Whats the pathophysiology behind chronic diseases / condition?

ASSESSMENT 2: PART 1 WRITTEN REPORT

Interview a person with a chronic health condition. This could be a family member, a friend or a work colleague. Answer the questions listed, using referenced answers where necessary. Write in sentences and ensure that each answer is at least 100 words.

1. What is the pathophysiology behind this chronic disease/condition? (Reference required)

2. Discuss the Anatomy and physiology of this chronic disease/condition. (Reference required)

3. What are the clinical manifestations of this chronic health problem on the health systems of the person you interviewed?

4. What is the interviewees understanding of their chronic health problem. Ask them to express in their own words, and transcribe this answer.

5. What physical and /or psychological impact does the chronic disease/condition have on the person’s activities of daily living?

6. Using the problem solving approach in nursing what are the steps you may use to assess the impact of this chronic disease processes on the client and/or their family and the achievement of activities of daily living when creating a plan of care

7. What resources and support services are available for the interviewee in their area? If your interviewee does not need these services, list at least three (3) services that would be available in your area for a person suffering from other chronic health problems.

ASSESSMENT 2: PART 2 – Question Bank 15 questions

CASE Scenario related to the questions below
3 months ago Steve Gray, a 20year old male was in a car accident with his Mother Dorothy Gray (50 years old) and his Grandfather Herbert Elliott (80 years old).
After their injuries were treated – but as a result of those injuries, Steve, Dorothy and Herbert suffer from chronic health problems.
STEVE
Steve had a below knee amputation of his left leg, and has to fit a prosthesis every day, to attend to activities of daily living. He suffers from chronic phantom leg pain. (Brown, D. & Edwards, H. (2012). Lewis’s Medical-Surgical Nursing Assessment and Management of Clinical Problems (3rd edn.). Sydney, Australia: Elsevier.
Reading: Page 1778 – 1781 (including Box 62-6).
Steve has been ordered BEDREST for back pain and the phantom leg pain.
Crisp J., Taylor C., Douglas C. Rebeiro R. (2013) . Potter and Perry’s Fundamentals of Nursing (4th edn.) Sydney, Australia: Elsevier
Reading: Pages 919 – 920. From complications of immobility to Metabolic Changes.

DOROTHY
Dorothy has suffered internal injuries, and has had to have surgery and an ileostomy has been formed. During the acute phase of her treatment, Dorothy had an indwelling urinary catheter inserted. http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=5381
Post-surgery, she was encouraged to use Incentive Spirometry. http://www.sswahs.nsw.gov.au/services/sgog/IncentiveSpirometry.html
She must learn how to maintain the ileostomy and change the ileostomy pouches. https://www.youtube.com/watch?v=U2Rxf7jSRwE
HERBERT
Herbert suffered extensive internal injuries and a crushed left femur with extensive soft tissue injuries. Due to the internal injuries, Herbert has had to undergo Haemodialysis. Haemodialysis is a method that is used to achieve the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of renal failure.
http://www.nhs.uk/Conditions/Dialysis/Pages/How-haemodialysis-is-performed.aspx.
http://www.kidney.org.au/LinkClick.aspx?fileticket=n1roiDsb%2Fqw%3D&tabid=609&mid=2002
Initially after numerous surgeries, he was sent to rehabilitation. After several weeks in rehabilitation and some improvement Herbert has been diagnosed with a very aggressive sarcoma and continues to deteriorate. His prognosis is poor and he has entered the Palliative Care Ward.
https://www.mja.com.au/journal/2007/186/12/clinical-practice-guidelines-communicating-prognosis-and-end-life-issues-adults

Please circle the correct answer

1. BED REST is a medical term in which a person lies in bed for a period of time to gain health benefits. It is prescribed in patients suffering:-
A) Gout
B) Acute pain in the spine and joints.
C) Heart Diseases
D) All of the above.

2. Following an amputation and the fitting of a prosthetic limb, the patient should
A) Elevate the residual limb on a pillow when the prosthetic limb is not in use.
B) Keep wearing the prosthesis if irritation occurs, because calluses need to develop.
C) Use Moisturiser on the residual limb if necessary twice every day to keep skin supple.
D) Perform range of motion exercises to all joints daily. Perform general strengthening exercises including to the upper extremities, daily.

3. Patients with chronic pain may be more sensitive to pain and other stimuli.
A.True
B. False.

4. Pain is always subjective.
A. True
B. False

5. Pain is best described as:
A. a creation of a person’s imagination
B. an unpleasant, subjective experience.
C. a maladaptive response to a stimulus
D. a neurological event resulting from the activation of nociceptors

6. Dorothy has had an indwelling catheter inserted. Answer the following questions on nursing care of indwelling catheters.
The drainage bag should be changed twice daily.
TRUE
FALSE

7. Daily, Dorothy’s genetalia should be cleansed with a Chlorhexidine 0.9% Irrigation Solution.
TRUE
FALSE.

8. the most effective way to prevent Urinary Tract Infections in patients with short term indwelling urinary catheter is.
A) Add antibacterial solution to drainage bags.
B) Flush the catheter twice daily with 50ml of Normal Saline.
C) Ensure use of correct size catheter.
D) Remove as early as possible.

9. Dorothy has an ileostomy, and her stoma pouch needs to be changed, and stoma care attended. Please put the following tasks in the correct order.
• Explain in detail the procedure and encourage Dorothy to ask questions.
• Observe for drainage and empty if one third to one half full, measure and Observe colour and consistency of drainage and record.
• Introduce self to patient, identify patient .
• Observe location colour and presence of trauma of stoma
• Place Dorothy in semi reclining position and place towel on lower abdomen.
• Hand hygiene and don gloves.
• Remove used pouch and skin barrier.
• Remove protective backing and apply pouch over stoma, close end of pouch.
• Measure stoma, and trace and cut pouch to correct size.
• Assess Dorothys understanding and her ability to perform the procedure at home.
• Cleanse skin around stoma with tap water and wash cloth, pat dry.
• Discard used pouch, perform hand hygiene, and document.

10. When her gut was recovering from post trauma surgery, Dorothy was being fed enterally via a nasogastric feed tube. Read about Nasogastric and nasointestinal tubes (BROWN AND EDWARDS, (2012)P. 1038 – 1042) and answer the following questions.

The best position for Dorothy when receiving intermittent enteral feeds via the nasogastric tube is supine.

TRUE
FALSE

11. The most reliable way to confirm the position of the Nasogastric tube before commencing an intermittent feed is –

A) Testing the pH of the gastric aspirate.

B) Blowing air from a 50ml syringe down the tube to auscultate bubbling sound at placement.

C) Judging how far it has been inserted by the measurements on the side of the tube, after checking the measurements of the original placement in the patient notes.

D) X-ray abdomen to establish position of tube.

12. To improve lung function, Dorothy was encouraged to use an Incentive Spirometry device.
Which 2 of the following statements is CORRECT.
A) The device should be used morning and evening.
B) Instruct the patient to exhale, letting all the breath out. Ask the patient to close their lips around the mouthpiece of the spirometer.
C) After using the Incentive Spirometry, it is essential to lie flat immediately.
D) If possible, sit up straight or lean forward. It may be helpful for the patient to sit on the edge of a chair or bed to promote optimal lung expansion while using the spirometer.

13. The first step when starting haemodialysis is to have an arteriovenous fistula created. This is formed by –
A) Joining a vein and a vein.
B) Joining venous lymph nodes with arterial lymph nodes.
C) A pouch created between the radial vein and artery.
D) Joining a vein and an artery.

14. Most People require ……………sessions of haemodialysis each week, lasting approximately …………………….hours for each session.
A) 2, 5
B) 3, 4
C) 2, 3
D) 3, 5.

15. Prognostic and end-of-life communication is a vital skill for health care professionals caring for patients with progressive life-limiting illnesses, and their families. When talking to Herbert about the sarcoma diagnosis and prognosis, it is essential to –
A) Confirm pathological diagnosis and investigation results before initiating discussion.
B) Show empathy, care and compassion during the entire consultation.
C) Clarify the patient’s or caregiver’s understanding of their situation, and establish how much detail and what they want to know.
D) All of the above.