NSB334 Integrated Nursing Practice Assignment

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NSB334Integrated Nursing Practice 4Assessment Task 1 Workbook
School of NursingASSESSMENT COVER SHEETStudent Name:Student No.:Unit Name: Integrated Nursing Practice 4Unit Code: NSB334Due Date: Lecturer’s/Tutor’s Name: Tutorial Day/Time: Assessment No. 1Assessment Title:Collaborative Practice Simulation Bachelor of NursingPage 2 of 23NSB334 Integrated Nursing practice 4
Mr Dwight SimulationSetting the sceneRefer to your simulation documentsEpidemiology / pathophysiology of disease processes The National Health Priority Area of Cancer Control was established with the aim of improving health outcomes in this area.The most common diagnoses for cancer in men are prostate (1 in 5 males), colorectal (1 in 11 males), melanoma of the skin (1 in 13 males) and lung (1 in 13 males). For women, the most common diagnoses are breast (1 in 8 females), colorectal (1 in 16 females), melanoma of the skin (1 in 23 females) and lung (1 in 22 females).Cancer screening programs have been large public health initiatives in this area aimed at reducing illness and death resulting from cancer through an organised approach to screening. It would be of benefit for you to research the three cancer screening programs of BreastScreen Australia, National Cervical Screening Program and the National Bowel Cancer Screening Program to understand the importance of these programs and the benefits obtained.The World Health Organisation defines palliative care as:‘An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.Your own values and beliefs about death and dying may impact on your interactions with a dying person, reflect on your own self-awareness as an important strategy in palliative care nursing. Bachelor of NursingPage 3 of 23NSB334 Integrated Nursing practice 4
Complete the following workbook questions from your simulation including the clinical reasonining cycle:Gain an initial impression of your patientQuestion 1.ReviewMr Dwight’s background and history. Mr Dwight has a history of bowel cancer. What two (2) signs and symptoms might Mr Dwight have had prior to his diagnosis? Why would these signs and symptoms have occurred?Answer: The two signs that might have occurred prior to the diagnosis of bowel cancer areconstipation and weight loss, accompanied with weakness and fatigue. Changes in thebowel habit result in bowel obstruction, which contributes to constipation. This commonlyoccurs due to physical blockage of the proximal colon, which in turn prevents passage ofsolid, liquid or gases through the colon. Thus, formation of tumor in the far end of the colonor in the rectum creates difficulties in the passage of the excretory wastes.This further leadsto bloating and abdominal cramps. Weight loss is another symptom that is associated withfatigue caused by the cancer cells that use up the body’s energy. Energy is also consumedby the immune cells that protects the physiological system by fighting against the disease.Change in bowel habit also results in blockage of the colon that contributes to thieunexplained weight loss and fatigue.Question 2:Mr Dwight has had a hemicolectomy with the formation of a colostomy. Discuss the anatomy and physiology of this condition and the surgical procedure?Answer: Bowel or colorectal cancer represent a complex disorder caused due to certain geneticalterations, which are associated with progression of the cancer from a pre-malignant lesionto an invasive adenocarcinoma. An abnormal growth of cells is observed in the rectum or thecolon, that is a part of the large intestine. Colostomy refers to the surgical procedure of Bachelor of NursingPage 4 of 23NSB334 Integrated Nursing practice 4
forming a stoma or an opening by drawing healthy end of the colon through the incision thatis made in the anterior wall of the abdomen. It is further sutured into place. This stoma incombination with an ostomy pouching system helps in providing an alternative route forpassage of fecal matter outside the body. The process of right hemicolectomy involves anremoval of the right side of the colon, the cecum, hepatic flexure, and terminal ileum, alongwith the lymph nodes and fat. through laparoscopy (Waters et al., 2012). The operation doesnot encompass removal of the stoma. This helps in removal of malignant neoplasm from theright colon. On the other hand, the procedure of ileostomy involves making a surgery in theabdominal wall by bringing together the loop or ends of the small intestine on the surface ofthe skin. It helps in collecting intestinal wastes in the artificial pouching system (Nagle et al.,2012). Bachelor of NursingPage 5 of 23NSB334 Integrated Nursing practice 4
Question 3:What two risk factors can lead to bowel cancer?Answer: The 2 risk factors are:Sedentary lifestyle leading to excess deposition of body fatSignificant family history of polyps or bowel cancerQuestion 4:MrDwights BGL on admission to the ED is 22 mmol. What level should a normal BGL be?Explain MrDwights BGL reading and the interventions in place to address his diabetes.Answer: Normal values of BGL ranges from 4-6.1 mmol/L during fasting. The mean normal BGL isabout 5.5 mmol/L. A BGL of 22mmol represents hyperglycemia, that suggests presence ofhigh blood sugar levels. The underlying factors that might have contributed to his conditionare related to increased consumption of carbohydrates, mental and emotional distress,physical inactivity, obesity and infection. On arrival of the ambulance, Mr. Dwight reportedthat he is diabetic. Thus, this increased BGL is due to the less insulin secretion in his body.The primary intervention that should be implemented for lowering the blood glucose levels isadministration of insulin. The hormone is synthesized by the beta cells of the islets oflangerhans, located in the pancreas and effectively manages to convert blood glucose toglycogen (Dall et al., 2014). There are 3 different types of insulin:Rapid acting Short actingIntermediate actingAnother intervention that can be applied is related to making dietary modifications. A holisticnutritionist should be consulted for formulating a healthy-eating plan that has low caloriesand fats and is rich in nutrients and fibers. This will also help in reducing the amount of bloodglucose. Review and recall knowledge on nasogastric tubes. Bachelor of NursingPage 6 of 23NSB334 Integrated Nursing practice 4

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