Case Study #3 Care of the Patient after a Total Hip Replacement Surgery

1. What would be three nursing diagnoses for M.Y. based on the data given?

· Impairment in physical movement

· Inadequate knowledge concerning the clinical procedure

· Severe pain

2. What would be three achievable goals that would coincide with the nursing diagnoses for M.Y.’s plan of care for today?

· Demonstrate as well as aid with utilizing mobility supports such as walkers, trapezes, etc., and transfer techniques, in addition to engagement in an exercise regime

· Offer diversion activities and comfort measures such as back rubs and repeated repositioning. Further, offer therapeutic touch when needed and promote stress management approaches which include progressive relaxation, meditation, guided imagery, and visualization.

· Articulate patient understanding of clinical diagnosis and process.

3. List two or three potential complications may occur for M.Y. which would be related to the procedure that she had.

· Hip dislocation

· Fracture

· Formation of leg clots following operation.

· Wound infection

· Leg length changes

· Loosening

4. If M.Y. expresses concerns or anxiety about her eventual discharge, what things could the nurse do to help decrease her anxiety? What referrals might be indicated for this patient?

· The nursing practitioner will aid the patient in deciding upon three coping mechanisms which may be applied for alleviating anxiety symptoms.

· The nursing practitioner will aid the patient in deciding upon a couple of support individuals to provide post-discharge assistance.

· The nursing practitioner will offer referrals to community support groups which may be attended by the patient to help cope with anxiety.

· Lastly, familial support will be ensured for the patient.

Case Study #5

Immune System Function

1. What changes in the immune system in the older adult increase the incidence of infection and cancer in this population?

As the adaptive immune system ages, a condition known as ‘immune senescence’, marked by reduced functionality, sets in. Deficiencies begin cropping up in the adaptive response’s cellular as well as humoral arms, including deficient T-cell functioning with age. Since the thymus forms the key T-cell growth and maturation area, slow thymic output weakening and thymic involution are regarded as the main events in age-related immune senescence. Moreover, an inverse linkage exists between occurrence of several cancer forms and immune function. That is, reduced immune function as an individual grows older is linked to increased cancer occurrence (Foster, Sivarapatna & Gress, 2011).

2. Explain why older adults may have decreased inflammatory responses.

Inflammation represents one of the chief factors in progressive lean tissue degeneration and reduced immune function that are associated with the ageing process. Polymorphisms within anti- and pro- inflammation cytokine genes’ promoter areas impacts aging and cytokine secretion levels. Therefore, a high pro-inflammation cytokine generation genotype leads to elevated secretion of cytokine, potentially speeding up the tissue degeneration process. On the other hand, anti-inflammatory cytokine gene polymorphisms might lead to decelerated tissue degeneration. Among healthy elderly males, the pro-inflammation cytokine polymorphisms have been found to be under-represented, whilst the anti-inflammatory cytokine gene polymorphism is found to be over-represented, suggesting a genetically controlled survival advantage when maintaining low-level inflammation (Grimble, 2003).

3. Why are older adults at increased risk for gastroenteritis and diarrhea secondary to the proliferation of intestinal organisms?

Aged individuals tend to exhibit elevated enteric infection contraction risks, on account of their lower gastric acidity,...

What questions should the nurse include to assess an elderly patient’s immunological status?
· What is the patient’s body temperature? A fever could be indicative of infection

· What is the cognitive orientation of the patient? Are any neurological complications evident?

· Has the patient lost or gained weight? (i.e., weight check)

· Is the patient consuming healthy food? (i.e., dietary examination)

· Does the patient suffer from any intestinal motility issue or gastric infection? (i.e., bowel movement recording)

· Does the patient suffer from any skin allergy or infection? Can any changes be found in the patient’s skin appearance? (i.e., skin examination)

5. List and explain what the nurse should include in the physical assessment to evaluate the patient’s immune system.

Patient physical examination must cover:

· Overall appearance

· Vital signs

· Body temperature, skin color and moisture assessment

· Mucus membranes inspection

· Lymph node palpation

· GU and GI system assessment

· Musculoskeletal system examination

· Respiratory system assessment

· Joint ROM examination

· Neurosensory system assessment

· Cardiovascular system examination

· Skin examination (Quizlet, 2018).

Case Study #6

Endocrine System

Management of a Patient with Hyperthyroidism

1. What is thyrotoxicosis and what are common symptoms of thyrotoxicosis? What are possible causes of thyroid storm?

The term ‘thyrotoxicosis’ refers to a condition characterized by excess thyroid hormone concentration within the body. Overt thyrotoxicosis symptoms are heat intolerance, tiredness, tremors, anxiety, muscle weakness, weight loss, and irregular menstruation (among female patients). The clinical findings can be tremors, moist, warm skin, tachycardia, and lid lag. Thyrotoxicosis may be caused by Graves’ disease, exogenous thyroid hormone, toxic adenoma, and toxic multinodular goiter, among others (Pearce, 2006).

2. What is the normal range for serum calcium and why would it be elevated in Ms. Brown’s case?

Age-based total female calcium reference ranges are:

· Less than one year: Not established

· 1-11 years of age: 9.6-10.6 mg / dL

· 12-14 years of age : 9.5-10.4 mg / dL

· 15-18 years of age: 9.1-10.3 mg / dL

· 19+ years of age: 8.9-10.1 mg / dL

The patient suffers from hyperthyroidism, a condition that has been associated with elevated blood calcium levels. Parathyroid hormone serves to stimulate the bone, reabsorbing the secreted calcium into extracellular fluid. In addition, increased mineral levels are attributable to the enhanced calcium absorption (Sofronescu, 2015).

3. Discuss symptoms of hyperthyroidism.

Hyperthyroidism symptoms are as follows:

· Increased appetite or loss of appetite

· Insomnia

· Fatigue and tiredness

· Heat intolerance

· Heart palpitations

· Diarrhea or the need to frequently clear one’s bowel

· Persistent sweating

· Missed or light menses

· Irritability

· Anxiety

· Mental disturbances

· Fertility issues

· Muscle weakness

· Breathlessness

· Tremors / shakiness

· Sudden paralysis

· Giddiness

· Vision changes

· Either weight gain or weight loss

· Potential elevated blood sugar

· Hair thinning

· Hives…