Nursing Assignment on Nursing Care For Aboriginal Client

Nursing Care Aboriginal Client Sample Assignments

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Nursing Assignment Question

Mr. Joe Munsie, an 80 year old aboriginal male client, was admitted to the hospital on 7/03/11 with Chronic Airways Limitation (CAL), Diabetes and the associated complications of Hypertension, Congestive Cardiac Failure (CCF) with acute exacerbation. His medical history includes coronary artery disease for the past 12 years. He had a balloon angioplasty in 2000 and a Myocardial infarction (M.I.) in 1988. His other symptoms include shortness of breath (SOB), kidney disease, impotence, peripheral neuropathy, glaucoma and repeated infections due to his poor immunity. He has had trouble passing urine at times and has had nocturia six times in the past week. He is a widower, states that for the past 3 to 4 weeks he has had increasing fatigue and shortness of breath. He visited his doctor two days ago, and his medications were changed. His preferred foods are fresh fruits and boiled vegetables. Mr. Munsie lives with one of his daughters and her family since experiencing his M.I.in 1988. He has six other children. He is a Catholic and attends church intermittently, however, since his declining health, he has been confined to his home. He smoked three packs per day x 40 years and quit in 1990. He currently sleeps on 4 pillows at night to ease breathing. He is hearing impaired and wears bilateral hearing aids. He wears glasses and reads with some difficulty. His schooling was to a Year 9 level of high school. He also has a previous history of heavy alcohol consumption for a number of years but very little now consumed.

Admitting history:

This is his third admission for CCF since his diagnosis five years ago. Physician progress notes state: Condition improving; complaining of (c/o) increasing SOB; chest x- ray improving; serum K+ is 2.9 mmol/L, with a weight gain of 5kg in the past two months. Poor diabetic control. He has moderate respiratory distress on exertion and crackles auscultated in left lung base.

Physical exam                       Vital Signs:     T = 37.4 oC, BP = 178/95 mm/hg, P = 110 bpm,

Ht = 176cm, Wt =120Kg, BGL = 12mmol/dl, O 2 SAT level = 90% on room air Bilateral swollen ankles evident with pitting oedema at 2+. Pedal pulses present. Complaining of increasing fatigue and severe shortness of breath (SOB) and leg pain on walking. Denies chest pain.

Medications ordered

Digoxin 0.25 mg po daily

Lasix 40 mg po bd

Nitro Patch 25 mg Top On at 0800 and Off at 2000

Metamucil 15 ml po daily in glass of water/juice

Slow K 600mg po daily

Lantus 80 units daily

Novo rapid 25 unit’s qid

Timoptol 2 (guttae) drops daily

Diagnostic tests results

7/3/2011-Chest X Ray     Mild left ventricular hypertrophy and pulmonary congestion resolving.

7/3/2011
Serum electrolytes: Normal Ranges:
Na+ 138 mmol/L 135-145 mmol/L
K+ 2.9 mmol/L 3.8 – 4.9 mmol/L
Ca+ 2.1 mmol/L 2.10 – 2.55 mmol/L
CL 102 mmol/L 95 – 110   mmol/L
Urea 8.6 mmol/L 3.0 – 8.0   mmol/L
Cr 0.6 mg/dl 0.8 – 1.4 mg/dl
Serum albumin 28 g/L 35 – 47 g/L
Serum digoxin level 2.6 ng/dl 0.6 – 2.3 nmol/L
Full Blood Count:
Hb 100 g/L 130 – 180 g/L
WCC 12 x 109/L 4.0 – 11.0 x 109/L
Platelets 125 x 109/L 150 – 400 x 109/L
HbA1C 10 % 4.0 – 5.5 %

Other admitting orders

Diabetic/No added salt diet; Restricted fluids 1,200 ml/day, Monitor input & output, daily weight, activity as tolerated, Monitor bowel actions, 4th hourly observations, O 2 at 3L/min per nasal cannula.

Nursing Interview & Observations

He states, “I have a touch of the sugar and my old heart is just wearing out. I get this extra fluid every now and then. I come here to the hospital to get rid of it”. He is well oriented, however, he is a poor historian with limited understanding of medications and treatments utilized at home. He complains of frequent constipation. Skin reddened over bony prominences and has small shallow ulcers on both his shins that are inflamed and weeping. Currently requires the head of his bed elevated to assist with his breathing. Requires lift up walking frame when ambulating as he has an unsteady gait. He requires assistance with most activities of daily living.

Questions

Question 1: Identify and briefly describe three (3) of Mr Munsie’s medical conditions.

Question 2: Explain how each of the above identified medical conditions result in pathophysiological changes that impact on each body system. Also their related structures e.g. Persons with diabetes, which is a disease of the endocrine system, who have poor glycaemia control, may have resultant damage to microvascular structures leading to blindness or damage of macrovascular structures resulting in peripheral gangrene.

Question 3: Describe briefly how two (2) Medical and two (2) Pharmacological interventions act to enhance Mr Munsie’s wellbeing. E.g. Mr Munsie has Congestive cardiac failure which has led to peripheral oedema and shortness of breath. He has been placed on a diuretic medication to assist his body to excrete excessive fluid.

Question 4: Review Mr Munsie’s Physical examination, and the Diagnostic Test Results. Identify and describe briefly four (4) abnormal parameters.

Question 5: Identify the drug actions, indications and contra indications for the following medications. Digoxin, Lasix, Slow K, Nitro patch and Timoptol.

Question 6: List four 4 diagnostic investigations that could assist in the diagnosis and management of Mr Munsie’s medical conditions.

Question 7: Identify and provide a brief rationale for four (4) services that meet the psychosocial and or medical needs of Mr Munsie on discharge.

Nursing Assignment Solution on Nursing Care For Aboriginal Client

Solution 1

From the above medical condition three medical conditions are identified- hypertension, congestive cardiac failure and diabetes. Mr. Joe Munsie is found to be hypertensive as his vital sign records are 178/85 as far as blood pressure is concerned. Mr. Joe Munsie is an old aboriginal male of 80 years old. With increase in age the elasticity of arteries and veins decreases substantially. Thus to supply blood to every part, the heart has to work as hard as possible in order to pump out the blood and supply it. It increases the blood pressure.

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Solution 2

Heart failure in general means inability of the heart to meet the oxygen and other nutrients demand of the organs. Thus the amount of blood circulated is not sufficient leading to less return of blood to heart after circulation. This leads to leakage of fluids from capillaries that increases shortness of breath, fatigue and swelling because of water leakage. In the above case study, the patient has congestive heart failure along with bilateral swelling at ankles as pitting edema. Congestive heart failure can be due to many reasons such as structural damage to heart, inability of heart to pump out blood, effect of drugs and medications etc.

Read more in the complete solution PDF document at the end of this page.

Solution 3

The two pharmacological interventions which can assist in improving the Mr. Joe conditions are –

Use of diuretics which enhances the increase of urine flow that is forced diuresis. As a result the excess salt as well a fluid is taken out of the body. This reduces the blood pressure and pressure on heart simultaneously.

Similarly a number of drugs are available to reduce diabetes (blood sugar level) in patient. Sulfonylurea, metformin and alpha glucosidase inhibitor can be used in order to reduce insulin resistance and enhance the carbohydrate metabolism.

Read more in the complete solution PDF document at the end of this page.

Solution 4

On admission Mr. Joe went through formal process of physical exam and other biochemical and diagnostic procedures to provide a deeper insight into his issues. The vital signs recorded the blood pressure at 178/95 which is abnormal taking normal blood pressure as 120/80 which can fluctuate +/- in aged patients. Similarly, from chest X-ray the findings reported left ventricular hypertrophy which is itself not any disease but act as a marker for any type of heart disease. This implicates the left ventricle have thickened over the period and lost the elasticity.

Read more in the complete solution PDF document at the end of this page.

Solution 5

Digoxin- Used in lowering of heart beat in atrial fibrillation cases thus treating heart failure. This should not be used in case of allergies to this particular medication, if inflammation of hear muscles has led to heart failure and pregnancy. Similarly, kidney problems, thyroid problems and low oxygen level patients must notify their physicians about the issues prior to taking this medication. It is sold under trade name Lanoxin (Finkel, 2007).

Lasix- It is the brand name for Furosemide which is used for treating edema in adults and pediatric patients which have been raised due to heart failure, liver chirrosis or kidney failure. This is either taken alone or with other medications such as diuretics for blood pressure. The patients who have allergies to this medication, or difficulty in urinating and on hydral chlorate or ethacrynic acid should avoid this medication (Finkel, 2007).

Read more in the complete solution PDF document at the end of this page.

Solution 6

The following four diagnostic investigations must be carried out in order to assist in Mr. Joe medical conditions.

HbA1C measurement over a period of 2-3 months to know the amount of blood glucose level in the blood and how it is going to impact upon his diabetes status as well as heart conditions.

Solution 7

The following four services can be taken by Mr. Joe in order to get his conditions improved

Meals at home- Where he will be provided meals at his residence cooked as per his choice but keeping an eye on his medical conditions.

 

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