Medical Assignment Help | Medical Science Project | Medical Education Assignment

Medical Assignment Help | Medical Science Project | Medical Education Assignment

 TASK 1

Medical Assignment Help Before handling the case of Sonya, certain documents that should be handed over to the staff and these documents are

  • Vital signs- this helps in understanding the situation of the patient as in terms of blood pressure, heart rate which is abnormally high in this case , level of oxygen saturation in blood as the blood oxygen carrying capacity is affected in this case, breathing rate, body temperature as patient often have fever in this case, urine as it shows dark and cloudy urine which shows infections and secretions like proteins, etc from the body.
Glasgow Coma Scale15 alert & orientated
Blood Pressure110/60mmHg
Heart Rate117bpm regular
Oxygen saturation99% on nasal prongs@2L
Respiratory rate18bpm
Pain score5/10
Temperature38.6oC
Output30mL/hr cloudy & dark

Urinalysis- this helps in investigating the situation of the patient based on their urine characteristics and the extent of infection. Also as the urine is cloudy and has offensive smell in patients this test also help in understanding the presence of various proteins, blood, nitrates, leukocytes, etc in the urine. Generally the technique used in Dipstick Urinalysis technique.

LEUPositive
NITPositive
URONegative
PROPositive
pH6.0
BLOPositive
SG1.005
KETNegative
BILNegative
GLUNegative

Blood cultures- this helps in understanding the cause of infections which may be helping in further prevention of infections in the patient (Christine et al , 2013)

  • Medical orders- helps the nurse in following orders in undertaking care of the patient
  • Medications- helps the nursing in-charge to administer timely and prescribed dosage of medicines to the patient to allow improvements
  • Renal ultrasound report- it is the first line in identifying the existence of any obstructions, stones, etc in the kidney and to identify any structural problems in the Medical Assignment Help | Medical Science Project | Medical Education Assignment patients.

Medical Assignment Help | Medical Science Project | Medical Education Assignment

These charts are necessary for the diagnosis of the patient Sonya as

If these documents were not documented correctly, then the nursing plan may not be designed appropriately and thus will lead to

  • Increasing severity of the kidney infection
  • Renal scarring development
  • Sepsis
  • Impairment of kidney functioning and leading to acute kidney failure or further cause any Chronic Kidney Disease (Chen et al, 2010)
  • Renal Abscess which may cost the life of the patient and is a form of necrosis in tissue which may be caused due to accumulation in the parenchyma of the kidney or perinephric spaces
  • Perinephric abscess or abnormality in the urinary tract (Foster et al, 2008)

TASK 2

The nursing care plan of the patient will be as follows:

PROBLEMS/ key focus areasINFERENCEGOALS OF CARENURSING INTERVENTIONSRATIONALEEVALUATION
Acute PAINPyelonephritis has symptoms like pain in urination or dysuria which is due to acute infections in the urinary tract and kidney along with pain and tenderness in the bladder and around (Pohl, 2007).To allow comfort to the patient and help in further treatment of the kidney infections.

Also to identify any other severities from being developed in the patients.

·         Understand the intensity, location and any deviations or exaggerations in the pains to the patient

·         Providing sufficient rest periods to the patient and shortening of the activity periods (Norby, 2007)

·         Giving proper dosage and administration of medications as directed by specialist on time to the patient

·         To help the patient through use of relaxation breathing technique

·         Severities of pain shows some infections

·         Allow peace and comfort to the patient and promote healing process in patients

·         Analgesics help in relieving pain and allowing feeling of comfort to the patient

·         To help and allow for relaxation in muscles

After the administration of the analgesics the patient pain will be relieved and controlled thus helping in promoting state of well being of the patient

No pain on urination of motion of the pelvis

Acute infections in kidney and urinary tractPyelonephritis is basically caused by the infections of the urinary tract and the kidney that develops from the cystitis or bacterial infection of the bladder.To control the severity of infection in the patient·         Assess body temperature every 4 hours

·         Record urine characteristic (Pohl et al, 2007)

·         Allow patient drinking 2-3 liter water if no other problems exists as this will help in rinsing out the bacteria or other infections causal microbes from body

·         Monitoring of urine culture and its sensitivity

·         Provide a clean and dry environment to patient

·         Allowing and asking patient to empty bladder completely each time

·         Administering proper and timely medications as prescribed by the experts

·         Giving periantal care to the patient

(Christine et al, 2013)

·         Vital signs indicate changes in body

·         Deviations from expected urine volume or patterns

·         Handling urine stasis problem

·          Determine impacts of the medications on patient

·         Avoid bacteria from infecting urethra or other parts of body

·         To prevent the bladder from distention

·         To keep the infection under control and prevent furtherance

·         Prevent urethra from any sort of contaminations

 

 

After successful nursing interventions, the infections as visible in form of urine and blood cultures will be showing negative or diminishing values on examination.
Changes in vital signsPyelonephritis is accompanied by changes in the body vital signs and may be accompanied by shivering fevers, headache, nausea, etc.Helps in understanding of the patient response to medications until the reports are finally received to allow further diagnosis

(Norby, 2007)

·         Monitor blood pressure continuously or periodically

·         Observation of the mental status of the patient and looking for consciousness level in patients (Colgan et al, 2011)

·         To understand the response to the hydration problems in the patient

·         The imbalance of the electrolytes can have impact on the functioning of the central nervous system of the patient

Checking for any deviations in the blood pressure or other vital signs of the patient which may reflect the inefficiency of the medications or need for surgical or other interventions
Anxiety or fear in the patientDue to development of so many symptoms and pain in the body, the patient may have high levels of anxiety in pyelonephritis patientTo improve the level of comfort in patients and reduce the fears thus improving the confidence towards well beingMonitoring facial expressions and body language of the patient while urination or passing motions·         Helping the patient through a range of motion exercises

·         Allowing level of comfort through rubbing the back or providing other kinds of breathing exercises to the patient

Let the patient express his level of comfort and well being in his own words

TASK 3

Sonya had been prescribed the following medications as:

Analgesics orally- as this helps in better absorption of the analgesic in the whole body along with helping in relieving of pain and controlling the fever from developing again and again in the patient.

Vancomycin intravenously- it is an antibiotic and thus administered to treat the kidney and urinary tract bacterial infections in the patient. Even before the urine test and diagnosis of the kind of microorganisms causing infections, the antibiotics are used to kill microorganisms. It had been administered intravenously as its absorption is quite low when it is administered orally to patients. If the patient responds appropriately to the antibiotics then surgical or other procedures may not be needed (Colgan et al, 2011).

Hartman’s 1000mls over 12 hours- As it is isotonic to blood and thus helps in replacement of the body fluid that may be lost along with the necessary minerals due to the acute kidney functioning impairment in Sonya. This will help the blood from being thick and further affecting the blood pressure in the patient and thus maintaining the loss of body liquids in case of Sonya.

In order to ensure that the patient is responding appropriately to the medications, the nurse must check for any deviations in the vital signs or any increase in the following symptoms as

  • Fever
  • Hypertension
  • Nausea
  • Vomiting frequency
  • Loin pains
  • Abnormalities or secretions in urine
  • Dysuria

TASK 4

As in case of the patient Sonya, the signs and symptoms are showing deviations in the vital signs as the blood pressure is reduced to 95/50 and the patient is on oxygen masks with a heartbeat of 135 bpm and the output is also reduced which shows the patient is not responding to the current medication and that the complications that may have caused such symptoms are

  • Significant damages in renal area and possibilities of renal failure (Saddeh et al, 2011)
  • Development of sepsis
  • Acute injuries in kidneys or development of Chronic Kidney Disease
  • Development of Abscess in perinephric area
  • Acute papillary necrosis which are seen more in old patients or those having previous incidents of diabetes
  • Obstructions or calculi in kidneys

ADMINISTRATION OF MEDICATIONS

While administering medications to Sonya, the nurse must be cautious of:

  • Right medications (check labels, etc) are being given to the right patient
  • Right dosage as prescribed
  • Right route as medical order shows
  • On time
  • Patient is positively responding to the medicines
  • Fill in the documents the administration of medications and other observations like vital signs, urinalysis, etc on time and with correct details (Chen et al, 2010).

This signs and symptoms shows that the patient is not reacting to the Vancomycin and the supportive therapy being given at the moment and in order to treat the abscess problem the patient must undergo surgical process for the per-cutaneous drainage or otherwise the doctors may resort to nephrectomy.

 However this process may be supported by antimicrobial therapy and if the Psuedomonas species are found to be causal agents then the doctors may opt for anti-psuedomonal beta lactam antibiotics while for enterococcci the use of ampicillin as antibiotic is desired (Saddeh et al, 2011).TASK 5

The handover using the ISBAR technique to the nurse of the ICU ward will look like this:

ISBAR

INTRODUCTION

 

Patient’s name- Sonya

Current Date – 11 August, 2016

Admitted on- 5 August, 2016

SITUATION

 

Diagnosis: Acute Urinary tract infection and Pyelonephritis

 

BACKGROUND

 

Medical history-

recurring urinary tract infections

Allergies-

allergic to penicillin

Current treatments or interventions-

Hartmann’ s 1000mls over 12 hours

Intramuscular Ondansetron 4 mg prn 12 hourly

Oral paracetamol1g 4 hourly

Oral ibuprofen 400mg 8 hourly

Intravenous vancomycin 1g 12 hourly

ASSESSMENT

 

Last vital signs-

BP-95/50

HR-135

RR- 26

TEMP-39.9 degrees

O.S-96 % HUDSON MASK @6L

CARDIAC- thread and irregular

CAPILLARY REFILL- > 3 seconds

SKIN- pale and poor turgor

DRESSING-

·         Indwelling catheter with hourly bag collections

·         Cannula in right arm

URINE/DISCHARGE-

·         Less than 25 ml/ hour and dark

·         offensive vaginal discharge

FLUIDS-

300 mls no change

RECOMMENDATIONSGoals- urgency and  control of infection

Consultant- Dr. x

Tests-

·         Blood cultures sent to pathology

·         MC&S sent to pathology

·         Ultrasound reports awaited

·         No artery blood gas done

 

TASK 6

In process of developing the care plan for Sonya who was facing acute urinary tract infections and Pyronecrlytis development, I have been facing problems in monitoring of the vital signs of the patient as it was too critical and sensitive part of observing the patient who was being given initial antibiotic therapy until her reports are finally out. I had been able to handle the situation quite well but things turned out terrific when there were deviations in case of Sonya who was not responding to the initial antibiotics treatment and she had to be shifted to the ICU for further procedures.

While undertaking the care of the patient Sonya and application of the nursing care plan for her, I have been able to provide holistic nursing care to the patient as

  • Monitoring of the vital signs and any deviations in the same thus allowing a check on the patients response to prescribed medications
  • Allowing administration of medications on time
  • Monitoring mental consciousness of the patient as may be impacted by electrolyte imbalances
  • Monitoring the urination patterns, volume and characteristics and periodic urinalysis to check severity or damages
  • Allowing patients with bed pan or other supports for urination
  • Allowing for maintenance of body fluid volumes
  • Analyzing signs of pain in patient

REFERENCES

  • Patient – Trusted medical information and support (2016) (online) available at http://patient.info/in/doctor/pyelonephritis last accessed on 12 August 2016
  • Christine, C. (2013)administration of medication (online) available at freeassignmenthelp.com.healthline.com/health/administration-of-medication#Overview1 last accessed on 12 August 2016
  • 8 rights of medication administration (2011) Online available at freeassignmenthelp.com.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration last accessed on 12 August 2016
  • Chen KC, Hung SW, Seow VK, et al (2010) The role of emergency ultrasound for evaluating acute pyelonephritis in the ED. Am J Emerg Med. 2011 Sep;29(7):pp 721-4
  • Saadeh, S.A., Mattoo, T.K. (2011) Managing urinary tract infections. Pediatr Nephrol. 2011 Nov; 26(11):pp 1967-76.
  • Colgan, R., Williams, M., Johnson, J.R. (2011) Diagnosis and treatment of acute pyelonephritis in women. Am Fam Physician. 2011 Sep 1; 84(5): pp 519-26.
  • Norrby, S. R. (2007) Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 306
  • Pohl A. (2007) Modes of administration of antibiotics for symptomatic severe urinary tract infections.Cochrane Database Rev. 2007 pp 17;(4)
  • Foster, R.T. (2008) Uncomplicated urinary tract infections in women.Obstet Gynecol Clin North Am, PP 235-48
  • Nursing interventions (2014) online available at http://nursinginterventions-diagnosis.blogspot.in/2011/06/nursing-intervention-for-pyelonephritis.html last accessed on 13 August 2016

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