HLTAP501B

These are the captures of some of the brainstorming of responses to questions in classes over Aug 21 - 30th. toc Please Note: The information on this page is not necessarily correct... the notes here come from rapid brainstorming. You will need to source your information from resources other than these brainstorms... However it is a starting point for those diving into the assessment task focused on Mr Munsie's diagnostics and treatment.

Some students did include references during their brainstorming activity which is a great help. :-)

Please Ignore typos - different teams information has been put in different colours so there will be significant repetition but also variation in the responses. Use the Table of Contents menu to assist you going straight to the Question you require.

Apologies - there is not every brainstorm response in these notes

Question 1
Question 1 Identify &briefly describe 3 of Mr Munsies medical ccf peripheral odema a medical intervention pressure stockings sob Oxygen therapy CAl He could be placed on a diuretic for excessive fluid Kidney disease diabetes glaucoma is a group of diseases which cause gradual blindness due to the destruction of the optic nerve Myocardial infarction hypertension? poor immunity repeated infection due to poor immunity Due to diabetes, peripheral disease, small shallow ulcers, prone to wound breakdown bed elevated for sob CA- is the occurrence of chronic bronchitis or emphysema, diseases of the lungs in which the airways become narrowed. leading to a limitation of airflow to and from the lungs

disorder of the endocrine pancreas, characterised by inappropriate hyperglaecemia / hypoglycaemia Betta cells in the pancreas are destroyed
 * Diabeties**-- Diabetes mellitus, or simply diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced

COPD is poorly reversible and usually worsens over time. Diagnosis is established through lung function tests. COPD is predicted to be the fourth leading cause of death by 2030
 * Chronic obstructive pulmonary disease** is a disease of the cardiovascular system. It is narrowing of the airways and loss of tissue and is slow onset with gradual progression. Three processes can occur which indicate COPD. Emphysema, Asthma, Bronchitis. The alveoli are damaged and this affects gas exchange in the lungs. Broncioles narrow which affect the airways. ( Lemone, Burke, Dwyer, Levett-Jones,Moxham, Reid-Searl, Berry, Carville, Hales, Knox, Luxford, Raymond. Medical Surgical Nursing Critical Thinking In Client Care. Pearson first edition. Page1339-1345

Diagnosed with echocardiography and blood tests. Common causes are Myocardial infarction and other forms of ischemic heart disesase,hypertenson, valvular heart disease and this is caused buy the ageing process as the resp cardiomyopathy. heart failure in Medical surgical nursing vol 2 pg 1038 the hearts inability to provide sufficient pump action to distribute blood flow to meet the needs of the body
 * congestive heart failure** fluid build up around the heart which can cause shortness of breath fluid build up or oedema in other parts of the body eg legs, feet,hands.

Question 2
Increased sodium levels in the body Puts pressure on heart affects cardiovascular system 178/95 BP Primary hypertension - no obvious cause Secondary hypertension - caused by through kidney disease Urinary System lead to atherosclerosis
 * Hypertension **

Disease of the respiratory system Many people with CAL have a mix of emphysema & chronic bronchitis-narrowed inflamed airways filled with mucous Low oxygen saturations Can lead to lung destruction Decreased physical ability Damage to peripheral circulation
 * CAL **

CCF Weakens chambers in the heart causes blood to pool in heart and nearby veins Disease of the cardiovascular system Lead to oedema

Slow progressive obstruction of the airways, often suffering from respiratory infections with increased symptoms of dyspnoea and sputum production narrowing of the small bronchioles, is also part of COPD COPD typically includes components of both chrinic bronchitis and emphysema.
 * Chronic Airways Limitation**

Primary hypertension is thought to develop from complex interactions among factors that regulate cardiac output and systematic vascular resistance. Early stages of primary hypertemsion typicaaly are asymptomatic marked only by elevated blood pressure. when symtooms do appear they are usually vague. headache, usually in the back of the head on awakening. other symtoms result from target oragna damage including nocturia, confusion, nasuea and vomiting, and visual disturbances
 * Hypertension**

CCF arises as a result of abnormality in cardiac structure, function, rhythm or conduction it indicates the inadequacey of the heart to maintain good oxygen delivery and an attempt systemically to compensate for the inadequacey
 * Congestive Cardiac Failure**

Question 3


Question 3 Medical internvetion

Fluid restriction, FBC, no salt diet - due to CCF

Dietician to assist with correct meals due to diabetes and BMI

Question 3 Medical intervention o2 to assist SOB

Question 3 pharmacological intervention Lasix - loop diuretic, oedema assoc with CHF, renal disease, hypertension

Question 3 pharmacological intervention

Slow k- because his potassium is low due to being on lasix (loop diuretic)

insulin and predisone novaripid fast acting insulin last for 5 hours 10 to 20 minutes to work atlantas long lasting insulin it is absorbed slowly so olasix helps to reduce fluids :it is a diuretic medication to assist his body to excrete excessive fluids cardiac function reduces the pressure on the heart increases uenal output Lasix helps the body to remove this excess fluid and via this removal of fluid from the blood vessels it decreases the pressure within the blood vessels. This makes it easier for a weak heart to pump blood around the body

oxygen concentrater and a moniter fluid input and out put if it's positive or negative y fluid balance chart daily weigh, wound care, regular leg examinations and wound dressings 1500ml daily : he is on 1200 ml fluid restriction daily or 3rd day dressings wet dressings monitor sugar levels Angioplasty is the repair of blood vessels damaged by disease or injury, generally by the insertion of a balloon-tipped catheter. (Mosby’s Pg. 96)This operation if successful will increase the blood flow through the arteries. A catheter is inserted through the groin up to the blockage (which is observed via a fluoroscopy.).Once it reaches the blockage the balloon at the end of the catheter is inflated pushing on inside of the artery open it to allow blood flow. A stent may also be inserted to further maintain the blood flow. (American Accreditation HealthCare Commission July 2012)

mepilex to dry out the ulcer solugel meticulous skin care, and cleansing of the wound is essential before dressing medicated honey vuctex bandage for protection daily wound chart also a photo for reference week or 25% healed

prn pain

.Prednisone is a synthetic Corticosteroid designed to assessment with Chronic Inflammatory Diseases. This will assist with maintaining Mr Munsie’s airway assisting to make breathing easier. (Make increase BGL) (MIMS 2012 & The Complete Home Guide to Medication 2003) may increase the blood sugar levels position for breathing and pressure areas vac pump bed cradle air flow mattresa wave mattress reposition every 2 hours physiotherapy percussion on chest

Question 4
Q 4 wcc is high low platelets potatsium is high Bilateral swollen ankles

Ca+ is 2.1 mmo/L.

pulse is high sats low

digoxin levels high

high blood glucose bgl 12mmol normal bgl is 3.8 -8mmol

an inadequate amount of potassium results in an electrolyte imbalance called hypokalaemia. ecg can detect hypokalemia potassium is needed for cells, especially nerve and muscle cells to function properly a metabolic disorder
 * k+ abnormal **

Hb 100 g/L 130 – 180 g/L Low hemoglobin (protein) concentration in a given volume of packed red blood cells. Can be caused by an abnomality or disease. You would need to get a physician to assertain what is wrong with the patient. Since a low count either shows that blood cells are not being created by the body fast or that their destruction is being speed up - you would need to make this a priority with your investigation... basically by telling the doctor ha In these situations where the person has a low count they are considered amemiac?
 * Full Blood Count: **

**Abnormal parameter - - Urea is high**

this would indicate that there may be a renal problem.urea is used to evaluate kidney function


 * Mid left ventricular hypertrophy and pulmonary congestion resolving **

Question 4

!low potassium haemoglobin low shows anemia 100g/Ll normal is 130-180g/L serum abumin lo low serum albumin 28g/L normal range is 35-47g/L this can be a sign of kidney or liver disease serum albumin 28g/L normal range is 35-47g/L this can be a sign of kidney or liver disease pitting oedema high temp 37.4 short of breath obesity low serum albumin 28g/L normal range is 35-47g/L this can be a sign of kidney or liver disease

CAL short of breath

Coronary Heart disease pitting odeama obesity low serum albumin 28g/L normal range 35-47g/L

Diabetes

Infection

Question 5
Digoxin i ncreases the strength and vigor of heart contractions treatment for atrial fibrillation also called lanoxin :( sad face.. Decreases rate but increases force of contraction.

Nitropatch Preventing chronic chest pain caused by heart disease . It works by relaxing (widening) blood vessels brand names minitran and nitro dur

Slow K mineral supplement used to prevent or treat low amounts of potassium in the blood normally given with lasix because lasix is loop diuretic and is not potassium sparing

DIGOXIN is used in managing cardiogenic shock, congestive heart failure and atrial fibrillation (irregular heart rhythm). This drug increases the force of contraction of the heart muscle (myocardium) and decreases the heart rate. Contraindications include not recommended for patients with ventricullar fibrillation. Also known as Proscillaridin. Digoxin derived from the Digitalis purpurea ( foxglove plant) Must monitor electrolytes, serum creatinine. Not to adminisre if digitalis hypertensitivity has ventricular tachycardia

LASIX is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose and dose schedule must be adjusted to the individual patient's needs. Lasix used for fluid retention due to heart failure or kidney disease potassium depletion drug Should not be given at night. Doses should be given at 0800 and 1200- WHY? as they will be up all night going to the toilet Freusemide is generic name


 * Nitroglycerin transdermal patches** are used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Nitroglycerin transdermal patches can only be used to prevent attacks of angina; they cannot be used to treat an attack of angina once it has begun. Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen

contra: bronchospam incl asthma, severe COPD, sinus bradtcardia, overt cardiac failure ensure eyes are cleaned first Timoptal is also known as Timolol Maleate
 * Timoptol** is used for a b blocker. reduction of elevated IOP IN ocular hypertension, chronic open angle glaucoma.

Question 6
Medical condition lung function test chest x ray exercise limited head of bed raised 02 at 3L/min ECG Daily weight to track Fluid balance changes
 * chronic airways limitation (CAL)**

chest x ray medication for control r/d bladder scanner ECG
 * congestive cardiac failure**

fasting BGL diet medication urinallys glucose tolerance test
 * diabetes /BGL**

KIDNEY DISEASE full blood count fluid balance in/out ultrasound

Q 6 chest xRAY, to see enlargement of heart or any lung conditions ultrasound on the heart, looks at cardiac output full body scan, WHY? blood pressure, Hypertensive fluid intake and out put chart-monitor oedema physiotherapy-for deep breathing to increase lung expansion

Q6 blood glucose, full blood count assesment of skin integrity check for enlargment of the postrate syringe driver to assist with pain pain patch

TPR, Q6 Angiogram, doppler, oxygen volume test. Do you mean arterial blood gases oximetry test, capillary refill, diabetes management QID BGL'S to monitor his levels lasix to reduce the fluid

what else?
 * mri ecg **

angiogram doppler

Question 7
to monitor poor eating habits and education of eating for diabetes Counsellor for alcoholism diabetic educator
 * Nutritionist/Dietitian**

Ulcers not healing has poor vascular return traditional methods ie: caltostat ( seaweed dressings ) has poor mobility and oedema in ankles with chronic recurrent vasculitis.. Ted stockings recommended
 * community nurses** to check ulcers and to montior medications may need home oxygen

someone from aboriginal service to help with education with medical needs. History of client and family diet and habits.. involve whole family if possible in nutritional education.. practical and financiall Refere to **aboriginal health service**
 * meals on wheels**

physio education exercises for mobility social workers for any home care and help needed
 * home care service** to assist with daily living activities.eg showering

Pharmacy webster pack delivery Wound dressings Education of medication and when he is to take it
 * district nursing service **

Community nursing visits to assess medication compliance, Fluid restriction compliance, check vital observations and assist with ADL's

Medication review-? reduce digoxin intake Physio assessment- active and passive exercises to improve circulation and prevent oedema

social worker-assistance with finance, assistance with aids such as glucometer, walking aids support groups (social outings) Dietician- diabetic diet and fluid restriction diet Transport assistance-to attend Medical Appointmernts and diabetic rehab clinic and day care centre for socialisation Aboriginal Liason Nurse-forgot is he Aboriginal Discharge Planner- to ensure all appointments, equipment and services are in place for discharge Meals on Wheels Pastoral visits ACAT assessment Medical Officer