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Assessments
Student
:
Mariama Kamara - S1711554
Course
:
Diploma of Nursing
Course Offer
:
17NDONB11
Course Unit
:
HLTENN005 Contribute to nursing care of a person with complex needs
Assessment type
:
Theory Assessment
1. Musculo-Skeletal Disorders (MSD).In the Emergency Department you have received a patient with a suspected leg fracture. What are the Signs & Symptoms of a fracture that you would look for to confirm such a diagnosis? (30-50 Words)
2. Complete the following table with brief description of what these conditions or terminologies mean.
Condition/Terminology
Description
2.1
Bursitis
Bursitis is the swelling or inflammation of the bursa, which is a bag filled with lubricating liquid that are present between bone, muscle or skin as a result the friction and irritation between the tissues and bones is reduced (“Bursitis symptoms and treatments,” n.d.).
2.2
Carpel Tunnel Syndrome
It is a common disorder that causes pain, numbness and also tickling in the hand or arm. It occurs when the median nerve is compressed as it travels through the wrist (“Carpal Tunnel Syndrome - Symptoms and Treatment - OrthoInfo - AAOS,” n.d.).
2.3
Muscular Dystrophy It is a term that is used to refer to a group of disorders that involve loss of muscle mass and also strength loss which further leads to weakness (“Muscular dystrophy - Symptoms and causes,” n.d.)
2.4
Myalgia
Myalgia is a term that is used to describe pain in the muscles or inside the muscles tissues (“Myalgia - an overview | ScienceDirect Topics,” n.d.)
2.5
Osteoarthritis
It is the most common disease type which is effecting millions of people worldwide, it is a type of arthritis which occurs when the shielding cartilage on the ends of the bones wears down with time (Hunter & Felson, 2006)
2.6
Osteomyelitis
It is an infection in the bone which is rare but if it happens then it can be quite serious. Bones are infected by a number of ways; infection can travel to the bones through blood circulation (Lew & Waldvogel, 2004).
2.7
Osteoporosis
in case of osteoporosis the bones of the individuals become weak and brittle, they become so brittle that a little stress or bend can cause fracture (Klibanski et al., 2001).
2.8
Scoliosis
Scoliosis is a sideway twist of the spine it occurs commonly before puberty during the growth spurt. The angle of the curve can be small, large or it can be in between (Aebi, 2005).
2.9
Sprain
The tearing or stretching of the ligaments cause sprain, it is the tough bands of fibrous tissue which connects two bones together in the joints. Ankle is the most common site of sprain (Ivins, 2006)
2.10
Total Knee Replacement
If an individual is suffering from serious damage of knee by arthritis or by injury, then it becomes hard to walk climb stairs so if the medications are ineffective then total knee replacement I done which is safe and effective procedure to ease the pain and also correct the leg deformity (“Total Knee Replacement - OrthoInfo - AAOS,” n.d.).
3. Cardiovascular disorders and conditionsDefine, list signs and symptoms, alleviating factors and describe typical ECG findings for Indigestion, Angina and Myocardial Infarction.
Criteria
Indigestion
Angina
Myocardial Infarction
Indigestion is the discomfort which occurs in the stomach that is linked with difficulty in digestion of the food, angina is a condition that is marked by severe pain in the chest which spreads to shoulders, neck and arms, while myocardial infraction is also known as heart attack which happens when blood flow reduces to one part of the heart which also causes damage in the heart muscle.
3.2
Signs and Symptoms
The signs of myocardial infraction are nausea, indigestion, short breath and fatigue, while the signs of angina are chest pain and discomfort, nausea, sweating and also dizziness while the signs of indigestion are abdominal pain, acidic taste in mouth, bloating and also nausea without vomiting (“Acute Myocardial Infarction,” 2012)
3.3
Alleviating factors
Some of the alleviating factors of angina are quitting smoking, controlling weight and also avoiding large meals, while some of the alleviating factors of myocardial infraction are diet control, fats and cholesterol and also exercising regularly (Lu, Liu, Sun, Zheng, & Zhang, 2015).
3.4
ECG Findings
As far as angina is concerned the ECG patterns vary among individuals. After a resting ECG about 50% of the patients have normal findings. But abnormalities like proofs of previous MI may be seen. In case of MI there will be some persistent ST elevations which results from dyskinetic wall motion (Pezzilli, Bellacosa, & Barakat, 2010).
4. Chest Tube ManagementYou have been assigned a post-operative cardiac patient with a chest drainage tube inserted mediasternally. List the important considerations in managing a chest drainage system (20-40 words)
4.1
Position of client and the drainage system
The preferred position for the drainage system is to sit upright or bending over a table with a pillow under the arms or even in the lateral system (ACI - Agency for Clinical Innovation, n.d.).
4.2
Observations
The nursing staff must make sure that there is no bending in the tube and fluid is not filled in the tube otherwise the patient will face issue in breathing (Gillaspie, n.d.).
4.3
Insertion site care
Te nurses must monitor the insertion site for any kind of infection and inform the doctor if the wound swells or even turns red. Although a small scar will remain at the insertion site. But the site should be kept clean and the patient must make sure not to touch it rapidly (“Clinical Guidelines (Nursing) : Surgical Drains (Non Cardiac),” n.d.).
4.4
Patency for drainage system
The healthcare official must make sure that the drainage system is patent on order to work effectively andfor that purpose strict monitoring is required.
4.5
Exercise
Exercise is not recommended when tub is exerted but minimal exercise like walk or roaming around is useful when the tube is inserted.
4.6
Contingencies/ Emergencies e.g. client pulling the tube out
If the patient pulls out the tube then he might feel sensations like pain in the chest and burning so at that time the nurse must be able to control the situation by taking care of the patient and avoid any chances of infections (Gift, Bolgiano, & Cunningham, 1991)
5. Supra-Pubic Catheter (SPC)What discharge advice would you give a patient with a SPC? (80 - 100 Words)
If a patient is going home with a SPC then the patient should be advised to shower as necessary and also changing dress every day. If the dress becomes dirty and also absorbed a lot of drainage, then it should be changed regularly. The patient must be told to drink water and also maintain good hand hygiene to prevent any infection (“How to Care for your Suprapubic Catheter (Aftercare Instructions) - What You Need to Know,” n.d.).
6. Cerebral PalsyIn relation to cerebral palsy, define the following
6.1
Quadriplegia
It is defined as a paralysis which is caused by illness or injury to humans that results in total loss of use of their limbs, this condition does not necessary effect the hands or arms (“What is Quadriplegia,” n.d.).
6.2
Hemiplegia
It is lifelong condition that is caused by the damage to the brain, it will effect one side of the body to a varying degree and also causes some less visible conditions like epilepsy anxiety and also behavior challenges (Ushiba & Soekadar, 2016, p.)
6.3
Hemiparesis
It is a partial weakness that occurs in one side of the body. It can occur either on the left or on the right side of the body. The weakness can include face, hands or legs (Fisher, 1978).
6.4
Hypertonic or spastic palsy
When muscles become stiff which occur due to the damage in the brain areas which basically controls the muscle movement. This condition can cause difficulty in walking and also controlling movements of the body(“Hypertonic Cerebral Palsy | Hypotonic Cerebral Palsy,” n.d.)
6.5
Dyskinesia
This is an abnormal and uncontrollable movements when a person wants to perform involuntary actions. This is often associated with Parkinson’ disease (“Dyskinesias,” n.d.).
6.6
Ataxia
It is described as a lack of muscle control and also coordination of voluntary movements like walking and also picking up of objects. Ataxia can have various movement, also difficulties are aerated in speech and also eye movements (“Ataxia - Symptoms and causes,” n.d.).
6.7
Dysphagia
People who have dysphagia have various problems in swallowing certain foods or liquids while other people cannot swallow at all. (“Dysphagia (swallowing problems),” 2017)
6.8
Dystonia
It is a condition in which a person’s muscles contract uncontrollably. This contraction causes the effected body to twit involuntarily which leads towards abnormal movements (Tarsy & Simon, 2006)
7. List 2 (two) specific nursing interventions for each of the following health issues commonly seen in Cerebral Palsy Clients
Health issue
Nursing interventions/ care plan (minimum 2 each)
7.1
Aspiration/Recurrent chest infections
The nurse must make sure to keep suction machine available while feeding patients who are at high risk, if aspiration occurs then the nurse can do suction immediately. The nurse also make sure to note new onset of abdominal distention or increased rigidity of the abdomen (Wayne, BSN, & R.N., 2016).
7.2
Oral/ Dental problems
Nurses can help in maintaining oral health by supporting oral hygiene and adequate nutrition, avoiding uneasiness and also by detecting various dental diseases early (Daly & Smith, 2015).
7.3
Incontinence
One of the most important nursing intervention are counselling that are related to liquid or caffeine intake and also pelvic muscle exercise and bladder training with regular time void (Borrie, Bawden, Speechley, & Kloseck, 2002).
7.4
Skin breakdown risk/ pressure injuries
The nurse can help the patients to keep their skin clean and dry and also he/she can prevent to rub the skin of the patient vigorously (“Clinical Guidelines (Nursing) : Surgical Drains (Non Cardiac),” n.d.).
8. Renal NursingList 2 (two) examples for the problems listed in the left column
Question
Answer
8.1
Alterations in the urinary elimination pattern
It refers to change in normal defection patterns. It is defined as the disturbance in individual pattern of urine elimination.
8.2
Reasons for increased glucose in urine
High level of glucose in urine can be due to renal glycosuria which is a condition in which kidneys release glucose in urine as a result levels of glucose increases in the urine (“Glucose in Urine Test,” n.d.).
8.3
Investigations related to urinary system
Although the investigation of urinary system is still uncertain but there are four methods that are used to investigate any urinary infections which are Urinary tract infection, ultrasonography, contrast micturating cystourethrography, intravenous urography and technetium-99m dimercaptosuccinic acid. These are some of the investigations methods that are used to investigate the urinary system infection (Smellie, Rigden, & Prescod, 1995)
8.4
Infectious disorders of the urinary system
These disorders are caused by microbes which overcome the body’s defense in the urinary tract. Urinary tract is divided into upper and lower urinary tract, the upper one contains kidneys and ureters and lower one contains bladder and urethra. These disorders are accompanied by strong urge to urinate, nausea and vomiting etc (Smellie et al., 1995)
8.5
Categories of incontinence
There are two main categories of incontinence which are urinary and feacal incontinence. Urinary incontinence is most common which is further categorized in stress incontinence, overflow incontinence, urge incontinence and also functional incontinence (“Types of Incontinence,” n.d.)
8.6
Reasons for catheterisation
Catheters are required to drain the bladder before or after an operation, to monitor output of the urine and also to clear the bladder of any blood clots (“Why you might need a urinary catheter,” n.d.).
8.7
Types of dialysis
There are two main types of dialysis which are hemodialysis and peritoneal dialysis both of these dialysis can be done either at home or in a dialysis unit (Cowper et al., 2000)
8.8
Parts of the urinary system
The urinary system contains kidneys, right and left ureter, bladder and urethera (Brown, Walling, & Mattix, 2016)
8.9
Purposes / indication for bladder irrigation
The purpose of bladder irrigation is to wash out clots out of the bladder, to restore the patency of the catheter and also to instill medication to bladder coating (“Continuous Bladder Irrigation - What You Need to Know,” n.d.)
8.10
Diseases causing proteinuria
Individuals who have proteinuria have urine which contains irregular amount of proteins. This is a condition which indicates kidney disease (“Proteinuria (Protein in Urine),” n.d.)
9. Stoma Care On examination of a 4/7 post bowel resection client with a temporary stoma, you find the stoma to be dark red, hard, dry and inactive. They also exhibit abdominal distension.Based on the above answer the following questions (30 -60 word each)
9.1
What is the possible complication that Mr Jacob is having?
This condition is called colostomy
9.2
List symptoms, signs and symptoms that led you to your answer in the above question.
The signs are not passing any stool, tummy cramps, swollen stoma and nausea
9.3
What are the main management strategies to be employed as a Nurse.
The nurse must make sure that the patient wash with warm water and clothes. He must make sure not to use wipes and always change clothes if there are any risks of infection.
10. Nursing Assessment Provide a minimum of 2 (two) signs or symptoms for the following conditions
Diagnoses
Signs and symptoms
10.1
Appendicitis
Synptoms of this condition are sudden pain on the lower side of the right abdomen, nausea and vomiting, loss of appetite and constipation.
10.2
Inguinal hernia
Symptoms include bulge in either side of the pubic bone, heavy and painful sensation in the groin, burning sensation in the bulge and also discomfort in the groin (Hair et al., 2001).
10.3
IBD- Inflammatory bowel disease
Symptoms are diarrhea, fever and fatigue, blood in stool and also reduced appetite (Manichanh et al., 2011)
10.4
Intestinal obstruction
Symptoms are lost of appetite, in ability to have bowel movement or pass gas, diarrhea and swelling of the abdomen.
10.5
Chronic Asthma
Symptoms include coughing, wheezing, shortness of breath and chest tightness.
11. Critical ThinkingAt 1930 hrs you check vital signs for Mrs Norris an 83 year old woman who is posted for surgery tomorrow. On observation the blood pressure is 92/ 60 and heart rate is 98/min. She also complains of mild dizziness and wants to lie down. She is prescribed Amlodipine 5 mg per oral at 2000hrs.Describe in point form what steps you would take to ensure patient safety. (40-80 words)
The nurse has to make sure to provide a comfortable position to the patient so that she will feel relax and then check her blood pressure to make sure that the blood pressure is normal and if any fluctuation is there she must report to the surgeon before the operation.
12. Nervous System DisorderYou witness a man drop to the floor unconscious in a shopping centre. On examination he is stiff, having jerky spasmodic body movements, has bitten his tongue and passed urine
12.1
What is the most probable diagnosis
The person has epliptic attack.
12.2
What is Status epilepticus?
It is a condition in which epileptic seizures follow one another without recovery of consciousness between them
12.3
How you would manage the patient?
I would first stay calm and firstly I would keep the man away from any kind of obstacles, I would not try to stop the person or hold their movement rather I would turn the person onto one side and call emergency service.
13. Eye disorders and conditionsComplete the following table with terminologies used to explain the following eye conditions.
Conditions
Terminology
13.1
Clouding of the eye lens impairing vision. Often develops slowly and usually in the aged.
Cataracts is an eye lens impairing vision. People who are above 40 it is the most common sign.
13.2
Increased pressure in the eye cavity (intraocular) causing damage to optic nerve and leading to impaired vision. Damage is usually permanent.
This is a condition which is elevated intraocular pressure this is also called ocular hypertension.
13.3
Inflammation of conjunctiva caused by infection or allergens. Client will often have difficulty opening their eyes on wakening.
This condition is called conjunctivitis, it is caused by infection of bacteria or virus.
13.4
Short sightedness- cannot see items that are located far away
Myopia is condition in which the person is unable to see faraway objects.
14. Ear disorders and conditionsComplete the following table with terminologies used to explain the following ear conditions.
Conditions
Terminology
14.1
Inflammation of the middle ear which is commonly caused by infection. This is often characterized by ear ache, discharge or fever.
14.2
Hearing noises when there is no external source available. Often described as ringing, ticking or buzzing. Causes include infection, wax and Meniere's.
14.3
Disease affecting the inner ear, specifically labyrinth that causes gradual loss of hearing and balance.
15. Reproductive system disorders and conditionsGive 2 (two)examples for each of the questions relating to the disorders of the reproductive system.
Question
Answers
15.1
Common symptoms of disorders of the female reproductive system
Some of the common symptoms are frequent urination, feeling of pelvic pressure and also intense pain in the pelvic region (Munro et al., 2011)
15.2
Common tumors of the reproductive system
Common tumors of reproductive system includes leiomyomas and cervical, endometrial and also ovarian carcinomas (Munro et al., 2011)
15.3
Common disorders of pregnancy
Some of the most common disorders of pregnancy are maternal bleeding, sepsis and also other types of infections including hypertensive disease of pregnancy.
15.4
Common diagnostic tests used for disorders of the reproductive system
Some of the diagnostic tets used are mammogram, pap smear and also blood and uterine tests.
15.5
Common contraceptive methods
Some of the common contraceptive methods are pills, females and males condoms and also intrauterine device
15.6
Sexually transmitted infections
These are the diseases which are caused by vaginal or oral sex. These are the infections which spread from one to another in dividual through sexual contact like HIV AIDS
16. DiabetesMr Jonathan (82 years) is a known diabetic for the past 30 years. He is on insulin treatment. He complaints of intermittent episodes of hypoglycaemia and visual impairment. On examination, there is a healed foot ulcer. Based on your knowledge about diabetes, answer the following questions below.
16.1
Define Diabetes Mellitus (DMT2) (40-80 words)
This is a chronic disease which is caused by the inherited or acquired lack in insulin production by the pancreas or the inability to control the sugar by the produced insulin. As a result due to this inefficiency the glucose level in the blood is increased which further damages the other systems in the body including blood vessels and nerves (American Diabetes Association. 2010).
16.2
List 4 (four) signs or symptoms of hypoglycaemia?
The early signs of hypoglycemia includes Dizziness, shakiness, anxiety or nervousness and also headache (Davis et al., 2005)
16.3
List 3 (three) long term complications of diabetes?
Some of the most common long term diabetes related problems are damage to the large blood vessels of hear, brain and legs and also small blood vessels are damaged which causes problems for eyes, kidneys and feet as well (Nathan, 1993).
16.4
List 4 (four) main points regarding foot care
Food Inspection on daily basis, Bathe you feet in lukewarm water but never hot water, moisturize your feet but not in between the toes and be very careful while cutting your nails.
16.5
What are the different tests for the monitoring of blood glucose?
There are various ways of testing blood sugar level either by pricking the finger using a glucometer for daily testing and other method is by drawing blood (Sacks, 2011).
17. Mediation/ NegotiationDavid is an alert and orientated 28 year old man with a terminal brain tumour. He has been sick for a year intermittently, having gone through two operations and rounds of chemotherapy. He has a Not for Resuscitation Order (NFR). David has agreed to the NFR order but his parents say that they are not ready to accept that he is dying and that a miracle might occur to cure the cancer. What are the mediation/ negotiation tasks to manage such situations? (30-60 Words)
As mediation gives a chance to settle down disputes in a simple and easy manner. Mediation helps both the parties to bring forward their thoughts without proving each other wrong. The doctors can use both these tools in such scenarios which will make the parents of the patients to know that whatever the doctors are choosing it is for the better of the patient.
18. Respiratory ConditionsExplain the following terms and conditions as per the given example.
Terminology
Conditions
Asthma
Inflammatory disease of the airway caused by narrowing of airways and bronchospasm characterised by expiratory wheeze
Terminology
Conditions
18.1
Bronchiectasis: It is a chronic condition in which the walls of bronchi are thickened by inflammation and also various infection (Barker, 2002)
18.2
Bronchoscopy: this is a procedure that allows the doctors to look inside the lungs including the bronchi which are responsible for air pathways (Mehta et al., 2012)
18.3
COPD/ COAD : This is a broad term which is used to describe various lung diseases like emphysema, chronic bronchitis and refractory asthma (Barners et al., 2009)
18.4
Pneumonia: it is an infection in which the air sacs of one or both the lungs are swollen, which further causes cough with fever and breathing difficulty (Ruuskanen et al., 2011)
18.5
Pulmonary fibrosis: is a lung disease which happens when lung tissues are damaged as a result it becomes hard for the lungs to work properly (Gross & Hunninghake, 2001)
18.6
Spirometry: it is a test which is used to evaluate the functions of lungs that how well you exhale and how quickly you exhale the air
18.7
Upper Respiratory Tract Infection: these are combination of various illnesses which includes the upper respiratory tract including the nose, sinuses, pharynx and larynx.
19. Skin disorders and conditionsDescribe the clinical presentation of the skin disorder below (50 - 70 Words)
19.1
Acne
Some of the clininal representation of acne are blackheads, white heads, small red tender bumps and also some painful pus-filled lumps below the skin surface (Williams et al., 2012)
19.2
Contact dermatitis
Clinical representation of this condition includes red rashes, dryness, itching, swelling and rashes (Margesson, 2008)
19.3
Psoriasis
The symptoms of Psoriasis includes red patches which are covered with thick scales, swollen and stiff joints and small scaling spots (Tsoi et al., 2012)
19.4
Squamous Cell Carcinoma
The symptoms of this conditions are represented by dome-shaped bump, patches of skin that are rough and crusty, when scraped they can easily bleed (Alam & Ratner, 2001)
20. Critical thinking, creative thinking and problem solvingCritical thinking, creative thinking and problem solving go hand in hand in nursing practice. Nurses often use these skills to manage situations with clients, co-workers and self. What nursing skill is demonstrated in the following scenarios a, b & c - Critical Thinking, Creative thinking or Problem solving? And why? (20-40 words each)
20.1
A nurse takes vital signs of a dizzy client and finds the systolic blood pressure to be low. The Nurse asks the client to stay in bed and elevates the foot end, checks the clients medication and fluid balance charts and arranges an urgent medical review. The Nurse then keeps fluids ready to be administered if prescribed following review.
This is critical thinking because the nurse has looked at all the perspective of the case and then resolved the issue.
20.2
A Nurse Unit Manager (NUM) finds a way to improve storage space by relocating damaged equipment to the workshops.
This is creative thinking because here the here the nurse has looked at the situation in a new way and solved the issue.
20.3
An Enrolled Nurse is addressing a client complaint. The Nurse comforts the client and addresses their needs. Later the Nurse reports the incident to the RN and suggests ways to address the issue.
This is problem solving because here nurse first identifies the client concern and then suggest ways to identify the issue.
21. Community services / ReferralsFor continuing care in the community, various referral options are available. List 5 (five) community referral options available for a client and briefly explain their functions as per the given example.
Community services/ Referral options
What is their function?
E.g. Physiotherapist
Community Psychologists
Nutritionist
Physicians
Fitness Expert
Assess clients with mobility, respiratory or other issues affecting ADLs and assist client with recovery / rehabilitation.
Assess how individuals are related to their community in response to their community and provide ways to enhance the interaction
They are quite important to take care of the nutrition requirements of the community and maintain a balance diet among them.
Physicians are required to evaluate the overall health of the patients and prescribing medication according to the health requirement
Fitness expert is important for the overall well being of the patients.
Community services/ Referral options
What is their function?
22. Endocrine SystemBriefly explain or define the following endocrine system conditions
22.1
Acromegaly
It is a condition when the pituitary gland produces too much growth hormone during growing. In such condition the bones increase in size including face hands and feet (Melmed, 2006)
22.2
Addison's Disease
Addison disease is a condition in which the adrenal glands do not produce enough of the cortisol and aldosterone. It’s an auto immune condition in which the immune system attacks their own organs and tissues (Nieman &Turner, 2006)
22.3
Cushing's Syndrome
Cushing’s syndrome is a hormonal disorder the main cause of this disease is the long term exposure to too much coristol which is the hormone that is made by the adrenal gland (Buscaro et al., 2001).
22.4
Grave's disease
This is an autoimmune disease which causes overproduction of thyroid hormone, although there are many causes for this overproduction but grave disease is the common cause (Weetman, 2000)
22.5
Hypothyroidism
This is a condition in which the thyroid gland is unable to produce some significant hormones in order to keep the body running (Cooper, 2001)
23. Diagnostic tests for respiratory conditionsName and describe the purpose of the equipment depicted in images below?
What is this equipment?
What is it used for?
23.1
Spirometry is one of the most common devices used to test lungs function. It is used to measure that how much air one can inhale or exhale.
23.2
this is an incentive spirometer and it is used after surgery to keep the patient’s lungs clear and active throughout the recovery process just like performing daily activities.
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