Medical Case Studies Essay Provides Valuable Insights Into Real-life Medical Scenarios.

Hypothermia and Homeostasis

Mrs Chan has been bought in by ambulance following a fall at home, where she fractured her hip. She believes she fell around 10pm last night, and was unable to get up to seek help. Her daughter found her still on the floor this morning at 6.00am and called the ambulance.

Mrs Chan’s past medical history includes:

• Urinary incontinence
• Osteoporosis
• Compression fractures to her spine due osteoporosis
• Removal of a Stage II melanoma in 2006

Regular medications:

• Fosamax
• Vitamin D
• Calcium
• Fentanyl patch

Question 4

When Mrs Chan is admitted to hospital, she is found to have mild hypothermia.

(a)Explain what hypothermia is and at least three factors that may have caused this in her case.

(b)Define homeostasis and name the three components that make up any biological homeostatic control mechanism

(c)Describe at least four different changes that would occur in Mrs’s Chan’s body to regain temperature homeostasis.

Mrs Chan had a Stage II melanoma removed in 2006 and the tissue was sent to pathology for testing.  The pathology report came back stating the tumour showed signs of dysplasia.  

Question 5.

(a)The four major types of cellular adaptation are hypertrophy, hyperplasia, metaplasia and dysplasia.  Briefly describe each of these types of cellular adaptation

(b)Define atrophy

(c)What does the term ‘surgical insult’ mean?

Question 6.

Part of the ENs role is to assist in referring clients care to the appropriate people within a multi-disciplinary team.

(a)List six (6) different professions that may be part of a multi-disciplinary team.

(b)Which part of the team has the role of interpreting test results in order to formulate a diagnosis?

(c)Why does the EN need to know the purpose of blood collection?

(d)Can an EN disclose pathology results to their client? Give a reason for your answer.

Scenario 2 – Mr Marconi

Mr Marconi is a 76-year old man who has hypertension, hyperlipidaemia and congestive heart failure. He is brought in to the Emergency department at 06:00.  On arrival, Mr Marconi states that he has chest pain when breathing in, he is coughing up yellow phlegm and he feels exhausted.  His left arm has a shallow wound that Mr Marconi said he got while weeding his garden two days earlier.

His vital signs include:

• Respiratory Rate: 28 bpm (shallow with pain on inspiration)
• SaPO2: 91% (2L O2)
• Blood Pressure: 105/70 mmHg
• Pulse Rate: 105 bpm
• Temperature: 38.9 degrees C
• BGL: 4.5mmol
• Weight: 78 kg
• Height: 174 cm

His current medications include Atenolol, Ramipril and Lipitor.

He has no known allergies.

Question 5.

Describe the process of coronary artery atheroma formation - include the following in your answer:

(a)Describe the steps of atheroma formation:

(b)Name three factors that trigger endothelial inflammation:

(c)How do high and low density lipoproteins contribute to atheroma formation?

Melanoma and Cellular Adaptation

(d)What is the role of macrophages in relation to atheroma formation?

(e)The patient is taking Atenolol and Ramipril. Describe in simple terms (that a patient could understand) how these two medications work in treating ischaemic heart disease.

Question 6.

You are asked to clean the wound on the patient’s arm.

(a)Explain the structure and the function of the skin and the problems associated with a break in the skin such as this wound.

(b)You notice that the patient’s skin appears thin and like ‘tissue paper’. Explain what may have caused this.

Question 7.

The patient wears reading glasses.  Explain degenerative changes that occur in the eye as we age and how this may have resulted Mr Marconi’s need to wear glasses.

Sarah Thompson is a 65 year old woman who presents to her GP clinic for an annual check up.  She was diagnosed with Type II Diabetes Mellitus (T2DM) in 2009

Mrs Thompson also has hyperlipidaemia and hypertension, and she is taking Metoprolol and Rosuvastatin daily.

Question 8.

Discuss Type 2 diabetes – include the following in your answer:

(a)What body systems and/or organs can be affected by T2DM?

(b)Name five risk factors for developing T2DM:

(c)Describe appropriate treatment for a patient such as Mrs Thompson who has T2DM

(d)Which part of the cell makes ATP (adenosine triphosphate) needed for cellular energy

(e)What is required to ensure a cell remains healthy?

Question 9.

Define hyperlipidaemia and explain the associated risks and causes of this condition. In your answer identify the roles of high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides

Scenario 4 – Miss Walker

Miss Walker is a 46-year-old female who presented to the emergency department with shortness of breath which has got progressively worse over the last two days. She has no other significant past medical history.

The doctor orders a chest X-ray which shows consolidation of fluid on his right lower lung. The doctor diagnoses right lower lobe pneumonia.

Question 10

Relate the diagnosis of pneumonia to two stages of respiration - external respiration and gas transport.

(a)Describe what occurs during normal external respiration.

(b)Describe what occurs during normal respiratory gas transport. Discuss how O2 and CO2 are transported in the blood

(c)Differentiate between pulmonary ventilation, internal respiration and cellular respiration.

(d)Briefly explain what respiratory acidosis and respiratory alkalosis are:

Question 11

Describe the steps involved in homeostasis of respiratory rate - include the following in your answer (min 200 words):

Heart Failure and Ischaemic Heart Disease

(a)Name two (2) respiratory gases detected in the blood?

(b)Where is the respiratory control centre located?  What is the stimulus that causes the respiratory control centre to increase respiratory rate?

(c)Why would the patient have an increased respiratory rate if they are suffering from pneumonia? You need to explain the physiology behind why having pneumonia causes increased respiratory rate

(d)How does administration of supplementary oxygen help to maintain homeostasis of respiration?

(e)What impact would the administration of supplementary O2 have on the patient’s respiratory rate? What impact would the administration of supplementary O2 have on the patient’s SpO2?

Question 12

Later in your shift, you find the patient crying. She tells you that she has been crying a lot lately and feeling sad since her husband asked her for a divorce. Explain psychological health as it relates to the patient and who you could refer them to.

Mrs Nguyen is a 75 year old woman who is bought into the GP clinic by her daughter Rosemary. Mrs Rosemary says that her mother has complaining of painful urination and her mental state has become confused over the past 24 hours.

The RN asks you to perform a urinalysis test.

Question 13

(a)Explain how you would prepare for a urinalysis test

(b)You assess the results of a urine dipstick test – list two (2) signs would you expect if a UTI was present?

(c)What symptoms could the patient be experiencing if she has a UTI

(d)A urine test is then ordered for culture and sensitivity. Describe what each of these tests are evaluating and how the results relate to medication prescription.

(e)Explain how the patient’s age could impact on the urinary system?

Mrs Nguyen also has had some dental problems, and lets you know that she is getting dentures in the next month or so.

(b)What is the term used to describe people with teeth and without teeth

During assessment, Rosemary shows you Mrs Nguyen’s medication webster pack. She is concerned that there are three days of medications missing and she thinks that her mother may have forgotten that she had taken her pills and took another dose.

The medication list on the webster pack lists the drugs as:

(c)List three (3) body systems that may be affected by the accidental ingestion of these medications.

Ruth and Michael Jackson have been trying to have a baby for the past five years.  In November 2016, Ruth gives birth to a son, Peter.  48 hours after birth, Peter undergoes the standard neonatal screening test, which helps to identify those infants at risk of rare, but serious medical conditions such as phenylketonuria, hypothyroidism and cystic fibrosis.  

Peter is found to have cystic fibrosis (CF), an autosomal recessive condition that affects mostly the lungs, but also the pancreas, liver, kidneys and small intestine.

(a)Discuss difference between having the disease of CF compared to being a carrier of CF from a genetic perspective.

At three months, Ruth and Michael take Peter to the paediatrician for a follow up.  The paediatrician notes FTT (failure to thrive) on Peter’s medical record.  She explains to the Jackson’s that this means Peter has poor weight gain, and that he will need a high calorie diet and enzyme supplementation for the rest of this life.

(b)Explain how CF causes failure to thrive and how this may impact on Peter’s biological maturation

(c)Why does Peter need a high calorie diet and pancreatic enzyme supplementation?

(d)How does CF contribute to malabsorption of nutrients in a teenager?

Ruth is worried about Peter’s future and how long he is likely to live.

(e)What is the life-expectancy of a patient with CF, compared to a non-CF patient?  How has current treatment affected this, compared to a patient diagnosed with CF twenty years ago?

You are talking to Ruth during a routine visit to the GP. She says that her husband Michael has taken up scuba diving. Ruth doesn’t understand much about scuba diving and is concerned that her husband may be injured, leaving her to care for Peter

Hypothermia and Homeostasis

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Melanoma and Cellular Adaptation

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Scenario 1 – Mrs Chan

Mrs Chan has been bought in by ambulance following a fall at home, where she fractured her hip. She believes she fell around 10pm last night, and was unable to get up to seek help. Her daughter found her still on the floor this morning at 6.00am and called the ambulance.

Mrs Chan’s past medical history includes:

• Urinary incontinence
• Osteoporosis
• Compression fractures to her spine due osteoporosis
• Removal of a Stage II melanoma in 2006

Regular medications:

• Fosamax
• Vitamin D
• Calcium
• Fentanyl patch

PRN endone

Question 4

When Mrs Chan is admitted to hospital, she is found to have mild hypothermia.

(a)Explain what hypothermia is and at least three factors that may have caused this in her case.

Hypothermia is a condition in which the body temperature is relatively low and it usually takes place when the body release too much heat than it is absorbing. One of the factors is vitamin D medication that cause weakening of skeletal muscles and therefore they are unable to contract and relax to release heat due to friction (Fujiwara et al., 2018). Another factor is the fact that she stayed on the cold floor for long time and this made her lose heat. Finally, hypothermia might be due to the melanoma that was previously removed.

(b)Define homeostasis and name the three components that make up any biological homeostatic control mechanism

Homeostasis can be defined as the state that is maintained by cells, tissues and organs by the constant adjustment of different biochemical as well physiological pathways. The three components that make up the homeostatic control mechanism include the receptor, the integrating centre and finally the effector.

(c)Describe at least four different changes that would occur in Mrs’s Chan’s body to regain temperature homeostasis.

The initial change is vasoconstriction of smooth muscles so less heat is carried to the surface of the body. The second change is that the sweat glands do not produce sweat to preserve heat within the body. The skeletal muscles contract and relax (Fujiwara et al., 2018). This act creates heat through friction. Finally, the erector pili muscles contract and hair is raised to trap warm air.

Heart Failure and Ischaemic Heart Disease

Mrs Chan had a Stage II melanoma removed in 2006 and the tissue was sent to pathology for testing.  The pathology report came back stating the tumour showed signs of dysplasia.  

Question 5.

(a)The four major types of cellular adaptation are hypertrophy, hyperplasia, metaplasia and dysplasia.  Briefly describe each of these types of cellular adaptation

Hypertrophy is the condition in which the cell or the muscle increase in size .This is due to increased size of the cells that make up the tissue or the muscle. Hyperplasia on the other hand is the enlargement of an organ or tissue and is usually due to increased reproduction of cells (Ratcliffe, Pan, Bishop, Yeger, & Cutz, 2016). Metaplasia refers to the reversible change from one cell type to another. Finally, dysplasia refers to the presence of an abnormal cell type within a tissue and this is common in cancer.

(b)Define atrophy

Atrophy can be defined as the wasting or tearing away of part of a tissue, or muscles that arise due to the degenerations of the cells.

(c)What does the term ‘surgical insult’ mean?

The term surgical insult is used to imply or refers to the resultant effects of surgery to the body or the patient.

Question 6.

Part of the ENs role is to assist in referring clients care to the appropriate people within a multi-disciplinary team.

(a)List six (6) different professions that may be part of a multi-disciplinary team.

General practitioners

Practice nurses

Community health nurses

Allied health nurses

Health educators

(b)Which part of the team has the role of interpreting test results in order to formulate a diagnosis?

It is the general practitioner who interprets and then formulates the diagnosis.

(c)Why does the EN need to know the purpose of blood collection?

The Enrolled nurse should know the purpose of blood collection so as they can be able to follow the necessary protocol when collecting blood. This is because blood needed for certain purposes should be collected in special vacutainers. If they are collected in the wrong vacutainer then the results will not be reliable.

(d)Can an EN disclose pathology results to their client? Give a reason for your answer.

The EN is not supposed to disclose the pathology results to the doctor. This is because it is not their role. The role of the nurse is to provide care to the patient while it is the general practitioner who should release the results to the patient.

Pneumonia and Respiratory System

Scenario 2 – Mr Marconi

Mr Marconi is a 76-year old man who has hypertension, hyperlipidaemia and congestive heart failure. He is brought in to the Emergency department at 06:00.  On arrival, Mr Marconi states that he has chest pain when breathing in, he is coughing up yellow phlegm and he feels exhausted.  His left arm has a shallow wound that Mr Marconi said he got while weeding his garden two days earlier.

His vital signs include:

• Respiratory Rate: 28 bpm (shallow with pain on inspiration)
• SaPO2: 91% (2L O2)
• Blood Pressure: 105/70 mmHg
• Pulse Rate: 105 bpm
• Temperature: 38.9 degrees C
• BGL: 4.5mmol
• Weight: 78 kg
• Height: 174 cm

His current medications include Atenolol, Ramipril and Lipitor.

He has no known allergies.

Question 5.

Describe the process of coronary artery atheroma formation - include the following in your answer:

(a)Describe the steps of atheroma formation:

There are 8 steps that are involved in atheroma formation. During step 1, the low density lipoproteins pass through the endothelium of the blood vessels and then they lodge themselves into the intima. This might be due to either injury, fluid shear stress or smoking. In step two, the LDL are then oxidised. At step 3,the oxidised LDL leads to release of MCP-1 which is a monocyte chemo attachment protein which is to be released from the endothelial and the SM cells(Reynolds & Craig, 2016). The MCP-1 then attracts the monocytes to move into the intima. The next step involves differentiation of the monocytes into macrophages under the influence of oxidized LDLs .The macrophages then release cytokines that lead to the expression of adhesion molecules on the endothelial cells and this allows more monocytes to move in the cell. The next step involves the release of growth factor M-CSF that leads to expression of the scavenger receptor on to the macrophage that then takes up the oxidised LDL and eventually form a foam cell. The next step is where the foam cells then release cytokines which result to smooth cell muscle differentiation. During step seven, there is formation of the fibrous cap which harden and then exert pressure on the endothelial cells. The final step involves rupturing of the unstable fibrous plagues that occur due platelets trying to fix the rupture.

(b)Name three factors that trigger endothelial inflammation:

The three factors that trigger endothelial inflammation include coagulation factors, cytokines and endothelin.

(c)How do high and low density lipoproteins contribute to atheroma formation?

They contribute to atheroma formation by lodging into the arteries and are later oxidised to release MCP-1.

(d)What is the role of macrophages in relation to atheroma formation?

UTI and Urinary System

The macrophages release cytokines that cause expression of the adhesion molecules on to the endothelial cells and this allows monocytes to lodge into cells.

(e)The patient is taking Atenolol and Ramipril. Describe in simple terms (that a patient could understand) how these two medications work in treating ischaemic heart disease.

Atenolol is a beta blocker drug and it works by blocking certain chemical substances in the body like the epinephrine that is found on the heart and blood vessels. This in return reduce the heart rate, blood pressure and straining of the heart (Cleveland et al., 2018). Ramipril on the other hand is an Angiotensin converting enzyme inhibitor that works through blocking of substances that can result to tightening of blood vessels. The blood vessels then relax and this eventually reduces blood pressure and increases the amount of blood supplied to the heart.

Question 6.

You are asked to clean the wound on the patient’s arm.

(a)Explain the structure and the function of the skin and the problems associated with a break in the skin such as this wound.

The skin is known to be the largest organ of the body and it is estimated to be 20 square feet. The skin has different functions such as protecting the body against infections from different microorganisms and elements. The skin also assists in regulating body temperature and it also allows the sensitivity to touch, heat as well as cold.

The skin is primarily made up of three layers .The epidermis which is the outermost layer of the skin and it acts as a waterproof barrier and it also creates the tone of the skin (Norlén, 2015). The dermis is another layer and it is below the epidermis. It contains the tough connective tissues, the hair follicles and the sweat gland. The final layers is the hypodermis and it is deepest subcutaneous tissue and its function is to produce melanin. There are special cells known as melanocytes that produce melanin and they are located in the epidermis.

In the event where the skin is breached such as a wound, there are different conditions that might arise such as dermatitis which is inflammation of the skin. Eczema is another condition, acne as well as cellulitis where the dermis is inflamed as well as the subcutaneous tissue.

(b)You notice that the patient’s skin appears thin and like ‘tissue paper’. Explain what may have caused this.

Medication Safety and Body Systems

A condition in which the skin appears like a tissue paper is known as thin skin. It is scientifically known as crepey skin. This condition is common in older people and it can be noticed through face, arms and hands .It is possible to skin veins, tendons, bones and even capillaries under the skin when suffering from crepey skin. This condition arise due to defects in the dermis layer (Stevens, 2014). Since it is the dermis that provides strength, flexibility and elasticity of the skin, aging impairs this function and therefore leads to thin skin. It can also be caused as a result of exposure to UV radiations.

Question 7.

The patient wears reading glasses.  Explain degenerative changes that occur in the eye as we age and how this may have resulted Mr Marconi’s need to wear glasses.

As we get older, there are different degenerative changes that occur in the eyes necessitating the use of   

Glasses. Some of the changes include reduced pupil size .This is due to the close of strength in the

Muscles that control the size of the pupil when it reacts to light. Another change that necessitates the use of

Glasses is known as loss of peripheral vision (Ratnayaka, Serpell, & Lotery, 2015). This is due to the decrease in the size of the visual field.

Scenario 3 – Mrs Thompson

Sarah Thompson is a 65 year old woman who presents to her GP clinic for an annual check up.  She was diagnosed with Type II Diabetes Mellitus (T2DM) in 2009:

Mrs Thompson also has hyperlipidaemia and hypertension, and she is taking Metoprolol and Rosuvastatin daily.

Question 8.

Discuss Type 2 diabetes – include the following in your answer:

(a)What body systems and/or organs can be affected by T2DM?

One of the body systems that is usually affected by T2DM is the urinary system.T2DM is a condition in which there is excess glucose in blood. The kidney therefore works very hard to filter glucose from the blood during urine formation. This in return leads to impairment in the filtering units at the kidney.

(b)Name five risk factors for developing T2DM:

There are several risk factors for type 2 diabetes. The most common factors include high blood pressure and if one has previously had a heart disease .Being overweight is another risk factor especially around the waist and this is why women are more at risk than men (Ríos, Francini, & Schinella, 2015). If an individual is also not physically active, it is a risk factor. Genetics is also another risk and this if one of the family members has previously suffered from diabetes.

Genetic Disorders and Inheritance

(c)Describe appropriate treatment for a patient such as Mrs Thompson who has T2DM

The appropriate treatment option for a patient like Mrs. Thompson include diet and exercise, pills and monitoring of the level of glucose. About the diet, the patient will be expected to pay keen attention to carbs, fibre, fats as well as salts so as to manage diabetes and avoid more complications (Inzucchi et al., 2014). Physical activity is also good for the patient as it helps the muscles to utilize the excess glucose. Pills such as Metformin are also effective in people with type 2 diabetes as they assist in the breakdown of excess glucose.

(d)Which part of the cell makes ATP (adenosine triphosphate) needed for cellular energy

Adenosine triphosphate is produced in the mitochondrion. The mitochondrial membranes that are next to the matrix are the ones that are used in the synthesis of Adenosine triphosphate.

(e)What is required to ensure a cell remains healthy?

There are two important things that the cell need to remain healthy. They include oxygen and glucose. Oxygen is required for respiration while glucose is used for glycolysis where the cell manufacture ATP that provides energy for the body. The cells also need amino acids and water for them to remain healthy.

Question 9.

Define hyperlipidaemia and explain the associated risks and causes of this condition. In your answer identify the roles of high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides.

Hyperlipidaemia is a condition in which there is excess cholesterol in the human body. The term generally refers to different disorders that result from excess fats in the body. The condition is however treatable. The condition is caused by cholesterol which is a waxy substance that the body makes. Consumption of foods that have high cholesterol therefore leads to hyperlipidaemia (Navarro-Millán et al., 2015). The foods include cheese, egg yolks, fried and processed foods, ice cream and pastries.

There are different lipoproteins in the human body and they have distinct functions. The high density lipoprotein for example is known as the good lipoprotein since it removes lipids from the blood vessels. Low density lipoprotein on the other hand is a bad lipoprotein since it adds cholesterol or lipids to the blood vessels.

Scenario 4 – Miss Walker

Miss Walker is a 46-year-old female who presented to the emergency department with shortness of breath which has got progressively worse over the last two days. She has no other significant past medical history.

The doctor orders a chest X-ray which shows consolidation of fluid on his right lower lung. The doctor diagnoses right lower lobe pneumonia.

Question 10

Relate the diagnosis of pneumonia to two stages of respiration - external respiration and gas transport.

(a)Describe what occurs during normal external respiration.

External respiration is the exchange of gases between the external environment and the lungs. External respiration involves inspiration and expiration. During inspiration, the intercostal muscles usually contract while the sternum move up and outwards. The ribs usually move upwards and outwards while the diaphragm flattens (Janssen, 2016). The thoracic volume increase while the pressure in the cavity reduce. Air is then drawn into the thoracic cavity.

During exhalation the intercostal muscles usually relax and the sternum move downwards and inwards. The ribs then move downwards and inwards while the diaphragm relax and forms a bell shape. The volume of the thoracic cavity reduce then the pressure increase and air is then expelled from the thoracic activity.

(b)Describe what occurs during normal respiratory gas transport. Discuss how O2 and CO2 are transported in the blood

Normal respiratory gas transport usually take place in the blood stream by the action of the cardiovascular system. Oxygenated blood leaves the lung and flows back to the heart through the pulmonary veins and then pumped to the body from the left ventricle via the aorta. It is the haemoglobin that transports oxygen in the blood (Greutmann, Rozenberg, Le, Silversides, & Granton, 2014). An increase in carbon dioxide, Hydrogen ions and temperature affect the amount of oxygen that binds to the haemoglobin. As the blood that is rich in oxygen reach the capillaries, gaseous exchange then take place where oxygen is delivered to the tissues and the deoxygenated blood leaves tissues and flow back to the heart and it is pumped to the lungs for oxygenation through the pulmonary arteries.

(c)Differentiate between pulmonary ventilation, internal respiration and cellular respiration.

Pulmonary ventilation is the process through which air flows to the lungs during inhalation and when air flows out of the lungs during expiration. The reason why air flows this way is due to the pressure differences. Internal respiration on the other hand is the exchange of gases between the different cells of the human body and the blood by the way of the fluid bathing of the cells. Finally, cellular respiration is the process through which metabolic reactions that occur in cells convert biochemical energy from nutrients to form ATP and then waste products are released.

(d)Briefly explain what respiratory acidosis and respiratory alkalosis are:

Respiratory acidosis is a condition where the lungs fail to remove excess carbon dioxide in the blood. The excess carbon dioxide then reduces the PH of blood as well as other body fluids and this makes them too acidic. A PH measurement of below 7.35 indicates respiratory acidosis (Greutmann, Rozenberg, Le, Silversides, & Granton, 2014). Respiratory alkalosis on the other hand refers to a disturbance in the acid base balance as a result of alveolar hyperventilation. This leads to reduced partial pressure of arterial carbon dioxide. The reduced arterial carbon dioxide increase the ratio of bicarbonate concentration and this therefore increase the PH level.

Question 11

Describe the steps involved in homeostasis of respiratory rate - include the following in your answer (min 200 words):

(a)Name two (2) respiratory gases detected in the blood?

There are two respiratory gases that can be detected in blood and they include oxygen and carbon dioxide.

(b)Where is the respiratory control centre located?  What is the stimulus that causes the respiratory control centre to increase respiratory rate?

The respiratory control centre is located in the medulla oblongata as well as the pons that form part of the brainstem. The centre usually receive different signals of the neural, chemical as hormonal nature and it controls both the rate as well as the depth of the respiratory movements of the diaphragm and the respiratory muscles (Crescimanno, Greco, & Marrone, 2016). The stimulus that can cause the respiratory centre to increase respiratory rates is the accumulation of carbon dioxide in blood that reduces the PH of the blood. It is the low PH that in return stimulates the respiratory control centre to increase the respiratory rate.

(c)Why would the patient have an increased respiratory rate if they are suffering from pneumonia? You need to explain the physiology behind why having pneumonia causes increased respiratory rate

Pneumonia is a condition in which certain bacteria enter the lungs. The alveoli then become inflamed and they fill up with fluids. This in return makes it difficult for gaseous exchange in the lungs. Since oxygen is not exchanged with carbon dioxide effectively, the PH of the blood increases and this again stimulates the respiratory control centres that leads to increased respiratory rates.

(d)How does administration of supplementary oxygen help to maintain homeostasis of respiration?

Administering of supplemental oxygen assists in maintaining the homeostasis of respiration in that the oxygen is used by the cells which in return releases the carbon dioxide which is taken to the lungs. The carbon dioxide then diffuse in water to form an acid. Expulsion of the carbon dioxide by the lungs is what constitutes a healthy PH balance or the homeostasis of respiration.

(e)What impact would the administration of supplementary O2 have on the patient’s respiratory rate? What impact would the administration of supplementary O2 have on the patient’s SpO2?

Administering supplemental oxygen would increase the respiratory rate. This is because as the supplement oxygen is used up by the cells, carbon dioxide is produced in return (Moschos, Usher, & Lindsay, 2017). Carbon dioxide reduce the PH of the blood that in return stimulate the respiratory centre to increase the respiratory rates. Administering supplemental oxygen also increase the SPO2 since there will be excess carbon dioxide that will dissolve to form the SPO2.

Question 12

Later in your shift, you find the patient crying. She tells you that she has been crying a lot lately and feeling sad since her husband asked her for a divorce. Explain psychological health as it relates to the patient and who you could refer them to.

Psychological health refers to the overall psychological well-being. This includes how the patient feels about herself, the quality of her relationships and the ability to manage her feelings and deal with hard conditions. Good mental health does not necessarily mean absent mental health problems and it is more of being anxious, depressed or other psychological issues.

In this case, the patient is not psychological healthy since she is depressed by the potential divorce as requested by the husband. In this case, I would refer her to a psychiatrist who would assist her overcome this depression.

Scenario 5 – Mrs Nguyen

Mrs Nguyen is a 75 year old woman who is bought into the GP clinic by her daughter Rosemary. Mrs Rosemary says that her mother has complaining of painful urination and her mental state has become confused over the past 24 hours.

The RN asks you to perform a urinalysis test.

Question 13

(a)Explain how you would prepare for a urinalysis test?

Before the urinalysis test, preparation is very key for reliable and valid results. Some of the preparations include telling the patient to avoid foods that can change the colour of urine such as blackberries and beets. The patient is also not expected to exercise heavily before the test. If the patient is menstruating or about to start her period, the doctor should be patient and wait (Medjahed, 2015). The patient should also wash her hands well and clean the area around the genitals. The patient should not collect the first drops rather subsequent drops. The patient should not touch the rim of the cup, tighten the lid and present for the urinalysis test.

(b)You assess the results of a urine dipstick test – list two (2) signs would you expect if a UTI was present?

Dipstick sensitive for Albumin

Positive Leukocyte esterase

(c)What symptoms could the patient be experiencing if she has a UTI?

When a female is experiencing UTIs, the common signs and symptoms include a burning sensation during urination, frequent urge to urinate, pain in the back or the lower abdomen, cloudy, dark and bloody urine and finally feeling tired or shaky.

(d)A urine test is then ordered for culture and sensitivity. Describe what each of these tests are evaluating and how the results relate to medication prescription.

Urine culture is a test that is done to find out possible germs or bacteria that could cause UTIs .If urine is cultured on media, the present bacteria is expected to grow which will be identified and the drug of choice would then be selected (Ostrowski & Rutkowski, 2016). Sensitivity test is carried out to select the best antibiotic to treat bacteria that leads to UTIs .It is done by placing antibiotic multidisc on media where the bacteria have been cultured and then measuring the diameter. The multidisc that provides the largest diameter at little concentration is selected as the drug of choice.

(e)Explain how the patient’s age could impact on the urinary system?

As a patient gets older, the urinary system experiences certain changes. Ageing causes the bladder, ureter, urethra to become inelastic and this makes it difficult for the urinary system to effectively excrete excess wastes from the body (Ridley, 2018). The amount of kidney tissue reduce while the number of filtering units also reduce. The blood vessels that supply blood to the kidney also harden.

Mrs Nguyen also has had some dental problems, and lets you know that she is getting dentures in the next month or so.

Question 14.

(a)List five (5) oral health diseases

Halitosis

Tooth sensitivity

Dry mouth

Mouth ulcers

Dental trauma

Oral cancer.

(b)What is the term used to describe people with teeth and without teeth

People with teeth are described as dentate while those without teeth are usually described as being edentate.

During assessment, Rosemary shows you Mrs Nguyen’s medication webster pack. She is concerned that there are three days of medications missing and she thinks that her mother may have forgotten that she had taken her pills and took another dose.

(c)List three (3) body systems that may be affected by the accidental ingestion of these medications.

The digestive system in that the walls of the digestive system will be irritated and this would lead to diarrhoea.

The urinary system especially the kidney during filtration.

The cardiovascular system since there will be increased heart rate.

Scenario 6 – Peter Jackson

Ruth and Michael Jackson have been trying to have a baby for the past five years.  In November 2016, Ruth gives birth to a son, Peter.  48 hours after birth, Peter undergoes the standard neonatal screening test, which helps to identify those infants at risk of rare, but serious medical conditions such as phenylketonuria, hypothyroidism and cystic fibrosis.  

Peter is found to have cystic fibrosis (CF), an autosomal recessive condition that affects mostly the lungs, but also the pancreas, liver, kidneys and small intestine.

Question 15

(a)Discuss difference between having the disease of CF compared to being a carrier of CF from a genetic perspective.

Cystic fibrosis is a medical condition in which the gland that is responsible for secreting mucus and sweat is impaired. It is usually an inherited condition. There is a very big difference between having the condition and being a carrier. Having the disease means that a child or rather the patient has inherited faulty genes from both the parents (Cutting, 2014). A carrier for the disease on the other hand occurs when a child or rather the patient inherits one faulty gene from one of the parent. So this means that a carrier of CF has one normal and one faulty gene while the one who has CF has all the faulty genes from the two parents.

Further Information:

At three months, Ruth and Michael take Peter to the paediatrician for a follow up.  The paediatrician notes FTT (failure to thrive) on Peter’s medical record.  She explains to the Jackson’s that this means Peter has poor weight gain, and that he will need a high calorie diet and enzyme supplementation for the rest of this life.

(b)Explain how CF causes failure to thrive and how this may impact on Peter’s biological maturation

Failure to thrive can be defined as children whose current weight is lower than that of their fellow children of same age and gender.CF is one of the risk factors for this condition. This is because the CF alters the movement of sodium chloride inside and out of the cells. This in return leads to impaired movement that results to a heavy and thick mucus that clogs up the lung (Farrell et al., 2017) .Digestive juices also become heavier and therefore there is impaired absorptions of nutrients. Without good nutrition means the child will who is Peter in this case will have delayed maturation as compared to his age mates.

(c)Why does Peter need a high calorie diet and pancreatic enzyme supplementation?

Since children with cystic fibrosis have impaired absorption of nutrients, it is recommended that they eat food with high calorie content. The rationale for this type of diet is to assist them make it up for the nutrients that are not absorbed (Stoltz, Meyerholz, & Welsh, 2015). Pancreatic enzyme supplementation on the other hand is used to assist or stimulate the digestion of the high calories food.

(d)How does CF contribute to malabsorption of nutrients in a teenager?

Since CF leads to sticky and heavy mucus secretion, there will be malabsorption of nutrients especially in teenagers. This is because the sticky mucus blocks the pancreatic enzymes from reaching the intestines so that food can be digested and absorbed easily.

Further Information:

Ruth is worried about Peter’s future and how long he is likely to live.

(e)What is the life-expectancy of a patient with CF, compared to a non-CF patient?  How has current treatment affected this, compared to a patient diagnosed with CF twenty years ago?

The life expectancy of a patient with CF is estimated to be 50 years and 70 years to the patient who is not affected by CF. The current medications have improved this life expectancy by increasing the rate of digestion and absorption of nutrients compared to 20 years ago where the life expectancy of a patient diagnosed with CF was only 10 years (Stoltz, Meyerholz, & Welsh, 2015).

You are talking to Ruth during a routine visit to the GP. She says that her husband Michael has taken up scuba diving. Ruth doesn’t understand much about scuba diving and is concerned that her husband may be injured, leaving her to care for Peter.

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