NURS 324 Concepts And Theories In Nursing Practice

1. John is a 39 year old man with a diagnosis of Dependant Substance use (alcohol) and drinks on average 8 pints of cider per day. He has recently complained of bloating and reports to spend his money on alcohol rather than food.

A) Explain your understanding of the Renal System

B) How might John’s alcohol use affect his physical health?

C) What interventions would you suggest in this situation? Please justify your answer.

 

2. Phyllis is a 78 year old lady with a history of low mood and suicidal ideation since the death of her husband 3 years ago. She lives alone in a 3rd floor flat and is increasingly isolated since falling 2 months ago and breaking her arm.
A) Explain your understanding of the different types and composition of bone.
B) Why might Phyllis be at an increased risk of fracture?
C) What interventions would you suggest in this situation? Please justify your answer.

 

3. Kofi is a 23 year old man who has been admitted to an acute mental health ward after concerns were raised by his family that’s he was behaving increasingly agitated and paranoid that his food was being poisoned. He has just completed his final exams at university and had been concerned about his grades. Since being in hospital he is pacing the ward and preoccupied with leaving, often spending much of the day sitting at the front door.

A) Explain your understanding of the stress response in humans?

B) Why might Kofi have developed psychotic symptoms at this particular time?

C) What interventions would you suggest in this situation? Please justify your answer.

 

4. Linda is a 25 year old lady with a diagnosis of Emotionally Unstable Personality Disorder. She has recently attended A and E having made a number of deep lacerations to her arms with a rusty razor blade.
A) Explain your understanding of the structure of the skin including the role of the different types of cell.
B) What are the normal stages of wound healing and what might affect Linda’s healing process.
C) What interventions would you suggest in this situation? Please justify your answer.

 

5. Fatima is a 43 year old lady with a diagnosis bipolar affective disorder and usually manages her Type 1 diabetes with minimal support. She is currently hypomanic and reports that she has not slept for more than 3 hours in the last 5 days.

A) Explain your understanding of Type 1 and 2 diabetes.
B) Why might Fatima’s current hypomanic presentation present additional risks to her physical health?
C) What interventions would you suggest in this situation? Please justify your answer

 

6. Nathan is a 50 year old man with a diagnosis of Paranoid Schizophrenia. He had been smoking around 20 — 40 cigarettes a day for the last 30 years. Recently he has been complaining of shortness of breath and has a persistent cough.
A) Explain your understanding of the respiratory system
B) Why might Nathan’s diagnosis of schizophrenia and history of smoking be important to consider given his current shortness of breath and cough?
C) What interventions would you suggest in this situation? Please justify your answer.

 

7. Pearl is a 45 year old lady with a history of Bipolar Affective Disorder. In the past ten years she has gained a considerable amount of weight (10 years ago she weighed 80kg and now she weighs 130kg). She has been complaining of chest pain and describes it as tightness in her chest.
A) Explain your understanding of the cardiac system.
B) Why might Pearl’s diagnosis of Bipolar Affective Disorder and the weight gain be important to consider in explaining her current presentation?
C) What interventions would you suggest in this situation? Please justify your answer.

 

8. Malaika is a 30 year old African lady with a history of Schizophrenia. She is currently taking Olanzapine 20mg. She has been complaining of feeling lethargic, increased hunger and increased thirst and frequent urination.
A) Explain your understanding of how insulin works.
B) Why might Malaika’s diagnosis of Schizophrenia, her ethnicity and the symptoms she is experiencing be important in explaining her current presentation?
C) What interventions would you suggest in this situation? Please justify your answer.

Case study 1- John

1. The renal system commonly referred to as the urinary system comprises of the kidneys, urinary bladder, ureter and urethra. The basic function of the renal system is to eliminate all kinds of nitrogenous waste products from the body, control the blood volume, blood pressure regulation and control the electrolyte balance and pH. The renal tract as the principle system that helps in the expulsion of urine from the body. In other words, urea that is carried to the kidneys through the bloodstream gets removed along with other wastes and excess water in the form of urine, through micturition (Hall 2015). The kidneys participate in urine formation by filtering the excess water and wastes from the circulating blood. This urine gets passed down to the urinary bladder through the ureter and is then expelled outside the body by relaxation of the sphincter muscles that guard the urethra opening.
2. Drinking excess alcohol takes a toll on the physical health and affects the human body in several ways. The use of alcohol might interfere with the communication pathways of the brain, and will in turn affect the way his brain functions. These disruptions might directly bring about an alteration in John’s mood and behaviour, thus making it difficult for him to think in a clear manner. Drinking also has the probability of damaging his heart, thus resulting in problems such as, cardiomyopathy, stroke, arrhythmias, and increased blood pressure (Kemp and Quintana 2013). Heavy drinking will also take a toll on his liver and result in several hepatic disorders namely, cirrhosis, fatty liver or steatosis, alcoholic hepatitis, and fibrosis. The pancreas might also begin the production of toxins that would eventually result in pancreatitis, which is an inflammation of the pancreatic blood vessels that disrupt digestion (WHO 2014). Another potential impact of alcohol on physical health is the onset of cancer.
3. One major intervention is behavioural treatment where John will be provided counselling services for altering his drinking behaviour. The treatments will be different, owing to the varied perspectives of alcohol consumption. While detoxification would lead to withdrawal symptoms, different forms of psychotherapy will help in limiting his drinking, thus lowering dependency rates. Drugs such as, acamprosate will also facilitate stabilization of the brain chemistry by antagonizing glutamate action, hence reducing relapse rates (Mann et al. 2013). The Sinclair method can also be used for treating alcoholism by blocking positive reinforcement impact of ethanol.

Case study 2- Phyllis

1. There are five main types of bones present in the human body namely, (i) long, (ii) short, (iii) irregular, (iv) flat, and (v) sesamoid. The long bones have a shaft called diaphysis that is longer than width, and a rounded epiphysis at end of the shafts. Short bones have a cuboid shape with thin compact bone layer around the spongy interior. Sesamoid bones are embedded in tendon and hold them away from bone joints. While the flat bones have parallel layers of compact bones and are curved, the irregular bones have bony sinuses that impart them the irregular shape. Bones are made up of collage fibres, which have a tripe helical structure and act as nucleation sites for the mineral crystals (Shier, Butler and Lewis 2015). Little amounts of glycosaminoglycans are also bound to the protein and present around the fibre bundles. Calcium and phosphate are the primary minerals, with the major component being hydroxyapatite. The bearing surfaces are formed by the hyaline or articular cartilages.
2. Phyllis is at an increased likelihood of suffering fracture due to her old age. With an increase in age, individuals become frail and results in falls that create a long-lasting impact on the health and quality of life of older adults. The fact that she lives alone is a risky situation, which when combined with her previous history of fall makes her more susceptible of suffering a fracture. Depression has also been allied with falls and fracture among the elderly (Iaboni and Flint 2013). Fear of falling and depression are related with an upsurge in the impairment of body balance and gait. These directly affect the sensory, motor and cognitive pathways. Furthermore, increased facture risk in Phyllis can also be accredited to the fact that medications for depression such as, serotonin reuptake inhibitors often increase the possibility of fragility fractures.
3. Prevention strategies would encompass keeping the flat free from any kind of clutter, from the floors. The floor surfaces will not be kept slippery. Phyllis will be made to put on low-heeled and supportive shoes. Adequate rubber mat in shower, lights in stairways and grab bars will be installed in the home. Fracture management would require bone immobilization with the use of plaster casts, or metal plates (Ungar et al. 2013). Another immobilization procedure might encompass the insertion of internal metal rods at the centre of the long bones.

Case study 3- Kofi

1. Any kind of stressful situation results in a cascade of stress related hormones that are responsible for producing physiological changes. Stressful incidents are also responsible for increasing the heart rate and breathing rate, accompanied by tension in the muscles and perspiration. In other words, stress refers to a psychological and biological response that is experienced upon encountering threats that cannot be dealt with adequate resources. The hypothalamus controls the stress response, which when triggered signals to the adrenal medulla and the pituitary gland. These short term responses are initiated by the ‘Fight or Flight Response’ with the help of the Sympathomedullary Pathway (SAM). The Hypothalamic Pituitary-Adrenal (HPA) system controls long term response by stimulating the pituitary to secrete ACTH, which subsequently stimulates corticosteroid production from the adrenal glands (Braun et al. 2013). Circulation of epinephrine in bloodstream results in physiological alterations such as, elevated heart rate, increased pulse and blood pressure, and opening of the small airways in the lungs. Release of cortisol and ACTH keeps the body on alert. Following passing of the threat, the levels of cortisol fall and the parasympathetic nervous system reduces the stress response.
2. It is essential to get quick help for the treatment of psychotic symptoms owing to the fact that delay in recognition of the signs and symptoms often result in a deterioration of the health condition. Kofi might have developed stress due to a worrisome drop in his academic grades. While problems in the neurotransmitters such as, glutamate and dopamine might have contributed to development of psychotic symptoms, some risk factors that might have increased Kofi’s likelihood of getting affected by the condition include familial history of schizophrenia, and older parentage (Popovic et al. 2014). Other factors which might have also played a vital role in the illness are increased activation of the immune system, complications during his birth, abuse in childhood and use of mind-altering drugs during the adolescent years.
3. Although the condition requires lifelong treatment, medications such as, antipsychotics should be considered as the main treatment option. These drugs will prove beneficial in controlling psychotic symptoms by affecting the dopamine neurotransmitter. Second generation antipsycotics such as, aripripazole, brexipiprazole, clozapine, and lurasidone, can also be administered owing to the lowered risk of adverse side effects (Leucht et al. 2013). Following reduction of the psychotic symptoms, the patient might also be subjected to social skills training, family therapy, and vocational rehabilitation.

Case study 4- Linda

1. The skin in humans is made up of two different layers namely, (i) superficial epidermis, and (ii) deeper dermis. The epidermis is composed of different layers, where the upper layer of dead cells is periodically and progressively replaced by new cells that originate from the basal layer. The dermis forms a connection between the epidermis and the hypodermis, and provides elasticity and strength due to elastin and collagen fibres. The hypodermis, located deep in the dermis acts in the form of a connective tissue that forms a connection of the dermis to the underlying structures. The epidermis can be divided into different layers such as, stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum germinativum. Keratinocyte cells present in epidermis are responsible for the manufacture and storage of keratin protein that is present in nail, hair and skin (Miller, Griffin and Campbell 2013). The colour of skin is predisposed by a plethora of pigments that include, carotene,melanin, and haemoglobin. Melanin pigment gets transferred to keratinocytes through melanosomes, a cellular vesicle.
2. Wound healing refers to a complex procedure where the skin and tissues underlying the skin are able to repair them, following an injury. Wound healing comprises of several steps namely, (i) haemostasis, (ii) inflammation, (iii) proliferation, and (iv) maturation. Haemostasis is the initial body response for stopping bleeding. Following achievement of haemostasis, inflammation would lead to swelling for controlling bleeding and infection prevention. New tissues, usually pink coloured, are formed in proliferation phase that cover the wounded region. This is followed by maturation phase that encompasses complete closure of the wounds and typically begins three weeks following the injury (Xie et al. 2013). The deep cut made by Linda with razor that has reached all way through her skin might create an effect on the muscle or fat layer and create an impact on the healing process.
3. Steps would be taken to ensure that Linda is made to wear personal protective equipment to avoid any kind of injury or wound that she inflicts upon herself, owing to her state of mind. Controlling the bleeding would be the first priority that can be achieved by applying direct pressure on the laceration sites, while holding them at a level near the heart, for at least 15 minutes. All efforts must be taken to avoid tourniquets. Following bleeding cessation, the lacerations and surrounding regions will be washed with soap and warm water, succeeded by stitches at the site, if required (Rui-feng et al. 2013). Stitching will prevent bacterial invasion and promote wound healing. These will then be covered with tape and sterile gauze. Linda will be administered ibuprofen or acetaminophen for pain relief and the dressings shall be changed on a regular basis.

Case study 5- Fatima

1. Usually the human body breaks down all carbohydrates and sugar that has been consumed, into glucose. The role of insulin hormone secreted from the Beta cells of the islets of Langerhans in pancreas is to maintain glucose levels in the blood stream and utilised for energy production. Type 1 diabetes is also referred to as insulin dependent diabetes or juvenile onset diabetes as it begins in childhood. This autoimmune condition occurs when the body attacks its own pancreas, with the help of antibody and the damaged pancreas fails to produce insulin.  The condition is often thought of to occur due to genetic predisposition or false in the beta cell. The condition also increases the likelihood of suffering from heart diseases and stroke. Individuals with type 2 diabetes report insulin resistance (Holt and Kumar 2015). Despite production of insulin from the pancreatic cells the body is unable to use it in an effective manner that results in a failure in lowering blood glucose levels to limits that can be sustained by the body. Range of genetic and environmental factors are also responsible for the onset of type 2 diabetes such as, familial history, obesity, sedentary lifestyle, smoking, alcoholism, and polycystic ovarian syndrome.
2. Bipolar affective disorder is a severe mental condition that is associated with increased risk of developing physical ailments such as, atherosclerosis, which refers to hardening of the arteries, and other cardiovascular diseases.  There is mounting evidence for the fact that people suffering from bipolar affective disorder have above average rates of increased levels of triglyceride or blood fat, increased cholesterol levels and hypertension (Vancampfort et al. 2016). The current hypomanic symptoms manifested by Fathima increased her likelihood of suffering from obesity, diabetes, substance abuse, and other metabolic conditions, which are common with bipolar disorder. She also carries an increased risk of early death due to these physical ailments with life expectancy reduced by a minimum of 10 years (Crump et al. 2013).  Hence, the hypomania symptoms might make her resort to unhealthy lifestyle activities, and prevent accessing appropriate healthcare services, which when combined with the side effects of medications such as, mood stabilizer and antipsychotic drug will take a toll on her physical health.
3. Psychotherapy can prove as an effective treatment for the condition. The primary goal of psychotherapy would be to enhance regular administration of medicines and eliminate substance abuse, while enhancing lifestyle and helping the patient recognise basic symptoms of mania and depression. Psychotherapy would encompass psychoeducation and cognitive behavioural therapy, which will increase knowledge of the patient on the illness and will also help her to return to a completely functional life.  Lithium can be administered for stabilization of mood, in accordance to depressive and maniac episodes (Malhi et al. 2013). However, some side effects such as, headache, tiredness, bloating, and muscle weakness might appear. Benzodiazepine such as, clonazepam and lorazepam can also be administered for managing acute agitation in the patient.

Case study 6- Nathan

1. The respiratory system refers to the biological system which comprises of organs and structures responsible for exchange of gases. The respiratory surface is internalized in the form of lung linings. Gaseous exchange occurs inside several air sacs called alveoli, which have rich supply of blood vessels, thereby bringing the respiratory air in close contact with bloodstream. The sacs are connected with the external environment with the help of a system of hollow tubes or airways, the largest of which is called the trachea. Trachea branches right at the middle of the chest to form two main bronchi, which enter respective lungs and progressively branch into narrow secondary and tertiary bronchi, forming smaller tubes, bronchioles that are connected with the alveolar sacs (Hall 2015). The upper tract of the respiratory system comprises of the nose, nasal cavity, pharynx and larynx. The process of respiration is controlled by a dome shaped diaphragm, located at the bottom of the lungs that demarcates between the abdominal cavity and the chest cavity.
2. Schizophrenia has been associated with an impairment in lung function and increase susceptibility of suffering from pneumonia, COPD, and chronic bronchitis. Patient suffering from schizophrenia demonstrate significantly reduced lung function values. Nathan’s diagnosis exposes him to a series of risk factors associated with severe medical comorbidity. Previous smoking history of Nathan has also increased his risk of suffering from lung diseases such as, lung cancer, heart disease, oral cancer, and stroke (Caponnetto et al. 2013). Smoking affects the air sacs and the large airways by increasing the size and number of the cells in the lungs which produce mucus. This directly increases the secreted mucus amount, thereby clogging the lungs, impeding circulation and resulting in respiratory diseases.
3. The most effective treatment comprises of administration of antihistamines decongestant and glucocorticoids. Blocking the action of histamine in the central nervous system, and loosening and thickening the mucus present in the lungs would make it easier to cut off the accumulated mucus (Ridolo et al. 2015). Inhaled asthma drugs when used in combination with steroids will also access bronchodialators and help in management of respiratory illness. Nathan will be made to abstain from tobacco. His schizophrenia will also be treated by medications such as, risperidone that less severe than atypical antipsychotics and would likely reduce the psychotic manifestations.

Case study 7- Pearl

1. The cardiovascular system helps in circulation of blood and transport of nutrients, carbon dioxide, oxygen, hormones, and blood corpuscles in the body for providing nourishments, stabilizing temperature, and fighting against diseases. Oxygenated blood enters systemic circulation while leaving the left ventricle through the aorta which distributes two different parts of the body for sending oxygenated blood. Arteries often get branched into small arterials and finally into capillaries, which combine to form venules and veins. The superior and inferior vena cava collect the oxygenated blood from all body parts and send them to the right auricle for oxygenation.
2. Bipolar disorder and its association with increased risk of cardiovascular diseases is governed by oxidative stress, inflammation, and the brain-derived neurotrophic factor (BDNF). Oxidative stress results in a dysfunction of the endothelium. The symptomatic phase of bipolar disorder will result in a decrease in the levels of BDNF, thereby damaging the endothelial cells. This in turn will increase the risk of suffering from cardiovascular events (Goldstein et al. 2015). Increase in weight will also take a toll on the cardiovascular health of the patient, when compared to the general population. Weight gain will trigger several inflammatory processes that would result in structural and functional changes and the heart. Plaque formation and the artery would trigger the onset of a heart attack (Laursen et al. 2013).
3. Pearl will be subjected to weight loss programs that would encompass bringing about modifications in the eating habits and levels of physical activity. Abstaining from a sedentary lifestyle and making dietary changes such as, cutting calories, making healthy food choices, would prevent the position of cholesterol and facts. Behavioural change such as, support group, counselling and prescription-based weight loss medications would also prove beneficial in reducing the risk of suffering from cardiovascular diseases (American Diabetes Association 2016). Depending on the severity of the condition, Pearl might also require angioplasty for restoring the blood flow. Administration of potent vasodilator nitroglycerine will also reduce myocardial oxygen demand and the hearts workload.

Case study 8- Malaika

1. The insulin hormone plays a major role in regulating blood glucose levels, and lack of insulin or inability to respond to it results in development of a metabolic disorder. The impacts of insulin are initiated by attachments to receptors, located in cell membrane that contains alpha and beta subunit. Two molecules join together to form a homodimer, following which insulin binds to the alpha unit. Beta subunit gets auto phosphorylated followed by phosphorylation of proteins inside insulin receptor substrate, which activates a cascade of signal transduction and helps insulin lower the blood glucose level (Belfiore et al. 2017). It promotes transport of glucose by ATP-dependent movement of GLUT4 glucose transporter.
2. Diabetes and schizophrenia have an association which can be accredited to certain factors that contribute to comorbidities such as, susceptibility to the illness due to autonomic hyperactivity, sedentary lifestyle and physical inactivity, cigarette smoking, use of antipsychotics for treating mental disorder, and social health determinants, like housing, food insecurity, and income (Vancampfort et al. 2013). Her ethnicity can also be considered as the contributed factor owing to the fact that African ethnic minorities often follow a lifestyle and adopt food patterns that increase the amount of fat around their waist and also blood cholesterol levels, both of which are responsible for diabetes onset (Attridge et al. 2014).
3. Interventions would include making her show adherence to a diet that is rich in nutrition and fresh foods, including vegetables, whole grains, fruits, and low fat dairy product. Refraining from consumption of excess alcohol, limiting intake of high sugar foods and engaging in regular exercise would prove beneficial. Anti-diabetic medications such as, metformin will also be administered in order to lower the blood sugar levels (Garber et al. 2013).

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