NUR2023 Pathophysiology, Pharmacology and Nursing Management Sample

NUR2023 Pathophysiology, Pharmacology and Nursing Management

Assignment Brief

This assignment is based, similarly, on your workbook from NURS2020 – however please read the questions carefully. You will be provided with some time in class each week to work on these individually. Your tutor will be available to clarify any points or guide you with elements such as referencing (which is compulsory) or paraphrasing. It is not the role of the tutor to give you the answer.

TASK: You are required to complete all questions below

Question 1

Betty Shale is 53 years old in the advanced stages of chronic kidney disease (CKD). On assessment at the clinic today, Betty tells you she has been feeling more tired and fatigued than usual and has also noticed that she is more and more short of breath, especially when doing normal daily activities. She appears tired and has multiples bruises to her arms which she states “seem to come from nowhere” although she does recall bumping into some furniture recently.

• Identify what condition (related to CKD), these symptoms Betty is experiencing indicate, and

• Demonstrating your knowledge of pathophysiology, explain how this condition you have identified, is linked back to CKD?

Question 2

41-year-old Patrick Granite has been diagnosed with renal calculi. He presented with excruciating pain to the Emergency Department (ED) describing pain which “moves” radiating from his back to his groin; on presentation he was administered a strong analgesic (Morphine). Now on the ward, Patrick indicates his pain has increased again. The Registered Nurse administers prescribed PRN analgesic Oxycodone 5mg and 1g of Paracetamol. Patrick is confused about his condition and asks you what is causing this intense moving pain.

• Explain to Patrick what is occurring in his body to cause this pain.

In your explanation, you need to outline the pathophysiology of this condition so that the marker will recognise your understanding, but also that the patient will understand.

Question 3

Robert Pebble has presented on the ward today with a history of heart failure. He has notably oedematous legs and “puffy” fingers. In your role as the RN, you have been requested to administer Frusemide/Furosemide.

• What class of drugs is Frusemide categorised as?

• Briefly explain the pharmacodynamics of this medication (your answer must demonstrate your understanding, to support any technical terms)

• Explain briefly how Frusemide can affect potassium levels in the body.

Question 4

A hypovolaemic patient may require fluid replacement to restore blood pressure and blood volume.

• Would you consider normal saline to be a medication? Please provide justification with your answer.

• Explain the difference between a hypotonic solution and an isotonic solution and an example of when each may be given to a patient.

Question 5

Mary Basalt is 22 years-old and has been diagnosed with Endometriosis.

• Please correctly write out a nursing problem/diagnosis around pain and provide a non-pharmacological intervention/s* with appropriate rationale.

Question 6

Chappy Sand is 69 years-old and of Aboriginal and Torres Strait Islander background; he has been admitted for monitoring overnight due to ECG changes on admission. In conversation today, Chappy was reflecting on how he came to be in the hospital. He states, “I was really sick with heaps of diarrhoea and vomiting right, and then over a bit of time, I started feeling really weak, like my legs couldn’t hold me and a couple times I even passed out because I was so dizzy, I was really scared hey! .... And now the doc is saying he needs to look at my heart”.

• Demonstrate your [formal] knowledge of the pathophysiology of hypokalaemia by linking Chappy’s signs and symptoms with the condition.

• With this knowledge, what self-care strategies might you suggest to Chappy should this happen again?

• Is there any other multi-disciplinary team member you think you could involve in the care and education of Chappy? Please justify your answer.

Solutions

Question 1

As manifested through the symptoms, Betty Shale is going through the stage 3 CKD, as identified through her symptoms. The symptoms indicate her shortness of breath and extreme fatigue. At this stage, creatinine levels decrease, resulting in the patient's diabetes, hypertension and heart failure. The patients should be entrusted with sincere caregivers who can restore stability and balance. People become the victims of forgetfulness at this stage due to the development of CKD. Pathophysiology denotes the condition of disoriented psychology when intracranial hypertension is not manageable for MBA assignment expert.

The symptoms that have been identified in Betty Shale are related to CKD. A reduced rate of glomerular filtration can cause fatigue this time. The concomitants of the unexpected changes in the physique also result in the psychological turmoil (Luyckx, Cherney & Bello, 2020). The chronic disease has the tendency to spread toxin throughout the body the increased chemicals in body tissues lead to sepsis gradually (Heerspink et al., 2020).

Question 2

It is to be explained to Patrick that the excruciating pain from left to back results from haematuria (the tendency of urine in blood).

Crystal formation in the kidney might account for conditions such as vomiting, burning feelings and chilled fever (Fontenelle & Sarti, 2019). There are chances of urine retention and health complications such as infection and damage to the kidney. Patrick needs to be operated immediately to eliminate cases of kidney infection. The rise in struvite, uric acid and calcium can bear severe implications for the future (Madaminov&Shernazarov, 2022). The pain can continue to increase and if needed, Patrick must undergo the immediate surgery. This can adversely impact Patrick's life quality, such as disruption of regular activities, sleep disturbance, and emotional stress.

Non-steroidal analgesic and paracetamol are being provided to Patrick to lessen inflammation. The enhanced pain is interconnected to the pain in the abdomen, which results in nausea and other severe conditions.

Question 3

Furosemide, the category of drugs known as loop diuretics, helps treat swelling and fluid retention that can be the output of heart failure, kidney, liver and other related diseases.

Loop diuretics work ion (NKCC2) to prevent chloride potassium sodium re-absorption. Pharmacodynamic mechanisms monitor the effects of Furosemide on the human body.The application of drugs helps in the faster absorption of water and sodium, which can help increase urine production (McMahon & Chawla, 2021). It assists in reducing the scope of fluid retention along with oedema. This drug helps in the treatment of diverse conditions such as oedema, hypertension and congestive failure of the heart, as identified in the condition of Robert Pebble.

Furosemide helps in the depletion of potassium levels in the human body. Consequently, the renal tubule keeps the ion and present it to the distal nephron. This can increase the side effects that can follow the ischemic injury and bring in the functional impairment of the kidney. The drug can help the kidney to excrete high amounts of potassium in the urine. This can stimulate the condition of hypokalaemia which makes the blood level in the human body low. It can lead to severe health conditions such as cardiac arrhythmias.

Question 4

The process of normal saline is related to fluid resuscitation, which restores the bodily fluids lost due to bleeding, fluid shifts and sweating. Normal saline, popularlyknown as Sodium Chloride, is used for treating hypovolemia. The infusion of Normal Saline brings back salt and raises the level of electrolyte. The chemical composition of normal saline is quite similar to the specification of natural fluid present in the human body (Zwager et al., 2019). Therefore, it is recognised as a safe medication that can be applied to the human body for hydration. The isotonic nature of normal saline reduces the level of cellular stress in the human body at times of medical administration.

Isotonic solutions contain equal osmotic pressure, while that of the pressure present in hypertonic solutions is lower. In a hypertonic solution, the cell obtains more water through osmosis as more water is found outside the cell. An isotonic solution contains no water circulation as there is equilibrium between the water outside and inside the cell.(Zwager et al., 2019). As an example, Isotonic solutions can be given to patients to maintain blood pressure, while hypertonic solutions can be given to patients with cerebral oedema.

Question 5

Nursing Problem: The nurse has to deliver the care rated to pain and the assessment, planning, diagnosis, evaluation and implementation. Mary Basalt suffers from endometriosis and the nurse is entrusted with the duty to constantly observe the patient, record the activities and change bandages. The nurse's responsibility is to have comprehensive knowledge concerning menstrual disorders (Leoni‐Scheiber, Mayer & Müller‐Staub, 2019).

Goal: The goal of the nurses is to bring about a reduction in the pain felt by the patient. The comprehensive goal is to relieve the pain with non-pharmaceutical processes such as exercise, sleep and therapy. This can be done by making the patient know about the symptoms, medical treatment and along with knowledge about potential complications (Leoni‐Scheiber, Mayer & Müller‐Staub, 2019).

Nursing Intervention: The intervention of nursing consists of giving proper care to the patient. In addition, the nurse can provide emotional support to the patient. The main objective is to get the patients relief from the intolerable pain of menopause and initiate infertility treatment. The nurses must assess the situation by identifying the severity of the disease. Then, the treatment will be provided to the patient according to the age. There can be non-pharmacological interventions that can include exercise, dietary habits and sleep intake.

Rationale: The nursing intervention of giving care is needed to manage medication. It can help the patient with pain relief and evaluate the side effects of the medicines. The nurses can further intervene by offering counselling and emotional assistance. It can help the patient in coping with the dynamic influence of endometriosis. This is essential, particularly in the case of Basalt, who is only 22 years old.

Evaluation/Outcome: The outcome of the nursing role results in faster recovery for the patient. The cure to endometriosis makes social, economic and public health better. Endocentric experience disrupts the social life of a person. Mary Basalt is expected to be free from infertility, anxiety and depression.

Question 6

As suggested by the symptoms, Choppy is suffering from the signs of hypokalaemia, which is iatrogenic-ally induced. This can result from the imbalanced potassium intake, leading to chronic heart failure and the consequent disaster. Impoverished intake of the constituents results in an intracellular shift which can be disastrous (WBHF, 2023). Choppy, suffering from diarrhoea and overnight vomiting, might be the victim of hypokalaemia. The metabolic alkalosis and decreased blood pressure can be why he sometimes feels dizzy and fails to stand straight.

The strategies must entail the measurement of potassium in the urine. The victim can do an ECG to assess the proper condition of the heart. Laxatives can be excluded from the list of diets and the person must comprehend the values of the parental nutritional diet. The potential strategies can be used to identify toxicities and inflammation in the body (Lederer, 2023). Surgical care must be catered to the patient suffering from the intensity of the disease. If this happens again, the patient must immediately be administered to the hospital to diagnose the condition.

The presence of a multidisciplinary team member can be helpful to Chappy. He can offer value-based care and take strategic initiatives to treat the patient immediately. Discontinuing diuretics is the alternative solution that the member can take. ECG monitoring can be taken seriously and the low magnesium level must be taken care of.

Reference List

Fontenelle, L. F., & Sarti, T. D. (2019). Kidney stones: treatment and prevention. American family physician, 99(8), 490-496. Retrieved from:https://fmhub.org/wp-content/uploads/2021/08/Kidney-Stone.pdf

Heerspink, H. J., Stefansson, B. V., Chertow, G. M., Correa-Rotter, R., Greene, T., Hou, F. F., ... & Wheeler, D. C. (2020). Rationale and protocol of the
Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomised controlled trial. Nephrology Dialysis Transplantation, 35(2), 274-282. DOI:https://doi.org/10.1093/ndt/gfz290

Lederer, E. (2023, June 13). Hypokalemia. Practice Essentials, Pathophysiology, Etiology. https://emedicine.medscape.com/article/242008-overview#:~:text=Hypokalemia%20is%20a%20potentially%20life,is%20the%20most%20common%20m

Leoni‐Scheiber, C., Mayer, H., & Müller‐Staub, M. (2019). Measuring the effects of guided clinical reasoning on the Advanced Nursing Process quality, on nurses’ knowledge and attitude: Study protocol. Nursing open, 6(3), 1269-1280. DOI: 10.1002/nop2.299

Luyckx, V. A., Cherney, D. Z., & Bello, A. K. (2020). Preventing CKD in developed countries. Kidney international reports, 5(3), 263-277. DOI:https://doi.org/10.1016/j.ekir.2019.12.003

Madaminov, M., &Shernazarov, F. (2022). Causes, symptoms, diagnosis and treatment of kidney stones (urolithiasis). Science and Innovation, 1(8), 760-765. DOI:https://doi.org/10.5281/zenodo.7441802

Maruhashi, T., Kajikawa, M., Kishimoto, S., Takaeko, Y., Yamaji, T., Harada, T., ... & Higashi, Y. (2022). Serum potassium levels of 4.5 to less than 5.0 mmol/L are associated with better vascular function. Journal of Atherosclerosis and Thrombosis, 29(11), 1588-1602. DOI:http://doi.org/10.5551/jat.63285

McMahon, B. A., & Chawla, L. S. (2021). The furosemide stress test: Current use and future potential. Renal Failure, 43(1), 830-839. DOI:https://doi.org/10.1080/0886022X.2021.1906701

WBHF (2023) Management of hypokalemia, Management of hypokalemia - walter Bushnell Healthcare Foundation. https://wbhf.walterbushnell.com/index.php?option=com_k2&view=item&id=13%3Amanagement-of-hypokalemia&Itemid=326 (Accessed: 08 August 2023)

Zwager, C. L., Tuinman, P. R., de Grooth, H. J., Kooter, J., Ket, H., Fleuren, L. M., & Elbers, P. W. (2019). Why physiology will continue to guide the choice between balanced crystalloids and normal saline: a systematic review and meta-analysis. Critical Care, 23, 1-13. DOI:https://doi.org/10.1186/s13054-019-2658-4