HLT54115 Diploma Of Nursing

PART A.

Left sided heart failure following a myocardial Infarction 6 years ago Hypertension Chronic Obstructive Pulmonary Disease (COPD) – Emphysema Swollen ankles and legs Benign Prostate Hypermegaly (BPH) He has been admitted to the Aged Care facility for respite and for assessment for permanent admission to a care facility. He is a past smoker. He states that he finds It hard to get around as he runs out of breath and says he stays In bed most of the day and lives alone In a large house where he has been for the past 46 years. His base line observations are as follows.
1. Plain the PathoPhysology of emphysema. 

2. Choose two vital sans that are affected by his emphysema? Explain why. 

3. Describe the pathophysiology of angina.

4. Explain the pathophysology of a Myocardial Infarction. Name one type of a MI – think about the area of the heart that may have been affected.

5. How 1 why would his past AMI have caused its CCF

6. Explain how his swollen ankles and legs are related to his CCF?

7. Explain Benign Prostate Hypermegaly (BPH)

8. What is Pulmonary Oedema? What signs and Symptoms would you be looking for in case Mr Brown started to show signs of 90?

9 Complete three nursing care plans for Mr Brown. Each plan must identify one patient problem/issue, one goal and two courses of action you would take. The outcome should then be evaluated.
10. State the general role of Allied Health workers providing patient care.
11. List those that should be Involved in Mr Brown’s care to ensure that when ho is discharged home, he will be able to live safely until he makes a decision to move into permanent care. Describe in detai their role and how they will assst Mr Brown (6 marks) 

PART B.
1. Whet Is the difference between a TIA and a stroke. explain the PalhOPelYsi0102Y7

2. Define and expkan the acronym FAST.
3. Explain looking at his current ctiservatons. which any would you be concerned about?Mehemet, you do. if anything about his observations?

4. List four signs and symptoms Jack may have presented with when dagnosed with a PE. (ements)

5. Define dyspnoea. Define tachycarcia. Define haemoplyas and diaphoresis.

6. Entail the pathcphysiology of asthma.

7. How would you position Jack If he was IIslang an asthma Mack?

8. What would you expect to happen to Jack’s HR and RR if he had on asthma attack and why?

9. List two Ailed Health workers that shoud form part of the routs-discipinary team assisting jack to rehabilitate foltming his stroke. Expbin what their role would be. (3marks) 

Part A- Case study of Mr Brown

Mr Brown had past habit of smoking. In lungs oxidative and inflammatory stress responses occurs with cigarette smoke that in triggers process critical to the development of COPD. The smoke is viewed as danger by the host and activates the mammalian target of rapamycin (mTOR). The process of alveolar maintenance is disturbed by oxidative stress, apoptosis and protease-antiprotease imbalance. A destructive pathway persists even after smoking cessation and result in structural damage.  This initiates emphysema an airflow limited state (Goldklang & Stockley, 2016).

• Low oxygen saturation-  is 90 % difficult breathing and due to COPD, restricting air flow
• Blood pressure- resembling hypertension in pulmonary arteries that are constricted due to hypoxia (Goldklang & Stockley, 2016)   

The imbalance between the oxygen demand and supply to heart results in Angina, characterised by severe chest pain. The increased demand for oxygen is not met due to obstruction or atherosclerotic plaques and is related with myocardial infarction, and hypertension in Mr Brown (Ford et al., 2018).   

Myocardial infarction is caused by the unstable atherosclerotic plaque that disrupts the vascular endothelium. It is due to formation of intracoronary thrombus which forms the coronary artery blood flow occlusion. The increase of risk of myocardium necrosis increases with the coronary occlusion being more proximal. Aldosterone hormone plays a role of damaging the vascular and myocardial function. As a result it promotes the coronary endothelial dysfunction. This hormone causes the left ventricular dysfunction and fibrosis followed by progression of heart failure. Thus, it adversely affects the heart and the blood vessels. It explains the myocardial infarction and left sided heart failure in Mr Brown.  There are five different situations to the myocardial infarction. In case of Mr. Brown, it is the situation of oxygen supply and demand imbalance (Kristensen et al., 2015).

One half of the patients with myocardial infarction develop left sided heart failure.  Mr Brown has hypertension. High blood pressure increases the work of left ventricle to pump blood out of circulatory system. This leads to weakening of heart and heart failure or CCF. With past myocardial infarction, the process of CCF is enhanced due to coronary artery blood flow occlusion (Mann & Felker, 2014).  

Swollen ankle and legs are related to fluid accumulation in body. It is caused by reduced blood flow from the heart due to CCF.  Since, the fluid does not move back from heart to veins results in fluid accumulation in lungs, liver, lower limbs and congestion.  However, with CCF the swelling in ankles and legs is obvious (Mann & Felker, 2014).

BPH is associated with the posterior urethral gland and affects most men at the age of or more. It is the non-cancerous enlargement of the prostate gland that results in hypertrophy of cells and compression of the urethral canal. It results in obstruction of urine flow (Aaron et al., 2016).

Pulmonary edema is the condition characterised by the fluid accumulation in air spaces of lungs leading to impairment in gaseous exchange. CCF is the common cause of the pulmonary edema in most cases.  If Mr Brown started to show the signs of PO the signs and symptoms I would be considering are- extreme shortness of breath, chest pain, rapid irregular heartbeat,  anxiety, wheezing, and cough with  frothy sputum and blood (Mann & Felker, 2014).

Problem of patients	Goal	Course of action	Evaluated
O2 saturation 90/% on room air	Maintenance of adequate gaseous exchange	1. Provide supplemental oxygen, via 100% O2 non-rebreather mask 2. Assess respiratory rate, breathing effort and pattern	SaO2 via pulse oximetry is 90 – 100%
High blood pressure	Lower the blood pressure	1.Monitor response to medication and administer beta antagonists 2.Encourage relaxation techniques such as distractions and comfort measures	The patient may maintain BP in normal range
Knowledge deficit	Paramagnet admission to care facility	1.Education of illness and adverse outcomes 2. Education on need of permanent aged care facility and outcomes	Patients shows willingness to be admitted in aged care facility as he lives alone

(Source: Baker & Fatoye, 2017)

In patient care the role of allied health professional is to support the diagnosis, patient recovery and quality of living.  They are involved in direct patient care through rehabilitation services, intensive care units, and educational nutritional programs for patients. They deliver scientific support in clinical laboratories; and provide data critical to diagnosis and seamless patient care. Their role is distinct from medical nursing (Saxon et al., 2014).

In Mr Brown’s care the following people should be involved (Day et al., 2018)-

• Home care nurse- Reconciliation of medication, prevent medication error, monitor side effects, management of medical equipment,  and techniques
• Social care worker- coordinate the patient’s medical care or addressing the financial issues
• Physiotherapist- to promote chest physiotherapy. May teach breathing techniques to patients to improve lung function  
• Family members if any or hired caretaker – emotional support, transfer from bed to chair, medication, handling procedures for ventilation, personal care such as eating or bathing,  engagement in meaningful conversation

Part B- Case study of Jack Jones

In case of TIA the blood flow is blocked to certain part of the brain and the symptoms may not appear again when flow is restored. In case of stroke the blockage persists and the brain has permanent damage. The pathophysiology of stroke is the heart disease or underlying damage of blood vessel. Hyperlipidemia, hypertension, atherosclerosis are the primary pathologies (Amy & Coutts, 2015).

FAST stands for face, arms, speech, and time and is the immediate action to identify the stroke patient.  Fast means to identify if an individual has face fallen on one side,  able to raise the arms, if the speech is slurred and immediately make a call to emergency care or hospital if any of these signs are observed (Wolters et al., 2015).

The patient has the high blood pressure of 160/95 and is a matter of concern. Being hypertension increases the risk of cardiac arrest since the patient already has three TIA’s. With high blood pressure the patients is at increased risk of morbidity and mortality. It may occur due to intracranial pressure and variable autonomic stress.  An immediate action would be taken to lower the blood pressure to prevent stroke of TIA (Amy & Coutts, 2015).

The four signs and symptoms Jack may have presented with when diagnosed with pulmonary embolus or PE are-

1. Tachypnoea, tachycardia-
2. Hypoxia
3. Gallop heart rhythm
4. Elevated jugular venous pressure

 Symptoms-

1. Dyspnoea
2. Cough
3. Pleurtic chest pain
4. Dizziness indicating right heat failure (Di Nisio et al., 2016)

Dyspnoea is defined as severe shortness of breath and difficult respiration. Tachycardia is defined as medical condition where the heart rate is greater than 100 bpm. Haemoptysis is defined as coughing up of blood from the lungs. Diaphoresis is defined as medical condition of excess sweating or production of perspiration (Villanueva et al., 2018).

Asthma is characterised by airflow limitations and is caused by various changes such as bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodelling.  Due to variety of stimuli such as irritant or allegens, the bronchial smooth muscle contraction occurs, and limits the air flow. Inflammation becomes more progressive due to edema, and structural changes such as hypertrophy and hyperplasia. Inflammation, dysfunctional neuroregulation, and structural changes result in airway hyperresponsiveness. The permanent structural changes in airway (airway smooth muscle hypertrophy, subepithelial fibrosis, sub-basement membrane, and hyperplasia) occur due to activation of many structural cells (Killeen & Skora, 2013).

I would position Jack in upright sitting position or high Fowler’s to allow unobstructed breathing and improve his condition (Chan, 2012).

If Jack has asthma attack then there will be marked changes in HR and RR. The heart rate increases (more than 120 bpm) during the asthma attack as high cardiac output can combat the low oxygen in the blood stream. The respiratory rate is also increases due to increase in breathing owing to narrowing of airways and ventilation perfusion imbalance (Papaiwannou et al., 2014).

Two allied health workers in case of Jack following stroke are-

1. Physiotherapist- physiotherapy constitutes an important part of rehabilitation after TIA or stroke. Physiotherapy is important for limb strengthening and relearn the patterns of movements. The role of physiotherapist is to help patient gain physical potential and recovery despite the disease severity. It is important for Jack as he has right sided hemiplegia, dysphasia, and dysphagia (Tamburella et al., 2017).  
2. Podiatrist- plays an important role in managing the fall risk in stroke patient. They also play an important role in cellulitis and diabetic limb salvage. Jack had cellulitis two months ago recurrence is expected, therefore, podiatrist is needed to prevent adverse conditions in future (Torpy & Livingston, 2012).

References

Aaron, L., Franco, O. E., & Hayward, S. W. (2016). Review of prostate anatomy and embryology and the etiology of benign prostatic hyperplasia. Urologic Clinics, 43(3), 279-288.

Amy, Y. X., & Coutts, S. B. (2015). Stroke: risk assessment to prevent recurrence after mild stroke or TIA. Nature Reviews Neurology, 11(3), 131.

Baker, E., & Fatoye, F. (2017). Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review. International journal of nursing studies, 71, 125-138.

Chan, Z. C. (2012). Role-playing in the problem-based learning class. Nurse Education in Practice, 12(1), 21-27.

Day, C. B., Bierhals, C. C. B. K., dos Santos, N. O., Mocellin, D., Predebon, M. L., Dal Pizzol, F. L. F., & Paskulin, L. M. G. (2018). Nursing home care educational intervention for family caregivers of older adults post stroke (SHARE): study protocol for a randomised trial. Trials, 19(1), 96.

Di Nisio, M., van Es, N., & Büller, H. R. (2016). Deep vein thrombosis and pulmonary embolism. The Lancet, 388(10063), 3060-3073.

Ford, T. J., Corcoran, D., & Berry, C. (2018). Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need. Heart, 104(4), 284-292.

Goldklang, M., & Stockley, R. (2016). Pathophysiology of Emphysema and Implications. Chronic Obstructive Pulmonary Diseases, 3(1), 454.

Killeen, K., & Skora, E. (2013). Pathophysiology, diagnosis, and clinical assessment of asthma in the adult. Nursing Clinics, 48(1), 11-23.

Kristensen, S. L., Jhund, P. S., Køber, L., Preiss, D., Kjekshus, J., McKelvie, R. S., … & Komajda, M. (2015). Comparison of outcomes after hospitalization for worsening heart failure, myocardial infarction, and stroke in patients with heart failure and reduced and preserved ejection fraction. European journal of heart failure, 17(2), 169-176.

Mann, D. L., & Felker, G. M. (2014). Heart Failure E-Book: A Companion to Braunwald’s Heart Disease. Elsevier Health Sciences.

Papaiwannou, A., Zarogoulidis, P., Porpodis, K., Spyratos, D., Kioumis, I., Pitsiou, G., … & Tsiouda, T. (2014). Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS): current literature review. Journal of thoracic disease, 6(Suppl 1), S146.

Saxon, R. L., Gray, M. A., & Oprescu, F. I. (2014). Extended roles for allied health professionals: an updated systematic review of the evidence. Journal of multidisciplinary healthcare, 7, 479.

Tamburella, F., Moreno, J. C., Iosa, M., Pisotta, I., Cincotti, F., Mattia, D., … & Molinari, M. (2017). Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis: a pilot study. Topics in stroke rehabilitation, 24(6), 447-456.

Torpy, J. M., & Livingston, E. H. (2012). Health Care Professionals and Qualifications. Jama, 308(21), 2296-2296.

Villanueva, A., Shaughnessy, G., & Ung, S. (2018, February). 70-Year-Old Woman With Sudden Onset of Chest Pain and Diaphoresis. In Mayo Clinic Proceedings. Elsevier.

Wolters, F. J., Paul, N. L., Li, L., & Rothwell, P. M. (2015). Sustained impact of UK FAST?test public education on response to stroke: a population?based time?series study. International Journal of Stroke, 10(7), 1108-1114.