CNA773 Contemporary Critical Care Nursing Science

Question:

Part A

For the task, review the modules and the discussion statements/forums. You are to complete eight discussion entries across at least six different discussion forums and at least four of your eight discussion entries should respond to, elaborate or challenge the position of another/other students. Scholarly references must be included where appropriate in both your postings and in you summary. When responding to entries posed by others in your group, you should create new threads of discussion. You should respond to the questions raised by others within the discussions, inviting and encouraging scholarly debate.

Part B

Your experience is to be summarised into a soo word reflective paper that is focused on exploring your experiences during Me discussions, the outcomes of your learning, future directions, how you might apply this learning in your practice and reflections upon the literature and/or questions asked by fellow students. Attach to this document as appendices four of what you feel are your best discussion entries. Submit your summary paper (including discussion entries) into the assignment drop box in MyLO by the due date.

Discussion Statements:

1: Factors such as age, community setting, comorbidities and travel influence the risk of developing bacterial meningitis.

2: Without an alternative treatment option, the administration of high dose methylprednisolone following an acute spinal injury is acceptable practice.

3: What barriers may present and impact on the prompt antibiotic treatment for suspected bacterial meningitis? What evidence Is there to support the prioritisation of antibiotic treatment?

4: Discuss the links between clinical depression and chronic back pain.

5: Consider the legal, moral and ethical considerations when a patent presents with a fungal CNS infection and a positive blood result for HIV, of which the patient was unaware of.

6. What are the treatment options for spinal cord tumours and when is surgery considered?

7. Discuss how you may approach the topic of vaccination to a mother , who is reluctant to vaccinate her children when one of her six children has presented with meningitis secondary to Haemophilus Influenza..What important information should she be informed of’?

8. Discuss the role of flexion and extension x-rays in cervical spine clearance.

9. Why are we currently experiencing an increasing incidence of tuberculosis meningitis in western counties that have otherwise had a low incidence of tuberculosis?

Answer:

Statement 5

Confidentiality and disclosure of HIV status. The patient has the right to have their HIV status not disclosed without their permission. Their medical condition can only be revealed with their consent and done within the agreed terms.

Consent for medical research. The patient should assent to any need to use their health status for purposes of medical research. They should be made to understand all issues that may arise from this research and any information necessary thereof disclosed to them. The patient should be allowed to seek further counsel before making such decisions (Walters 1998).

The patient has a right to respect for their human rights and dignity. Both national and international laws stipulate the rights of persons. These human rights are to be upheld and the patient should be handled in a manner that upholds their dignity as humans.

The patient should be able to access care and medical support. It should be made known to the patient the options there are for further treatment and the way they can access these crucial services. The patient has the right to also seek the services in facilities they deem fit. Information as to the side effects and contraindications of the treatment offered.

The patient should give consent to any further examination and testing that may be required. The tests to be performed and the importance of the results thereof should be made known to the patient. If any complications may arise it should be made known when seeking consent from the patient.

Statement 7

I would highlight the reasons why vaccination is important to the mother. She would appreciate the need for vaccination if it is made known to her that vaccination can prevent some diseases.

Children under five years of age are more susceptible to Haemophilus influenzae which is a leading cause of meningitis among these children. Vaccination however has made its occurrence less often (Adams et al 1993). The child that developed meningitis secondary to Haemophilus influenzae infection is because the virus can spread into lungs from the upper airway or into the bloodstream ending in the meninges covering the spinal cord and the brain. It is therefore not only invasive but also infectious. It therefore spreads from one person to another. Vaccination can therefore contain the spread of H. influenzae among her other children who have not presented with the disease.

Haemophilus influenzae type B can also cause other diseases such as pneumonia, infections of blood, bones, and joints. It can also cause death if not treated earlier. Vaccination therefore can help avoid such eventualities if those who do not suffer the infection are vaccinated against it (Ribeiro et al 2003).

The clinical efficacy of the H. influenzae among properly and completely vaccinated children is approximated to be around ninety to hundred percent. The mother can therefore have the assurance that the vaccine will effectively combat any manifestations of the haemophilus type b disease. The vaccine has also demonstrated to be immunogenic in patients that are more susceptible to the invasive disease hence highly recommended that the mother gets her children vaccinated ( Peltola, Kilpi, and Anttila, 1992).

Statement 9

There has been an increasing incidence of tuberculosis meningitis in the western countries which have previously shown lower numbers than countries in sub-Saharan Africa. Tuberculosis meningitis is caused by Mycobacterium tuberculosis. The increasing incidence has been attributed to factors such as increased incidence of new HIV infections. HIV suppresses the immunity of those with the virus reducing their ability to mount an immune response. This makes individuals with HIV contact Mycobacterium tuberculosis as an opportunistic disease due to their weakened immunity (Walls and Shingadia, 2004).

Increased migrations into the western countries from the less developed countries where the incidence of tuberculosis meningitis has previously been high could have contributed to this new occurrence. Individuals infected with tuberculosis that move in to other areas could pass as focal points of infection. The individuals in the western countries therefore become susceptible to this transmissions especially tuberculosis being airborne (Lan et al 2001).

Drug abuse and misuse among the western countries is another contributing factor to this new occurrence. Smoking is prevalent among individuals in the western countries and generally the developed world. Smoking compromises the integrity of the physical barrier of the airway. The respiratory tract being an external environment hence exposes the smokers to the bacterium from aerosols or any other sources that can contaminate the air. Smokers have a weakened immunity making them also more vulnerable to infection.

Increased populations in western cities is another factor that creates the greatest challenge of containing the spread of the diseases causing bacterium Mycobacterium tuberculosis. The airborne bacterium therefore spreads faster among this large populations in these cities.

Bibliography

Adams, W.G., Deaver, K.A., Cochi, S.L., Plikaytis, B.D., Zell, E.R., Broome, C.V., Wenger, J.D., Stephens, D.S., Farley, M.M., Harvey, C. and Stull, T., 1993. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. Jama, 269(2), pp.221-226.

Lan, S.H., Chang, W.N., Lu, C.H., Lui, C.C. and Chang, H.W., 2001. Cerebral infarction in chronic meningitis: a comparison of tuberculous meningitis and cryptococcal meningitis. Qjm, 94(5), pp.247-253.

Peltola, H., Kilpi, T. and Anttila, M., 1992. Rapid disappearance of Haemophilus influenzae type b meningitis after routine childhood immunisation with conjugate vaccines. The Lancet, 340(8819), pp.592-594.

Ribeiro, G.S., Reis, J.N., Cordeiro, S.M., Lima, J.B., Gouveia, E.L., Petersen, M., Salgado, K., Silva, H.R., Zanella, R.C., Almeida, S.C.G. and Brandileone, M.C., 2003. Prevention of Haemophilus influenzae type b (Hib) meningitis and emergence of serotype replacement with type a strains after introduction of Hib immunization in Brazil. The Journal of infectious diseases, 187(1), pp.109-116.

Walls, T. and Shingadia, D., 2004. Global epidemiology of paediatric tuberculosis. Journal of infection, 48(1), pp.13-22.

Walters, L., 1988. Ethical issues in the prevention and treatment of HIV infection and AIDS. Science, 239(4840), pp.597-603.

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