HLTAAP003 Assignment: Analyse and Respond to Client Health Information

Read the workplace simulated scenarios on the following pages and answer the questions related to the information provided in each case study scenario.

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 1

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

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

• Define homeostasis and name the three components that make up any biological homeostatic control mechanism

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

Further Information:

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.

HLTAAP003 Assignment: Analyse and Respond to Client Health Information

Question 2.

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

• Define atrophy

• What does the term ‘surgical insult’ mean?

Question 3.

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

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

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

• Why does the EN need to know the purpose of blood collection?

• 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.

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Question 4.

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

• Describe the steps of atheroma formation:

• Name three factors that trigger endothelial inflammation:

• How do high and low density lipoproteins contribute to atheroma formation?

• What is the role of macrophages in relation to atheroma formation?

• 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 5.

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

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

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

Question 6.

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.

HLTAAP003 Assignment: Analyse and Respond to Client Health Information

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:

Weight: 95kg

Height: 164cm

BMI 36

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

Question 7.

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

• What body systems and/or organs can be affected by T2DM?

• Name five risk factors for developing T2DM:

• Describe appropriate treatment for a patient such as Mrs Thompson who has T2DM

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

• What is required to ensure a cell remains healthy?

Question 8.

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.

RR:   26

SpO2:  93%.

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 9

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

• Describe what occurs during normalexternal respiration.

• Describe what occurs during normalrespiratory gas transport. Discuss how O2 and CO2 are transported in the blood

• Differentiate between pulmonary ventilation, internal respiration and cellular respiration.

• Briefly explain what respiratory acidosis and respiratory alkalosis are:

Question 10

Describe the steps involved in homeostasis of respiratory rate – include the following in your answer

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

• Where is the respiratory control centre located?  What is the stimulus that causes the respiratory control centre to increase respiratory rate?

• 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

• How does administration of supplementary oxygen help to maintain homeostasis of respiration?

• 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.

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

• Explain how you would prepare for a urinalysis test?

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

• What symptoms could the patient be experiencing if she has a UTI?

• 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.

• 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.

Question 14.

• List five (5) oral health diseases

• 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:

Serepax: 10mg  at night

Metoprolol: 50 mg twice per day

Aspirin: 100mg in the morning.

Metforman: 500mg BD

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

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

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

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.

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

• Why does Peter need a high calorie diet and pancreatic enzyme supplementation?

• How does CF contribute to malabsorption of nutrients in a teenager?

Further Information:

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

• 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.

• List three (3) common emergencies experienced by divers.

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Scenario 1 – Mrs Chan

1.

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

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

Hypothermia refers to a condition where the body loses more heat than it produces result in a state of abnormally low temperatures.

In her case, the causes would have been:

1. Lying on the floor for a long period increases the rate of loss of heat
2. A removal of melanoma can alter the thermoregulatory mechanisms of the skin hence its inability to respond to decreased temperatures
3. The use of fentanyl, an opioid, has an effect on the central thermoregulatory centres in the brain and is associated with hypothermia, (Yoo, Lee& Suk, 2015).

• Define homeostasis and name the three components that make up any biological homeostatic control mechanism.

It refers to the continuous attempt of the body to maintain a constant internal environment

Components of a homeostatic control mechanism include:

• Sensor
• Control centre
• Effector

 

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

Shivering which increases muscle contraction to generate heat. It is a centrally mediated mechanism in the thermoregulatory centre (Werner, 2018).

The erector Pilli muscle will contract causing the hair to stand erect maintaining the air along the surface which is warm lowering the rate of diffusion

Vasoconstriction to shunt blood away from the body surface reducing the rate of loss

Increased metabolism in the liver to generate more heat through exothermic reactions. Heat resulting from theses reactions is distributed to other parts

Decreased rate of sweating to decrease the rate of heat loss through the skin.

Further Information:

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.

2.

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

Hyperplasia refers to an increase in the number of cells in a tissue. For example, the increase in cells in breast tissue in puberty due to hormonal influence.

Hypertrophy refers to an increase in the size of the cells in a tissue or organ which results in a general increase in its size. For example, hypertrophy of the cardiac muscle of the left ventricle in stenosis of the aorta.

Metaplasia refers to an abnormality in cellular differentiation. An irreversible change where an adult cell type is replaced by another adult cell type. For example, a change from columnar epithelium to stratified squamous epithelium in the respiratory epithelium of cigarette smokers

Dysplasia refers to an abnormality in cellular development. There is an abnormal cell proliferation which is usually non-neoplastic for instance an increase in the number of epithelial layers. There are also some cytology changes in the cells that differ from the normal cells. For instance, loss in the basal cell polarity.

• Define atrophy

it refers to the shrinkage of a cell due to the loss of cellular substance resulting in the decrease in size of a tissue or the organ. May result from factors such as decreased work load, diminished blood supply or loss of innervation.

• What does the term ‘surgical insult’ mean?

It refers to the physiological response of the body following stress inflicted on the body due to a surgical procedure. It is usually a multisystem approach producing a particular outcome. They all produce an additive effect. HLTAAP003 Assignment: Analyse and Respond to Client Health Information

3.

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

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

General practitioner

Practice nurses and Community health nurse

Psychiatrists

Physiotherapists and occupational therapists

Dieticians

Social workers

Health educators

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

The general practitioner is usually the first contact with the patient. They take history, examine and order for tests to confirm a diagnosis.

In the case of a mental illness, a psychiatrist will make the diagnosis and interpret the tests.

A nursing diagnosis is done and the care plan formulated.

• Why does the EN need to know the purpose of blood collection?

In order to collect it in the right specimen bottle for a particular intended test. For example, blood for hemogram would be differently collected than that for a coagulation screen.

In order to send it to the right laboratory for testing and confirmation of diagnoses.

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

No.

Pathology results can only be well interpreted be the doctor who requested the test. The doctor is only one in the best position to disclose them since after taking a history and making the examination, they can make a meaningful diagnosis.

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

Incomplete …