Questions Related To Nursing Case Study :
1. Explanation of the pathophysiology of three signs and symptoms that Jamee has shown to indicate dehydration in Given Nursing Case Study:
It can be assessed that Jamee has suffered dehydration as mentioned in the given Nursing Case Study. Infants and small children develop dehydration due to gastroenteritis with vomiting and diarrhea, at the same time refusing food intake. In infants, a slight dehydration can lead to a weight loss of 5%, at 10%, the dehydration is serious and medium. If the weight loss is 10 to 15%, it is a case of severe dehydration (Stachenfeld, 2012, p.370). Older children are more sensitive to some of the fluid loss. It can be assessed from the case study that Jamee is dehydrated due to the following symptoms:
Vomiting: Repeated vomiting leads to water loss, which can cause dehydration. Jamee has vomited quite a few times in the span of 3 days. She has mostly thrown up whatever she has been fed. In the last instance of vomiting, she has also thrown up blood. If the water content of the body is too low, bleeding happens. Thus, this indicates that she is dehydrated.
Reluctance to eat: A common smptom of dehydration is reluctance to eat. Jamee has been reluctant to eat for the past few days, and has mostly vomited. Thus, from this symptom, it can be concluded that she is dehydrated.
Change of behaviour, mood, etc.: Dehydration impacts moods of the affected negatively. It can cause confusion, irritability, fatigue, etc. The case suggests that though Jamee is normally a social and happy child, she has been tired and flat lately. Her mood is negative. This implies that she is dehydrated (Stachenfeld, 2012, p.90).
Thus, from the different symptoms assessed above, it can be confirmed that Jamee is dehydrated present in Nursing Case Study.
2.1 Discussion of the tests that were ordered for Jamee and explanation of why they were chosen in regards to the chosen element:
In order to diagnose the problem, the health care professionals involved in the scenario, are most likely to suggest a blood test. The blood will be taken from the patient and transferred to equipment and analyzers to evaluate the composition and the factors that indicate problems or diseases. Often examinations are conducted in a laboratory for analysis, but in recent years, thanks to the miniaturization of technology, one can move the equipment to the patient, with the analyzers portable or point of care shown in Nursing Case Study. The evaluation of the measurements, in order to derive a clinical picture, is done by a medical specialist (Sullivan, 2012, p.220).
2.2 Discussion of any results that were given and what they add to the diagnosis/element:
The blood test report is likely to reveal hypoalbuminemia. This denotes a reduced concentration of the plasma protein albumin in the blood plasma of Jamee. It is caused by reduced formation of albumin due to chronic liver damage, malnutrition, or by albumin loss that can be carried in acute inflammation and burns or via the kidneys in renal damage. In case of Jamee, malnutrition is probably the key cause. In the absence of albumin colloid osmotic pressure falls in the blood plasma. In turn, water can not be kept in physiological amounts in the vascular system and enters the interstitium, leading to edema. Since albumin is most represented in the human body protein and, inter alia, used for the transport of endogenous (for example hormones) and exogenous (eg drugs), substances, it is responsible for the effectiveness of a deficiency in the blood and albumin (Cordes, 2011).
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2.3 Discussion of any tests that should have been ordered and expected results:
Ideally, an urine test should have been ordered. This can be highly effective in the detection of red or white blood cells. It can be used to assess whether urine is centrifuged and the urine sediment is examined under the microscope. Red blood cells in urine indicate a hemorrhage from the kidneys and urinary tract and can indicate kidney cancer, urinary stones or diseases of the renal corpuscle. White blood cells in urine, however, usually indicate a urinary tract infection. The most common cause of protein in the urine test strips are diseases of the renal corpuscle such as diabetic nephropathy, nephrosclerosis or glomerulonephritis. This test is needed for Jamee as she has vomited blood. It is important to assess whether her urine has blood too. Urine test can also help assess loss of albumin, which is a cause of dehydration. A moderately elevated loss of albumin in the urine (> 300 mg Protein/24h), is not classified as harmless and can be an incipient preeclampsia. It can indicate a loss of > 3g Protein/24h. This is referred to as heavy loss (Dedomenico, 2013), Please referred from given Nursing Case Study
3. Implications of prescribing Benzyl Penicillin 300mg IV 4/24 and Salbutamol 2.5mg 4/24:
Benzyl Penicillin 300mg IV 4/24:
Benzyl Penicillin 300mg IV 4/24 has been prescribed as it is used for infections caused by pathogens. Jamee has probably been affected by such a pathogen (MyVMC, 2014).
Pharmacodynamics: This medicine can prevent the development of bacterial endocarditis. Benzylpenicillin intiates bactericidal action against Nursing Case Study micro-organisms which are the causes of infections.
Pharmacokinetics: Benzyl Penicillin has effect for 4-6 hours. If kidneys function normally, 70% of the medicine is excreted in 6 hours. 30% becomes inactive in liver and 4.5% gets excreted through bile. The half life becomes greater if the kidneys do not function properly. Neurotoxicity can be caused if big intravenous doses are given to a patient (MyVMC, 2014).
4. Low urine output:
Low urine output is a major problem which should not be avoided, especially, in case of the children as Jamee. The oliguria is disease, if the kidneys produce less quantity of urine per day which is less than 500 ml. The further decrease in urine output (less than 100 ml per day) is called as anuria. The oliguria may indicate too low a fluid intake. In older people, this often happens due to the reduced aged sense of thirst and therefore absolutely insufficient fluid intake (Brown and Edwards, 2011, p.160). But in Nursing Case Study oliguria may also occur when people with an increased loss of fluid to which it eg in great physical exertion (heavy laborers, athletes, sweating) or in an existing diabetes mellitus may occur relatively insufficient drink. Furthermore oliguria occurs as a sign of renal dysfunction or a hypodynamen shocks.
The urinary obstruction occurs in contrast with a closure or otherwise functional impairment of the urinary tract. In the area of the lower urinary tract (bladder and urethra), it results in an impaired urinary excretion, which may present as oliguria. A chronic obstruction in the range of only one ureter can remain completely asymptomatic, however, despite the possible destruction of the upstream kidney, as a healthy solitary kidney has ample scope for compensation in Nursing Case Study. The etiology of the low urine output is referred as the:
- Decreased glomerular filtration rate
- Increase tubular reabsorption
- Obstruction of the lower urinary tract
The mechanisms causing oliguria can be grouped into three categories:
- Prerenal: In response to a shock of the kidney (for example due to poor oral intake dehydration, diarrhea, bleedingmass or sepsis)
- Renal: Since kidney damage (for shock, rhabdomyolysis, drugs)
- Postrenal: Consequence of an obstruction in urine flow (e.g. benign prostatic hypertrophy or hematoma) (DeLange, 2013, p.28).
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The Treatment of the low urine output depends on the underlying cause of this symptom. easier to treat the cause is obstruction of urinary flow, which are often solved by inserting a urinary catheter into the bladder. Mannitol is a drug used to increase the amount of water removed from the blood and, therefore, improve blood flow to the kidneys. However, mannitol is contraindicated in anuria secondary to renal disease, severe dehydration, intracranial hemorrhage (unless during craniotomy), severe pulmonary congestion or pulmonary edema. Dextrose and dobutamine are both used to increase blood flow to the kidneys and act within 30 to 60 minutes.
5. The pathophysiology of Jamee if she had been diagnosed with the Pertussis:
pertussis is considered as a bacterium disease, more rarely characterized by Bordetella parapertussis with induced highly contagious infectious disease we can see in Nursing Case Study on page number 553. After a nonspecific initial stage it runs regular way for several weeks. At the initial stage it can be diagnized with cough which is called as catarrhal stage, followed by the paroxysmal stage paroxysmal typical staccato cough attacks. In infants, the cough seizures may manifest as atypical respiratory arrest and thus extend life-threatening. Finally, the coughing can increase in number and severity in the further stages. A causal therapy is possible only in the initial stage (Lee and Bishop, 2010, p. 121). For prophylaxis, there is a generally recommended effective vaccination.
The disease goes through three stages as we can see in Nursing Case Study classically: catarrhal tage, paroxysmal stage and decrementi stage. In neonates and infants but also atypical curves are exactly as for adolescents and adults.
Catarrhal stage:
After an incubation period of seven to 14 days, there is a flu-like symptom with low grade fever, runny nose and dry cough. This takes about one to two weeks. At this stage, the risk of infection is greatest (Higgins, 2007, p. 111).
Paroxysmal stage:
This is the second stage that occurs in the typical sudden onset of staccato cough attacks with his tongue sticking out. The attacks include in the following inhalation from a shriek with delight. During the attacks often glassy mucus is regurgitated, and vomiting occurs. The coughing can be very numerous, are piling up at night and can be triggered by external factors such as physical exertion. The paroxysmal stage lasts two to six weeks.
Decrement stage:
In the last stage, first, the number of attacks of coughing slowly, eventually they fall out less difficult. This phase lasts for another approximately three to six weeks. Without antibiotic, it may also be six to ten weeks of treatment. Due to the generally very long disease duration of whooping cough is sometimes also called the “100-day cough”.
For primary prophylaxis, the treatment is an effective (protection rate 80 to 90% exists) and well-tolerated vaccination. Today acellular vaccines, which are much better tolerated than the previously used whole-cell vaccines. They do not contain the whole seed, but only those components of the pathogen that cause an immune response in the body of the vaccinated child. The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the three-dose vaccination in the first year of life, beginning in the ninth week of life, as well as a refresher between the 12th and 15th month of life (primary immunization). In addition, children should receive five to six years and adolescents between the 9th and 18th birthday routinely refresh against whooping cough. If they were not yet or insufficiently vaccinated in childhood primary immunization should also be rescheduled. Adults should generally receive a one-time vaccination against whooping cough. In particular seronegative women to have children should be vaccinated before pregnancy. If there is already a pregnancy, the mother should be vaccinated as soon as possible after birth. Also, the vaccination status of all household members such as father or partner, siblings, grandparents, etc. should be reviewed and updated if necessary.
Chemoprophylaxis:
After close contact of whooping cough susceptible individuals with infectious enabled whooping cough patients, antibiotic treatment in the same manner as in case of illness to prevent the eruption of the disease makes sense. With only questionable or volatile Contact accurate observation is sufficient (Martini, Nash and Bartholomew, 2011, p. 135). In case of cough symptoms a study on whooping cough pathogens and antibiotic treatment should then immediately be initiated.
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Duration of infectivity, insulation:
Patients who are infectious are neither unable nor about five days after the start of antibiotic therapy and should be isolated for this period. Without appropriate treatment, the infectivity remains up to three weeks after the start of stage paroxysmal exist. Therefore, such patients may earlier than three weeks after onset of the disease re-visit community facilities (Metheny, 2012, p.67). Before being allowed to return, may be required that is checked by means of a pathogen detection, whether the patients are still capable of contagion.