CNA116 Introduction To Nursing
Questions:
Part A
Chronic diseases or chronic health conditions Any three major presenting features or manifestations
- Chronic asthma
- Chronic obstructive pulmonary disease
- Chronic pain
- Chronic renal failure
- Congestive heart failure
- Diabetes insipidus
- Diabetes mellitus
- Eczema
- Bladder incontinence
- Motor neurone disease
- Severe traumatic brain injuries (neurological injury)
- Long term unconscious or coma
- Osteoarthritis
- Parkinson’s disease
- Rheumatoid arthritis
- Middle cerebral artery (MCA) stroke
- Systemic lupus erythematosus (SLE)
- Chronic back pain
Various concepts and models of chronic health care Description
- Chronic disease continuum
- Five key strategic objectives of the Chronic Diseases and Health Promotion Department (World Health Organisation)
- Innovative Care for Chronic Conditions Model
- Six elements of the Chronic Care Model
- Purpose of the National Strategic Framework for Chronic Conditions
- Nine national health priority areas agreed by the Australian Health Ministers’ Advisory Council
Various strategies to address and manage chronic diseases Description
- Four strategies to prevent chronic diseases
- Four treatment strategies used to address and manage chronic diseases
- Five principles of person-focused nursing practice
- Five examples of recommended practices for person-focused nursing practice
- Four strategies to assist a person with chronic disease to maintain positive life roles
- Five strategies to enable changes in a person’s behaviour over time
- Five stages of change to establish readiness for attitudinal and behavioural change
- Palliative care and domains of palliative care that must be undertaken as a strategy to address and manage chronic diseases
Various rehabilitation strategies, techniques and equipment used for chronic health conditions Description
- Five focus areas of physiotherapy in managing chronic conditions
- Aim of occupational therapy in rehabilitation
- Role of hydrotherapy in rehabilitation
- Four advantages of the use of Pilates in rehabilitation
- Four advantages of massage in rehabilitation
- Role of art therapy in rehabilitation
- Four advantages of music therapy in rehabilitation
- Five considerations when choosing a wheelchair, scooter or walking aids for a person with chronic disease
- Three considerations when choosing a prosthesis for a person with chronic disease.
Part B – Case study
Case study scenario 1:
Assume that you are working as an EN in a stroke unit. Sherly, 48 years, is admitted with middle cerebral artery stroke and is recovering well. She is due to be discharged tomorrow.
Sherly has severe paresis and sensory loss of left extremities, uncoordinated movements and slurred speech.
Sherly requires restorative care and is anxious about her future life.
She requires a wheel chair to move around.
Sherly is a migrant with permanent residency in Australia. She has limited knowledge and understanding of resources that she could utilise in managing her condition.
- Identify and briefly describe any three (3) specific community based care services that are available for Sherly to ensure a coordinated service approach to provide her with rehabilitation care.
Case study scenario 2:
Mrs Melisa Carfi, a 65-year-old female patient with Type 2 diabetes mellitus, was admitted in your health care facility with a non-healing foot ulceration. Prior to admission, Melisa’s diabetes was managed with metformin. Upon admission, subcutaneous insulin with a diabetic diet was initiated along with oral anti-diabetic agents to achieve optimal blood glucose control.
- Provide a list of four (4) specific questions you would ask Melisa in order to seek information to confirm her understanding of the condition and its impact.
- What specific information will you give to Melisa if you are to provide health education on dietary management and physical activity with the goal of losing weight?
Case study scenario 3:
Mr David Ventor, 76 years old, has Type 2 Diabetes Mellitus, hypertension and a history of a Transient Ischemic Attack x 3 months ago. Mr Ventor’s wife passed away a month ago.
A community enrolled nurse visiting Mr Ventor’s home noticed the kitchen in an unhygienic condition with leftover food including pizza, juice and ice cream cartons.
The enrolled nurse observed that Mr Ventor was upset and teary when talking about his health status and the demise of his dear wife.
The community RN is due to visit Mr Ventor next week. At the previous visit, there were no unusual activities to be noted or cause worry in relation to Mr Ventor.
Mr Ventor’s son moved in with him a week ago. His son is unemployed and an alcoholic. He was not at home during the visit.
The enrolled nurse asked Mr Ventor how supportive his son was in addressing his father’s needs. Mr Ventor didn’t reply and stared away with teary eyes.
Mr Ventor was unwell with a cough and chronic back pain.
The enrolled nurse convinced Mr Ventor to seek medical support. An ambulance was called and Mr Ventor was transferred and admitted to a medical ward in the hospital for further evaluation and management.
- Identify and discuss the current contribution of community agencies and professionals in supporting Mr Ventor, referring to the scenario provided.
- Identify and discuss the level and type of contribution and support made by Mr Ventor’s son in managing his health condition and current situation.
- How effectively did the enrolled nurse respond to variations in Mr Ventor’s needs?
- Mr Ventor’s blood sugar level was observed to be high (14 mmol/dL). Mr Ventor was not complying with diabetic diet requirements. How should the enrolled nurse respond to these variations and Mr Ventor’s changing needs? Briefly describe a coordinated service approach required for Mr Ventor in this situation.
- Discuss strategies you could implement to actively involve Mr Ventor in the development of approaches to self-manage his condition.
Answers
Part A
1.
|
Health issues |
Sign and symptoms |
|
Chronic asthma |
· Shortness of breath. · Chest stiffness or pain. · Trouble in sleeping ( National Institute of Heart, Lung, and blood, 2018) |
|
Chronic obstructive pulmonary disease |
· Blueness of lips · Recurrent respiratory contaminations · Lack of energy (National Institute of Heart, Lung, and blood, 2018) |
|
Chronic pain |
· pain remain more than twelve weeks · fatigue, · sleep disturbance ( Medicine Plus, 2011) |
|
Chronic renal failure |
· Nausea · Vomiting · Loss of appetite ( NHS, 2016) |
|
Congestive heart failure |
· Reduced exercise capability · Shortness of breath · Swelling (edema) ( Binanay et al., 2005) |
|
Diabetes insipidus |
· Great thirst · extreme amount of thinned urine · Trouble in sleeping ( Grois et al., 2006) |
|
Diabetes mellitus |
· Recurrent urination · Extreme thirst · Unexplained weight loss ( Grois et al., 2006) |
|
Eczema |
· Very scratchy skin · Red skin · Dry skin |
|
Bladder incontinence |
· trouble talking or walking · weakness or tingling · loss of visualization |
|
Motor neuron disease |
· weakness in arms and legs · Limbs turn into increasingly weaker · unable to move, eat, or breathe without assistance |
|
Severe traumatic brain injuries (neurological injury) |
· Sensitivity to bright or sound · Memory or attention problems · Dizziness |
|
Long-term unconscious or coma |
· Eyes closeness · Unhappy brainstem reactions, like pupils not reacting to light · No reactions of limbs |
|
Osteoarthritis |
· Grating feeling · Bone spurs · Joint difficulty |
|
Parkinson’s disease |
· Slowed movement (bradykinesia) · Rigid muscles · Loss of involuntary movements. |
|
Rheumatoid arthritis |
· Tender, warm, inflamed joints · Joint stiffness · Fatigue, temperature and weight loss |
|
Middle cerebral artery (MCA) stroke |
· Face Weakness · Arm or Leg Weakness · Slurred Speech |
|
Systemic lupus erythematosus (SLE) |
· serious fatigue · joint pain · joint enlargement |
|
Chronic back pain |
· a dull ache in the back · stabbing sporadic pains · lower back pain dispersal to the legs |
2 (NSW Government (2017)
- upkeep and safe management of enteral nourishing equipment
- plan for removed tube
- stoma care
- oral care
- positioning (Tabloski, 2006)
- diet and liquid intake
- exercise
- impact of medicines (Norton, et al., 2010)
3. a) This appraisal backings staff in enlightening how to grow and monitor decent health upkeep that can knowingly progress a person’s health result. It has been advanced for Nurses who deliver individual-centered health help for persons with incapacity as the nurses are the leading and significant mediator among doctors and patient; therefore it is essential for them to follow this document (NSW Government (n.a).
-
- the records of baseline data
- the rationale for healing interventions
- the basis for health care preparation
- the assessment of therapeutic interventions
4. A temporary tracheostomy is formed when a diseased person needs long-term respiratory care or are incapable to guard own air route. A tracheostomy pipe can be introduced to retain the potential of the air route. This can be detached when the diseased person improves. A short-term tracheostomy may turn into permanent if the patient’s disorder needs this. A everlasting tracheostomy is shaped in which the trachea is transported out to the superficial part of the skin and sewed to the neckline wall. This hole is kept exposed by the inflexibility of the tracheal cartilage (Freeman et al., 2000).
5.
|
Concepts and models |
Description |
|
Chronic disease continuum |
Mental health is hypothesized alongside a continuum that varieties from decent mental health, such as the decent emotional, intellectual and social regulation and communication, to the mental disease that unfavorably affects thinking, feelings, behavior, and capability to function and work together. The signs of individuals with ASD may fall on a continuum. |
|
Chronic Diseases and Health Promotion Department |
This is the initiative of world health organization to provide management and direction for crucial global, local and national determinations to endorse health and to stop and regulate major chronic illnesses and their threat factors. |
|
Innovative Care for Chronic Conditions Model |
The model offers a “road map” for nations and health organizations to modernize their health maintenance to encounter the requirements of chronic circumstances (Pruitt, and Epping-Jordan, 2002) |
|
elements of the Chronic Care Model |
· Health organizations · Decision upkeep · Clinical info systems · Patient self-management support · Communal assets to organize patient resources · Delivery scheme design for medical care and self-management care (National Institute of Diabetes and Digestive and kidney diseases, n.a) |
|
Purpose of the National Strategic Outline for Chronic Situations |
The Framework delivers direction for the growth and application of policies, approaches, actions, and facilities to lessen the influence of prolonged situations in Australia. The Framework delivers national way appropriate to a wide range of prolonged illnesses and for the avoidance and organization of many continuing conditions (Department of Health, 2017) |
|
national health priority areas |
1. Cancer regulation 2. Cardiac health 3. Injury avoidance and control 4. Psychological health 5. Diabetes mellitus 6. Asthma 7. Arthritis and musculoskeletal conditions 8. Obesity 9. Dementia |
6. Financial impact; financial influence included movement aids, clothes, transport.
Social; social isolation, negative impact on relationships, isolation from social activities
Physical; lack of energy, lack of ability to do daily tasks, weight issues
Psychological; feelings of impossibility, tiredness, and frustration
7
- Skin
- Lungs
- Female Breasts
- Prostate
- Colon and Rectum (Smith, et al., 2006)
8
- Alcohol
- Drugs
- Healthy Weight, Diet & Exercise
- Sexual Health
- Smoking(Diener, and Chan, 2011.)
9
|
strategies to address and manage chronic diseases |
Description |
|
strategies to prevent chronic diseases |
· Evade smoking and Tobacco · Uphold a Healthy Weight · Maintain Daily Bodily Activity · Eat Healthy Food |
|
treatment strategies |
· Endorse health and lessen risk Planned Priority Area · Corporations for health Planned Priority Area · Serious life stages Planned Priority Area · Timely and suitable discovery and intervention |
|
|
|
|
principles of person-focused nursing practice |
· Appreciating people · Understanding relationships · Understanding the significance of the patient’s past · Balancing privileges, risks, and accountabilities. · Responsive care that is reactive to individual needs |
|
practices for person-focused nursing practice |
· making sure persons are bodily relaxed and harmless · emotional care · connecting family and friends · making sure there is steadiness within service area · concerning people’s morals and placing individuals in the middle of care |
|
strategies for positive life roles |
· Be empathetic · Responsive · Listen to them · Provide Emotional support |
|
strategies to enable changes in a person’s behavior |
· Assess behaviors risks · Advice about behavioral change · select suitable treatment goals · Assist them with interventions · Schedule follow-up connections to provide on-going help |
|
stages of change |
· Precontemplation · Contemplation · Preparation · Action · Maintenance · Relapse |
|
Palliative care and its domains |
Palliative care and domains of reassuring care that should be commenced as an approach to address and cope with chronic diseases. Domains: Family domain, Financial domain, Legacy domain |
10
|
Various rehabilitation strategies, techniques, and equipment used for chronic health conditions |
Description |
|
focus areas of physiotherapy in managing chronic conditions |
· Decrease pain · shortness of breath · Increase sureness and assurance to exercise · Improve social interaction · Decrease muscle stiffness |
|
The aim of occupational therapy |
Provide a helpful rehabilitation service, which inspires persons to maximize their potential in, and over, day-to-day doings linked with daily life.
|
|
Aim of hydrotherapy |
intended to use the benefits of water to increase movement and function |
|
Advantages Pilates in rehabilitation |
· stable muscular strength on both edges of the body · improved muscular regulation of the spine and limbs · better stabilization of the spine · rehabilitation or avoidance of injuries linked to muscle inequities |
|
advantages of massage |
· decreased muscle tension · better circulation · triggering the lymphatic system · decreasing stress hormones
|
|
Role of art therapy |
· Increase Self-Management. · Lessen Symptoms of Depression. · Increase Communication Skills. · Deal with Past Traumas. · Decrease Stress
|
|
advantages of music therapy |
· Grows relaxation and managing skills · Improves consciousness of self and one’s atmosphere · Delivers a feeling of regulation on life by having a positive experience throughout the session · Improves problem-solving skills |
|
Considerations when choosing mobility devices |
· physical ability to handle the device · the weight of the device · How comfortable the device is? · How strong the device is to support the person? · Will health insurance pay for the device? |
|
Considerations while choosing a prosthesis |
· The site and level of the amputation · The situation of the remaining limb · the activity level, chiefly for a prosthetic leg or foot · the particular goals and requirements |
11. Rehabilitation services
- Podiatry and Foot Care
- Physiotherapy
- Occupational Therapy
- Clinical Psychology
- Neuropsychology
- Counseling
- Prosthetics and Orthotics
- Specialized Wheelchair and Posture Seating
- Clinical Technology Workshop – Equipment repairs and modification
Part 2
Case 1
1.
- Specialized Wheelchair and Posture Seating
- Counseling
- Emotional support
Case 2
2
- What is your current diet?
- How much sugar do you consume daily?
- Do you have any additional symptoms associated with the disease?
- Do you have any allergies?
- How you take care of your wound at home?
3. I will provide her the information related to the daily diet, essential exercises, how to prevent ay infection to the wound, how to take the medicine and make her believe that her health issues can be treated.
Case 3
4. The current community agencies like social and psychological health care agencies can help him to encourage toward getting treatment. He could be proved with emotional support and diabetic health interventions. The rehabilitation groups can help his son to recover from alcohol addiction.
5. As Mr. Ventor responded to the question asked to him about his son it does seems that his son supported him. His son was also facing issues of alcohol addiction, therefore it only increases the psychological problem of the patient. He would have given him financial and emotional support in this scenario.
6. The enrolled nurse did well in observing the current situation of the patient. However the question she asked the patient was not appropriate. Was not very effective in order to deliver the psychological help to the patient, she ignored that fact that the patient is already in pain.
7. The nurse should provide emotional and psychological interventions to the patient encourage him to maintain his diet in order to achieve the diabetic health goals already set for him. The person-centered approach can be followed in this case by using therapeutic communications.
8.
- The patient can be involved in the decision making about the treatment
- Helping patients gain the knowledge, skills
- Helping the patient in understanding how their disorder affects their lives and how to manage their symptoms
- The usage of electronic instructive technology in learning and teaching, delivering data for patients
- An contract between the diseased person and their health care providers inpatient notes
- Behavioral change therapies should be implemented in the treatment care for the patient in order to change his behaviors toward the daily healthy diet
References
Binanay, C., Califf, R.M., Hasselblad, V., O’Connor, C.M., Shah, M.R., Sopko, G., Stevenson, L.W., Francis, G.S., Leier, C.V. and Miller, L.W., 2005. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. Jama, 294(13), pp.1625-1633.
Department of Health 2017. National strategic framework for the chronic condition. Available from: https://www.health.gov.au/internet/main/publishing.nsf/content/nsfcc [Accessed 23 December 2018].
Diener, E. and Chan, M.Y., 2011. Happy people live longer: Subjective well?being contributes to health and longevity. Applied Psychology: Health and Well?Being, 3(1), pp.1-43.
Freeman, B.D., Isabella, K., Cobb, J.P., Boyle, W.A., Schmieg, R.E., Kolleff, M.H., Lin, N., Saak, T., Thompson, E.C. and Buchman, T.G., 2001. A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Critical care medicine, 29(5), pp.926-930.
Grois, N., Pötschger, U., Prosch, H., Minkov, M., Arico, M., Braier, J., Henter, J.I., Janka?Schaub, G., Ladisch, S., Ritter, J. and Steiner, M., 2006. Risk factors for diabetes insipidus in langerhans cell histiocytosis. Pediatric blood & cancer, 46(2), pp.228-233.
Medicine Plus (2011). Chronic pain: Symptoms, Diagnosis & treatment. Retrieved from: https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg5-6.html
National Institute of Diabetes and digestive and kidney diseases. n.a. Chronic care model. Available from: https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/practice-transformation-physicians-health-care-teams/team-based-care/chronic-care-model [Accessed 23 December 2018].
National Institute of Heart, Lung, and blood (2018). Asthma. Retrieved from: https://www.nhlbi.nih.gov/health-topics/asthma
NHS (2016). Symptoms: chronic kidney disease. Retrieved from: https://www.nhs.uk/conditions/kidney-disease/symptoms/
Norton, C., Whitehead, W.E., Bliss, D.Z., Harari, D. and Lang, J., 2010. Management of fecal incontinence in adults. Neurourology and Urodynamics: Official Journal of the International Continence Society, 29(1), pp.199-206.
NSW Government (2017). Working with people with chronic and complex health care needs practice package. Retrieved from: https://www.facs.nsw.gov.au/__data/assets/file/0003/301782/Working-with-people-with-chronic-and-complex-health-care-needs-Practice-Package.pdf
NSW Government (n.a). Working with people with chronic and complex health care needs practice package. Retrieved from: https://www.facs.nsw.gov.au/__data/assets/file/0003/301782/Working-with-people-with-chronic-and-complex-health-care-needs-Practice-Package.pdf
Pruitt, S. and Epping-Jordan, J., 2002. Innovative care for chronic conditions: building blocks for action: global report. World Health Organization.
Smith, D.I., Zhu, Y., McAvoy, S. and Kuhn, R., 2006. Common fragile sites, extremely large genes, neural development, and cancer. Cancer letters, 232(1), pp.48-57.
Tabloski, P.A., 2006. Gerontological nursing. Pearson Prentice Hall.
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