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Question 1
A vein thrombus occurs in the deep veins located in the legs of pelvis. The vein thrombus entails a clot that blocks the blood vessels causing serious health complications. Numerous risk factors may lead to development of a deep vein thrombus (DVT). These risk factors include a previous history of venous thromboembolism may cause a deep vein thrombus condition. Further, a previous episode of deep vein thrombus may also increase the chances of one developing a serious deep vein thrombosis condition.
Further, major surgeries in the lower limb or the abdomen may cause deep vein thrombus. Immobilization that is caused by old age or severe medical problem also increases the risk of one developing deep vein thrombus. Research studies also show a relationship between antiphospholipid syndrome especially systemic lupus erythmatosis (SLE). Consequently, other conditions such as pregnancy, Crohn’s disease and combined use of oral contraceptives are also risk factors of developing deep vein thrombus. Symptoms of the condition entail limb pain located along the deep veins, distention of the superficial veins, swelling of the thigh, skin discoloration low-grade fever, and a hard thick palpable vein (Buttaro, 2013).
Various tests are performed to confirm the presence of a deep vein thrombus. A medical history is important to show if the patient has had any predisposing medical conditions such s surgeries or cancer. Further, a physical exam is used to confirm the presence of a deep vein thrombus. Physical exams evaluate legs, heart, lungs and the level of blood pressure. Diagnostic tests such as ultrasound, D-dimer tests, venography and computed tomography scanning are also used to determine if a patient has deep vein thrombus. These tests assess if there are blood clots located in the deep veins leading to the deep vein thrombus condition (Buttaro, 2013).
Question 2
Cardiovascular disease may occur because of pregnancy complications. Pregnancy related cardiovascular disease conditions have increased over the past decade. This is because major hemodynamic changes occur during pregnancy, labor and delivery. These hemodynamic changes occur develop during the first five weeks of gestation. Further, patients with a previous medical history of cardiovascular disease may increase the chances of developing the condition during pregnancy. During pregnancy, the blood volume increases to 50% and this outweighs the increase in the number of blood cells (Bickley, 2010). This leads to the falls in the overall hemoglobin concentration mostly referred to as anemia of pregnancy.
Consequently, the cardiac output increases from 30%-50% during pregnancy. The rise in the cardiac output is caused by the great blood volume during pregnancy, fall in the systemic vascular resistance and increase in the maternal heart rate. The level of blood pressure falls to 10 mm Hg at the end of the second pregnancy trimester. This is caused by the reduction of the systemic vascular resistance and the increase in the number of blood vessels present in the placenta and the uterus (Bickley, 2010).
Cardiovascular disease can be complicated during pregnancy. This is because pregnancy entails the well-being of the mother and the unborn child. Thus, effective treatment measures should be performed to safeguard the live of the mother and the unborn baby. Percutaneous therapy is essential in the management of the condition during pregnancy. The best time to perform this therapy is after the fourth month during the second semester of the pregnancy. In addition, cardiac surgery should be performed with cardiopulmonary bypass. However, cardiac mobility increased the chances of fetal mortality (Buttaro, 2013). Thus, this surgery is recommended when other therapies have failed. Lifestyle self-management measures are the most effective in this case. This include, eating healthy balanced diets during pregnancy, engaging in simple exercises that do not harm the fetal condition and avoiding substance abuse.
Question 3
Low leg edema is the swelling of the leg due to abnormalities in the locoregional lymphatic drainage. This leads to the increase in the interstitial volume that occurs because of accumulation of tissue fluid. Lymphedema condition can mostly occur in the lower leg region. However, the condition can also occur in the arm and the external genitalia.
There are differential diagnoses that arise with similar clinical manifestations as lower led edema. These differential diagnoses include secondary lymphedema, lipedema, adverse reactions resulting from ipsilateral limb surgery and venous disease. computed tomography, ultrasound or magnetic imaging are used to confirm the possibility of lymphedema. Further, lymphoscintigraphy is necessary to demonstrate the lymphatic anatomy (Buttaro, 2013).
Treatment measures in lower leg edema entail conservative treatment, pharmacologic and surgical treatment. Conservative treatment entails physical treatments to reduce the elevated levels of lymphangitis and cellulitis. Physical treatment entails special exercises, massage and compression to drain the lymphatic fluid. Moreover, heat therapy is used to reduce the leg volume and improve the level of skin tonometry.in addition, pharmacologic treatments include micronized purified flavonoid fraction. This is an effective drug used to reduce idiopathic cyclic edema, postmastectomy lymphedema and chronic venus insufficiency. Surgical treatment such as prophylactic surgery and bypass surgery are advised incase other therapies fail (Bickley, 2010).
Venus insufficiency occurs when the veins have trouble sending blood from the limbs back to the heart. In this condition, blood flows abnormally causing poor blood drainage in the leg region. Symptoms of the condition include pain, ulcers of the legs and swelling. On the other hand, arterial insufficiency is a condition that leads to slow flow of blood through the arteries. This can be caused by atherosclerosis or blood clots present in the arteries. Symptoms include chest pains, heart attacks, leg cramping and stroke (Buttaro, 2013).
Question 4
Herpes virus is the cause of ventricular lesions of the oral mucosa. These lesions are commonly referred to as cold sores. The Herpes virus affects a wide variety of body organs including the genitalia, eye, liver, ventral nervous system and the lung. The signs and symptoms of herpes include pain or itching, ulcers, scabs, tiny red bumps or white blisters. The ulcers in the genitalia make it hard to urinate. Various laboratory tests are used to assess the herpes condition. Viral culture is a test that entails a tissue sample or scraping the sores for laboratory examination. Further, polymerase chain reaction tests is used to detect DNA tests from blood, tissue or sore samples. These samples are tested to evaluate what type of herpes the patient has. Moreover, blood tests are necessary to test for the presence of herpes virus in the body (Bickley, 2013).
Herpes treatment entails an intermittent suppressive therapy, episodic therapy and chronic suppressive therapy. These therapies are conducted based on the presenting clinical manifestations of the patient. Evidence based treatments include dosing regimens. Valacychloride, acyclovir and famciclovir are antiviral drugs used to treat symptomatic herpes virus. In addition, patient information is necessary regarding the presenting clinical condition. Patients should be educated about their condition. Patients with herpes should take a lot of fluids and eating healthy balanced diets. Further, patients suffering from herpes should not engage in sexual intercourse to avoid further spread of the condition (Buttaro, 2013).
Question 5
Tanner stages entail pubertal maturation that influence the sequence, timing and adolescents tempo among young adults. Tanner adolescent stages may vary from culture to culture leading to early or late puberty. Excess hormone stimulation leads to early puberty. This comes from the brain or from the gonads. Hormone stimulation may lead to overproduction of sex hormones. On the other hand, delayed puberty is caused by insufficient sex hormones.
However, various congenital disorders referred to as polyglandular deficiency syndromes lead to failure of the hormone output. Children with this syndromes experience abnormal puberty. The onset of adolescent developments can vary among individuals. For instance, one may start developing body changes before other age mates because of different genetic factors, body mass, general health and nutritional state. Thus, this leads to the culture to culture differences among adolescents (Fung, Gomez, Hwang, Dash, Allen, Hilakivi-Clarke & Wang, 2015).
Question 6
Bethesda classification for pap smears entails assessing different degrees of cervical cell changes. The Bethesda classification system grades minor cervical cell changes into three categories. This includes atypical squamous cells evaluation that can be categorized into high-grade intraepithelial lesions, low-grade squamous intraepithelial lesions and mild dysplasia. Abnormal Pap smear test results may indicate the possibility of an underlying infection, inflammation of the cervical cells and atrophic vaginitis caused by menopause. Further, abnormal pap smear test results may also indicate cervical cancer (Buttaro, 2013).
Low-grade pap smear is managed by CIN 1 biopsy in women. Furthermore, if biopsy tests are positive the pathologists engage the patient in a loop electrosurgical excision to remove the infected area in the cervix. On the other hand, high-grade pap smear is treated by removing or destroying the infected region. In addition, hysterectomy is performed on women who have completed childbearing (Bickley, 2010).
References
Buttaro, T. M. (2013). Primary care: A collaborative practice. St. Louis, Mo: Elsevier/Mosby.
Fung, T., Gomez, S., Hwang, Y. T., Dash, C., Allen, L., Hilakivi-Clarke, L., & Wang, J. (2015).
Institute of Medicine (U.S.). (2011). Child and Adolescent Health and Health Care Quality: Measuring What Matters. Washington, D.C: National Academies Press.
Lynn S. Bickley. (2010). Guide to Physical Examination and History Taking. Lippincott Willians & Wilkins, ISBN: 9781609137625.
HPI (History of Present Illness: It has being going on for the last 6 months.
PMH (Past Medical History—include current medications, any known allergies, any history of surgery or hospitalizations): The patient has a family history of heart disease and type 2 diabetes. Further, the patient has a medical history of hypercholerolemia and cholesystectomy.
Significant Family History: There appears to be a genetically transmitted type B diabetes condition in the family. Two brothers diagnosed with type B diabetes. Mother died of breast cancer and father died of heart disease.
Social/Personal History (occupation, lifestyle- diet, exercise, substance use): The patient is a carpenter who does not engage in regular exercises and he smokes cigarettes. The patient only takes one meal a day.
Description of client’s support system: The patient has no close friends just his wife.
Behavioral or nonverbal messages: The patient appears stressed by his health state and his financial situation.
Client awareness of his/her abilities, disease process, healthcare needs
- The patient requires various therapeutic sessions, patient education and consistent follow- up.
Objective Data:
Vital signs including BMI: BP: 160/92 left are sitting; P: 60; T: 98; Wt: 220#; Ht: -70”
Physical Assessment findings: HEENT: WNL
Lymph Nodes: None
Lungs: Decreased breath sounds throughout, no adventitious sounds
Heart: RRR without murmur
Carotids: Right bruit
Abdomen: Android obesity, WC = 44 inches
Rectum: Not examined
Genital/Pelvic:
Extremities, Including Pulses:
Decreased pedal pulses BL with lower leg edema from ankle to mid calf.
Neurologic: Not examined
EKG: No change from baseline
Lab Tests and Results:
Total cholesterol - 210
LDL- 200
HDL- 25
Triglycerides – 250
Fasting blood sugar – 140
HgbA1c – 7.5
CXR – hyperinflation of the lungs – no infiltrate
EKG – no change from baseline.
Client’s Support System as Perceived by Healthcare Professional: He does not have much support since his wife (the only support system) is disabled.
Client’s locus of control and readiness to learn as perceived by Healthcare Professional: The patient has no or less control over his situation. Therefore, therapy is needed for the patient.
Diagnoses/Client Problems (include medical diagnoses): Acute Coronary Syndrome.
Patient Care Program
The nursing profession has increased its obligation duties towards patient care. Nurses have advanced their professional maneuvers aimed at improving the quality of patient care. Advanced practice nursing aims at providing safe, effective, patient-centered, timely and efficient nursing services to patients. Nursing practices are no longer limited to clinical practices. Nursing practitioners are now compelled to engage in a patient follow up to ensure the effects of their diagnosis towards various patients are positive.
The thesis of my essay is to design a holistic care plan for a diagnosed patient. The care plan entails my nursing assessments, diagnosis and interventions towards the patient. The depth of my nursing interventions should cover the patient’s support system and it should ensure the diagnosis is effective after the clinical treatment.
The patient is a 52 year old Irish American who was lately discharged from hospital after an emergency admission after suffering from angina symptoms. The patient suffered from massive chest pains, which lead to his emergency admission to the hospital. According to the patient’s medical history, the problem started months ago and he thought it was a heart attack and he was afraid of seeking medical help. Prior to admission, the problem was relieved with rest. He has never sought therapeutic help before, thus I am dealing with a first time therapy patient.
I am carrying out a follow-up program for the patient to ensure the effects of his diagnosis are well perceived by the patient to prevent a similar situation in the future. Further, I aim at reducing the patient’s condition to a mild state or curing the condition completely. In order to achieve this, various nursing measures come into play. I am required to design a holistic patient care plan for the patient.
In order for me to create the most functional care plan for the patient it is vital for me to assess the risk causing factors. The patient has been diagnosed with a chest disorder. According to the lab results and the patient history, there are many risk factors prevalent on the patient. The risk factors include; high blood pressure, positive family history, type 2 diabetes, cigarette smoking, hypercholesterolemia and android obesity.
According to the lab results, the patient has high levels of cholesterol present in his body. Further, the chest x-rays show that the patient has a hyperinflation of the lungs. In addition, the patient needs to have a regulation of his sugar intake levels because the lab results simulate a high level of blood sugar level, which may cause diseases or complicated conditions in the future.
In order to reduce the prevalence of risk causing factors, various measures should be put in place. First, the high blood pressure calls for regular check-ups to measure the level of blood pressure. There are multiple ways to reduce high blood pressure. The patient must keenly follow medication prescription without skipping prescription. In addition, patient education is necessary in order to reduce the chances of the condition reaching emergency levels (Mahan, Trybulski, Polgar & Sandberg-cook, 2013). For instance, the patient should engage in regular exercises since he admits that he rarely engages in exercises.
Further, he should lose considerable weight since obesity is one of the predisposing factors to the condition. The patient needs to engage in therapeutic practices to reduce his consumption of cigarettes. In addition, the patient should take healthy meals and avoid skipping meals. In a patient diagnosis, the patient revealed that, he usually takes one meal a day.
Consequently, the hypercholesterolemia and type 2 diabetes risks require proper medical help. In order to reduce the prevalence of the predisposing factors, I engaged the family in a medical therapy consultation aimed at improving their awareness towards the type 2 diabetes condition and the hypercholesterolemia. The effectiveness of medications should consider engaging the family and community in solving the problem (Rickles, Wertheimer & Smith, 2010). I advised the family to consider their health issues as a matter of family concern. Thus, in order for them to incorporate positive measures, I designed a meal intake program and an exercise program. Furthermore, the family requires regular therapeutic check-ups in order to increase the effectiveness of the medication.
The program included a list of locally available fruits and vegetables that the family should start taking in their meals. Consequently, I encouraged the family to participate in regular exercises at a local gymnasium. This was to increase their health status considering the patient’s obesity condition and preventing a similar health condition for his wife. Nonetheless, the patient care plan included regular therapeutic visits to measure the level of blood pressure and chest hypertension. As an advanced practice nurse, I also carried out a regular check up on the family (Dossey & Keegan, 2013). I ensured that they followed the patient care plan and they took medications as prescribed. In addition, I engaged the entire extended family in a health awareness program to ensure they all sought medical help to measure their prevalence towards the type B diabetes, which appears to be genetically replicated in the family.
The patient’s health state and working conditions call for a routine change. According to the patient, he rarely takes rest or vocations from his work since he is the sole breadwinner for the family. Therefore, I advised the patient to consider taking breaks and increase his resting time until the condition is stabilized. With reference to advanced nursing practices, self-care should be at the center of holistic care services. This is because the family should learn how to independently apply healthy measures in order to reduce the risk of the condition happening again in the future (Hamric, Hanson, Tracy & O'Grady, 2014).
It is vivid that the patient has emotional stress. The situation worsened because he had no one to talk to about his situation. Thus, I arranged for a psychology therapy for the patient as an extension of the patient diagnosis services. This would enable the patient learn various ways of improving his stress tolerance measures in the future.
I also sketched a patient-care program that I was obliged to follow as part of the patient’s diagnosis implementation plan. I engaged myself in a weekly visit to the patients’ family and I also wrote various reports considering the patient’s health. For instance, I worked collaboratively with the gymnasium and the therapists involved in the diagnosis in order to assess the effectiveness of the patient-care program. Further, the family also gave me feedbacks and any emerging situations such as the level of fatigue gained from numerous exercises. Considering the age of the patient, the exercises should not be extreme as they may affect the rest periods of the patient (Wolper, 2004).
Advanced practice nursing advocates for extensive patient care services that are aimed at increasing the effectiveness of the diagnosis for patients. Scientific evidence should be properly analyzed to create the best healing conditions for patients. Nonetheless, the nursing practices should cover all medical aspects such as disease diagnosis, reduction of the risk causing factors and prevention of the disease from reoccurring. The holistic patient care program extends its services to wide levels such as patient follow-ups. These increase the potential of nursing services and the effectiveness of the services.
References
Mahan, T, B., Trybulski, J., Polgar, P, B.,Sandberg-cook (2013): Primary Care. Fourth edition, 9780323075015. Elsevier-Health Sciences Division.
Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice. Burlington, MA: Jones & Bartlett Learning.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2014). Advanced practice nursing: An integrative approach. St. Louis. Missouri publications.
Wolper, L. F. (2004). Health care administration: Planning, implementing, and managing organized delivery systems. Sudbury, MA: Jones and Bartlett Publishers.
Rickles, N. M., Wertheimer, A. I., & Smith, M. C. (2010). Social and behavioral aspects of pharmaceutical care. Sudbury, Mass: Jones and Bartlett Publishers.
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