Professional Documents
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MS Compilations Juan Jenaica
MS Compilations Juan Jenaica
MS Compilations Juan Jenaica
JENAICA JUAN
Belle is a young, healthy adult who slipped off the stairs going down to the basement and
struck her forehead on the cement flooring. Belle did not lose consciousness but did
sustain a mild concussion and a hematoma that was 5cm in width and protruded about
6cm. she experienced immediate acute pain at the site of injury plus a pounding
headache.
2. During the assessment process, the nurse attempts Belle’s physiologic and behavioral
responses to her pain experience. The nurse is aware that the patient can be in pain yet
appear to be “pain free” what is the behavioral response indicative of acute pain?
- I will assess Belle's facial expression because experience of pain is often represented
by changes in facial expression. Evidence of pain that is available from facial
expression has been the subject of considerable scientific investigation, facial
assessment in the study of patient also reviewed, facial assessment in patient are also
described. Alternative techniques that have the potential to overcome barriers to the
application of facial assessment arising out of its resource intensiveness are described
and evaluated.
3. The nurse uses distraction to help Belle cope with her pain experience. What
suggested activities can help her cope?
- I will ask the patient to do the Learn deep breathing or meditation to help Belle to
relax, and asking her some question . Exhale slowly through the mouth, while pursing
the lips, for a count of 10. After that Belle feel relaxing and feel comfortable.
4. After treatment, Belles is discharge to home while still in pain. What should the nurse
do?
- I will use the Nurse teaching skill to Belle by doing cold compress or ice pack
application for 20 to 30 minutes for the 48 hours following injury to reduce swelling,
rest and also follow the doctor's home medication. Cold numbs the affected area,
which can reduce pain and tenderness. Cold can also reduce swelling and
inflammation.
COURSE TASK- CU3
JENAICA JUAN
Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.
Study Questions:
ELECTROLYTE IMBALANCES:
Several patients were admitted in the medical ward. Answer the following questions
pertinent to the patients’ conditions.
PATIENT C–A post thyroidectomy patient presented with severe muscle cramps and
prolongation of QT-interval in the ECG and was referred to the medical consultant for
co-management. Serum calcium level is 4.0 mEq/L.
PATIENT D–A patient receiving magnesium for the management of seizure disorder
suddenly presented with depressed deep tendon reflex and becomes stuporous.
Laboratory values reveal a Serum Magnesium level of 2.6 mg/dL.
1. Given the Patient B’s presentation, trace the pathophysiological cause of the
decrease in serum potassium level.
- In Patient B The physiological increase in potassium level during exercise has already
been mentioned. A similar increase in potassium level has been described as a result of
generalised muscle cramps such as in epilepsy. It may also be seen in generalized
skeletal muscle breakdown such as rhabdomyolysis, trauma against skeletal muscles,
burns, and hyperthermia. Hyperkalaemic periodic paralysis is a rare genetic anomaly in
skeletal muscle ion channels causing depolarization of muscle cells and
hyperkalaemia. In these patients, exercise or ingestion of potassium rich nutrients may
provoke attacks of paralysis and hyperkalaemia that may be abated by inhalation of a
β2-adrenoceptor agonist at the beginning of the attack. Intravenous administration of
potassium may increase potassium level, cause hyperkalaemia, cardiac arrest, and
sudden death. Thus, intravenous potassium should always be given with utmost
precaution. Oral potassium intake combined with reduced potassium excretion may
cause hyperkalaemia. Several cardiovascular drugs ACE-inhibitors, AT2-inhibitors, β-
adrenoceptor antagonists, aldosterone antagonists, and digoxin—may increase
potassium level. Interestingly all of these drugs have a positive or neutral effect on life
expectancy in heart failure patients that may be due to a decreased risk of
hypokalaemia. Digoxin intoxication may be associated with hyperkalaemia due to
inhibition of skeletal muscle Na,K-pumps. Diabetes mellitus may be associated with
hyperkalaemia due to lack of insulin-stimulated Na,K-pump mediated potassium
uptake in skeletal muscles. Also, acidosis may due to reduced kidney excretion of
potassium cause an increase of potassium level and hyperkalaemia. It should be noted
that reduced oxidation arising from hypoxia only induces a modest increase in
potassium level due to high affinity of the Na,K-pump for oxygen.
- The use of calcium and magnesium reduces both the incidence and time of
development of peripheral sensory neurotoxicity, oxaliplatin-limiting toxicity
Treatment of severe magnesium toxicity consists of circulatory and respiratory support
and administration of 10% calcium gluconate 10 to 20 mL IV. Calcium gluconate may
reverse many of the magnesium-induced changes, including respiratory depression. So
the Patient D may back the tendon reflexes after Calcium gluconate administered.
3. Explain the relationship of thyroid surgery and the development of hypocalcemia
in Patient C.
4. Explain the relationship of Patient A’s prior activity and the development of
hyponatremia.
- The prolonged QT interval is both widely seen and associated with the potentially
deadly rhythm, While it can occur spontaneously in the congenital form, there is a
wide array of drugs that have been implicated in the prolongation of the QT interval.
Some of these drugs have either been restricted or withdrawn from the market due to
the increased incidence of fatal polymorphic ventricular tachycardia. The list of drugs
that cause QT prolongation continues to grow, and an updated list of specific drugs
that prolong The QT interval on the surface EKG represents the summation of action
potential (AP) of ventricular myocytes. The action potential reflects the flow of ion
currents across a cell membrane through specialized channels made of protein
complexes. Malfunction of these protein channels can lead to either increased inward
current or reduced outward current. This subsequently increases the action potential
duration and hence QT interval prolongation.
- Pt A- Hyponatremia
Knowledge deficit related to the hydration maintenance, as evidenced by behaviors
that resulted in current electrolyte imbalance
Pt B- Hypokalemia
Altered electrolyte balance related to active fluid loss secondary to vomiting and
diarrhea
Pt C- Hypocalcemia
High Risk for Injury R/T increased neuromuscular irritability resulting from
hypocalcemia
Pt D- Hypermagnesemia
Reduced cardiac output
Impaired gas exchange
ACID-BASE IMBALANCES:
PATIENT A–admitted in the medical ward 30 minutes ago with chief complaint of
severe dizziness and vertigo accompanied by frequent vomiting. As the patient moves,
vomiting follows which is now recorded to be 7-8 times from the time of admission.
Diphenhydramine 1 ampule TIV and metoclopramide 1 ampule TIV as stat doses were
given to the patient.
PATIENT B–a dialysis patient who have stopped attending his dialysis session was
admitted in the ward due to changes in sensorium. Serum creatinine level is elevated as
well as the Blood Urea Nitrogen (BUN). Shallow respiration is noted upon the
assessment of the patient.
PATIENT C–a patient was rushed to the emergency department and later was admitted to
the ward with chief complaint of shortness of breath, numbness and tingling around
mouth and fingers, and lightheadedness after taking a major examination in school. The
patient was offered a brown bag by the admitting nurse.
PATIENT D–A patient with emphysema as admitted in the ward due to difficulty of
breathing. The patient appears reddish and is complaining of lightheadedness. The patient
was immediately hooked to oxygen therapy at 2 Lpm. Choose from the following ABG
results which will be consistent with the patient’s condition:
Answer :
11. Explain why Patient B presented with shallow respiration in relation to the
patient’s condition.
- I think patient B experience Shallow breathing because from muscle weakness may
lower oxygen and increase the carbon dioxide levels in blood, causing muscles to
become even weaker. With neuromuscular weakness, these muscles may become tired
(fatigued), making it difficult for you to inhale and exhale normally. This weakness
may cause you to take shallow breaths and feel short of breath when lying down or
sleeping.
12. Explain why Patient D experiences lightheadedness and why the patient appears
reddish in relation to the patient’s condition.
- Because patient D had emphysema chronic obstructive pulmonary disease (COPD) and
respiratory issues can cause shortness of breath, which leaves Patient D feeling dizzy,
weak, and fatigued. Not being able to breathe well depletes the oxygen levels in the
blood, affecting the body's ability to function properly, chronic obstructive pulmonary
disease (COPD) and other chronic respiratory issues can cause shortness of breath,
which leaves Patient D feeling dizzy, weak, and fatigued. Not being able to breathe
well depletes the oxygen levels in the blood, affecting body's ability to function
properly. That’s why patient D experience Lightheadedness.
- Breathing into a paper bag is a technique that can help Patient C regulate
hyperventilation. It works by putting some of the lost carbon dioxide back into the
lungs and body. This helps to balance oxygen flow in the body. Hyperventilating
breathing at an abnormally rapid rate does just the opposite, decreasing carbon dioxide
in the blood. So too, panic attacks. Along with the decrease to the body’s supply of
carbon dioxide, panic attacks often cause tightness in the chest and difficulty breathing.
In both the cases just described, health professionals recommend the paper bag
technique to offset the loss of carbon dioxide in the blood and provide relief for the
symptoms.
14. Create a drug study for the medication: METOCLOPROMIDE specifying the
following:
· Drug classification
· Mechanism of action
· Contraindication
· Side effects
· Nursing Considerations
Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.
Mr. Nathaniel is a 46 year-old man who has developed symptoms of acute pericarditis
secondary to viral infection. Diagnosis was based on characteristic sign of a friction rub
and pain over the pericardium. (30 points)
The patient is experiencing pericardial pain. To alleviate this discomfort, what position
could the nurse assist the patient with maintaining?
- Due to patient discomfort the nurse should assist Mr. Nathaniel in upright position the
patient head at 45 degree of bed elevated in this position Mr. Nathaniel helps to relief
his pain, bedrest with comfort position is the best way to relief the acute pericarditis.
When planning Mr. Nathaniel’s care, what should the nurse understand are the
objectives of pericarditis management?
- Nurse should make sure to provide oxygen support to Mr. Nathaniel, and also make
sure that always arrange the cardiac monitor to monitor the cardiac activities of the
patient, because chest pain is a life threatening due to pericarditis symptoms or such as
myocardial infarction pr aortic dissection. Nurse must be evaluate the hemodynamic
instability, and also as a nurse we should assess the Mr. Nathaniel condition and also
always monitor the hemodynamics like Heart rate, blood pressure and pulse rate and to
provide psychologic support always assess the neurologic status.
The nurse is auscultating Mr. Nathaniel’s chest for a pericardial friction rub. Where will
the nurse auscultate in order to locate the rub?
- In Mr. Nathaniel's condition the best auscultation is in the over of the left lower sternal
edge or apex during end expiration Mr. Nathaniel must be sitting up and leaning
forward.
COURSE TASK- CU7
JENAICA JUAN
Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.
Lita a 65 year-old retired secretary, is admitted to the medical surgical area for
management of chest pain caused by angina pectoris. (20 points)
The patient asked the nurse “What is causing this pain?” What is the best response by
the nurse?
- The pain is usually because of not enough blood flow in the heart
The patient is diagnosed with chronic stable angina. The nurse can anticipate that her
pain may follow what type of pattern?
- I think the diagnosis in the patient is CHRONIC STABLE ANGINA, because this
disease are when the heart muscle doesn't get the oxygen it needs to function properly.
Patient heart works harder when they exercise or experience emotional stress. Certain
factors, such as narrowing of the arteries atherosclerosis, can prevent your heart from
receiving more oxygen. Patient need to rest and take nitroglycerin to relief this disease.
Lita has nitroglycerin at her bed side to take PRN. The nurse knows that nitroglycerin
acts in what ways?
- This nitroglycerin medication can provide relief to our patient that uncomfortable due
to sign and symptoms of stable angina, This medication can cause headache,
lightheadedness from the patient. It also can increase the physical exercise tolerance.
Lita took a nitroglycerin tablet at 10:00 AM, after her morning care. It did not relieve
her pain, so 5 minutes later, she repeated the dose. 10 minutes later, and still in pain, she
calls the nurse. What is the priority intervention of the nurse?
- The nurse intervention to the patient is always monitor the blood pressure and the
asking systolic blood pressure is less than 90 mmHg. for better result.
The nurse is aware that there is critical time period for this patient. When should the
nurse be most vigilant in monitoring this patient?
- Nurses should be aware and attentive to patient any alteration in heart rate, rhythm and
some conduction because to reduce the frequency and severity of myocardial disease and
also to delay the progress of the underlying disease if possible, and to prevent
complications.
The nurse is interpreting the result of the ECG. What findings does the nurse understand
are indicative of initial myocardial injury?
- Patient had myocardial infarction, ST Elevation is a very serious type of heart attack
during which one of the heart's major arteries one of the arteries that supplies oxygen and
nutrient rich blood to the heart muscle is blocked.
- Myocardial Infarction need to assess the patient if the sign and symptoms of MI is
present and also need to have a diagnosis like ECG, ST Elevation, Troponin, and also
other causes of biomarker elevation.
The nurse should closely monitor the patient for a complication of an MI that leads to
sudden death during the first 48 hours. Which complication should the nurse monitor
for?
CK is a type of protein. The muscle cells in your body need CK to function. Levels of
CKcan rise after a heart attack, skeletal muscle injury, or strenuous exercise.
CK–MB isoenzyme is found almost exclusively in the myocardium, and the appearance
of elevated CK–MB levels in serum is highly specific and sensitive for myocardial cell
wall injury.
3. TROPONIN I AND T
Cardiac troponin T (cTnT) and troponin I (cTnI) are structural proteins that act to
regulate muscle contraction (1,2). They are released into the bloodstream from injured
muscle cells during cardiac ischemia with no overlap with skeletal muscle troponinsunder
normal conditions (3,4).
4. MYOGLOBIN
Myoglobin is an oxygen-binding protein found in cardiac and skeletal muscle.
Measurement of myoglobin provides an early index of damage to the myocardium, such
as occurs in myocardial infarction (MI) or reinfarction. Increased levels, which indicate
cardiac muscle injury or death, occur in about 3 hours.
5. LACTATE DEHYDROGENASE
An LDH test is most often used to: Find out if you have tissue damage. Monitor disorders
that cause tissue damage. These include anemia, liver disease, lung disease, and some
types of infections.
These can be further categorized on the basis of the level of disturbances in the hierarchy
of the normal cardiac conduction system.
COURSE TASK- CU8
JENAICA JUAN
1. Give the rationale for each of the following nursing interventions and selected
activities for the nursing care plan for ineffective airway clearance: (20 pts)
INTERVENTIONS RATIONALE
1. Encourage the client to take several Deep breathing promotes oxygenation
deep breaths before controlled coughing.
5. Monitor rate, rhythm, depth, and effort To provide a basis for evaluating adequacy
of respirations of ventilation.
7. Auscultate lung sounds after treatments Assists in evaluating prescribed treatments
to note results and individual outcomes.
9. Monitor client’s ability to cough Respiratory tract infections alter the amount
and character of secretions. An ineffective
effectively cough compromises airway clearance and
prevents mucus from being expelled.
10. Monitor for increased restlessness, This clinical manifestations would be early
anxiety, and air hunger indicators of hypoxia.
2. Match the following concepts with each other. Write the letter only. Use CAPITAL
letters. (2 points each)
Create YOUR OWN infographic brochure for nursing management for caring for a
client with your choice among the following disorders: (may be hand made or with the
use of computer software)
▪ CAD
▪ Angina pectoris; or
▪ Myocardial Infarction.
Week 9: Individual Assignment: Obstructive Disorder
JENAICA JUAN
Compare and Contrast using various aspect any 2 Obstructive Disorders of the Lungs.
• Weakened or
suppressed immune • Exposure to fumes
system. People who from burning fuel. In
have HIV/AIDS, the developing world,
who've had an organ people exposed to
transplant, or who fumes from burning fuel
receive chemotherapy for cooking and heating
or long-term steroids in poorly ventilated
are at risk. homes are at higher risk
of developing COPD
SIGN AND SYMPTOMS Signs and symptoms of COPD symptoms often don't
pneumonia may include: appear until significant lung
damage has occurred, and
• Chest pain when you
they usually worsen over time,
breathe or cough
particularly if smoking
exposure continues.
• Confusion or changes in
mental awareness Signs and symptoms of COPD
(in adults age 65 and may include:
older)
• Shortness of breath,
• Cough, which may especially during
produce phlegm physical activities
• Fatigue • Wheezing
• Shortness of breath
• Unintended weight
loss (in later stages)
• Swelling in ankles,
feet or legs
• Lung abscess. An
abscess occurs if pus
forms in a cavity.
Compare and Contrast using various aspect any 2 Restrictive Disorders of the Lungs.
Instructions
You are caring for a 34-year-old patient who experienced blunt chest trauma in a motor
vehicle crash. A chest tube was inserted to treat a simple pneumothorax and hemothorax.
The chest drainage system has drained 400ml of light red fluid during the 1st 6 hours
after insertion. The patient has become increasingly short of breath during the past hour..
What physical assessment skills and strategies would you use to determine potential
changes in the patient’s respiratory condition? What are potential causes of this
increasing shortness of breath? What would you do to prepare for an emergency situation
in this patient? (30pts)
1. Respiratory conditions can affect breathing either through damage to the lungs or
excess secretions. To ensure that the correct treatment is implemented, a thorough
respiratory assessment should include both a comprehensive subject and objective
component to get a complete understanding of the clients function and baseline.
• A good careful observation is must to assess rate, shortness of breath, changes in skin
color, labored breathing and sign and symptoms or respiratory distress. It has been
noted that measuring and recording the respiratory rate is frequently overlooked, not
carried out accurately, or in up to 50% of cases is not carried out at all.
• Accurate recording of the respiratory rate forms an integral part of current evidence-
based clinical early warning scoring system and is the first parameter documented in the
national warning score.
• Sounds Underpinning knowledge of the importance of measuring this vital signs are
crucial.
• Should be done in maintaining poor hygiene with proper use of PPE with patient
consent, maintain privacy especially for females, with adequate light.
• The patient should be relaxed and resting in a quiet, well lit environment; otherwise,
recent activity should be noted.
• The patient should be positioned in a comfortable position - sitting upright if possible
GENERAL EXAMINATION
• Temperature
• Pulse
• Respiratory rate
• Blood pressure
• Oxygen saturation (SpO2)
• Nails - clubbing
• Eyes - pallor ( anaemia); Plethora ( high hemoglobin); Jaundice ( yellow color due to
liver or blood disturbance)
• Tonge and mouth - Cyanosis - hypoxemia
Observation of Chest
• Transverse diameter > AP diameter
• Kyphosis
• Kyphoscoliosis - retrive lung defect
• Pectus carinatum - pigeon chest
• Hyperinflation or barrel chest - AP = transverse - ribs horizontal
Measuring Chest Expansion (using a tape measure) Technique at residual volume - the
examiner’s hands are placed spanning the posterolateral segment of both bases, with the
thumbs touching in the midline posteriorly both the sides should move equally with 3-5
cm being the normal displacement.
• Supramammary - 1.5cm
• Mammary - 1.5cm
• Inframammary - 1cm
• Percussion - it is performed by placing the left hand firmly on the chest wall is that the
finger have good contract with the skin, the middle finger of the left hand is stuck over
the DIP joint with the middle finger of the right hand.
• Auscultation - the stethoscope provides important clues to the condition of the lungs
and pleura, all sounds can be characterized in the same manner as the percussion notes,
intensity, pitch, quality and duration.
2. Consider the scenario and answer the following questions. Case Study: Community
Acquired Pneumonia. Teresa, a 20 year old college student, lives in a small dormitory
with 30 other students. Four weeks after start of classes, she was diagnosed as having
bacterial pneumonia and was admitted to the hospital. (20 pts, 5 pts each)
(A) What intervention can the nurse provide to decrease the viscosity of secretions?
POTENTIAL CAUSES OF INCREASING SHORTNESS OF BREATH CAN BE:
• It can be due to drainage of large volume of blood from pleural space that can disturb
hemodynamics and cause shortness of breath.
• It can be a sign of pneumothorax that can be cause due to leaking of air into lungs.
(B) The nurse is assessing Teresa during the admission process. What manifestations of
bacterial pneumonia does the nurse expect to find?
Sign and Symptoms of Bacterial Pneumonia
• Cough with thick yellow, green or blood tinged mucus.
• Stabbing chest pain that worsens when coughing or breathing.
• Sudden onset of chills sever enough to make you shake.
• Fever of 102-105F or above (fever lower than 102F in older persons).
• Confusion of changes in mental awareness (in adult age 65 and older).
• Nausea, vomiting or diarrhea
• Shortness of breath
(C) The nurse assesses Teresa for arterial hypoxemia. What does the nurse understand is
the reason why this complication develops?
Arterial hypoxemia early caused by the persistent of pulmonary artery blood flow to
consolidated lung resulting in an intrapulmonary shunt, but also to a varying degree, it is
cause by intrapulmonary oxygen consumption by the lung during the acute phase and by
ventilation-perfusion mismatch later, It occurs due to hypoventilation.
(D) The nurse is assessing vital signs and lung sounds every 4 hours. What complications
should the nurse monitor for?
COMPLICATION OF BACTERIAL PNEUMONIA CAN BE:
• Empyema
• Pulmonary abscess
• Respiratory failure
• Acute respiratory distress syndrome
• Superinfection
COURSE TASK- CU10
JENAICA JUAN
Applying Your Knowledge: Consider the various scenarios and answer the questions. (20
points each scenario)
George is a 75 year-old patient with urosepsis being treated in the Intensive care unit
(ICU). The nurse assesses George and finds that he has blood in his urine and stool, and
is oozing blood from his central line site and his gums.
- Nursing suspect in this situation is Urosepsis is an infection arising from the urinary or
genital organs that manifests with systemic signs and symptoms because blood in
Blood in your urine from bleeding in your kidneys or bladder. Blood in stools from
bleeding in intestines or stomach. Blood in stools can appear red or as a dark, tarry
color urine and stool, In oozing blood from his gums maybe Purpura and Petechiae
Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from
brushing in teeth. Heavy or extended menstrual bleeding in women.
3. The nurse is monitoring George’s vital signs every 15 minutes. What other
monitoring is essential to include along with the vital signs?
- The primary predictor was the frequency of vital signs monitoring including BP,
temperature, pulse, and respiratory rate. We abstracted all vital signs recordings
available for the duration of each admission together with their associated date and
time. Vital signs monitoring was calculated as the total count for each recording of
vital signs divided by days in hospital. It is of help in monitoring change in position
and increase in size or number of renal stones.
• In those patients diagnosed with sepsis, the nurse plays a critical role in monitoring
appropriate administration of fluids as the patient transitions between levels of care
(ICU)
Measure lactate level; if elevated (>2 mmol/L), ensure that a repeat level is obtained
within 6 hours.
1. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?
• Hair loss on the feet and legs.
• Intermittent claudication – the thigh or calf muscles may feel pain when walking or
climbing stairs; some individuals complain of painful hips.
• Leg weakness.
• Brittle toenails.
• Sores or ulcers on the legs and feet that take a long time to heal (or never heal).
2. The patient is having ankle-brachial index (ABI) determined. The right posterior
tibial reading is 75 mm Hg, and the brachial systolic pressure is 150mm Hg. What
would the ABI be for this patient?
- The ABI of this patient would be, 0.5 which is an abnormal value or ABI.
3. The nurse is educating Fred about managing his condition. What methods can the
nurse suggest to increase arterial blood supply?
- The nurse can suggest methods such as exercise, getting a massage, increasing fluid
intake, drinking green tea, dry brushing your skin daily, reducing stress through certain
activities such as; yoga, meditation, limiting your caffeine intake, chewing gum,
writing in a journal, listen to relaxing music, and also spending time with loved ones.
You can also cut back on alcohol, elevate your legs and also stretch.
4. What is the best method for the nurse to assess Fred’s peripheral pulses to obtain
consistent results with other health care practitioners?
- The patient should be examined in a warm room with arrangements made such that the
patient's pulses can easily be examined on both sides of the bed. A cool atmosphere
can cause peripheral vasoconstriction and reduce the peripheral pulse. Palpation should
be performed with the fingertips and pulse amplitude rated on a scale of 0 to 4 + :0
indicating no palpable pulse; 1 + indicating a weak but detectable pulse; 2 + indicating
a pulse slightly lower than average; 3 + indicating a normal pulse. The examiner must
be alert to the possibility that the pulse he or she detects in his or her own fingertips
may be due to digital artery pulsations; this source of uncertainty may be resolved by
matching the pulse in question with his or her own radial pulse or the cardiac sounds
of the patient as determined by precordial auscultation. It is usually inadvisable to use
the thumb for peripheral pulses while palpating. With the examiner's own pulse, the
thumb has a greater chance of uncertainty and usually has a less discriminating feeling
than the fingertips. Inspection can often be an aid to the pulse position. The examiner
may be able to see the skin rise and fall along the course of an extremity artery with
each pulsation, particularly if a bright light is tangentially aimed across the skin
surface.
- They might no longer work effectively if the kidneys' blood vessels are damaged.
Some waste and excess fluid from the body will not be removed from the kidney if this
occurs. Extra fluid can increase blood pressure further and build a risky cycle,
resulting in more damage to the blood vessels, heading to renal failure.
2. The nurse informs Georgia that she should see her ophthalmologist. Why is it
important that Georgia adhere to follow up with an ophthalmologist?
3. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the
nurse understand about the action of Lasix?
- Prior to administering the medication to the patient, the nurse needs to consider the
mode of action and side effects of Furosemide. The patient will receive this because of
renal insufficiency and hypertension.It works mainly by preventing electrolyte re-
absorption from the kidneys and increasing the secretion of water from the body, this
also reduces blood pressure. Adverse effects such as dizziness, fatigue, diarrhea and
excessive urination have to be recognized by the nurse.
4. What health education can the nurse suggest to Georgia to reduce complications and
improve disease outcomes?
- Health education that the nurse can suggest to Georgia on prevention of hypertension
may be considering weight control, increasing physical activity, advice the client to eat
food with moderated sodium or salt restriction, instruct patient to avoid alcohol intake
and also quit smoking. Instruct the patient to have an increased potassium intake, have
a diet rich in fruits and vegetables and low-fat meat, fish, and dairy products, perform
appropriate diuretic therapy and lastly, promote healthy lifestyle.
COURSE TASK- CU13
JENAICA JUAN
2. Over 50 studies have been conducted on the connection between exercise and the risk
of colon cancer. Research shows that adults who increase their physical activity in
intensity, duration or frequency can reduce their risk of developing colon cancer by 30 to
40 percent, compared to adults who are sedentary. Download a research article on
studies relating to the effect of exercise on colorectal cancer prevention and treatment.
Study Questions:
1. Read about the Epidemiology of Cancer in the Philippines. Submit a 200-300-word
essay reflection.
https://doh.gov.ph/sites/default/files/health_programs/The-Philippine-Cancer-Control-
Program.pdf
“Breast cancer was the most frequent type of cancer among females in the Philippines.
There were a total of 10,083 new cases registered among females during 1998 to 2002.
The CR was 35.6 per 100,000 while the ASR was 52.2 per 100,000. The incidence rates
varied from 12.7 per 100,000 in Baras, Rizal to 75.9 per 100,000 in San Juan. The ASR
of PCS-MCR (56.1 per 100,000) was significantly higher than that of the overall (Table
3.10.1 & Figure 3.10.1). DOH-RCR on the other hand, had a significantly lower ASR
(48.6 per 100,000) than that of the overall. The DOH-RCR Metro Manila areas had a
significantly higher ASR (54.7 per 100,000) while Rizal Province exhibited a
significantly lower ASR (32.3 per 100,000).
The cities/municipalities that showed a significantly higher ASR than the overall were
Manila, Quezon City, Makati, Mandaluyong, Parañaque, Pasig and San Juan.
Contrastingly, those that presented significantly lower ASRs were Caloocan, Malabon,
Navotas, Taguig, Angono, Antipolo, Baras, Binangonan, Cardona, Jala- jala, Montalban,
Morong, Pililia, San Mateo, Tanay, Taytay and Teresa. The breast cancer ASRs observed
among women in the PCS-MCR area, Singaporean Chinese and Chinese residents in L.A.
were similar (Figure 3.10.2). Interestingly, the rate among female Filipino residents in
L.A. was almost double, and higher than those observed among Black residents in L.A.
and in Saarland. The highest rate was seen among the Non-Hispanic White residents in
L.A. The differences (or similarities) between populations could be largely attributable to
variations in reproductive behavior and lifestyle.”
- My opinion in this article presents an epidemiological profile of the major cancers in
Metropolitan Manila and the province of Rizal, Data from the two population based
registries, the Department of Health Rizal Cancer Registry and the Philippine Cancer
Society Manila Cancer Registry, were analyzed in detail with the age standardized
rates for each area being compared with the age standardized rates for all the areas
combined. Comparison with rates from other areas in the world are presented, as well
as incidence maps. In this article it shows that it is simplistic to ascribe increasing rates
of breast cancer in low and middle income countries to the lifestyles. This fails to
recognize that there are already substantial differences in breast cancer risk in those
populations which are not obviously explained by differences in those habits. For this
reason, etiological research in Asian and other middle income countries offers a
powerful opportunity to test hypotheses developed in high risk populations and thus
could provide much needed new ideas.
The aim of cancer prevention is to develop methods, plans or policy for interventions
that will benefit the population, as well as develop systems for monitoring and
evaluating these interventions in the future. The purpose of interventions is to reduce
the incidence, morbidity, mortality rates of cancer and cost of cancer management.
Because the modes of interventions that will be employed involve changes in lifestyles,
behavior, and environment, it is logical to assume that complex psychological,
physiological and cultural problems may arise. In cancer prevention and control,
priority should be given to those that cause the greatest morbidity and mortality, those
for which substantial risk is associated with certain exposures, and for which
apparently effective interventions are available
2. Illustrate your own Pathophysiology of Cancer depending on
a case you have selected.
Tumor becomes
invasive
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Create an original poster, infographic or one-page guide on ‘Recommendations for
the Early Detection of Cancer In Average-Risk Asymptomatic People.
COURSE TASK- CU12
JENAICA JUAN
Study Questions:
1. Summarize the guidelines for the early detection of breast cancercby developing a
teaching plan for breast self-examination for patients.
- For early detection of breast cancer, The most important screening test for breast
cancer is the mammogram. A mammogram is an X-ray of the breast. It can detect
breast cancer up to two years before the tumor can be felt by you or your doctor.
Women age 40 - 45 or older who are at average risk of breast cancer should have a
mammogram once a year.
- Breast self-examination is a useful and important screening tool, especially when
used in combination with regular physical exams by a doctor, mammography, and in
some cases ultrasound and/or MRI. Each of these screening tools works in a different
way and has strengths and weaknesses. Breast self-exam is a convenient, no-cost tool
that you can use on a regular basis and at any age. We recommend that all women
routinely perform breast self-exams as part of their overall breast cancer screening
strategy.
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and
your arms on your hips.
If you see any of the following changes, bring them to your doctor's attention:
◦ A nipple that has changed position or an inverted nipple (pushed inward instead of
sticking out)
◦ Redness, soreness, rash, or swelling
Step 2: Now, raise your arms and look for the same changes.
Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both
nipples (this could be a watery, milky, or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left
breast and then your left hand to feel your right breast. Use a firm, smooth touch with the
first few finger pads of your hand, keeping the fingers flat and together. Use a circular
motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top
of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple,
moving in larger and larger circles until you reach the outer edge of the breast. You can
also move your fingers up and down vertically, in rows, as if you were mowing a lawn.
This up-and-down approach seems to work best for most women. Be sure to feel all the
tissue from the front to the back of your breasts: for the skin and tissue just beneath, use
light pressure; use medium pressure for tissue in the middle of your breasts; use firm
pressure for the deep tissue in the back. When you've reached the deep tissue, you should
be able to feel down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that
the easiest way to feel their breasts is when their skin is wet and slippery, so they like to
do this step in the shower. Cover your entire breast, using the same hand movements
described in step 4.
2. A 48-year-old man is married with two young children and has been newly diagnosed
with ametastatic spinal cord tumor. Identify appropriate nursing interventions to
alleviate the patient’s and family’s physiologic and emotional stressors.
- Nurses, both inpatient and outpatient based, play an important role in early
recognition of symptoms, patient and family education and coordination of
appropriate referrals. Knowing who is at highest risk and educating these patients of
the importance of what may seem like minor symptoms is a major step in early
intervention. In the outpatient setting, nurses may need to triage symptoms over the
phone, requiring knowledge of symptoms, risk factors and what questions to ask.
Many nurses take responsibility for coordinating referrals for imaging studies and
coordinate consultation with radiation oncologists and neurosurgeons. Time is critical
to positive outcomes and nurses can often expedite this process, helping patients and
families understand what is going on along the way. As we tirelessly advocate for our
patients, know that astute nursing care can help these patients maintain dignity and
quality of life.
3. Oxygen therapy is required for a 65-year-old patient with terminal lung metastatic
cancer.Discuss teaching and safety precautions indicated for the patient and his or
her family. Describe the patient teaching that will be required for the patients who
will be discharged from the hospital with a prescription for oxygen therapy.
- I will instructed patient or caregiver of the patient about a few simple precautions
that can be taken to create a safe home environment when using oxygen. Oxygen
canisters should be kept at least 5 - 10 feet away from gas stoves, lighted fireplaces,
wood stoves, candles or other sources of open flames. Do not use electric razors while
using oxygen ( These are a possible source of sparks ). Do not use oil, grease or
petroleum - based products on the equipment. Do not use it near you while you use
oxygen. These materials are highly flammable and will burn readily with the presence
of oxygen. Avoid petroleum - based lotions or creams, like Vaseline, on your face or
upper chest. Check the ingredients of such products before purchase.
◦ Pressurize your oxygen tank. This is for compressed tanks only. Other devices can
simply be turned on. Follow the directions from your healthcare provider or
medical supply company.
◦ Check the oxygen gauge on the tank to be sure you have enough. Your medical
supply company will tell you when to call for more oxygen. Or they will deliver
your oxygen on a regular schedule.
◦ Check the water level if you have a humidifier bottle. When the level is at or below
half full, refill it with sterile or distilled water. Ask the company how often to
change your humidifier bottle. This helps prevent germs.
◦ Attach the nose tube (cannula) to your oxygen unit as you were shown.
◦ Set the oxygen to flow at the rate your healthcare provider gave you.
◦ Never change this rate unless your provider tells you to.
◦ Put the cannula in your nose. Breathe through your nose normally.
◦ If you are not sure if the oxygen is flowing, do a simple test. Put the cannula in a
glass of water. Oxygen is flowing if the water bubbles.
COURSE TASK- CU14
JENAICA JUAN
Study Questions:
1. You are caring for a 78-year-old patient after the creation of an ileal conduit. What is
the best description of the ileal conduit?
- An ileal conduit is a system of urinary drainage which a surgeon creates using the
small intestine after removing the bladder. To do this, the surgeon takes a short
segment of the small intestine and places it at an opening he has made on the surface of
the abdomen to create a mouth, or stoma. The ureters, which normally carry urine from
the kidneys to the bladder, are then attached to the other end of the segment of
intestine. The urine now travels from the kidneys, via the ureters and the newly formed
ileal conduit, to the stoma and out into a collecting pouch known as an ostomy bag or
urostomy. This is worn outside the body around the stoma 24 hours a day. Because the
nerves and blood supply are preserved, the new conduit is able to propel the urine out
of the body and into the urostomy.
Recuperation after the Surgery
- One of the advantages of the ileal conduit is that it requires less surgical time than
other, more complex, diversions. This procedure was developed during the 1940’s and
is still the most used technique for urinary diversion. When it was released from the
hospital, It came home with no tubes or catheters. Had no diet restrictions because only
a small part of the intestine is used. However, Understand many doctors will
recommend a low residue diet for the first few weeks post op. With conventional
surgery, the recuperation period is about 6-8 weeks.
3. A 55-year-old patient has been diagnosed with cervical cancer. She reports that she
has a strong family history of cancer; two sisters have breast cancer. Her mother
died of cancer when the patient was a child, and she is not certain of the type of
cancer. Because of her strong family history, she is concerned about the health status
of her twin daughters who are in their early 30s. She has asked you to discuss the
risks for cancer with them.
Explain what counseling and education you will provide to the patient and her
daughters.
- I will explain to my patient and to her daughter that was instructed in cervical cancer
explaining of type of cancer and the therapeutic or surgical procedures to be
performed. Patient Undergoing Surgery, the patient was reviewed avoid coitus and
douching for 2 to 6 weeks after surgery, avoid heavy lifting and vigorous activities.
Patient Undergoing Cryosurgery/Laser Therapy , the patient was taught that perineal
drainage is clear and watery initially progressing to a foul-smelling discharge that
contains dead cells, reviewed perineal care and hygiene, recommended need for
regular Papanicolaou and pelvic examinations. Patient Undergoing Pelvic
Exenteration, the patient was instructed to obtain appropriate supplies for ostomy
care, the patient was taught on perineal care explaining the drainage may continue for
several month, the patient was reviewed in wound irrigation procedures and
application of sanitary pads, avoid prolonged sitting.
Identify the evidence base for the counseling and education and the strength of
that evidence.
Serve as a single point of contact for patients and families
• Assess patient barriers to care and help patients overcome barriers (e.g.,
transportation, childcare, financial counseling, lodging)
• Advocate for patients and coach patients to advocate for themselves
• Coordinate scheduling of appointments and procedures
• Contact patients who are at risk for missing appointments
• Discuss Advance Care Planning with patients and families
• Arrange interpreter services for patients with language barriers
• Direct patients and families to community resources and supportive services
• Refer patients to Social Work and Complementary Therapies
• Accompany patients to appointments
• Inform the clinical team of patient beliefs, cultural norms, and goals relevant to
their care
• Maintain follow-up communications with patients in need of additional assistance