Question:

Answer the questions and analyze the case study.

X, a 47 years old construction worker with a 36 pack/year smoking history, is admitted with a diagnosis r/o of myocardial injury.

He is very obese in male-pattern.

(“beer-belly”, high Waist to Hip Ratio “WHR”, barrel chest. He reports a history consuming high-fat foods.

His wife brought him into the ED after he complained of “indigestion” that was not being relieved.

His admission vitals showed BP-202/124 with PR- 96/min, RR-18/min and T-36.8 C. X was given O2 2lt/ nasal cannula, a D5W IV, and sublingual nifedipine.

He was admitted at Dr. Graham’s.

He exclaims that he is fine, but he shouts in an angry voice and asks for a cigarette.

a. Check whether these vital signs seem reasonable for a male of this age.

If so, what is your concern?

Be specific.

b. Plan 5 priority issues associated with the care for a patient like X.

c. Provide 3 relevant nursing diagnoses to a cardiac patient such as X.

d. Describe which laboratory tests could be ordered in order to diagnose X.

e. You call Dr. Graham, who will prescribe 10mg Morphine sodium IV push q1hr prn to treat pain (burning).

Explain the reasons behind this order.

f. Analyze which precautions should be taken when you administer Morphine sodium sulphate via IV push.2.

Please briefly explain the following nursing interventions.

a. Subcutaneous administration insulin

b. Oral glycaemic administrationc) Blood Glucose Level Monitoring

d. Mid-stream specimen of urine

e) 24-hour urine collection/bladder washes

f. Removal of IDC

g. Contraceptives

h. Urine sample from catheter

i. Glasgow coma scale/neurological observation3.

Show examples of bioethical concerns in nursing4.

The two most important things to do after you have prescribed medication to a client are:5.

Be a good role model for nurses and be tolerant.

a) Based on your knowledge, please give examples of two situations that you would advocate to your patient.

Identify and resolve potential conflicts of interest.6.

Demonstrate how you can best resolve conflicts between the wishes of the clients and the wishes their family members?7.

Explain the social justice principles and how they relate to the health-care system.

Answer to Question: HLTEN505C Contribute To The Complex Nursing Care Of Clients

A) Vital Signs

B.P.-202/124 means that there is high blood pressure. It can also indicate heart disease.

R.R. 18/min which is normal breathing.

T- 36.7 Degree, which means he was not febrile.

b. The following priority problems are related to the case studies:

i. Obesity of Mr. X caused by the consumption fatty food, which can increase heart problems.ii.

ii.iii.

X was suffering a myocardial attack.iv.

His high blood pressure was an indicator of his old age.c) i.

Feelings of pain and squeezing in the chest may indicate decreased cardiac output.ii.

Respiratory distress as a result of inefficient clearing due to the accumulation secretions.iii.

Tissue perfusion decreases, nausea, vomiting chest pain, sweating and indigestion.

d. Laboratory tests to test X’s health.i.

An electrocardiogram is required for physical assessment.ii.

Determination of cardiac markers- Certain enzymes can be detected in the myocardial tissue through damaged cell membranes.

These markers are released into your blood stream.

The cardiac troponins and Creatine kinase MB subtypes are commonly used as markers.

Other cardiac markers include enzymes such SGOT and LDH.i.

Also, the chest radiograph can be used to determine MI.ii.

Histopathological examinations can reveal the condition and extent of damaged heart muscles.iii.

Angiogram of the Coronary to check for obstruction in the heart vessels.

e) Intravenous MPH Sulphate is used when there is chest pain of undetermined etiology.

Morphine can lower the blood pressure.

It lowers the heart rate, which relieves anxiety.

It decreases the myocardial oxygen requirements, lowers respiration, and reduces oxygenation.

f. Every patient should undergo an assessment before administering the doses. Also, the risk of developing complications should be monitored.

Different formulations of the drug may not be bioequivalent so it is essential to follow a prescribed dose.

Patients over 65 years old should receive half the daily dose as the average adult.

Motov et.al. (2015) recommends that patients refrain from consuming alcohol while taking this drug. 2015).

2. a. Subcutaneous insulin therapy is followed by intravenous insulin glucose. This helps to improve the patient’s life quality and long-term survival.

The role of insulin and glucose in ischemic reperfusion metabolism is important.

Increased availability of the glycolytic substrat increases the synthesis rate of anaerobic alosine triphosphate.

It aids in reducing post-ischemic heart dysfunction.

b. It lowers blood glucose.

Type 2 diabetes patients may be managed using glycemics.

They can improve glycemic controls and help to prevent macrovascular (Hsia et.al.2012). The ATP-dependent potassium channel regulators in the pancreatic beta cell regulates them.

They stimulate insulin release from beta cells and help to control the glucose level.

c. Blood glucose monitoring would enable the caregiver to keep an eye on the glucose levels and to determine the appropriate doses and medicines to treat the condition.

A midstream sample of urine is typically taken to confirm the diagnosis. This helps to determine which antibiotic to use.

In this situation, the urine comes from the middle of your bladder.

e This method can be used to measure the levels of hormones, proteins, minerals, and chemical compounds found in the urine.

It can be used in diagnosing kidney diseases such as diabetes, neprotic Syndrome, polycystic Ovarian Diseases, and others (Yismow, et al. 2012).

f. After an indwelling catheter has been introduced into a patient’s urinary system, it is important to remove the catheter promptly from the bladder. This could lead to bladder neck injuries or infections (Yismow et. al.2012).

g. Contraceptives can be used to prevent unwanted pregnancies.

Contraceptive drugs can also be used for other reasons than to prevent pregnancy.

Some contraceptives are also used to treat PCOS conditions in women.

Some hormonal birth controls help to regulate menstruation cycles and reduce acne (Khalili und al. 2012).

If the patient has a suspicion of infection, the bacteriological exam of the urine sample is performed.

It can also be used to identify clinical conditions such as bacteriuria that is not possible in patients who are using catheters (Yismow, et al. 2012).

ii) The Glasgow Comma Scale can be used to diagnose neurological dysfunction in patients. 2012).

It is an important tool to aid patients with trauma, BTI victims.3.

Suicide- It is still debated whether people can choose to die as they wish, particularly for those who are terminally ill (Johnstone 2015).

The right not to.

Lying to patientsResources utilization

The difference between empirical and personal knowledge

4. i. To monitor any changes in the patient’s health or condition, it is vital to maintain a regular follow-up.

iii. To make sure that the client is taking their medication as prescribed.5.

Nursing should not be judgmental.

Nurses should offer appropriate care, regardless of patient limitations. They should also be kind and compassionate to the patient.

Patients from different backgrounds and with different problems are the patients of nurses. Therefore, they must not judge.

a) In certain cases, the patient might decide to switch to a different treatment.

The nurse and the patient would have to agree on a conflict of interests in this instance.

In such situations, discussions are necessary.

Possible conflicts of interest can arise between the patients concerning the tools and methods used to provide appropriate care.

In these situations, it is essential to explain everything to the patient’s family.6.

To resolve any conflicts between clients, it is important to have a thorough discussion about the pros/cons of the treatment.

If necessary, the family can provide specific examples regarding other patients to help the client and their families decide on the best treatment.7.

There are four principles to social justice: equity, access, rights, and participation.

Social justice principles aim to eliminate inequality in health care and to provide health care that is appropriate for different classes of people (Rhodes 2012).

You can explain the social justice principle in health-care as:

Participation: In the making of plans, taking decisions, and implementing them in community health.

Equity- A fair and equal distribution without discrimination of the resources.

Access- Wide range of health benefits are available.

Everyone has the right to equal rights regardless of economic status

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