Ms Connie Chen is 52 years old. She is currently single and has two adult children. Ms Chen reports that she has been feeling rather fidgety lately, as if she can’t sit still. She has also been feeling unusually hot. Her sleep is interrupted at night by the urgent need to pass urine and have a drink. She is always thirsty and is wondering if it is due to feeling so warm. Recently, she noticed that there is a large lump in her neck, just below her ‘voice box’ and her eyes seem to be ‘popping out’ more than normal.
She has come to the clinic in which you work because she is concerned about her symptoms.
As part of Mrs Chen’s assessment, you perform a random blood glucose measurement, which provides a reading of 13.8 mmol/L.
1. Make a list of the cues from Connie’s case study and provide an interpretation of, or explanation for, each of these.
2. Explain the difference between Diabetes Mellitus types 1 and 2. Describe the treatment options for each condition.
3. State the hormones that can affect blood glucose levels. Describe where each is produced, what its target is, and how it alters blood glucose.
Mrs Amy Adams is 74 and has been brought to the hospital for a suspected broken Neck of Femur (NoF). According to her daughter, who arrived with her in the ambulance, Mrs Adams has a five-day history of vomiting due to a ‘stomach bug’. This morning her mother rose from her bed to let her cat out, experienced about of dizziness and lost her balance. She fell over and now has severe pain in her right hip and leg. You notice that she looks pale and her lips are dry. Her daughter reported that her mother had told her that she has hardly urinated in over 24 hours.
4. Make a list of the cues from Amy’s case study and provide an interpretation of, or explanation for, each of these.
5. What changes are happening in Amy’s kidneys as a result of her current fluid balance status? Explain what you would expect in terms of her eGFR, blood results, urinalysis and hormonal responses.
6. For Amy’s IV therapy, state the equipment required, the procedure for establishing her IV line, any precautions that you will take and suggest any indications for concern after the line has been established.
7. Amy is at risk of acute kidney injury (AKI). Explain why. Explain how AKI differs from chronic kidney disease (CKD).
8. Amy also has benign prostatic hyperplasia (BPH). Explain how BPH poses a risk to her kidneys. After problems with urethral obstruction, an indwelling catheter (IDC) is inserted. Explain the procedure, and your precautions and nursing considerations.
Robert and Julie have been together for four years. They have been trying to conceive for the past two years. Robert is 52 and Julie has just turned 40. They attend your clinic to discuss their fertility issues.
You conduct sexual and reproductive health interviews with both Robert and Julie.
Robert informs you that he had a vasectomy at the age of 42, followed by reversal surgery at the age of 50 when he and Julie decided that they wanted a baby together.
During the sexual and reproductive health interview, Julie informs you that she had been taking the oral contraceptive pill for 20 years prior to their decision to conceive. Julie also reveals that she was diagnosed with Chlamydia in her early 20’s despite having no initial symptoms. It then developed into pelvic inflammatory disease (PID).
9. Make a list of the cues from given case study and provide an interpretation of, or explanation for, each of these.
10. Julie has two STIs. From the cues provided, what are they likely to be? What nursing considerations do you have for managing each condition? What is the likely long-term prognosis for each condition?
11. Julie has acquired an STI due to infected semen from early age. Describe the pathway of sperm from its site of production to the site of deposition in the vagina. Name five circumstances under which successful transfer of sperm from the male into the female may be impaired/impeded.
12. When taking a blood sample from Julie, what equipment will you use and what will the procedure be? If you accidentally stick yourself with the needle, what steps will you take?
Mr David Dixon is 63 years of age and a retired bank manager. He is married and has 6 grandchildren. Mr Dixon’s father died of colorectal cancer and Mr Dixon has had several colonoscopies in the past to remove polyps from his colon, all of which have turned out to be benign. Unfortunately, his most recently removed polyps have come back as cancerous and he has been diagnosed with adenocarcinoma of the colon.
Mr Dixon has been recommended surgical resection followed by adjuvant therapy. He has also been told that the staging and grading of his cancer can only be performed post-operatively.
His blood tests demonstrate that he is severely anaemic as a result of blood loss caused by the cancer.
13. Explain the meaning of Dixon’s blood test results. What are the risks to Dixon for each finding?
14. Explain what chemotherapy is, how it works to treat cancer, and what precautions should be taken around administration.
15. Name 4 potential side effects of adjuvant therapies including chemo- and radio-therapy. Choose one side effect and discuss the goals of care and management options for that side effect.
16. Dixon requires a blood transfusion. Explain the process and checks that need to occur for this type of therapy. If Dixon is of blood type B+, what blood types can she be transfused with?
17. Name three nursing considerations for Mr. Dixon relating to her a) Anaemic, b) blood transfusion