Helen McHugh
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Why is dehydration and electrolyte imbalance a danger?
Dehydration is described as ‘an excessive loss of water from body tissues’ (Mosby Elsevier, 2009) and it also affects an imbalance of electrolytes in the body. It can be very dangerous and even fatal as most of the physiological systems in the body are dependent on water levels and the changes in concentrations of the electrolytes will disturb almost every vital function of the body. (Martini & Nath, 2009)
How have the functions of the skin been impaired?
The body’s first line of defence has been breached, allowing pathogens and bacteria to penetrate the body as well as impairing its ability to regulate temperature, synthesis Vitamin D and loss of some senses i.e. touch, pressure.
How will the body try and repair the areas that have been burnt?
This will happen in three stages, Inflammation, Reconstruction and Maturation.
Inflammation – this stage takes approximately 3 days and happens immediately the wound occurs. The inflammation causes an increased blood flow to surrounding tissues which produces erythema, swelling, heat and discomfort. As a defence response, different types of white blood cells called polymorphonuclear leucocytes arrive at the wound and are involved in the immune response to fight infection.
Reconstruction – This stage can take from between 2 – 24 days and is a time of cleaning and temporary replacement of tissue. Polymorphs kill the bacteria and phagocytic macrophages digest the dead bacteria and clean the wound. Epidermal cells start to activate, new blood capillaries are developed and granulation tissue is laid down. Epithelial cells move over the granulation from the edges of the wound. When the wound is covered the epithelium thickens to 4-5 layers, forming the epidermis. The wound would then start to contract reducing in size.
Maturation – This stage can take between 24 days to 1 year. This is the remodeling stage where collagen cells are reorganized and strengthened. The wound is still at risk during this stage and protection is necessary. (Koutoukidis, et al., 2013)
What could impede the body from successfully achieving this? Think of internal and external factors when you answer this.
Intrinsic- (Internal)
Health Status – Illnesses/Conditions/Diseases can affect healing, i.e. anaemia, immune disorders, cancer, diabetes.
Age – Older people take longer to heal due to slower metabolism, thinner skin and less elasticity of skin.
Bodybuild – Both Obese and Thin people can have various issues related to healing
Lifestyle factors – Smoking, Alcohol can have contraindications to healing
Nutritional status
Extrinsic (External)
Mechanical stress
Debris – scabs, necrotic tissue, and excess slough can all impair epithelial migration and supply of nutrient. Also prolongs inflammatory stage.
Temperature – Extremes can cause tissue damage
Desiccation or maceration – Both dryness and excess moisture can slow healing
Infection – Bacteria slows wound healing
Chemical stress
(Lumsden, 2014)
Mary undergoes debridement of the burns. What does this mean?
Debridement is the first step in cleansing. It is to remove dirt, foreign objects, damaged tissue and cellular debris from wound/burn which promotes healing and helps prevent infection.
(Mosby Elsevier, 2009)
The burns were subsequently grafted with a split skin graft. What layers of the skin are used for this graft?
A split thickness skin graft is a tissue transplant using both the epidermis and part of the dermis layer.
(Mosby Elsevier, 2009)
3.1
Admission Form
Acute Pain Observation Chart
Observation chart
Fluid Balance Chart
Medication Chart
Neurovascular Chart
Intravenous Drug Chart
Care Plan
Progress Notes
4.2
Define Hypertension and Arteriosclerosis
Hypertension – Elevated blood pressure consistently over 140/90
Arteriosclerosis – A thickening/ calcification of arterial walls and loss of elasticity in arterial walls. The result of this is reduced blood supply.
(Mosby Elsevier, 2009)
How are they often related?
High blood pressure (hypertension) can cause a build up of the muscular and elastic tissues of the arterial walls – hypertensive arteriosclerosis
(Mosby Elsevier, 2009)
Why is hypertension called the ‘Silent killer’
Hypertension is called the silent killer because it can often be asymptomatic, i.e. no symptoms are apparent. There is no single cause but there are possible risk factors.
(Mosby Elsevier, 2009)
Name three changes in your lifestyle that may help prevent cardiovascular disease in old age.
Do not smoke, Eat healthy and exercise more.
Undesirable clot formation can occur as a result of endothelial damage due to arteriosclerosis. How does the body form undesirable clots within intact blood vessels?
If the endothelium of a blood vessel is rough it can encourage clinging of platelets which can be a risk factor for blood clotting (Thrombus)
The legs are particularly prone to the formation of blood clots and can be caused by blood pooling in the legs or slowly flowing blood especially in immobilized patients.
(Marieb, 2003)
5.2
At handover you are told a patient is cyanotic. What would you expect to observe? Define tissue hypoxia. Three conditions where this could occur.
Cyanosis presents as a bluish discolouration of the skin and mucous membranes caused by not enough oxygen in the blood and excess of deoxygenated blood.
I would expect to see a bluish colour on the skin of the patient, possibly on lips, nailbeds, tip of the nose, external ear and underside of the tongue.
Three conditions where this could occur are
Asthma
Emphysema
Heart failure
5.3 Describe the difference between tracheostomy and endotracheal intubation.
An endotracheal intubation is a flexible cuffed tube inserted via the mouth or nostril through the larynx into the trachea, whereas a tracheostomy is a surgical creation of an external opening into the trachea.
(Koutoukidis, et al., 2013)
5.4 Why will a patient who is anaemic complain of shortness of breath?
Being anaemic means that you do not have enough red blood cells in your body. The red bolos cells carry oxygen around the body and remove carbon dioxide. Fewer less red blood cells equals less oxygen which equals shortness of breath.
(Koutoukidis, et al., 2013)
5.5. What type of allergic reaction is suspected?
Anaphylaxis is suspected. This condition may be fatal.
Why has this caused problems with his breathing?
The upper respiratory tract is often involved with nasal congestion or sneezing and tightness in the throat may occur with significant airway obstruction. The patient can have bronchospasm or upper airway swelling
(S Shahzad Mustafa, 2013)
6.1 Sever appendicitis, what would be result if left untreated?
The appendix can perforate spilling the contents into the abdominal cavity causing peritonitis.
(Koutoukidis, et al., 2013)
6.2 Why does a lack of fibre in the diet encourage the formation of diverticula?
Faeces usually move along the large bowel with gentle peristalsis; however when there is insufficient fibre in the diet the faeces may become dry and is more difficult to move along with peristalsis. The intestinal muscles then have to perform strong contractions and generate high pressure. This high pressure may cause bulging pouches in the intestinal mucosa and these are called diverticula.
(Murtagh, 1995)
6.3 Explain why obstruction in the common bile duct causes interference with the digestion of some foods?
An Obstruction would prevent bile from entering the small intestine. The bile is needed to aid digestion and is needed to breakdown large fat globules into small ones. When the food is not digesting properly bile can back up into the gallbladder. It then becomes concentrated by removal of water and the cholesterol it contains may crystallize and form gallstones. Blockage of the common bile duct can also stop bile entering the small intestine and backing up into the liver and bile salts and bile pigments will begin to enter the bloodstream and as this circulates through the body the tissues will become yellow or jaundiced.
(Marieb, 2003)
6.4 What nursing observations of their skin, faeces and urine would support the diagnosis of an obstructed bile duct? Where would these observations be recorded?
Bilirubin levels will increase in the blood and this can cause yellow, jaundiced skin, dark urine and pale coloured faeces. Itching of the skin may also occur.
Recorded in progress notes, fluid balance and bowel chart and observation chart, care plan and urinalysis.
(Marieb, 2003)
8.2 Adrenaline affects the sympathetic nervous system. Explain the effect on blood pressure, heart beat, breathing and the liver.
Blood Vessels – Constricts blood vessels In viscera and skin, increases blood pressure
Heart – Increases rate and force
Liver – Causes glucose to be released to blood.
All of these effects are part of the fight or flight response. The body alters its normal state to one of optimum performance in order for us to take flight (run faster) the heart beat starts to pound, our breathing gets deeper, driving oxygen around the body and glucose is released into the blood stream to give us energy.
(Marieb, 2003)
9.1 Explain why someone who is haemorrhaging, i.e. has falling systemic blood pressure/volume will have a decreased urine output.
When there is significant blood loss the blood pressure falls and the blood pressure in the renal artery will also fall. The body tries to raise the blood pressure by preventing further water and electrolyte loss. To do this the kidney secretes the hormone ‘renin’ which stimulates other hormones to cause vasoconstriction (Marieb, 2003)
References:
Koutoukidis, G., Stainton, K. & Hughson, J., 2013. Tabbner’s nursing Care Theory and Practice. 6th ed. NSW: Elsevier.
Lumsden, S., 2014. Wound Management – Class Notes. Adelaide: s.n.
Marieb, E., 2003. Essentials of Human Anatomy and Physiology. 7th ed. San Francisco: Pearson Education Ltd.
Martini, F. & Nath, J. L., 2009. Fundamentals of Anatomy and Physiology. 8th ed. San Francisco: Pearson Education Inc.
Mosby Elsevier, 2009. Mosby’s Dictionary of Medicine, Nursing and Health Professions. 8th ed. s.l.:Mosby.
Murtagh, J., 1995. Diverticular Disease. [Online] Available at: http://www.nevdgp.org.au/info/murtagh/general/Diverticulardisease.htm [Accessed 25th February 2014].
S Shahzad Mustafa, M., 2013. Anaphylaxis Clinical Presentation. [Online] Available at: http://emedicine.medscape.com/article/135065-clinical [Accessed 25th February 2014].
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