NSB236 Integrated Nursing Practice

NSB236 Integrated Nursing Practice

Based on Janette’s procedure identify three key nursing assessments that should be performed.   Provide a rationale for the administration of Hartmann’s solution for a post operative patient. Identify which of the vital signs is the most sensitive to physiological changes that occur in clinical deterioration, along with a supporting rationale for your selection.

Question 2 Caine is a 45 year old male who has presented to the emergency department with increased bruising after tripping over a his cat at home. Subjective data: Reports of painful mouth ulcers – on assessment you note white patches covering his tongue He has a 2 month history of fatigue, malaise and flu-like symptoms. Objective data: Bruises and ecchymosis present to arms and legs attributed to his fall Gingiva with petechiae and patchy white spots Temperature 39 degrees Haemoglobin 88 d/L (normal range 110-125 d/L) White blood cell count 12 (normal range 4-9.8) Based on the assessment data provided, identify two (2) nursing priority problem. What are the priorities for teaching Caine regarding his newly diagnosis  acute myelogenous leukemia? Caine is a 45 was recently diagnosed with acute myelogenous leukemia. He askes you how does his leukemia differ from acute lymphoblastic leukemia. Outline your response to Cains question. Outline three (3) life threatening problems that can occur as a result of Caine’s diagnosis of acute myelogenous leukemia? Caine is a 45-year-old male who was recently diagnosed with acute myelogenous leukemia. He reports that he become very fatigued after starting his chemotherapy. He wants to know if he can still exercise even if he is so fatigued. Outline your advice for him? Define ecchymosis.

Question 3 Kelly has been admitted with acute renal failure secondary to acute pyelonephritis. Her vital are as are: Temp 37.6 BP 115/68mmHg HR 102 beats/minute RR 25 breaths/minute SpO2 97% on room air Pain score 7/10 Based on the above clinical information identify what is classification (pre, intra or post renal) of acute renal failure she is experiencing and provide a justification for your response.  

Question 4 Terri is a 28-year-old woman with a history of type 1 diabetes mellitus, diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her partner, Greg, as she is lethargic and unable to make any sense. Greg reports she has been unwell with a flu-like illness for the past week. On examination you Terri has a Glasgow Coma Scale score of 10/15 (eye opening 3; verbal response 3; motor response 4); she has deep, rapid respirations, acetone smell on her breath and her skin is flushed and dry. Her blood glucose level is 31mmol/l and her ketone levels are 7.1mmol/L. Her vital signs are: BP 102/54mmHg HR 112  beats/minute RR – 36 beats/min Temp 36.3 degrees SpO2 96% on room air.  Outline what is occurring physiologically that results in the production of ketones. Identify two abnormal vital signs and discuss why they are abnormal from the perspective of physiological compensation? Identify which of the above abnormal vital signs activates the renin-angiotensin-aldosterone mechanism?  

Question 5 A patient in hypovolemic shock has been administered 3 units of packed red blood cells whilst in the emergency department and the medical team is now ordering a unit of pooled platelets to be administered. Outline the purpose of administering platelets in hypovolemic shock. Outline – provide a discussion that supports your response. 

Question 6 A patient with suspected cardiogenic shock is found to be in rapid atrial fibrillation as per a recent ECG with a heart rate of 122 beats per minute. Discuss the adverse effects this would have on the patients cardiac output. 

Question 7 The pharmacological agents noradrenaline and adrenaline are commonly used vasopressors and inotropes in the treatment of acute shock episodes. Outline what the differences are between an inotrope and a vasopressor

Question 8 Benedict is a 68 year old gentleman with Chronic kidney Disease. He has been admitted to the renal ward toward in preparation for the insertion of an arterio-venous fistula with the plan to potentially commencing dialysis in 6 months. He is normally prescribed calcium acetate (PhosLo). Outline the relationship between calcium and phosphate in chronic kidney disease.

Question 9 You are working with another student on the respiratory ward and the patient you have been allocated to care for today is requiring a blood transfusion of red packed cells. You are collecting the IV tubing and normal saline to commence priming the line in preparation for the blood transfusion. Your student colleague asks “why do we prime with normal saline”. Outline your response to your fellow student.

Question 10 Compare and contrast the benefits and negative of peritoneal dialysis versus haemodialysis conducted in the renal dialysis unit. Compare = what are the similarities Constrast = what are the differences   

Question 11 In Australia approximately 25% of patient receiving dialysis treatment elect to have peritoneal dialysis. Outline how peritoneal dialysis work to remove metabolic waste products      

Question 12 You are caring for a 78 year old man with stage 3 chronic kidney disease, who is requiring education regarding a low potassium diet. In preparation for providing education to the patient you are first practising with your buddy RN. Outline the education you would provide this patient regarding a low potassium diet.    

 Question 13   You are practising your assessment skills on a patient who has been admitted to the respiratory ward with a diagnosis of COPD. You are providing a summary of your findings which include; a respiratory rate of 29 breaths per minute; heart rate 89 beats per minute and regular, fingers nails have a capillary refill time of less than 3 seconds, hands are warm to touch, breath sound can be auscultated in all lung fields, and the patient oxygen saturation are 88% on room air which you determine to be an indicator of hypoxaemia. Differentiate between hypoxia versus hypoxemia. Differentiate = what are the differences, consider the definitions of these terms.    

Question 14 A patient has been admitted post operatively after a repair of a liver laceration which occurred post a motor vehicle accident. The blood pathology results indicate that his haemoglobin level are 75 g/d/L  (normal range (110-125g/dL) and currently has oxygen saturations reported as  95% on 2L of oxygen. The nurse you are working with asks you;  “based on these findings would you remove the oxygen”. Provide a response, along with a rationale for your clinical decision. Rationale = provide reasoning to support your response, consider the pathophysiology that woudl support your decision.       

Question 15 You are caring for a patient who needs second hourly neurological observations performed using the Glasgow Coma Scale (GCS). List the sequence in which you would perform the GCS assessment, with a supporting rationale for the chosen order. List = identify the order  Rationale = provide a reason for the order of the assessment         

Question 16   John is a 57 year old man who has been diagnosed with acute myelogenous leukemia (AML). The nursing team are focussing on a collaborative care plan that focusses on attaining remission. Outline what remission means in the context of acute myelogenous leukemia.  

Question 17 You are working on the orthopaedic ward with another student. The student is discussing with you the management of shock and has reported that “understanding the clinical management of shock is easy, as all shock states require intravenous fluids as their first line management” . Outline your response to the student indicating if they are correct or incorrect, along with a justification for your response. Outline = consider the similarities and differences between the shock states  Indicate = do you agree or disagree with the statement  Justification = discuss the ideas that support your views on the statement

Question 18 The ABC (airway; breathing; circulation) assessment framework is used to identify life threatening injuries and complications. Identify and outline the three underpinning concepts associated with the ABC assessment framework.  Indentify = what are the underpinning concepts Outline = provide a short discussion of the concepts  

Question 18 You are caring for a patient in the orthopaedic ward who has a fractured pelvis. An external fixation device has been applied to stabilise the fracture and the patient is required to be cared for in a supine position and is not permitted to weight bear for approximately 6 weeks. On the morning medical round, the junior doctor is asking you for the latest pathology result relating to the patient’s haemoglobin level. Discuss why this might be a relevant clinical consideration in the context of the patient’s injury.   

Question 19 A patient on the renal ward has been reviewed by the dietician who has identified the patient having an imbalance to nutrition linked to their chronic kidney disease. Outline two nursing interventions that can be implemented to help address this patients problem.  

Question 20 List three clinical manifestations of acute kidney injury that effect the following body systems and explain: Urinary Cardiovascular Respiratory Gastrointestinal Haematological Neurological Metabolic  

Question 21 You are allocated to care for the following patients: Sally McNally a 24-year-old engineering student who has developed sepsis post operatively. Ben Burger a 56-year-old gentleman who was admitted 2 days ago with gastrointestinal bleeding. Compare(what the similarities) and contrast (what are the differences) in the pathophysiology and clinical manifestations of septic shock and hypovolemic shock. This morning a patient has been admitted to with an anaphylactic reaction to a bee sting. Discuss(what are the key points providing reasoning for and against, determining some conclusions) the patient education you would provide this patient regarding anaphylaxis.

Question 22 1.Outline the rationale for the pharmacological treatment of cardiogenic, anaphylactic  and hypovolemic shock 2.Compare and contrast the aetiology, clinical manifestations and management of hypovolemic, cardiogenic and anaphylaxis  3.Discuss the evidence-based treatment goals for shock states.  

Question 23 1.Develop the ability to recognise a deteriorating patient and implement interventions tosupport the patient and their family   2.Describe the lifespan changes and their impact on haemodynamic responses 3.Develop the capacity to interpret normal and abnormal haemodynamic values and correlate these to the underlying pathophysiology of the patient’s condition

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