BN6002 Knowledge For Nursing Practice 3


Answer:

An old woman of 54 year, named Rainey, Maori descendent, married for 22 years and is having two children who were grown up. Her parents died of heart attacks. She has four brothers among them two have heart attacks and a problem of high blood pressure. Rainey is a housewife and has a sedentary lifestyle as most of the time she used to be seated. Her diet is also high as she used to consume foods containing sugar and fats. She is having a body mass index of 31kg/m2 and her waist is measuring 101cm. Rainey explained that she is suffering from the symptoms of flu. Her blood pressure was measured and it was found 160/100. Her chest was found to be clear. She fell around six years before and having some backbone problem. She was prescribed to do some other tests which will help to find the reason behind the increase blood pressure. She was then asked to come to the clinic after two days for checking her blood pressure. She is very much religious whenever she gets time she wants to go to the temple for worshiping the Mao god but due to her illness and inability to walk properly she is unable to go and for this reason she stays unhappy.

Etiology

Coronary artery disease (CAD) is a type of disease which is most common in the Maori people. It is generally caused by accumulation of plaque in the inner walls of the arteries through which blood is supplied to the heart and different part of the body. The deposition of cholesterol, fats and other substances form plaque. The formation of plaque cause narrowing of the arteries which blocks the blood flow partially or fully. This process is known as atherosclerosis.

Large amount of plaque deposition and narrowing of the arterial walls make it difficult for the blood flow throughout the body. It causes chest pain when the heart doesn’t get the sufficient amount of blood and this situation is called Angina, which is the most common symptom of coronary arterial diseases. It may further lead to a serious condition such as heart failure due to the inability to pump the blood normally.

It can be detected by the following process:

Test

Uses

ECD or EKG (Electrocardiogram)

It is used to detect the rate, normality and electrical activity.

Echocardiogram (ECHO)

It is used to create an image of heart by using ultrasound.

Test of stress

In this case a treadmill is used to measure the heart rate while walking on it.

X-ray of chest

In this images of heart and other organs of the chest are created by using X-rays

Cardiac catheterization

A thin and flexible tube is inserted through an artery in the groin towards the arm or neck to reach the heart for checking whether there is any blockage inside the heart.

Coronary angiogram

X-rays are used to detect blockage and blood flow through the arteries by injecting dye via catheterization

To prevent CAD the patient is suggested to follow the steps underneath:

To bring change in the lifestyle, as for example, eating something healthier, increase in the physical activity and to quit smoking.
The patient is prescribed with medications to reduce the risk factors for CAD, such as high blood pressure, irregularity of heartbeat, high cholesterol and lower levels of blood flow.
To restore the blood flow by the surgical procedures.

Te Whare Tapa Wh? health tool relating with clients health

 

The image of the Wharenui describes the four aspects of M?ori health, with its strong infrastructure and four equivalent sides.

When any one the four aspects is harmed or somehow missing, a man, or a group may be unhealthy or sick.

For some M?ori present day services of healthcare need acknowledgment of taha wairua (the profound measurement). According to the M?ori approach, the incorporation of the wairua, the part of the wh?nau (family) and the stability of the hinengaro (mind) are as critical as the physical appearances of disease.

Taha tinana (physical wellbeing) – It describes the limit with respect to physical development and advancement. A good health is required for ideal improvement. Our wealth is supported by our good physical health and keeps us safe from the external world. For M?ori health and prosperity can’t be isolated from the part of mind, soul and family.  

In case of my client Rainey, she is suffering from pain in the muscles, mild cough with mucous, dehydration, fever, fatigue, congestion near the throat, shortness of breath and swollen lymph nodes. Her blood pressure was measured and it was found 160/100.

Taha wairua (spiritual health) – It is the ability to belief and a broad conversation. Health is identified with spiritual energies. The profound wealth of man is the force of the life. This decides us as people and as a group, our presence, the place we have originated from and way to our goal. According to the traditional M?ori the detection of physical examination of the signs of disease is concentrated on the wairua or soul, to decide that it is a harming factor or not.

Rainey has a good spiritual health and it can confirm by her statement, that she wants to go to temple and as she is unable to walk properly she used to worship at home.

Taha wh?nau (family health) – It describes the ability to have a place, take care and to share with other peoples of the society. Wh?nau gives us the quality of our identity. This is the connection to the forefathers, our bonding of our past, present and the future. Understanding the significance of wh?nau and how wh?nau (family) can add to disease and help with curing sickness is the only way to understanding M?ori medical problems.

The family health of Rainey is not well as her parents died of heart attacks. She has four brothers among them two have heart attacks and a problem of high blood pressure.

Taha hinengaro (psychological health) – The capacity to pass on, to think and to feel mind and body are undefined. Contemplations, assessments and sentiments are fundamental parts of the body and soul. This is about how we see ourselves in this universe, our correspondence with that which is remarkably M?ori and the perception that others have of us. Mental health of Rainey is not good as she is suffering from stress factors. Most of the time remains upset as she can’t move due to which she cannot make her involvement in social activities.

Impact Of The Health Condition On The Patient

As per the patients perspective she told that it began a little once again a year back when she was 53 years old. Whenever she would stroll up stairs, she felt a pain in the center upper piece of my trunk, which she can feel into her jaw. Later she came to know that this was called angina, which mean that her heart wasn’t getting enough blood. She also started getting migraines. However the worst was the jaw pain. That time she thought that coronary arterial disease was for individuals in their 70s. Additionally, she fell around six years before and have had backbone problem from then. She had one herniated plate and two bulged disks. She always feels like she was always complaining about her illness and people around her is getting irritated of hearing those things. She thought that after all these things couldn’t discuss the chest and jaw pain she was suffering. She thought to check it out by meeting a doctor and make sure what was happening to her.

That time while she was watching TV she saw a show which talked about the symptoms of a heart attack. However she doesn’t have an attack but she was also facing the similar symptoms which were getting worse by time. During this time she was always staying depressed which again caused more harm to her. Having these symptoms is very stressful and some people also suffer from severe psychological problems. Particularly the patients tend to get depressive symptoms of high levels which ultimately cause more harm to the patients.

Wh?Nau Ora And The Way They Help People

Wh?nau Ora is a comprehensive way to deal with giving administrations and chances to all families in need crosswise over New Zealand. It engages wh?nau all in all – as opposed to concentrating independently on individual relatives and their issues – and requires different government organizations to cooperate with families as opposed to independently with individual relatives.

Together executed by Te Puni K?kiri and the Ministries of Social Development and Health, Wh?nau Ora is about a change of wh?nau – with wh?nau who set their own heading. It is driven by an emphasis on results: that wh?nau will act naturally overseeing; living solid ways of life; partaking completely in the public eye; unquestionably taking an interest in Te Ao M?ori; financially secure and effectively included in riches creation; and firm, versatile and supporting. Wh?nau Ora will work in a scope of routes, affected by the approach the wh?nau takes. Some wh?nau will need to concoct methods for enhancing their own lives and might need to take a shot at this with a hap?, iwi or a non?government association (NGO).

Other wh?nau will need to look for assistance from pro Wh?nau Ora suppliers who will offer wrap-around administrations customized to their necessities. Wh?nau will have a specialist or “pilot” to work with them to recognize their necessities, cause build up an arrangement to address those requirements and handle their entrance to a scope of wellbeing and social administrations.

The Wh?nau Ora approach will proceed to advance and, in the initial couple of years, is required to affect on wh?nau building their ability to be more self-overseeing; suppliers of administrations to wh?nau; wh?nau who utilize those administrations; and government offices that reserve administrations to wh?nau.

Firstly she saluted Ian Kaihe-Wetting; Te Kaahui Ora and Middlemore Hospital for their extraordinary activity to build up a Patient and Wh?nau Centered Care program.

She thought the subject for the Grand Round Panel is the best communicated way in holding this awareness – “from administering to somebody to thinking about somebody: how quiet encounters share our practice”. It indicates an essential change from doing “to and for”; following up for another – to an extensive approach which is driven and dictated by the general population themselves. Thus wh?nau are seen not as customers but rather as makers – playing a dynamic part in deciding their fate; exhibiting their conviction that their wh?nau are their future. She like the needs which Whanau Ora have set themselves in central goal to enhance the experience of patients – perceiving Whanau as care accomplices; enhancing open doors for patient and Whanau input; giving more better engagement and keeping quiet. These are all reasonable, substantial steps towards inviting the patients. Thus she thinks that they should perceive that wh?nau ability is the gauge for wh?nau prosperity. In some cases she feel that for a really long time they have sought others for our own particular salvation – whether it be the arms of the express, a M?ori supplier, a wellbeing administration, a group gathering.

Finally she thanked me to you for giving me a chance to impart a few considerations to you about the estimation of the refocus practice you are seeking after. I genuinely trust that all your wh?nau will thank you for the intense feeling of reason you are seeking after.

Wh?nau Ora is about co-ordinating care for the benefit of patients and guaranteeing care arranges and Wh?nau Ora arranges thoroughly address customer needs. It is a wh?nau-driven model of administration reconciliation utilizing a M?ori kaupapa to enhance all results for our enlisted customers. Essential care experts will, after some time, have focuses in their neighborhoods and groups like this one that grid crosswise over sub-districts to give benefits that may have been generally given under and by standard administrations or providers. Apart from essential and optional medicinal services benefits inside the middle, we have a lot of instruction, social administrations, equity and psychological well-being administrations, which are known as wrap-around administrations. This implies wh?nau that get to our administrations are taken a gander at exhaustively – not only depictions of care or contact. After some time, we will build up a referral triaging process, clinical and non-clinical, that positions customer needs in view of requirements. Get to and financial issues will be considered and mind arranges and Wh?nau Ora arrangements will be produced around those necessities. There will be a cultivating of new models of administration conveyance that will center on utilizing Wh?nau Ora and Wh?nau Tahi models to enhance customer results. We will likewise be simultaneously growing how we measure our execution to accomplish enhanced results for clients. Along with general practice and nursing administrations, the inside offers podiatry, maternity care and dietician administrations. We are going to utilize a General Practitioner to run a ceaseless care center and we are taking a gander at working with an endocrinologist to run virtual and on location facilities for our troublesome diabetic customers. We likewise have a family savagery benefit, M?ori portable nursing administrations, cardiovascular recovery administrations and oral wellbeing administrations coordinated with the center. The middle offers a suite of ten administrations under the ‘Administrations to Improve Access’ agreement. At last, a M?ori mirimiri benefit (customary back rub) is likewise being produced. Benefit pilots will likewise work to adjust and draw in customers with fitting and important administrations. This is an energizing time for this urban M?ori expert in west Auckland, to give benefits inside the Wh?nau House and for staff working in the middle and for our group. Waipareira is the main administration substance of its kind in New Zealand run and worked by M?ori for all individuals needing new ways to deal with their own care and the care of their wh?nau.

Pathophysiology

Coronary corridor ailment creates when the real veins that supply your heart with blood, oxygen and supplements (coronary courses) wind up plainly harmed or ailing. Cholesterol-containing stores (plaque) in her veins and irritation are as a rule to fault for coronary corridor illness. At the point when plaque develops, they limit the coronary veins, diminishing blood stream to her heart. In the long run, the diminished blood stream may bring about trunk torment (angina), shortness of breath, or other coronary supply route sickness signs and side effects. A total blockage can bring about a heart assault. Coronary arterial disease is a chronic disease that starts in the mid of pre-adulthood and gradually advances all through life. Autonomous hazard elements incorporate a family history of untimely CAD, cigarette smoking, diabetes mellitus, hypertension, hyperlipidemia, stationary way of life, and heftiness. These hazard components quicken or adjust an intricate and incessant incendiary vascular process that at last shows as sinewy atherosclerotic plaque.

The most broadly acknowledged hypothesis of atherosclerosis expresses that the procedure speaks to the body’s endeavor to recuperate in light of an endothelial harm. The initial phase in the atherosclerotic procedure is the advancement of greasy streaks, which contain atherogenic lipoproteins and macrophage froth cells. These streaks frame between the endothelium and inward flexible lamina. After some time, a middle of the road sore made out of an extracellular lipid center and layers of smooth muscle and connective tissue framework in the end shapes a stringy top. The edge of the sinewy top (the shoulder area) assumes a basic part in the advancement of intense coronary disorders. The shoulder area is the site where most plaques lose their respectability or break. Plaque crack uncovered the hidden thrombogenic center of lipid and necrotic material to circling blood and its thrombogenic particulates. This introduction brings about platelet adherence, collection, and dynamic luminal narrowing, which can quickly advance and—frequently without coronary course guarantee improvement—are related with intense coronary disorders.

Inflammation of vessels has risen as a basic and built up segment of atherosclerosis beginning, movement, and potential plaque precariousness. Patients with built up CAD who have a juncture of hazard variables known as the metabolic disorder stay at especially high hazard for a future vascular occasion, for example, an intense MI or cerebrovascular mishap. Biochemical markers, for example, lifted levels of high affectability or ultra-touchy C-responsive protein without systemic aggravation are thought to flag an improved probability of vascular irritation and to predict a higher danger of vascular occasions. This marker may likewise flag all the more quickly propelling CAD and the requirement for forceful preventive measures.

Since pain differs from people to people, self-report is viewed as the Gold Standard and most exact measure of pain. The PQRST strategy for evaluating torment is a profitable device to precisely portray survey and report a patient’s torment. The technique additionally helps in the determination of fitting agony solution and assessing the reaction to treatment. According to the client’s present condition I had done a pain assessment which includes the following process:

P = Provocation/Palliation

When she was climbing up stairs, she felt a pain in the center upper piece of my trunk, which she can feel into her jaw.

It is relieved by medications, massage and changing position.

It is aggravated by movement, bending, lying down, walking and standing.

Q = Quality/Quantity

 It is reported in the middle/upper sub-sternal region and the pain is often described as “constricting” or a “crushing” sensation. 

R = Region/Radiation

Common sites include the anterior chest, shoulders and arms. Less common is pain that extends to the neck and jaw. Some patients may describe their pain radiating to the jaw and feeling like a dull ache or a tooth ache, whilst some may describe the radiation as a band around the ribs.

S = Severity Scale

On a scale of severity the pain is approx 6 out of 10.

Symptoms include nausea, vomiting and diaphoresis. The patient may also experience dizziness, hypotension or a feeling of impending doom and feeling scared.

T = Timing

Pain typically lasts for 2-5 minutes (but can la

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