HLTEN505C Contribute to the Complex Nursing Care of Clients

1. a) Vital Signs:-

B.P- 202/124, which indicates a high blood pressure, which is a matter of concern for a patient of his age and can signify heart disease.

R.R-  18/min, which indicates normal breathing.

T- 36.7 degree, which indicates that he was not febrile.

b) Priority problems associated with the case study are as follows:-

d) Laboratory tests, that may be ordered to investigate X’s condition-

The commonly used markers are the MB subtype of the enzyme Creatine kinase and the cardiac troponins. Enzymes like SGOT and LDH are also used as cardiac markers.

e) Intravenous morphine Sulphate is used in the case of chest pain of uncertain etiology. Morphine reduces the B.P. It slows down the heart rate, thus relieving anxiety. It also helps to lessen the myocardial oxygen demands, depresses the respiration and decreases the oxygenation.

f) Each patient should be assessed prior to the application of the doses and should be monitored regularly for the development of the risks. Proper dose regimen should be followed as different formulations of this drug are not bioequivalent. In case of the elderly patients, the doses should be reduced to half of the normal daily dose for the adults. Patients should not consume alcohol while taking this drug (Motov et al. 2015).

2. a) The intravenous administration of insulin glucose followed by the subcutaneous insulin therapy helps in improving the life quality of the patient and helps them in the long term survival. Insulin and glucose plays an important role in ischemic reperfusion metabolism. A rise in the availability of the glycolytic substrate increases the synthesis of anaerobic adenosine triphosphate. It helps to reduce the post ischemic cardiac dysfunction.

b) It helps to lower the blood glucose level.  Glycemics can be used to manage the patients with Type 2 diabetes patient. It can improve the glycemic control and helps to prevent macrovascular and the microvascular complications (Hsia et al.2012)  They act by regulating the ATP-dependant potassium channels in the pancreatic beta cells. They stimulate the release of insulin from the beta cells and thus help in controlling the glucose level.

c) Blood glucose level monitoring would help the caregiver to get a regular knowledge about the glucose level in the blood and would help to choose the medicines and the required doses to manage the complications.

d) A mid stream specimen of urine test is generally done in order to confirm the diagnosis of a urine infection and to decide what antibiotic should be taken. In this case the urine is taken from the middle of the bladder.

e) This method is used to measure proteins, hormones , minerals and other chemical compounds present in the urine. It can be used to determine kidney diseases like diabetic nephropathy, neprotic syndrome, polycystic ovarian diseases and many more (Yismow et al.2012).

f) After an indwelling catheter is being introduced in to the patient’s bladder, Urinary catheters should be removed in due time from a patient’s bladder as it can lead to complications like infections, encrustation or bladder neck damage (Yismow et al.2012).

g) Contraceptives are generally taken to prevent unwanted pregnancy. Contraceptive drugs are also used to prevent certain complications other than preventing pregnancy. Some contraceptive drugs are used to treat PCOS diseases in woman. Some hormonal birth control helps to regulate menstruation cycle, reduce acne (Khalili et al. 2012).

h) It is normally done for the bacteriological examination of the urine sample, if the patient is suspected with an infection. It can be used to determine the clinical conditions like the bacteriuria which is unavoidable in patients with catheters (Yismow et al.2012).

i) The Glasgow comma scale is used to determine the neurological dysfunction in patients and is used to follow up the progressive level of the consciousness (Rhodes et al. 2012). It is an important tool to assist the patients suffering from trauma , the BTI victims.

• The right to say no.
• Lying to patients
• Resources utilization
• Personal belief and empirical knowledge.

5. Nurses should not be judgmental. Nurses should provide appropriate care to the patients in spite of their limits and should show empathy and understanding to the patient. The nurse’s patients come from different walks of their life and suffer from various problems, hence they need to be non judgmental.

a) In some cases a patient might not want to stick to the medications and want a switch in the mode of treatment. In such a case a conflict of interest would definitely arise between the nurse and the patient. In such cases discussions are required.

6. The best way to deal with the conflicts between the clients wishes is to discuss thoroughly about the pros and cons of the treatment. If required, specific examples can be given to the client and the families, regarding other patients and help them in deciding the appropriate care.

Participation- In making plans, taking decisions and implementing the plans in community health.

Equity- Equal and fair distribution of the resources irrespective of discrimination.

Access- the availability of a large range of health benefits.

Rights- Equal right for everyone irrespective of the economic status.

References

Hsia, E., Seggelke, S., Gibbs, J., Hawkins, R.M., Cohlmia, E., Rasouli, N., Wang, C., Kam, I. and Draznin, B., 2012. Subcutaneous administration of glargine to diabetic patients receiving insulin infusion prevents rebound hyperglycemia. The Journal of Clinical Endocrinology & Metabolism, 97(9), pp.3132-3137.

Johnstone, M.J., 2015. Bioethics: a nursing perspective. Elsevier Health Sciences.

Khalili, H., Higuchi, L.M., Ananthakrishnan, A.N., Richter, J.M., Feskanich, D., Fuchs, C.C. and Chan, A.T., 2012. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut, pp.gutjnl-2012.

Motov, S., Rockoff, B., Cohen, V., Pushkar, I., Likourezos, A., McKay, C., Soleyman-Zomalan, E., Homel, P., Terentiev, V. and Fromm, C., 2015. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial. Annals of emergency medicine, 66(3), pp.222-229.

Rhodes, R., Battin, M. and Silvers, A. eds., 2012. Medicine and social justice: essays on the distribution of health care. Oxford University Press.

Sievenpiper, J.L., Chiavaroli, L., De Souza, R.J., Mirrahimi, A., Cozma, A.I., Ha, V., Wang, D.D., Matthew, E.Y., Carleton, A.J., Beyene, J. and Di Buono, M., 2012. ‘Catalytic’doses of fructose may benefit glycaemic control without harming cardiometabolic risk factors: a small meta-analysis of randomised controlled feeding trials. British Journal of Nutrition, 108(3), pp.418-423.

Voight, B.F., Peloso, G.M., Orho-Melander, M., Frikke-Schmidt, R., Barbalic, M., Jensen, M.K., Hindy, G., Hólm, H., Ding, E.L., Johnson, T. and Schunkert, H., 2012. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. The Lancet, 380(9841), pp.572-580.

Yismaw, G., Asrat, D., Woldeamanuel, Y. and Unakal, C.G., 2012. Urinary Tract Infection: Bacterial etiologies, drug resistance profile and associated risk factors in diabetic patients. European Journal of Experimental Biology, 2(4), pp.889-898.