NUR2102– Clinical Skills for Practice A | Assessment Answer

Case Study One Question: How Should Mrs. Christine Brown's Type 1 Diabetes, With Unstable Glucose and Pain, Be Assessed and Managed?

The aim of the essay is to evaluate the case scenario of Mrs Christine Brown, a patient with diagnosis of type 1 diabetes. She was admitted to the hospital with unstable blood glucose levels. She is not able to take food and has been in considerable pain. The essay will describe the pathophysiology behind type type 1 diabetes and discuss about two assessment cues, nursing diagnosis and nursing tasks linked to the condition.

Type 1 diabetes is a condition that takes place due to the autoimmune destruction of the beta cells of the endocrine pancreas. Both genetic and environmental factors play a major role in the onset of the disease. The condition leads to deficiency of insulin hormone. It is associated with symptoms of polyuria, polyphagia, blurred vision, unintentional weight loss and fatigue. If the condition is not managed adequately, patient may require hospitalization, frequent monitoring and treatment with insulin and intravenous fluids (Paschou et al., 2018).

Two assessment cues that can help to identify the nursing problems are fasting blood sugar level and increase in symptoms of urination. Mrs. Christine is suffering from unstable blood glucose levels and the assessment of fasting blood glucose level can help to evaluate the extent of the problem. It will support identify the issue and initiating appropriate medications (Gordon, 2019). The second nursing assessment that is important is to conduct vital sign assessment. It can help to predict patient health status.

Two nursing diagnosis that has been identified for Mrs. Christine are unstable blood glucose level and risk for infection. The sign of anaphylaxis due to penicillin allergy was found. Penicillin anaphylaxis is a problem as not treating the problem may further lead to deterioration of symptoms and anaphylactic shock. In addition, as patient has a history of T1D, unstable blood glucose level is a concern. Hence, active patient monitoring and implementation of nursing intervention will be important.

The first nursing intervention that will be important is to monitor for signs of hyperglycemia or hypoglycemia and initiate insulin therapy for the management of the conditions. Before initiating the treatment, the patient needs to be assessed for adherence to insulin therapy as she has a long history of T1D. The HbA1C level should be checked to evaluate the stage of T1D and initiate pharmacological treatment accordingly. The main rational for multiple daily injection of insulin is to achieve optimal glycemic control and avoid hypoglycemia or any other adverse effects (Janež et al., 2020). The second nursing task that is important is to initiate intervention for management of penicillin anaphylaxis. As the patient was showing symptom of rigor, there is a need to active monitor vital sign of Mrs. Christine. Vital sign assessment is important because her blood pressure may drop quickly and she may lose consciousness. The use of antihistamines needs to be prioritized to improve symptom and manage anaphylactic shock (Ince & Ruether, P. (2021)..

To conclude, T1D and penicillin anaphylaxis were identified as two major nursing problems for Mrs. Christine. To promote recovery and prevent the risk of complication, routine vital sign assessment, monitoring of blood glucose level and implementation of pharmacological treatment was prioritized.

Case Study Four: How Should Master Jamie Peel's Asthma, Triggered by Peanuts, Be Assessed and Managed, Including Pathophysiology, Diagnoses, and Treatment Tasks?

The essay deals with the case scenario of Master Jamie Peel, a 10 year old boy with a history of mild asthma triggered by peanuts. He has been given emergency EpiPen after accidentally eating peanuts at school. The patient is found to experience wheeziness and lethargy. The essay will explore the pathophysiology behind the condition, two nursing assessment, nursing diagnoses and two nursing task to treatment and manage Jamie’s condition.

The main medical diagnoses identified for Jamie is history of asthma. It is a chronic disorder that leads to airway inflammation, intermittent airflow obstruction and bronchial hyper-responsiveness. The main organ that is affected is the lungs. In the first phase, IgE antibodies are released in response to triggers in the environment such as pollens or allergens. The inhalation of pollutants triggers the release of cytokines from the mast cells. Other mediators that are released are histamine, prostaglandins and leukotrienes. These cells result in contraction of the smooth muscles and airway tightening. In the late phase, all the eosinophils, basophile and helper T-cells localized to the lung and causes bronchoconstriction. These pathophysiological changes lead to symptom of wheeziness and lethargy in patients. Similar symptom was found for Jamie (Sinyor & Perez, 2022).

Two important nursing assessments that needs to be prioritized for Jamie is to assess the respiratory status of patient. It can help to assess the severity of the symptoms. A focused respiratory assessment involves evaluating breathing pattern, skin colour and palpation to identify abnormalities. Assessment of lung function is important to predict airflow limitation and this can be done through spirometry (Majellanon et al., 2021). In addition, chest auscultation should be conducted to identify wheezing sound. Wheezing is an indication of airway obstruction and it can give the clue for types of interventions to be implemented for the patient (Hew et al., 2020).

Two important nursing diagnosis that have been identified for Jamie are ineffective breathing pattern and ineffective airway clearance evidenced by symptom of wheezing and lethargy. The goal of care will be to improve airway clearance and maintain optimal breathing patterns. To address the problem, the firsts nursing intervention that needs to be prioritized is administer short acting beta-2 adrenergic agonist to patient. It is a bronchodilator that can relax the smooth muscles and clearing the airways. They can reverse symptom of asthma and improve lung function in patients (Janson et al., 2019). The bronchodilator that was prescribed to Jamie was Salbutamol. To promote efficacy of the drug, it is planned to provide teaching on correct use of the drug via metered dose inhaler and spacers. The benefit of this intervention for patient is that it will provide relief from symptom of wheezing and breathlessness. The second nursing intervention that is important for patient is to implement non-pharmacological intervention such as breathing exercise. Breathing exercise can help patient to control the symptom of hyperventilation. It helps ease breathing symptoms, lung function and promotes the quality of life of patients. Different breathing techniques that are available are lateral costal breathing, pursed-lip breathing and diaphragmatic breathing. As per patient preference, it is planned to educate patient about breathing exercise (Macedo et al., 2016).

To conclude, asthma is a condition that is triggered by exposure to allergens. The essay discussed about the pathophysiologic of the condition and identified use of bronchodilators as the mainstay of treatment. In addition, to control the recurrence or relapse of symptoms, it was planned to engage patient in breathing exercise such as pursed-lip breathing, diaphragmatic breathing and lateral costal breathing as per the preference of patient.

References

Gordon, C. (2019). Blood glucose monitoring in diabetes: rationale and procedure. British Journal of Nursing, 28(7), 434-439. https://pubmed.ncbi.nlm.nih.gov/30969870/

Hew, M., Menzies-Gow, A., Hull, J. H., Fleming, L., Porsbjerg, C., Ten Brinke, A., ... & Tay, T. R. (2020). Systematic assessment of difficult-to-treat asthma: principles and perspectives. The Journal of Allergy and Clinical Immunology: In Practice, 8(7), 2222-2233. https://pubmed.ncbi.nlm.nih.gov/32173508/

Ince, M., & Ruether, P. (2021). Histamine and antihistamines. Anaesthesia & Intensive Care Medicine, 22(11), 749-755. https://www.sciencedirect.com/science/article/abs/pii/S147202992100

Janež, A., Guja, C., Mitrakou, A., Lalic, N., Tankova, T., Czupryniak, L., ... & Smircic-Duvnjak, L. (2020). Insulin therapy in adults with type 1 diabetes mellitus: a narrative review. Diabetes Therapy, 11, 387-409. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995794/

Janson, C., Malinovschi, A., Amaral, A. F., Accordini, S., Bousquet, J., Buist, A. S., ... & Jarvis, D. (2019). Bronchodilator reversibility in asthma and COPD: findings from three large population studies. European Respiratory Journal, 54(3). https://pubmed.ncbi.nlm.nih.gov/31221806/

Macêdo, T. M., Freitas, D. A., Chaves, G. S., Holloway, E. A., & Mendonça, K. M. (2016). Breathing exercises for children with asthma. Cochrane Database of Systematic Reviews, (4). https://pubmed.ncbi.nlm.nih.gov/27070225/

Majellano, E. C., Clark, V. L., Winter, N. A., Gibson, P. G., & McDonald, V. M. (2019). Approaches to the assessment of severe asthma: barriers and strategies. Journal of asthma and allergy, 235-251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712210/

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine connections, 7(1), R38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776665/

Sinyor, B., & Perez, L. C. (2022). Pathophysiology of asthma. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551579/

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