NURS1103 : NURSING
Question:
Consider the following case study: Mr Bill Sykes is a 55-year-old who presents to the Emergency Department with left sided abdominal pain. The pain is associated with a large amount of explosive watery diarrhoea. Mr Sykes also complains of nausea. Mr Sykes has no known allergies and takes ibuprofen prn for an old knee injury. He had an appendectomy at age 15; he is smoker and consumes alcohol. He estimates that he has lost a considerable amount of weight as his trouser pants are now loose. You are the registered nurse assigned to care for Mr Sykes.
a. Compile a list of the initial questions you would ask Mr Sykes, you should also consider the rationales for these questions. Remember that your questions must relate to case study.
b. Post your list of questions and rationales on the discussion forum.
before this assignment tutor gave us this to do as activity may be this one also help for the assignment ( module 3 activity
A patient who has suffered a CVA has profound damage to the left motor strip. Describe the communication difficulties this person may have and what strategies you can use to complete the health history. Remember to post your ideas in the discussion forum and review some other students posts and add some comments to their posts.)
tutor write this for the assignmnet ( Reflection The idea of giving individualistic care is not a new concept in nursing; however, achieving person centred care can be difficult in a setting that is busy and where time is limited. Using the health history as the basis for assessment and care delivery provides a good base for patient centred care. Many of the environments we work in provide a ‘tick box’ as a way of speeding up the health history. This is contrary to the notion of patient centred care in addition to providing limited data to use in assessment and care planning.
1. Does your workplace use a standardised health history form? 2. Discuss the advantages and disadvantages to using the standardised form?
Consider the following case study: Mr Bill Sykes is a 55-year-old who presents to the Emergency Department with left sided abdominal pain. The pain is associated with a large amount of explosive watery diarrhoea. Mr Sykes also complains of nausea. Mr Sykes has no known allergies and takes ibuprofen prn for an old knee injury. He had an appendectomy at age 15; he is smoker and consumes alcohol. He estimates that he has lost a considerable amount of weight as his trouser pants are now loose.
a. Compile a list of the initial questions you would ask Mr Sykes, you should also consider the rationales for these questions. Remember that your questions must relate to case study.
Answer:
Initial questions to ask Mr. Sykes and the rationales for these questions
The aim of carrying out an accurate patient history assessment is to understand the underlying factors leading to the presentation of the patient at the healthcare unit. The approach of undertaking the assessment depends of the condition of the patient and the urgency demonstrated by the patient presentation (Tagney, 2008). In the present case Mr. Sykes has presented to the care unit with a multiple symptoms such as explosive watery diarrhea, nausea and left abdominal pain. It is crucial that the nurse carries out a successful investigation of the patient condition with the help of certain questions.
Introductory questions-
- Hello Mr. Sykes how are doing? Seems you are in much discomfort.
- Can you please tell me your age and your present address?
- Who do you have as your family members? Have they come with you?
- What do you do for a living?
Rationale- A nurse is the first point of care when a patient presents to the healthcare unit with varying symptoms. It is therefore crucial that a nurse establishes an effective therapeutic relationship at the initial stage of conversation so that further care delivery is articulated in an effective manner (Moorhead, Johnson, Maas & Swanson, 2018).
Regarding pain in left abdomen-
- When did you start feeling the pain?
- Have you felt such pain before?
- Which is the exact site of pain and is it radiating to other directions?
- Are you having any other symptoms?
- Is the pain getting worse?
- Is any factor making the pain worse?
- Please rate the pain on a scale of 1 to 10
Rationale- The use of SOCTATES mnemonic for more details of pain symptoms is helpful in understanding the care needs for a patient. Pain in the left abdomen might be related to conditions of the liver and intestine. The questions mentioned would aid in early diagnosis of the condition that the patient is suffering from (Jangland, Kitson & Muntlin Athlin, 2016).
Regarding diarrhea and nausea-
- How many times have you passed stool in the last one day?
- How do you describe the colour and consistency of the stool?
- Have you noticed blood in your stool?
- Do you feel nausea only after vomiting?
- Have you noticed blood while vomiting?
Rationale- The above questions would help in understanding the cause of diarrhea. The link between diarrhea and ulcerative colitis would be established in the patient through the assessment. The answer to these questions along with the answers to the questions on pain would help in accurate diagnosis (Muhrer, 2014).
Regarding past medical and drug history-
- When did you last visit a general physician?
- Do you have heart conditions, high blood pressure or diabetes?
- For how long are you taking ibuprofen?
- Are you allergic to any particular drug?
Rationale- Knowledge of past medical conditions and drug history is essential for outlining medication treatment for a patient. Further, possible risk of adverse effects due to pharmacological interventions can be avoided (Ingram, 2017).
Regarding social history-
- For how long have you been smoking?
- How many packs cigarettes do you smoke in a week?
- How much do you drink in a week?
- Do you have a family history of any such similar conditions related to GI system?
- Can you please briefly describe your daily food intake?
Rationale- Smoking and excessive drinking has been linked with gastrointestinal conditions whose health impact is adverse. Family history assessment helps in understanding the risk factors for developing GI disorder (Moorhead, Johnson, Maas & Swanson, 2018).
References:
Ingram, S. (2017). Taking a comprehensive health history: learning through practice and reflection. British Journal of Nursing, 26(18), 1033-1037. DOI https://doi.org/10.12968/bjon.2017.26.18.1033
Jangland, E., Kitson, A., & Muntlin Athlin, Å. (2016). Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: A multi?stage qualitative case study. Journal of advanced nursing, 72(4), 791-801. DOI https://doi.org/10.1111/jan.12880
Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2018). Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=LYlIDwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+assessment,+book,&ots=bOUtY1zwbQ&sig=NcZgcdu_4wycNhKvH1CWQP-dRr0#v=onepage&q=nursing%20assessment%2C%20book%2C&f=false
Muhrer, J. C. (2014). The importance of the history and physical in diagnosis. The Nurse Practitioner, 39(4), 30-35. DOI 10.1097/01.NPR.0000444648.20444.e6
Tagney, J. (2008). Skills in taking an accurate cardiac patient history. British Journal of Cardiac Nursing, 3(1), 8-13. DOI https://doi.org/10.12968/bjca.2008.3.1.27994
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