HLTENN001 Practise Nursing Within The Australian Health Care System

Patient’s overview

Chronic kidney disease is a critical disorder that has necessitated the patient to hemodialysis as an alternative means to purify blood because the kidneys are not functioning normally. Hemodialysis assists in removal of unwanted products in the body like urea, free water from the blood and creatinine when the kidney fails to perform. In addition to kidney disease, the man is suffering from other diseases like insulin dependent diabetes, nephropathy, neuropathy and retinopathy. The insulin-dependent diabetes is a disorder in which the body mistakes the insulin-producing cells to be foreign cells and destroys them hence they no longer produce insulin to be used in the body ^[4]. Nephropathy is associated with diabetes and occurs due to kidney malfunction. When the glomeruli are damaged there is the loss of protein in the urine and serum albumin become low due to body swelling which leads to nephrotic syndrome. The pathophysiology of this disorder starts with inappropriate control of blood sugar ^[6]. Neuropathy is a term used to refer to health disorders such as peripheral nerves damage and the symptoms of these problems. The symptoms of this disorder are; paralysis, burning sensation, permanent numbness, muscle weakness, impairment to sexual function and urination, pain and increased sensitivity to touch ^[5]. Retinopathy is a disorder that results from damage of the eye retina which may lead to the impairment of the vision. It is caused by abnormal blood flow that leads to the retina is damaged.

In most cases, retinopathy is caused by diabetes which leads to blindness. The relevant co-morbidities include high blood pressure, diabetes, heart failure, myocardial infarction, and hypercholesterolemia. The Aboriginal man is under the following medications insulin glargine that is used to regulate glucose metabolism, pantoprazole that is used as an antacid, aspirin that is used to relieve pain in the body and insulin as the part which lowers blood glucose activity. The other medications include digoxin, warfarin, temazepam, pantoprazole and nebivolol. The reason why this patient needs to be admitted to the hospital is that of the body health status ^[1].

The patient has myocardial infarction which occurs when there is a decrease in the flow of blood, or it has stopped in one part of the heart which causes damage to the muscle of the heart. The patient feels pain in the chest or discomfort, and it may spread to the back, arm, neck shoulder, and jaw. In most cases, myocardial infarction occurs on the lift side or center of the chest, and it may last for minutes ^[7]. Other symptoms include; nausea, cold sweat, feeling faint, shortness of breath and feeling tired. This disorder occurs due to disease of coronary artery and the risk factors include; lack of exercise, smoking, obesity, diabetes, poor diet and high blood cholesterol. Aspirin in most cases is the most appropriate treatment for myocardial infarction. The stents implantation is an intervention in which a mesh tube is inserted in an artery which has been narrowed by plaque accumulation. The tube, edge through an artery in the arm or leg will expand to hold it open at the point where the flow of blood is restricted. Atrial fibrillation is an irregular heartbeat or a quivering which leads to heart failure, stroke, blood clots among other complications that are related to the functioning of heart ^[3].

Furthermore, the patient has several other medical conditions which include; heart failure which occurs the muscles of the heart fails to pump the blood as usual. This may be as a result of high blood pressure or coronary artery disease which weakens the heart hence inefficient pumping of blood. Pleural effusion is an uncommon amount of fluid around the lung which is caused by leaking of fluid from other body organs, infections like pneumonia, pulmonary embolism and cancer problem. The symptoms of this disorder include; a cough, shortness of breath, fever and chest pain when breathing deeply. Type 1 diabetes is a disorder in which the pancreas releases very little amount or no insulin hormone at all hence glucose cannot enter the cell to aid in the production of energy ^[8]. Hypertension is the force which the blood applies on the vessels of the blood due to the resistance of blood vessels or work being done by the heart. This pressure may lead to severe complications such as stroke, heart disease or even death. Hypercholesterolemia is a condition where the levels of cholesterol in the blood are high, which is a consequence of obesity, an unhealthy diet or inherited disease. And finally, is Gastric esophageal reflux disorder which is the digestive disease which affects the lower part of esophageal ring muscle that is between the stomach and esophagus ^[2].

The medications information

Aspirin

Aspirin is used to reduce inflammation and relieve pain from the patient body. Aspirin is regularly suggested to be used by patients who suffer from a stroke or heart attack. It works by keeping the blood cells of the patient from clumping together. The clumps block the heart and brain blood vessels. Oxygen and other nutrients cannot reach brain and heart if the vessels are blocked. As a result, a heart attack may occur due to the lack of blood in the heart, and also stroke occurs due to lack of blood in the brain. Aspirin may increase the danger of bleeding in the brain, small intestine and stomach ^[10]. If high doses aspirin are taken for an extended period, it may damage the walls of small intestine and stomach slowly which leads to bleeding. Use of aspirin for blood clot prevention may also interfere with the healing of damaged blood vessels which occurs naturally and raise the danger of bleeding in the brain. Hence there is a need to monitor the medication for this patient to avoid such complications that may occur later in his body. Aspirin is necessary for this patient because he/she has a heart attack and diabetes which will be cured by this medication. If a patient has diabetes or heart disease or has had the stroke or heart attack, the healthcare specialist will recommend him to use aspirin. But if the patient has high cholesterol, smokes, or have a family history of heart disease, it is necessary to deliberate on other better options available to use. Aspirin is a common drug that is used to treat mild pain, fever and migraines. Some common uses of aspirin include reducing period pains, long-term conditions like arthritis, headaches, strains & sprains, and colds & flu. Aspirin is used alone on mild pain to moderate pain, but for moderate pain and severe pain, it is used alongside other drugs.

Insulin Aspirant

Insulin as a part is a combination of insulin that acts faster than human insulin, to normalize glucose metabolism by binding on fat cells and muscles the insulin receptors, hence facilitating the cellular glucose uptake. This helps in lowering the levels of blood glucose in the patient’s body. Besides, insulin apart prevents the conversion of glycogen that is stored to glucose by the liver which also aids in lowering the levels of blood glucose. Insulin apart enhances synthesis of protein by inhibiting the proteolysis and lipolysis in adipose tissue. Insulin as part acts by binding to the receptor of insulin a heterotetrametric protein which is made of two transmembrane extracellular alpha units and beta units. This binding stimulates the activity of tyrosine kinase which is essential to the beta receptor. Aspartic acid lowers the chances of forming hexamers consequently absorption rate becomes faster, and the duration of action becomes faster.

Pantoprazole

Pantoprazole is composed of a weak base that enters parietal acidic cell canaliculus through the membrane of parietal cell and it is protonated to form a covalent bond that is irreversible. This results in formation of two sites of enzyme that are in the gastric parietal cell, thus production of stimulated gastric acid and base is inhibited. Pantoprazole is used in the therapy of peptic ulcer disorder and gastroesophageal reflux. Pantoprazole is a drug that is used to treat erosion and ulcers of the esophagus which are caused by gastroesophageal reflux disorder. It is also used as a cure to assist in maintenance after primary response is attained. Pantoprazole suppresses the last step of production of gastric acid by creating a covalent bond between the sites of the enzyme system of the gastric parietal cell at the secretory surface. This impact is related to dose and inhibits the secretion of both stimulated gastric acid and basal irrespective of the stimulus. The pharmacokinetics of pantoprazole for renal failure patient is unaltered. Inhibition of hydrogen-potassium blocks the ultimate step of gastric acid production, which lead to the inhibition of stimulated acid and basal secretion. The period for inhibition of secretion of acid is not correlated with shorter elimination pantoprazole half-life ^[16].

Insulin glargine

Insulin glargine facilitates cellular glucose uptake in the fat cells and muscles by binding insulin receptors through regulating glucose metabolism. This helps in lowering levels of blood glucose as well as inhibiting glycogen conversion to glucose that also contributes to low levels of blood glucose. Insulin glargine is a soluble solution, and upon injection in the body, the solution neutralizes forming a micro precipitate. Insulin glargine is released small amounts from micro precipitates which gives the drug a reasonably constant concentration over a short period ^[13]. This mechanism of release provides the drug with an imitator level of basal insulin within the body. Incorrect dosage that is comparative to energy expenditure and food intake can result to a severe, life-threatening and prolonged hypoglycemia. Neuroglycopenic symptoms of hypoglycemia may include lethargy, difficulty concentrating, drowsiness, dizziness, difficulty speaking, confusion, vision changes and headache.

Nebivolol

Nebivolol induces arterial relaxation which is endothelium-dependent in a manner that depends on a dose, by stimulating the release of endothelial nitric oxide. The produced nitric oxide acts to relax muscles cells and inhibits platelet adhesion and aggregation. Nebivolol is a beta-1 adrenergic receptor which is opposite to vasodilatory and antihypertensive activity ^[9]. Nebivolol blocks the beta-1 adrenergic receptors in the heart, hence lowering the cardiac contractility rate. This assist in reducing the cardiac output, therefore, lowering blood pressure. Nebivolol also activates nitric oxide, thus exerting vasodilatory impact and relaxing the vascular smooth muscle. The activation of the receptors by epinephrine raises the blood pressure and heart rate, and the heart uses more oxygen. Nebivolol blocks the receptors that converse the impacts of epinephrine, decreasing the blood pressure and heart rate.

Further, beta inhibitors hinder the release of hormone renin, that kidney produces which assist in constriction of blood vessels. Hypertension and bradycardia are common signs of taking an overdose of nebivolol. Other adverse effects include dizziness, cardiac failure, vomiting, fatigue and hypoglycemia. Hence the medicine should be monitored to avoid side effects of overdose ^[14].

Digoxin

Digoxin is a medication that is used to treat several heart diseases.  It is frequently used to treat heart failure, atrial flutter and atrial fibrillation. The drug is taken by injection into the vein or by mouth. The side effects of the drug are breast enlargement due to taking an overdose. Other effects include nausea, loss of appetite, confusion, irregular heartbeat and trouble seeing. Hence there is a need to monitor the use of the drug by the patient to avoid these side effects ^[15].

Temazepam

It is a drug that is used treatment of insomnia for a short-term and assists in relaxation of skeletal muscle. It is used mainly to reduce the number of times one wakes up at night. The negative impact of the drug is distorting the regular pattern of sleep ^[12].

Warfarin

It is an anticoagulant that is used to inhibit blood clots form in the body as the blood circulates in the body. The patient’s genotype affects the dose that is required and the speed of the drug in metabolism. Warfarin has a negative effect in that the dose-response relationship cannot be easily predicted hence it must be monitored to ensure the appropriate and safe dose is taken by the patient ^[11].

Conclusion

To sum up, the patient needs to accurately control his body conditions relating to insulin-dependent diabetes, myocardial infarction, hypertension, retinopathy, atrial fibrillation, nephropathy, pleural effusion and neuropathy. The chronic kidney disorder needs special attention because the kidney functioning has been disrupted and it cannot filter waste and excess fluid from the blood. The disorder needs to be attended to avoid it reaching to unmanageable levels where the waste builds up in the body.

References

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3.) Smart NA, Williams AD, Levinger I, Selig S, Howden E, Coombes JS, Fassett RG. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. Journal of Science and Medicine in Sport. 2013 Sep 1;16(5):406-11.

4.) Al Zarea BK. Knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of AlJouf and Hail Province of Saudi Arabia. Journal of clinical and diagnostic research: JCDR. 2016 May;10(5):NC05.

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9.) Kosmala W, Holland DJ, Rojek A, Wright L, Przewlocka-Kosmala M, Marwick TH. Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial. Journal of the American College of Cardiology. 2013 Oct 8;62(15):1330-8.

10.) Jernberg T, Hasvold P, Henriksson M, Hjelm H, Thuresson M, Janzon M. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. European heart journal. 2015 Jan 13;36(19):1163-70.

11.) Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P, Christiansen AV, Friedman J, Le Maulf F, Peter N, Kearon C. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis. Circulation. 2014 Feb 18;129(7):764-72.

12.) Zhou QP, Jung L, Richards KC. The management of sleep and circadian disturbance in patients with dementia. Current neurology and neuroscience reports. 2012 Apr 1;12(2):193-204.

13.) Diamant M, Van Gaal L, Stranks S, Guerci B, MacConell L, Haber H, Scism-Bacon J, Trautmann M. Safety and efficacy of once-weekly exenatide compared with insulin glargine titrated to target in patients with type 2 diabetes over 84 weeks. Diabetes care. 2012 Apr 1;35(4):683-9.

14.) Kaya MG, Ozkan M, Gunebakmaz O, Akkaya H, Kaya EG, Akpek M, Kalay N, Dikilitas M, Yarlioglues M, Karaca H, Berk V. Protective effects of nebivolol against anthracycline-induced cardiomyopathy: a randomized control study. International journal of cardiology. 2013 Sep 1;167(5):2306-10.

15.) Kirilmaz B, Saygi S, Gungor H, Turk UO, Alio?lu E, Akyuz S, Asgun F, Tengiz I, Ercan E. Digoxin intoxication: An old enemy in modern era. Journal of geriatric cardiology: JGC. 2012 Sep;9(3):237.

16.) González-Ortiz M, Martínez-Abundis E, Mercado-Sesma AR, Álvarez-Carrillo R. Effect of pantoprazole on insulin secretion in drug-naïve patients with type 2 diabetes. Diabetes research and clinical practice. 2015 Apr 1;108(1): e11-3.