NURS90129 Nursing Science Case Study Sample

• Subject Code : NURS90129
• University : University of Melbourne My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Nursing Science - Case Study 1

1a). Explain the Significance of Red Blood Cell Parameters and Iron Studies in Klara’s Blood

Answer: From Klara’s case study it can be found that her counts of red blood cells, haemoglobin, mean corpuscle haemoglobin and mean corpuscle volume are fairly low. The significance of low MCV accounts for small size of the red blood cells. It also signifies the presence of microcytic anaemia, usually caused by poor dietary intake, or iron deficiency. Low range of MCHC reveals that the average amount of haemoglobin in the red blood cells is less. The level of ferritin (20 ug/L) as well low percentage of transferrin saturation (11 per cent). This is suggestive of severe anaemia (Jaiswal, Srivastava & Siddiqui, 2019). The symptoms of Karla are consistent with the severe anaemia, because shortness of breath is caused due to lack of oxygen supply to the lungs and brain which controls the rate of breathing in an individual. When the oxygen saturation is low in the blood which reaches the brain, the brain sends a signal through the carotid sinus nerve to stimulate the breathing rate which is a compensatory breathing mechanism, such as shallow breathing is triggered in order to increase the intake of oxygen in to the lungs. Haemoglobin is a carrier of oxygen and not having enough haemoglobin causes deficiency of oxygen in the body which causes dizziness, feeling of nausea and light-headedness. Therefore, the significance of conducting the red blood cell parameters and iron studies in Klara’s blood is vital to reach the underlying disease such as anaemia, other gastrointestinal diseases, other blood or haematocrit disorders, unknown pregnancy.

1b) Propose a Physiological Explanation for The Respiratory Symptoms Experienced by Klara. in Your Answer Explain how Cellular Respiration Is Likely to Be Affected in Klara’s Case?

Answer: At the cellular level, the respiration occurs through a process called glycolysis to produce ATP. This occurs by synthesizing or metabolizing glucose. When there is lack of ATP production the cells cause it to convert the glucose at a faster rate than it usually does. Transportation of oxygen is the most vital role of the red blood cells as they go through the microsystem vessels circulating multiple times. The research conducted by Vidhya et al., (2019) stated, “This requires a delicate balance between, constant replenishment of circulating red cells by erythropoiesis and degradation of old cells.” The haemoglobin in these cells consist of two alpha chains and two beta chain which are embedded one the one heme molecule. This heme molecule is responsible for carrying oxygen in the circulatory system and to maintain the integrity of the cell by helping it to maintain the cellular functions.

The affinity of the oxygen molecule to the heme is directly relational to the tension of oxygen, pH and the amount of metabolic intermediate 2-3 biphosphoglycerate, adenosine triphosphate as well as the temperature of the body. Klara’s respiratory symptoms and shortness of breath are caused due to the effect on the condition of anaemia, “One of the physiologic compensatory mechanisms in anaemia is a rise of the respiratory rate in an attempt to increase blood oxygenation. If the respiratory rate exceeds a certain level, the patient will experience shortness of breath, a symptom most often developing in a state of exertion when reduced blood oxygen meets increased oxygen requirements of exercising muscles. However, patients suffering from severe anaemia may complain of dyspnoea even while resting. In a state of dyspnoea, the minute ventilation and residual air are increased, but forced expiratory volume is reduced.5 In addition, the lungs also may be directly affected by anaemia. If increased cardiac workload results in congestive heart disease, pulmonary oedema may occur as a consequence of increased blood pressure in the pulmonary circulation. This leads to severe dyspnoea and may even become life threatening (Pleil, Beauchamp & Miekisch, 2017).”

Nursing Science - Case Study 2

2a). Discuss Why George’s Doctor Collected a Viral Swab to Confirm Suspected Influenza Infection

Answer: The nasal swab is obtained for detection of influenza virus because the virus exhibits respiratory infection and are mostly present in the mucous membranes of the respiratory tract. Many researchers believe that the nasopharyngeal swabs have higher yield than the specimen of the throat swab. The nasal swab has high sensitivity when it is collected closer to the period of illness or an infection, for instance within 2 to 4 days (CDC, n.d.). On the other hand, the researchers believe that the throat test may be inadequate in providing respiratory viral surveillance for diagnosing influenza and may account only as a supplementary test (Ali et al., 2015).

2b) Explain Why George Had a Sore Throat and Cough

Answer: Influenza virus causes an inflammatory response in the upper respiratory tract, such as the bronchial tree and the trachea. In most of the individuals the disease is limited due to good response of the immune system. However, if the load of the virus is high the body’s immune system can fail and lead to symptoms such as sore throat and fever. When the symptoms get severe, it may even lead to complex conditions such as pneumonia, bronchitis and even death. The virus can start replicating itself into the lower respiratory tract after the first forty-eight hours of its inoculation (El-Radhi, 2018). It replicates withing the epithelial cells of the membranes of the lungs causing their ‘desquamation and destruction’ of the epithelial cells and inflammation of the basal layer. Both sore throat and cough are body’s reaction to forcefully exhale out the virulent which is causing the inflammation in the respiratory tract. It is the natural and most vital of all the reflexes and defence mechanisms that the human body exhibits. It attempts to clear the breathing passage by expelling the particles out. It aids breathing effectively. (250)

2c). Explain Why George Developed Fever in Response to Viral Infection

Answer: Fever is the body’s response to the virulent which invades the respiratory system of the body. It is a cytokine-induced reaction (El-Radhi, 2018). When the virus invades into the blood stream and reaches the hypothalamus, which is called the thermoregulatory centre of the body, causing elevation of temperature and heat producing behaviour for instance, it causes severe vasoconstriction and shivering. More often pyogenic materials such as those substances released from the macrophages and the breakdown of cellar protein, reaches the thermoregulatory centre and causes the same mechanism to occur. The symptom of fever provides clinical indication for inherent infection inside the body. Most of the viruses which cause infection in the body are not able to sustain the extreme temperatures, thus, elevation of body temperature helps to fight he virus by exposing them to increased temperature within the body. However, it is lower down the temperature, so that there is no damage caused to the other vital organs in carrying out their routine functions in a proper way.

2d) At Home, George Has Ibuprofen and Paracetamol in His Cupboard. Considering George’s Presentation, Suggest Which Medication May Be More Appropriate. Provide a Rationale to Support Your Statement

Answer: Ibuprofen must be administered to George as it is a NSAID which helps in reducing the inflammation and decrease the severity of symptoms such as fever, throat soreness and cough. On the other hand, paracetamol is acetaminophen which is more effective as a painkiller and primarily used to treat fever. It works more on the symptom rather than working on the cause of the disease. According to the study conducted by Sloan et al., (2020) Ibuprofen of 600mg along with VIS410 infusion demonstrated the most improvement in the cases of influenza virus infection (Su et al., 2019).

Nursing Science - Case Study 3

3a) Discuss the Importance of The Fractured Cranium and The Underlying Haematoma with Respect to Maintenance of The Intracranial Pressure and Integrity of Immune Defence Barriers in Sam’s Case

Answer: The presence of cerebral oedema is the primary reason of increase in the intracranial pressure in case of Sam. Due to the excessive accumulation of blood in the skull causes increase in the pressure within the cranium (Williamson & Colbourne, 2019). It also damages the blood brain barrier and thereby demolishing the immune defence barriers of the brain. “damage to the cerebral vasculature and neural cell bodies, caused by traumatic brain injury (TBI) activates innate immunity with concomitant infiltration of immunocytes into the damaged nervous system. This leads to pro-inflammatory cytokine and prostaglandin production and lost synaptic integrity and more generalized neurotoxicity. Engagement of adaptive immune responses follows including the production of antibodies and lymphocyte proliferation (Clark et al., 2019).” In the brain, the first line of defence for establishing of immunity are the ‘blood borne macrophages and microglia’ and constitute 10 per cent of the brain cells. On occurrence of damage to the central nervous system, these cells are activated and start moving to the site of injury, however the research states, “Improvement in behavioural and histological outcomes through inhibition of microglia activation with the use of minocycline, a semisynthetic antibiotic in the tetracycline family, has been controversial (Carter et al., 2016; Nizamutdinov & Shapiro, 2017).”

3b) Considering the Significance of The Brain Injury, Propose Which Body Functions May Be Compromised in Sam’s Case, if Brain Swelling Is Extensive

Answer: In case of hematoma, the brain structures which get compressed usually lose their function. In case of Sam, his CT revealed brain injury in the temporal region, which is responsible for abilities such as hearing, perception, auditory simulation., visual sensing, recognition and attention (McKee & Lukens, 2016). Hence, all the capabilities related to these functions will be affected. Sam may also exhibit episodes of memory loss, loss of hearing ability, tinnitus and may lose his ability to focus or concentrate on any task, he may lose his ability to recognize faces, perform tasks which require critical thinking or problem-solving abilities. He may also feel disoriented towards people, time and place. Along with the complications of speech called Wernicke’s aphasia. These many factors can cause immense psychological trauma to the patient, leading to aggressive and irritable behaviour. This may impact the health of Sam and lead to further deterioration of his bodily functions. The prognosis of this condition is usually poor at the age of Sam, however, if rehabilitation is sought immediately, the damage can be reversed over a period of few months. Many rehabilitation techniques are available to improve the cognitive impairment in such patients, who suffer traumatic brain injury.

References for Nursing Science

Ali, M., Yaqub, T., Mukhtar, N., Imran, M., Ghafoor, A., Shahid, M. F., ... & Su, Y. C. (2019). Avian influenza A (H9N2) virus in poultry worker, Pakistan, 2015. Emerging Infectious Diseases, 25(1), 136.

Carter, E. L., Hutchinson, P. J., Kolias, A. G., & Menon, D. K. (2016). Predicting the outcome for individual patients with traumatic brain injury: a case-based review. British journal of neurosurgery, 30(2), 227-232.

Clark, D. P., Perreau, V. M., Shultz, S. R., Brady, R. D., Lei, E., Dixit, S., ... & Boon, W. C. (2019). Inflammation in traumatic brain injury: roles for toxic A1 astrocytes and microglial–astrocytic crosstalk. Neurochemical research, 44(6), 1410-1424.

El-Radhi, A. S. (2018). Pathogenesis of Fever. In Clinical Manual of Fever in Children (pp. 53-68). Springer, Cham.

Jaiswal, M., Srivastava, A., & Siddiqui, T. J. (2019). Machine learning algorithms for anemia disease prediction. In Recent Trends in Communication, Computing, and Electronics (pp. 463-469). Springer, Singapore.

McKee, C. A., & Lukens, J. R. (2016). Emerging roles for the immune system in traumatic brain injury. Frontiers in immunology, 7, 556.

Nizamutdinov, D., & Shapiro, L. A. (2017). Overview of traumatic brain injury: an immunological context. Brain sciences, 7(1), 11.

Pleil, J., Beauchamp, J., & Miekisch, W. (2017). Cellular Respiration, Metabolomics and the Search for Illicit Drug Biomarkers in Breath: Report from PittcCon 2017. Journal of breath research, 11(3), 039001.

Sloan, S. E., Szretter, K. J., Sundaresh, B., Narayan, K. M., Smith, P., Skurnik, D., ... & Shriver, Z. (2020). Clinical and virological responses to a broad-spectrum human monoclonal antibody in an influenza virus challenge study. Antiviral Research, 104763.

Su, C. P., Tsou, T. P., Chen, C. H., Lin, T. Y., Chang, S. C., Group, I. C., & Infectious Disease Control Advisory Committee. (2019). Seasonal influenza prevention and control in Taiwan—Strategies revisited. Journal of the Formosan Medical Association, 118(3), 657-663.

Vidhya, S. S., Keerthana, K., Janaki, M., & Kanimozhi, J. (2019). A survey of control algorithms used in physiological closed loop control for oxygen therapy. International Journal of Applied Engineering Research, 14(3), 694-702.

Williamson, M. R., & Colbourne, F. (2017). Evidence for decreased brain parenchymal volume after large intracerebral hemorrhages: a potential mechanism limiting intracranial pressure rises. Translational Stroke Research, 8(4), 386-396.

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