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Q1. Explain these terms and provide examples of what observation data could be charted to represent these signs and symptoms (200 words)
Tachycardia is a medical condition in which the heartbeat rate exceeds 100 per minute. Under this condition, the heartbeats may be regular or irregular. It is usually occurred due to a high level of exertion. Tachypnoea is a condition under which an individual incurs rapid abnormal breathing which may be shallow or rapid. A rate greater than 20 is usually concerned with this condition. Angina is concerned with chest pain. When the cardinal muscles do not get access to the required amount of oxygen-rich blood ten the muscles incur discomfort that gives rise to chest pain.
Hypertension is often regarded to as a situation with high blood pressure and is usually a chronic condition. In this condition, the arteries sustain high blood pressure for longer periods. It occurs when the blood pressure elevates above 140/90. When subjected to stress, anxiety is witnessed. It is a mental health disorder that is concerned with strong emotions of dread and apprehension. Obsessive-compulsive disorders and panic attacks are common outcomes of this situation. Tremor is involuntarily contraction and relaxation of the body. It usually impacts head, face, vocal cords, legs and hands and can vary from a mild one to severely intense shaking.
Q2. What immediate action would you take to assess and monitor these signs and symptoms? (150 words)
As a registered nurse, the patient can be helped in dealing with the anxiety and tremor situation by aiding in getting back to the relaxed state. Tremor can also be dealt with by ensuring that the Primidone is given to the patient. Progressive muscle relaxation can be suggested to the patient and recommending the mindful exercises. For prompt relief, 0.125–3 mg/day dose of Alprazolam can be suggested. Amiodarone such as Cordarone can be referred for dealing with Tachycardia. For Tachypnoea, the underlying causes will be determined which may involve lung infection. Nitro-glycerine tablets can be recommended for the Angina. A diabetes test needs to be conducted before recommending ACE inhibitors for hypertension. Since the patient has a history of Asthma, Salbutamol can be recommended so that the airways are clear.
Q3. Explain the pathophysiology of Asthma (300 words)
Pathophysiology of asthma involves inflammation of airways and obstruction of the airflow resulting in bronchial hyperresponsiveness. It is a common pulmonary condition that incorporates chronic inflammation of the respiratory tubes and frequent incurrence of the bronchoconstriction. From the provided scenario, it can be inferred that Jolene already has a history of hypertension and hypertension and anxiety which may act as boosters in leading to airway inflammation and other asthmatic symptoms. The onset of asthma for Jolene is interconnected with the other patterns of persistent diseases. Jolene has reported other medical conditions involving tachycardia which can be a consequence of asthma as asthma causes usage accessory muscles for respiration which can generate diaphoresis. Jolene is already under medications involving Atrovent which is effectual in maintaining and treating the bronchospasm concerned with chronic obstructive pulmonary disease and Ventolin which is used for bronchospasm with the reversible obstructive airway.
Since Jolene is incurring chronic obstructive pulmonary disease, only Atrovent needs to be considered as the reaction between Atrovent and Ventolin may not be beneficiary. Ventolin has many side effects which can further deteriorate the health condition of Jolene which involves tremor, muscle pains and alterations in taste. Since Jolly is witnessing tremor, nervousness, shaking, she must discontinue the use of Ventolin and adhere to Atrovent for the treatment of asthmatic symptoms. Since she is not incurring any side effects of Atrovent which usually involves the upset stomach, dizziness, back pain, constipation or headache; so, she must incorporate it as a medication for asthma.
Q4. Provide the generic details of these medications and explain their indication and action (200 words)
In the case of occasional unexplained diarrhoea, it is crucial to consider the Rectal urgency of the patient. Diarrhoea is an increment in the bowel movement and is usually associated with the loosening of the stool. The possible causes for which Jolene is incurring diarrhoea are deflated absorption of the fluid by the intestine, increased release of fluids into the intestine and rapid passage of food through the intestine. The effective treatment which can be offered to Jolene for treating diarrhoea involves antimotility medications such as Bismuth compounds. The possible reasons for diarrhoea can be determined by examination of stool under a microscope or by measurement of the orthostatic hypotension and also indulging in immunologic tests. Treatment that can be offered to Jolene for dealing with it can involve Loperamide or Imodium which are antimotility drugs.
Hair thinning and brittle nails can be a result of elevated levels of prostaglandin in the body and especially the scalp. chronic flares of IBD can be another reason for the same. Finasteride can be suggested to Jolene for overcoming hair thinning and brittle nails. Some treatments involve Methimazole and Propylthiouracil.
Q5. What is Graves’ disease? (100 words)
Grave's disease is basically a disorder associated with the immune system that results in hyperthyroidism. In this disease, the thyroid produces hormones in an excessive amount and is usually common in elderly women. Jolene also sustains the key symptoms of this disease which involve tremor, weight loss, goitre, and anxiety. As a part of this disease, the immune system attacks the butterfly-shaped gland in the throat and pressurizes the thyroid to produce more hormones then what the body actually requires. It is also called as an autoimmune disease. This is the reason that Jolene witnesses frequent hand tremors and enlarged thyroid. It is more common among women as compared to men. In this disease, the abnormal antibodies mimic the TSH. The Grave's disease directly impacts the thyroid. Jolene is having a severe case of Grave's disease along with goitre. Antithyroid drugs that can be prescribed involve Methimazole which is an anti-thyroid medication known for its ability to resist the excessive release and formation of thyroid hormone by the thyroid.
Q6. Describe antithyroid drug treatment for Graves’ disease (150 words)
The antithyroid drug treatment ensures that the thyroid antibodies are diminished and the remission of the disease is induced. Radioactive iodine therapy is another antithyroid drug medication that assists in destroying the thyroid and causes hypothyroidism. These drugs can be suggested to Jolene so as to prevent the thyroid from producing excessive hormones. The generic medication that is usually provided to such patients involves propylthiouracil. The suggested antidrug treatment for the patient is incorporated with beta-blockers; this is so because beta-blockers are effective in cases of hypermetabolic symptoms in diverse states of hyperthyroid. They can also be used alone as they offer vital symptomatic relief. Jolene has both goitre and Grave's disease; in this case, the treatment with beta-blockers is effectual in tackling both.
Q7. Explain the rationale for this combination of drug therapy and discuss the interactions with the bronchodilators already used (200 words).
Antithyroid drug treatments are intended to suppress the secretion of thyroid which may cause an adverse impact on other parts of the body. The most common impact that these drugs incorporate is allergic reactions. These reactions are responsible for manifesting rashes, urticaria, amelioration of immune disorders and fever. The symptoms are usually reflected in patients who consume antithyroid drugs and the degree to which these symptoms occur ranges between 1 to 5% of the patients. These reactions are usually developed within 1 to 2 weeks of consumption. Since Jolene is planning to have a baby, such allergic reactions may turn out to degrade the situation. Agranulocytosis is one of the common side effects that women usually incur due to the ingestion of antithyroid drug treatments. Jolene needs to understand that the ingestion of these drugs in the teratogenic period of pregnancy may lead to an increased chance of birth defects which may be severe and pose a considerable impact on the life of the child. Liver failure is another negative consequence of this drug treatment which Jolene must take into consideration before planning for a baby.
Q8. How would you respond to Jolene? What advice would you give her about her existing condition and drug therapy related to pregnancy? Write your response as if you were speaking to Jolene. That is in clinical conversation language instead of academic language. Consider your professional codes and standards when writing your response (200 words).
Hyperthyroidism is a critical situation and managing the same is complicated during pregnancy. Carbimazole and Methimazole have the ability to control the Grave's disease but they also pose a serious side effect involving major congenital abnormality and hepatotoxicity. Propylthiouracil is another antithyroid drug treatment that can upsurge the chances of birth defects, agranulocytosis and liver failure. Taking into consideration the severity of the Grave’s disease, it is hence cardinal that the illness is primarily treated in operative custom. Also, hyperthyroidism which can be a major consequence of Grave’s disease can result in adverse obstetric consequences that involve stillbirth, intrauterine, growth restriction, pre-term birth or even miscarriage. The management of this disease is complicated and the consumption of radioiodine in the situation is completely contraindicated. The level of mobility in a pregnant woman elevates in comparison with non-pregnant women. This is a major reason that at this stage Jolene must not consider the idea of conceiving a baby as there are subsequent fatal risks involving thyrotoxicosis. Keeping in mind the complicated management of Grave's disease during pregnancy, it is crucial to avoid it and hence lay emphasis on the treatment of the disease so that health is retained. Also, if proper treatments and adequate medications are given during pregnancy there is still a risk of obstetric complications that may lead to foetal loss. Jolene has poor control over Grave's disease that can result in a higher rate of complications
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