Total Hip Replacement Surgery

Case Study #3
Care of the Patient after a Total Hip Replacement Surgery
1. What would be three nursing diagnoses for M.Y. based on the data given?
· Impairment in physical movement
· Inadequate knowledge concerning the clinical procedure
· Severe pain
2. What would be three achievable goals that would coincide with the nursing diagnoses for M.Y.’s plan of care for today?
· Demonstrate as well as aid with utilizing mobility supports such as walkers, trapezes, etc., and transfer techniques, in addition to engagement in an exercise regime
· Offer diversion activities and comfort measures such as back rubs and repeated repositioning. Further, offer therapeutic touch when needed and promote stress management approaches which include progressive relaxation, meditation, guided imagery, and visualization.
· Articulate patient understanding of clinical diagnosis and process.
3. List two or three potential complications may occur for M.Y. which would be related to the procedure that she had.
· Hip dislocation
· Fracture
· Formation of leg clots following operation.
· Wound infection
· Leg length changes
· Loosening
4. If M.Y. expresses concerns or anxiety about her eventual discharge, what things could the nurse do to help decrease her anxiety? What referrals might be indicated for this patient?
· The nursing practitioner will aid the patient in deciding upon three coping mechanisms which may be applied for alleviating anxiety symptoms.
· The nursing practitioner will aid the patient in deciding upon a couple of support individuals to provide post-discharge assistance.
· The nursing practitioner will offer referrals to community support groups which may be attended by the patient to help cope with anxiety.
· Lastly, familial support will be ensured for the patient.
Case Study #5
Immune System Function
1. What changes in the immune system in the older adult increase the incidence of infection and cancer in this population?
As the adaptive immune system ages, a condition known as ‘immune senescence’, marked by reduced functionality, sets in. Deficiencies begin cropping up in the adaptive response’s cellular as well as humoral arms, including deficient T-cell functioning with age. Since the thymus forms the key T-cell growth and maturation area, slow thymic output weakening and thymic involution are regarded as the main events in age-related immune senescence. Moreover, an inverse linkage exists between occurrence of several cancer forms and immune function. That is, reduced immune function as an individual grows older is linked to increased cancer occurrence (Foster, Sivarapatna & Gress, 2011).
2. Explain why older adults may have decreased inflammatory responses.
Inflammation represents one of the chief factors in progressive lean tissue degeneration and reduced immune function that are associated with the ageing process. Polymorphisms within anti- and pro- inflammation cytokine genes’ promoter areas impacts aging and cytokine secretion levels. Therefore, a high pro-inflammation cytokine generation genotype leads to elevated secretion of cytokine, potentially speeding up the tissue degeneration process. On the other hand, anti-inflammatory cytokine gene polymorphisms might lead to decelerated tissue degeneration. Among healthy elderly males, the pro-inflammation cytokine polymorphisms have been found to be under-represented, whilst the anti-inflammatory cytokine gene polymorphism is found to be over-represented, suggesting a genetically controlled survival advantage when maintaining low-level inflammation (Grimble, 2003).
3. Why are older adults at increased risk for gastroenteritis and diarrhea secondary to the proliferation of intestinal organisms?
Aged individuals tend to exhibit elevated enteric infection contraction risks, on account of their lower gastric acidity, weaker immune system and intestinal motility ailments (Chen, Liu, Glass & Kirk, 2015).
4. What questions should the nurse include to assess an elderly patient’s immunological status?
· What is the patient’s body temperature? A fever could be indicative of infection
· What is the cognitive orientation of the patient? Are any neurological complications evident?
· Has the patient lost or gained weight? (i.e., weight check)
· Is the patient consuming healthy food? (i.e., dietary examination)
· Does the patient suffer from any intestinal motility issue or gastric infection? (i.e., bowel movement recording)
· Does the patient suffer from any skin allergy or infection? Can any changes be found in the patient’s skin appearance? (i.e., skin examination)
5. List and explain what the nurse should include in the physical assessment to evaluate the patient’s immune system.
Patient physical examination must cover:
· Overall appearance
· Vital signs
· Body temperature, skin color and moisture assessment
· Mucus membranes inspection
· Lymph node palpation
· GU and GI system assessment
· Musculoskeletal system examination
· Respiratory system assessment
· Joint ROM examination
· Neurosensory system assessment
· Cardiovascular system examination
· Skin examination (Quizlet, 2018).
Case Study #6
Endocrine System
Management of a Patient with Hyperthyroidism
1. What is thyrotoxicosis and what are common symptoms of thyrotoxicosis? What are possible causes of thyroid storm?
The term ‘thyrotoxicosis’ refers to a condition characterized by excess thyroid hormone concentration within the body. Overt thyrotoxicosis symptoms are heat intolerance, tiredness, tremors, anxiety, muscle weakness, weight loss, and irregular menstruation (among female patients). The clinical findings can be tremors, moist, warm skin, tachycardia, and lid lag. Thyrotoxicosis may be caused by Graves’ disease, exogenous thyroid hormone, toxic adenoma, and toxic multinodular goiter, among others (Pearce, 2006).
2. What is the normal range for serum calcium and why would it be elevated in Ms. Brown’s case?
Age-based total female calcium reference ranges are:
· Less than one year: Not established
· 1-11 years of age: 9.6-10.6 mg / dL
· 12-14 years of age : 9.5-10.4 mg / dL
· 15-18 years of age: 9.1-10.3 mg / dL
· 19+ years of age: 8.9-10.1 mg / dL
The patient suffers from hyperthyroidism, a condition that has been associated with elevated blood calcium levels. Parathyroid hormone serves to stimulate the bone, reabsorbing the secreted calcium into extracellular fluid. In addition, increased mineral levels are attributable to the enhanced calcium absorption (Sofronescu, 2015).
3. Discuss symptoms of hyperthyroidism.
Hyperthyroidism symptoms are as follows:
· Increased appetite or loss of appetite
· Insomnia
· Fatigue and tiredness
· Heat intolerance
· Heart palpitations
· Diarrhea or the need to frequently clear one’s bowel
· Persistent sweating
· Missed or light menses
· Irritability
· Anxiety
· Mental disturbances
· Fertility issues
· Muscle weakness
· Breathlessness
· Tremors / shakiness
· Sudden paralysis
· Giddiness
· Vision changes
· Either weight gain or weight loss
· Potential elevated blood sugar
· Hair thinning
· Hives and itching
4. Discuss normal thyroid panel lab values.
Test
Abbreviation
Typical Ranges
Free Thyroxine
FT4
0.7-1.9 ng/ dl
Thyroid hormone binding ratio
THBR
0.9-1.1
Free Thyroxine index
FT4I
4-11
Serum Triiodothyronine
T3
80-180 / dl
5. What can be done to not only help but to teach Ms. Brown about beneficial nutritional suggestions to help her gain weight?
The following suggestions will be offered to the patient:
· Consume more nutritious meals
· Drink a couple of smoothies with added protein everyday
· Engage in light weightlifting exercises a minimum of three days every week 
· Correct all mal-absorption issues
Case Study #7
Female Reproductive System
Care of a Patient after a Hysterectomy
1. Outline at least three (3) Nursing Diagnoses for Jane.
· Foley catheter presence
· Surgery-related infection risk, since the wound is exposed to the outside environment
· Grieving one’s lost childbearing capability owing to uterus removal
2. List SMART goals and prioritize at least two (2) nursing interventions for the Nursing Diagnoses that you have listed in question #1.
The patient needs to have normal body temperature. Any temperature reading over 100.5°F will be recorded and reported, in addition to high WBC count, low BP reading, tachycardia, and elevated respiration rate; the above symptoms are potential infection symptoms. The patient’s wound will be examined on an everyday basis for abnormal redness or purulent drainage. Foley catheter removal will occur on the third day following surgery after surgeon examination and order. Hand hygiene is crucial prior and subsequent to patient contact for ensuring no infection occurs.
3. After the abdominal hysterectomy, Jane appears depressed and states she is worried that her marital relations will “never be the same.” How should the nurse respond to Jane’s concerns?
· The nursing practitioner will aid the patient in deciding upon three coping mechanisms which may be applied for alleviating grief linked to lost childbearing ability.
· The nursing practitioner will aid the patient in deciding upon a couple of support individuals to provide post-discharge assistance (mainly the patient’s husband)
· The nursing practitioner will offer referrals to community support groups which may be attended by the patient to help cope with her grief linked to lost childbearing ability.
4. What might be some other modalities (options) for treating uterine fibroids besides surgery?
· Hormone medication for shrinking hormones: Hormones can be administered in multiple forms. Progesterone, the hormone in females responsible for counteracting excess estrogen, can be administered in one of the following forms: tablet, injection, intrauterine device or implant
· UAE or Uterine Artery Embolization: Microscopic particles may be injected from the groin for blocking blood vessels which supply to fibroids. This usually leads to their shrinking by over 50 percent. Consequently, fibroid-related symptoms may alleviate or entirely disappear.
· UFE or Uterine Fibroid Embolization: Here, a fluoroscope (x-ray camera) is employed for guiding small particle delivery to the uterine fibroids. These particles, injected using a catheter, block blood flow providing arteries, thereby leading to fibroid shrinkage (RadiologyInfo, 2018).
Case Study #8
Male Reproductive System
Care of a Patient after a Prostatectomy
1. Describe the indications for this type of surgery.
TURP is typically utilized for treating males suffering from moderate or acute urinary issues unable to be resolved by medication. Historically, this surgical procedure has been regarded as the ideal prostate enlargement treatment (Mayoclinic, 2018).
2. Describe what a bladder irrigation system is and why it would be necessary for this patient. How long is a bladder irrigation usually be continued?
CBI or continuous bladder irrigation denotes smooth, simultaneous bladder infusion and draining using fluid. CBI decreases risk of bladder clot formation through irrigating using a three-way catheter containing Sodium Chloride of concentration 0.9%. Such a catheter enables simultaneous fluid flow to, and drainage from, the patient’s bladder. With passage of clearer urine, irrigation is slackened, for maintaining a light pink color. Likewise, darker urine passage requires acceleration until a light pink color is maintained. Most post-surgical patients require overnight CBI (Okorie, 2015).
3. What are priority nursing interventions if the nurse notices that the urinary outflow is less than the irrigation input after bladder irrigation?
In case of occurrence of clot obstructions, irrigation using piston syringe might be needed. Intermittent BI or CBI using a normal saline solution ensures the catheter remains free of any obstruction. Besides, it help detect obstruction and any other complications (Wasson, 2010).
4. Why is it important to attend to complaints of pain from bladder spasms as soon as possible? What medication is generally used for this type of pain?
It is imperative to attend to any case of bladder spasms in a timely manner as they might be an infection symptom. Such pain may be treated using Detrol (tolterodine) or other antispasmodics and Ditropan (oxybutynin) or other tricyclic antidepressants.
5. What would be good instructions for the nurse to give to the patient before discharge about the probability of temporary urinary incontinence related to this procedure?
· Pay attention to daily fluid intake
· Ensure your body is kept flexible
· Refrain from excess alcohol or caffeine consumption
· Stop smoking 
· Ensure healthy weight maintenance
Case Study #9
Management of a Sexually Transmitted Infection
Care of a Patient with Chlamydia
1. Describe what chlamydia is, how it is diagnosed, and how it can progress.
Chlamydia denotes a widely-occurring STI (sexually transmitted infection). It may be diagnosed using a swab and urine test. Untreated or inappropriately treated chlamydia may cause harm to the reproductive organs of the patient. For instance, the infection may spread to the fallopian tubes or uterus, giving rise to pelvic inflammatory disease (Pebody, 2015).
2. Outline three (3) nursing diagnoses for patients with STIs.
· Unprotected sex
· Two or more sexual partners
· Infection transmission risk associated with contact transmission exposures  
3. What types of questions should the nurse ask in the initial focused assessment for patients who present with problems similar to this young woman’s?
· Do you currently engage in regular sexual activity?
· If not, have you done so previously?
· How many persons did you engage in sexual activity with, of late?
· How many persons did you engage in sexual activity with during the last one year?
· Do you engage in sexual activity with males, females, or both? (In case the answer to this question is “both”, the prior two questions need to be repeated for both genders individually).
4. Describe some possible factors that may make it difficult to take an accurate history or provide education for a patient with an STI?
Patients might not be comfortable with answering the aforementioned personal questions. Inadequate or intentionally incorrect replies might render it hard to create awareness and inform patients of effective STI management and precautionary measures.
5. Give some principles about the prevention of sexually transmitted infections.
· Have limited sexual partners
· Make use of latex condoms
· Get immunized
· Don’t engage in risky sexual activities
References
Chen, Y., Liu, B. C., Glass, K., & Kirk, M. D. (2015). High incidence of hospitalisation due to infectious gastroenteritis in older people associated with poor self-rated health. BMJ, 5(12). Retrieved from https://bmjopen.bmj.com/content/5/12/e010161
Foster, A. D., Sivarapatna, A., Gress, R. E. (2011). The aging immune system and its relationship with cancer, Aging Health, 7(5), 707-718. doi:  10.2217/ahe.11.56
Grimble, R. (2003). Inflammatory response in the elderly. Curr Opin Clin Nutr Metab Care, 6(1), 21-9. doi: 10.1097/01.mco.0000049047.06038.eb
Mayoclinic. (2018). Transurethral resection of the prostate (TURP). Retrieved from https://www.mayoclinic.org/tests-procedures/turp/about/pac-20384880
Okorie, C. O. (2015). Is continuous bladder irrigation after prostate surgery still needed? World J Clin Urol, 4(3), 108-114.  doi: 10.5410/wjcu.v4.i3.108
Pearce, E. N. (2006). Diagnosis and management of thyrotoxicosis. BMJ, 332(7554), 1369-1373. doi:  10.1136/bmj.332.7554.1369
Pebody, R. (2015). What are the stages of Chlamydia? Retrieved from http://www.thebody.com/content/76634/what-are-the-stages-of-chlamydia.html
Quizlet. (2018). Nursing assessment: Immune system. Retrieved from https://quizlet.com/148627624/nursing-assessment-immune-system-flash-cards/
RadiologyInfo . (2018). Uterine fluid embolization. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=ufe
Sofronescu, A. G. (2015). Serum calcium. Retrieved from https://emedicine.medscape.com/article/2087447-overview
Wasson, D. (2010). Transurethral Resection of the Prostate. Perspectives: Recovery strategies from the OR to Home, 1(3). Retrieved from http://www.perspectivesinnursing.org/assets/perspectives3.pdf