (in 50 – 80 words)

This is a medical operation in which the hip joint is restored by a prosthetic implant that is a hip prosthesis. During the process, the patient is given general anaesthesia to relax his muscles and put into a deep sleep. A spinal anaesthetic may also be provided to assist in preventing pain as an alternative, and a cut made along the hip side and the muscles connected to the top of the thighbone moved to expose the hip joint. Therefore, the ball portion of the joint is ejected by cutting the thighbone with a saw, and the artificial joint connected to the thighbone using either a unique substance or cement which permits the remaining bone to connect to the new joint.

1. Craniotomy (in 50 – 80 words)

This is referred to as the medical procedure in which a bone flap is temporarily ejected from the skull to reach the brain. The procedure starts by sedating the patient be under general anaesthesia and securing his head in place with pins to a skull fixation device connected to the operating table.

The surgeon makes an incision in the skin and muscle over the part of the skull to be removed, and then the skin flap and muscles lifted and pulled back to expose the head (Yadav, Jain and Singh, 2017). Small holes called burr holes are cut into the skull with a drill to serve as an outline for the bone flap and using a particular saw called craniotome the surgeon cuts amidst the burr holes to generate a bone flap. The bone flap is displaced, an incision made in the dura, the required brain surgery performed, the bone flap restored, the muscles and skin restored and sutured and a soft adhesive bandage placed over the incision.

1. Tonsillectomy (in 50 – 80 words)

 Is a surgical procedure to remove the tonsils. For the process to commence the patient will be sedated under general anesthesia and then the surgeon might use cold knife dissection method by removing the tonsils with scalpel and stop the bleeding with sutures or extreme heat, a harmonic scalpel to cut and stop the bleeding with ultrasonic vibrations or electrocautery method by using heat to remove the tonsils and stop the bleeding and this usually takes 20 to 30 minutes.

1. Appendectomy (in 50 – 80 words)

It is the surgical removal of the appendix. The patient’s skin is shaved to get rid of the hair and swabbed with a germ-killing solution and sterility precautions taken to prevent diseases. The appendix is ejected by an open technique and an incision made in the lower right-hand side of the abdomen to remove the appendix.

1. Laparotomy (in 50 – 80 words)

It is a medical process entailing a large incision via the abdominal wall to gain access into the abdominal cavity. An incision is made over the abdominal wall to gain access into the abdominal cavity and then observe the parts to identify the cause of the problem.

1. Hysterectomy (in 40 – 70 words)

It is a medical procedure to remove all or part of the uterus. The surgeon provides general anaesthesia or regional anaesthesia and removes the uterus through an incision in the abdomen or vagina. If it is performed through the vagina doctors, use a laparoscope to assist them to observe the womb and perform the procedure.

1. Prostatectomy (in 50 – 80 words)

It is a medical operation for the partial or full removal of the prostate. The surgeon provides general anaesthesia or a spinal block and uses one of the many methods to eject the prostate gland and the surrounding tissue. The urethra will be reattached to the bladder neck, and he may also remove lymph nodes to check for cancer. Finally, a cut will be made below the navel and possibly via the bladder and the parts of the prostate that were causing problems to be removed.

1. Cataract extraction (in 50 – 80 words)

This a medical procedure performed to remove a clouded lens from the eye. During cataract extraction, the patient’s cloudy natural cataract lens is removed and an artificial intraocular lens implant inserted in its position.

11. Briefly describe the characteristics of internal bleeding due to trauma and its management (in 150 – 200 words).

The bleeding is not visible hence it is dangerous and results from apparent injuries that need fast medical care. Also, some internal bleeding due to trauma stops on its own but if continues the surgeons need to correct it (Raj et al., 2015). The management of internal bleeding due to trauma is the particular interventions to identify and control bleeding sources using surgical, pharmacological along with physiological methods including the closure and stabilisation of the pelvic ring disruptions, packing, and embolisation along with local haemostatic measures.

12. Outline five (5) key considerations when monitoring and managing a person on intravenous infusion via a peripherally inserted central catheter (PICC)/midline/central venous catheter (CVC).

When motoring and managing the patients, the internal diameter of the syringe administering the dose should be considered to be of a 10Ml to avoid excessive pressure and catheter rupture. The other considerations are that the solution used should only be a single-dose and the dose should be administered using an infusion pump. Moreover, the insertion sites should be assessed every shift for the detection of early signs of infection (Cooper, Kelly and Brown, 2017). The PICCs should not be replaced routinely but on clinical indications. Finally, when the PICC is replaced clinicians should also replace the fluid administration tubing and connectors.

13. Outline five (5) key considerations when monitoring and managing a person on continuous positive airway pressure (CPAP).

When monitoring a patient on CPAP, the CPAP pressure and rate of flow should not be altered or escalated without discussion with the medical staff. Also, the CPAP gauge should be adjusted to the pressure setting of 5 to 7 cm/H₂O, and the bubble chamber should be observed to make sure the bubbling is constant but not excessive (Murphie, Little, Paton, McKinstry and Pinnock, 2018). Whenever the patient is being handled the CPAP delivery must always be maintained to avoid atelectasis in CPAP dependent infants, and the orogastric tube should be inserted and secured for gastric decompression in which the decompression of the stomach and air removal must be done in 3 to 4 hours.

14. Outline five (5) key considerations when monitoring and managing a person on Bi-level positive airway pressure (BiPAP).

The key considerations are the response to noninvasive treatment by using arterial blood gas analysis, hemodynamic and respiratory stability, ventilation tolerance, identification of air leaks around the interface and detection of noninvasive failure (Parrish, 2018).

15. Outline five (5) key considerations when assisting a person with fluid intake via a nasogastric tube.

When monitoring people with nasogastric tube comfort to the person should be considered by ensuring the tube is securely anchored to prevent excess tube movement which leads to discomfort. Patients are allowed to suck on ice chips, or their mouth should be rinsed with cold water to avoid dehydration caused by blocking of one nostril (Elke, Felbinger and Heyland, 2015). Also, since these patients are at risk of aspiration flat lying should be considered and also the drainage flow should be obstructed and the tube irrigated if the patient complains of discomfort or abdominal pain. Moreover, for the clinicians monitoring the patients should ensure the machines used are labelled.

16. Identify four (4) complications of acute bed rest.

Complications of acute bed rest include contractures, muscle weakness, loss of skeletal mass and disuse osteoporosis.

PART B

Irene underwent a tonsillectomy under general anaesthesia and was transferred to your surgical ward from the recovery unit. Irene was conscious and oriented. She had swallowing difficulty and throat pain. She was allowed to sip a small quantity of water until further reviewed by the doctor.

Irene’s vital signs post-transfer to the surgical unit are as follows:

Time: 1630

Vitals: T – 36.8-degree Celsius, P – 74/mt, R – 16/mt, BP – 120/80 mm Hg, SpO2 – 98% in room air.

Other observations: Irene is awake and lying on her bed.

Time: 1830

Vitals: T – 39-degree Celsius, P – 86/mt, R – 22/mt, BP – 130/86 mm Hg, SpO2 – 98% in room air.

Other observations: Irene appears irritable.

1. Briefly describe the expected responses from an enrolled nurse in this situation.

The enrolled nurse should make an emergency call since the oxygen requirements seem to have increased to maintain the patient’s respiratory rate along with the pulse rate. Also, since the patient’s temperature is high, the enrolled nurse should hydrate the patient to manage the temperature.

2. The registered nurse asked you to continue monitoring Irene’s level of consciousness. Which clinical assessment should you undertake?

The clinical assessment to be undertaken is by use of coma scale performed commonly alongside an evaluation of pupil size and reaction, vital signs and focal neurological signs in the limbs.

3. The eye-opening score was 2 at the time of your clinical assessment. What does this indicate? What is the recommended nursing intervention in this scenario?

It shows an eye opening in response to painful stimuli, and it indicates pressure. What is recommended here is the induction of vocalization in an acceptable, consistent and replicable manner (Majdan, Steyerberg, Nieboer, Mauritz, Rusnak and Lingsma, 2015).

Bibliography

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Majdan, M., Steyerberg, E.W., Nieboer, D., Mauritz, W., Rusnak, M. and Lingsma, H.F., 2015. Glasgow coma scale motor score and pupillary reaction to predict six-month mortality in patients with traumatic brain injury: comparison of field and admission assessment. Journal of Neurotrauma, 32(2), pp.101-108.

Matsuda, A., Miyashita, M., Matsumoto, S., Matsutani, T., Sakurazawa, N., Takahashi, G., Kishi, T. and Uchida, E., 2015. Comparison of long-term outcomes of the colonic stent as “bridge to surgery” and emergency surgery for malignant large bowel obstruction: a meta-analysis. Annals of surgical oncology, 22(2), pp.497-504.

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