NURS2100 Chronic Bronchitis Assignment Sample

• Subject Code : NURS2100
• Subject Name : Nursing

Medical Surgical Nursing - Question 1

Answer

A. Probable diagnosis for patient is Flu and common cold

B. Patient oxygen stats on room are 92% which can be due to shortness of breath. Patient has fever and shortness of breath (SOB) and fatigue for last three days, he also has productive cough which is normal in viral flue and common cold. This symptom is also similar to Acute Bronchitis but due to his young age chances of that is very low. Hence in my diagnosis it is viral flu or common cold, as symptoms direct the diagnosis towards that.

C. Common cold happens due to body response to the virus not because destruction of nasal mucosa. A very limited viral infection of nasal epithelium can trigger an influx of cytokine release, polymorphonuclear leukocytes and a vascular leak. It is an illness caused by a virus in upper respiratory tract. In adults fever, paranasal sinuses and the middle ear cavity are commonly involved while common cold. It is self limited illness. None of the medicine are curative used in symptom relief of common cold. Ineffective treatment may be considered efficacious in absence of adequate blinding of controls. But effect of flue can be treated with proper medication and rest.

Medical Surgical Nursing - Question 2

Answer

A. Probable diagnosis of patient is Type 2 diabetes.

B. To confirm the diagnosis patient need to run Glycated haemoglobin (A1C) test.

C. As her mother told about her symptoms, she is eating more but losing weight, suffering from fatigue, and drinking too much water and using bathroom frequently. In case of Diabetes type 2, frequent urination, increased thirst and hunger, weight loss, fatigue can be seen. But it is very uncommon for any person of age 14, but it is not impossible that it can happen in this young age. Its pathophysiology is characterised by pheriphereal insulin resistance, declining of β- cell function and impaired regulation of hepatic glucose production. It eventually leads to failure of β- cell. Type 2 diabetes is heterogeneous disorder with varying prevalence in each group of population. Alone in US some 16 million individual have been diagnosis with type 2 diabetes mellitus. As patient is losing weight which is due to phepherical insulin resistance, which led to rise in glucose/sugar level of blood resulted in frequent urination which is causing excessive thirst. Over eating is also causing increase in blood sugar level. And loosing in weight is causing extreme fatigue which resulted in unconscious sleep this week to patient.

Medical Surgical Nursing - Question 3

Answer

There are five steps involved in development of atherosclerotic plaque-

1. Endothelial dysfunction – It is an event in atherogenesis which caused by physical stress and chemical irritants. In this condition endothelial layer of small arteries fail to perform its important function in normal way, which causes bad things to tissue dependent on those arteries.

2. Formation of lipid layer – in this step a thin polar membrane of lipid molecules which consist of fatty acid chain consist of amphiphilic phospholipids is formed.

3. Migration of leukocytes into vessel wall – in this steps leukocytes passes into intact vessel wall, this process is known as leukocytes extravagation. It happens due to movement of leukocytes toward damage or infected part of tissue.

4. Foam cell formation – When circulating monocyte derived cell gets accumulated at site of fat deposited in vessel wall. This droplets appears foamy, hence they are called foam cell.

5. Degradation of extracellular matrix – extracellular matrix is highly dynamic structure which goes under constant remodelling with the response to an injury. It happens for extravasation into tissue to propagate response.

If a person has atherosclerosis his risk depends on which arteries are blocked, if atherosclerosis had narrowed down arteries close to heart it may risk in heart attack or heart failure.

Medical Surgical Nursing - Question 4

Answer

Myocardial infarction also known as heart attack is an irreversible caused by hypoxia and prolonged ischemia to myocardial tissue. It occurs due to the rapture of an atherosclerosis plaque which happens after coronary artery becomes occluded, it leads to the formation of blood clot. The myocardium normally supplies by the vassal will become hypoxic and ischemic if a vessel becomes completely occluded. With lack of enough oxygen a tissue dies. This damaged tissue gets surrounded by a border comprised of necrotic core which either recovers the normal function or become permanently damaged. This tissue may become site for generating arrhythmias. To determine the infract size collateral blood flow is important.

After several weeks of Myocardial infarction, infatracted tissue forms a fibrotic scar. In long term consequences of that include development of compensatory hypertrophy, ventricular failure, sudden death. 

Complications associated with Myocardial infarction are heart failure, cardiac rupture, pricardities, angina pectoris, thromboembolism, ventricular septal defect, sudden death etc.

Medical Surgical Nursing - Question 5

Answer

A. Patient is suffering from Acidemia, it happens when serum pH is less the 7.35 which is normal lowest value for pH. As we can also see in his test result that, his pH is 7.21 which is below normal range. With his pH test and its result we can conc;ude he is suffering from academia. As Acidemia is a process which cause acid accumulation or alkali loss. Hence, we can say patient is suffering from acid disorder.

B. As we can see in patient ABG analysis, partial pressure of arterial oxygen is lower than its normal range while partial pressure of arterial carbon dioxide is higher as well as carbonate and bicarbonate in blood. As patient is pack a day smoker and having issues in breathing he seems to be suffering from lung disorder, or a repertory dieses most probably chronic bronchitis. As chances of chronic bronchitis is high due to his weekend lungs caused by smoking a pack of cigarette every day. His age also suggest that he is more prone to this chronic bronchitis, and most important he coughing for years that point toward this direction. As I think Mathew is suffering from chronic bronchitis.

C. When high production of tracheobronchial mucus happens enough to cause cough with expectoration for more than few months, it is then associated with chronic bronchitis. As Mathew complained he has cough for years. Both target and initiator of inflammation in chronic bronchitis is alveolar epithelium. When cells of tissue with bronchial lining are irritated which causes mucous membrane to becomes edematous and hyperaemic, this reduces bronchial mucociliary function in medical situation of acute bronchitis. It results in clogged of air passages by debris which result in increase of irritation. Cough in case of bronchitis happens due copious secretion of mucus production in response to that. Peribronchial and neutrophils distribution predominance of fibrotic change result in change in the behaviour of colony stimulating factors, interleukin 8, and other proinflammatory chemotactic cytokines. To respond against infectious, toxic, and inflammatory stimuli inflammatory mediators are released by airway epithelial cells in addition decrease in realise of regulatory substances such as neutral endopestidase or angiotensin converting enzyme.

Chronic bronchitis is categorised in simple chronic bronchitis, chronic mucopurulent bronchitis and chronic bronchitis with obstruction. Mucoid Suputum release comes under simple case of simple chronic bronchitis while recurrent or persistent purulent sputum release, when there is no localised disease like bronchiectasis is present comes under chronic mucopurulent bronchitis.

As we can see in case of Mathew as he said to ease his breathing previously he was suggested with some medication which he didn’t take properly as he thought they are not effective, that seems to be now resultant in Chronic bronchitis, as his lungs has weekend due to excessive smoking. And he didn’t treated his symptoms in beginning.

Medical Surgical Nursing - Question 6

Answer

A. Patient rhythm is regular as it can be seen ECG

B. Rate of rhythm is 60

C. As person is going through cardiac arrest, first this is to give him breath. Person should be laid and must not move, then after putting hand on his chest putting other hand on top of it, push will be given. Pressure must be that adequate to push his chest at least 2 inches down. After counting pressure will be released, then same process must be repeated multiple time till his breathing is back. Once his breathing is back the he must be put on mechanical ventilation. His treatment should be first to put him on respiratory support system to ease him in breathing. Continuous supplement of oxygen therapy must be used to ease his discomfort in breathing. As he has regular heart beats, helping him breathe might pull him back to life.

He must be put into mechanical ventilation, while effort to bring his central pulses by giving him CPR (cardiopulmonary resurrection). 

Medical Surgical Nursing - Question 7

Answer

As she has been into bush walk and there is a rash in her leg then there is huge chance that she might have got into contact with something from which is allergic to. Due to allergy shortness of breath and high pulse rate can be explains. She must be given some anti allergic and must be put on mechanical ventilation to be provided with oxygen therapy. As low oxygen stats indicated she is going through low oxygen level on her blood. After giving her anti allergic she must be put on intensive watch and her each reaction must be properly reported and anything caused more risk must be dealt with urgently. There is also a chance that she might had get bitten by a venomous snack or bug, so it it mandatory that her leg must be checked for any bite mark and if there is none the treatment with anti allergic must be continued. She must be put on life support for few hours so that there is no risk to her life. With her response to anti allergic treatment further treatment action will be decided.

Medical Surgical Nursing - Question 8

Answer

A. First priority would be easing his muscle, it might be done with giving his some pain reliever to ease his muscular tension. His muscle contraction might also be due to low water level in his body as he has not eaten or drink anything and continuously vomiting. He must be given saline fluid through IV. A violence muscle contraction can case issue in breathing and cardiac arrest so he must be provided with oxygen through mechanical ventilation. Even though his blood oxygen level is normal.

B. As there is 7 missing Frusemide 40 mg tablets which is used to treat high fluid level of body, and as side effect cause vomiting. There is a chances that Kevin knowingly/unknowingly took this pills together which are responsible for his this condition. Since Kevin have took 7 pills together this caused side effect like vomiting to him.

So taking care that Kevin takes only that amount of drug that is prescribed to him will be the priority.

C. As Kevin is having violence muscle concentration in his whole body, it might trigger cardiac arrest and respiratory failure. So first priority must be to ease his muscle that can be done with help of pain killer. 

As he has lost huge bodily fluid due to vomiting and he haven’t eaten or drink anything his body need energy, so by IV sline snd glucose must be given to him so his body can have the energy to recover.

As he is 65 year old and just had an violent muscle contraction he must be put on ventilation to support his breathing as there is chances that again muscle contraction can be triggered, or due to his wrak body and cardiovascular issue may be arrised so putting him on ventilation will be till he recovers will be good.

Medical Surgical Nursing - Question 9

Answer

As she had just been through a surgery of her left grater trochanter two weeks ago, due to medication or pain may trigger a cardiovascular issue or issue in breathing. As her age is 67 year, recovery from surgery is slowed. As her blood pressure is low and she is having shortness of breath, as she is breathing 30 breath per minute. Her body temperature is just above normal, as surgery pain can cause that level of fever,

First step would be to give her oxygen therapy and put her on mechanical ventilation to provide her with sufficient breath. As soon as her breathing will be normal her blood pressure will return to normal and she will stop feeling anxious. The need breathing support primarily. This can be provided by ventilation. She must be put into continuous observation so that her body response can be observed for further treatment if needed. With that she needs proper rest.

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