comment1

The fourth intervention hit a nerve because its unfortunate to know that polypharmacy is prevalent in the elderly population. As a former CNA/Home Health Aide, I would take care of patients that were taking multi-medication. Some were medication that are prescribed for existing health related issues some where not. They would have pain medication from past outpatient surgeries and still take them years later. Some medications were even expired and they still choose to take them. In my research I discovered that elderly patients  tend to have more complicated chronic conditions and respond differently to medication therapy or experience more severe adverse reactions due to differences in pharmacokinetic and pharmacodynamic characteristics, compared with younger patients(Golchin et al.,2015). They may also visit multiple prescriber’s and use multiple pharmacies that will lead to increased risk of medication-related problems through poorly coordinated or duplicated care ( Golchin et al.,2015).

comment2

Preventing polypharmacy from occurring in the first place is another area that nurses can help older adults with. They can do this by educating patients and their families about the importance of writing down all medications including OTC, prescriptions, vitamins, and even herbals and bringing this with them to every doctor’s appointment or hospital visit. By doing this the patients entire care team will be better able to prevent prescribing medications that could have a negative impact on the patient. In addition to all of these interventions the nurse must teach the patient to always tell their care team about new symptoms that they feel after taking new medications (Woodruff, 2010). This will prevent interactions from going unnoticed and or blamed on other disease processes which could then lead to more medications being given. It is important to instruct all patients to speak up for themselves and how they are feeling. A journal is another good step the older patient can take to ensure proper documentation of when and what is happening with their medications (Woodruff, 2010).  

 

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comment1

Mucor is a fungus, a specie of moulds commonly found in the soil, plant surfaces, rotten foods and in the digestive system. (Mucor- Wikipedia).

Pathophysiology:  Fungus usually affect people whose immune system has been compromised/weakened by other health conditions, healthy people can also be affected. It mostly affects the sinuses or the lungs by inhalation of the fungal pores in the air. It can also enter through an impaired skin integrity such as cuts, scrapes, burns or trauma. (Mucormycosis|Fungal Disease|CDC, 2015). Reactivation of latent infection can also, result in fungal pneumonia. Once the fungi is in the alveoli it can travel in the spaces between the cells and adjacent alveoli via connecting pores. Invasion of the fungi in the alveoli triggers the immune response to send out neutrophils from WBCs to attack the microorganism. The neutrophils destroy the attacking organism but then release cytokines in that process leading to general activation of immune system causing the fever, fatigue and chiles noted in fungal or bacterial pneumonia. The alveoli is then filled up with the fluid leaked from surrounding blood vessels and neutrophils causing an impairment in gas exchange. (Fungal Pneumonia-Wikipedia).

Comment2

Chronic obstructive pulmonary disease (COPD) is the coexistence of chronic bronchitis and emphysema. Compare emphysema and chronic bronchitis. What are the hallmark assessment findings for each? What should your patient teaching include? How does COPD affect the hematologic system? Describe the pathophysiology.

 

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comment1

Hypertension, high cholesterol and triglycerides, type 2 diabetes, sleep apnea are actual health risks that Mr. C. has. He is also at risk for cancer, cardiovascular disease, stroke, and death as a result of his obesity as well (Cleveland Clinic, 2018).

~Is bariatric surgery an appropriate intervention? Why or why not?

At 68 in. and 134.5 kg Mr. C. has a BMI of 47.8. According to the Cleveland Clinic a BMI greater than 40, and negative health effects such as hypertension, diabetes as a direct result of this morbid obesity, makes you an ideal candidate for bariatric surgery (2018). As Mr. C. has many of these negative health effects it would be appropriate for him to have the gastric surgery.

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.

Ranitidine (Zantac) 300 mg PO at bedtime.

Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

comment2

Problem number one that I identified for Mr. C is the desire for bariatric surgery without any expressed attempts at losing weight. He has been heavy most of his life which may indicate some genetic predisposition but even with the surgery it is very important that patients practice self-control in making better choices with diet and exercise (Mayo Clinic, 2017).  Problem number two is type two diabetes. Mr. C would require some more testing to diagnose (A1C) but with the lifestyle choices he has made he along with other comorbidities such as obstructive sleep apnea, low HDLs and high triglycerides, he is definitely at risk for decreased insulin sensitivity leading to a whole host of problems (Mayo Clinic, 2017). Problem number three is the hyperlipidemia  as evidence by the lab values provided. Hyperlipidemia can lead to atherosclerosis, which in turn can lead to much more serious problems like stroke, heart attack, and death (Lewis, Bucher, Heitkemper, & Harding, 2017). Problem number four is the potential for coronary artery disease (CAD). Mr. C displays a lot of risk factors associated with CAD such as obesity, sedentary lifestyle, hyperlipidemia and hypertension (Lewis, Bucher, Heitkemper, & Harding, 2017). Problem five is his mental well-being. Stress is a risk factor for all of the other problems listed before this point. Physiologically cortisol levels increase the way the body stores fat, decreases metabolism, decreases the secretion of testosterone all of which contributes to Mr. Cs eating habits, weight gain, blood glucose, and perpetuates the whole negative state of health and of consciousness (American Psychological Association, 2018).

 

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COMMENT1

Acute kidney injury has three categories, they are prerenal, postrenal, and intrarenal/intrinsic.  The first category, prerenal, means that the injury to the kidney occurs before the kidney itself.  This type of injury is caused because of reduced perfusion of the kidney. This reduction can be caused by absolute decrease in circulating volume caused by hemorrhage, dehydration, or burns. It can also be caused by relative decrease in circulating volume caused by, distributive shock, third-spacing and edema, or decreased cardiac output.  Another cause can be renal abnormalities such as occlusion or stenosis of the renal artery.  The second category is postrenal, this can be caused by obstruction of normal outflow of urine from the kidneys.  Things that can cause this are: benign prostatic hyperplasia, kinked or obstructed catheters, intraabdominal tumors, strictures, or calculi.  The third category is intrarenal/intrinsic, this involves either vascular, interstitial, glomerular, or tubular.  If it is vascular, it can be caused by vasculitis, emboli, or nephrosclerosis (due to primary hypertension, hypertensive emergencies, and urgency).  If interstitial, it can be caused by acute allergic interstitial nephritis or acute pyelonephritis.  If glomerular, it can be caused by acute glomerulonephritis.  If tubular, it can be caused by ischemic issues such as prolonged prerenal failure, transfusion reactions, or rhabdomyolysis.  Tubular can also be caused by nephrotoxic issues like prolonged post renal failure, certain antimicrobials (antibiotics, antifungals, and antiviral drugs), radiographic contrast media, certain cytotoxic chemotherapy agents, recreational drugs, environmental agents, and snake and insect venom.

COMMENT2

Obesity is measured by a screening tool measuring one’s body mass index (BMI). Body mass index is measured by your height and weight.  A BMI of 30.0 or higher means a person is obese. Being obese is an unhealthy weight that is over what would be normal.

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr.C’s health risk includes heart disease, diabetes, cancer, respiratory issues, physical immobility issues, and mental issues. Premature death. (1)

If Mr.C has done everything to try and lose weight on his own and nothing has worked, then I believe bariatric surgery would be an appropriate intervention. Some patients don’t even try to lose the weight the correct way and go for the easy way out. Complications of having bariatric surgery will pose problems when the patient continues to live this unhealthy life style post-surgery. Bariatric surgery may improve quality of health. It may treat or control diseases such as diabetes, hypertension, and heart disease (2).

 

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comment1

The projected nursing shortage impact to the nursing profession and to the public could be very serious.  The nursing profession is impacted because over 55% of nurses are of the retirement age and if we are already slated to have a shortage then it’ll be really tough to replace over half of the nurses that end up retiring.  This also impacts the public because we care for the public and are a vital component in the type of care they receive.  If there aren’t enough nurses to adequately care for them the quality of care could falter and the public image of nursing will be distrust and negative in general.  Personally, I feel that I must make each one of my patients parents feel as though I have nothing but time for them and that all of their questions and concerns are addressed in a thorough manner.  I don’t feel like the doctors have a whole lot of time to supply the kind of care that we do and if that component is lost then the whole spectrum of care the patient expects is broken.  

comment2

The impact on the nursing profession related to the projected nursing shortage may be nurses working longer hours with larger patient workloads and possibly working with less qualified staff.  This will most likely cause job dissatisfaction and burnout.  Pay increases may help reward these nurses for their hard work but being an over worked and over stressed medical staff does not promote patient safety.  These conditions can cause medication errors and other dangers to patients and staff.  However, pay increases would attract more students to the health care field to pursue careers in all areas including faculty for teaching.      

A significant association between high patient-to-nurse ratios and nurse burnout was associated with increased urinary tract and surgical site infections according to a study conducted in Pennsylvania hospitals.  Researchers also found that by increasing a nurse’s patient load by one patient was associated with higher rates of infection.  It was concluded that by reducing nurse burnout it can improve the wellbeing of nurses and the quality of care (Cimiotti, Aiken, Sloane, & Wu, 2012).

 

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