Nursing Assessment: Etiology, Features, and Surgical Procedures

This nursing assessment addresses various acute health problems, providing etiologies and at least two clinical features for each condition, including Acute Kidney Injury (AKI), Acute Gastrointestinal Disorder, Ischemic Stroke, Complex Regional Pain Syndrome (CRPS), Asthma, Acute Unconscious State, Angina Pectoris, Cellulitis, Dehydration, Haemorrhagic Shock, Concussion, Myocardial Infarction, Nephrolithiasis, and Bacterial Sepsis. The assessment also outlines eight key principles of surgical nursing, encompassing assessment, planning, implementation, and evaluation of care; fluid and electrolyte balance; nutrition; pain management; infection control; wound care; stress and anxiety management; and altered body image. Furthermore, the assignment briefly explains several surgical procedures using correct terminology, such as elective/emergency surgery, general/local/epidural/spinal anesthesia, amputation, open reduction, hip replacement, and craniotomy. This comprehensive overview provides a detailed understanding of acute health problems and related nursing and surgical practices.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the student:
Name of the university:
Author note:

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Q1. Explain the etiology and outline at least TWO (2) clinical features for each the
following acute health problems.
a. Acute kidney injury: Acute kidney injury (AKI), previously called acute renal failure
(ARF), is a common clinical problem. The term AKI has largely replaced acute renal
failure (ARF), as it more clearly defines renal dysfunction as a continuum rather than
a discrete finding of failed kidney function. The few reasons behind the occurrence of
the condition are acute tubular necrosis (ATN), severe or sudden dehydration, toxic
kidney injury from poisons or certain medications, autoimmune kidney diseases, such
as acute nephritic syndrome and interstitial nephritis and urinary tract obstruction
(Hoste et al., 2015).
Clinical feature: bloody stools and generalized swelling or fluid retention.
b. Acute gastrointestinal disorder: There are several different types of GI illnesses,
including viral gastroenteritis, food poisoning, and even constipation. Gastrointestinal
infections can be caused by viruses, bacteria, or parasites that settle in your GI tract.
Viral or bacterial infections normally resolve in a few days, whereas parasitic
infections may require medical treatment to resolve (Graziano, 2015).
Clinical feature: Vomiting and Watery diarrhoea
c. Ischemic stroke: Ischemic stroke is sudden neurologic deficits that result from focal
cerebral ischemia associated with permanent brain infarction (e.g., positive results on
diffusion-weighted MRI). Common causes are (from most to least common)
atherothrombotic occlusion of large arteries; cerebral embolism (embolic infarction);
no thrombotic occlusion of small, deep cerebral arteries (lacunar infarction); and
proximal arterial stenosis with hypotension that decreases cerebral blood flow in
arterial watershed zones (hemodynamic stroke) (Goyal et al., 2015).

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Clinical feature: increasing plaque build-up in the blood vessels and damaging the
lining of blood vessels
d. Complex regional pain syndrome (CRPS): The cause of complex regional pain
syndrome isn't completely understood. It's thought to be caused by an injury to or an
abnormality of the peripheral and central nervous systems. CRPS typically occurs as a
result of a trauma or an injury (Molus, Abd-Elsayed & Eldabe, 2019).
Clinical feature: Joint stiffness, swelling and damage and decreased ability to move
the affected body part
e. Asthma: Asthma exacerbations are common, and the major morbidity, mortality, and
health care costs associated with asthma are related to exacerbations. The majority are
related to viral infection, and although progress has been made in identifying the
mechanisms of virus-induced asthma exacerbations, there is still much to be learned.
Allergen exposure causes some exacerbations and can participate in virus-induced
exacerbations, as can other environmental exposures. A role for atypical bacterial
infection in exacerbations is also increasingly recognized (Akinbami, Simon &
Rossen, 2016).
Clinical feature: Trouble sleeping caused by shortness of breath, coughing or
wheezing and Chest tightness or pain
f. Acute unconscious state: Comas are caused by an injury to the brain. Brain injury
can be due to increased pressure, bleeding, loss of oxygen, or build-up of toxins. The
injury can be temporary and reversible. It also can be permanent.
Clinical feature: Autonomic dysfunction and Eye abnormalities (Threlkeld et al.,
2018)

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g. Angina pectoris: Angina is caused by reduced blood flow to your heart muscle. The
most common cause of reduced blood flow to your heart muscle is coronary artery
disease (CAD).
Clinical feature: Pressure, fullness or a squeezing pain in the centre of your chest that
lasts for more than a few minutes and Prolonged pain in the upper abdomen
(Borgeraas et al., 2016)
h. Cellulitis: Cellulitis may be caused by indigenous flora colonizing the skin and
appendages, like Staphylococcus aureus (S. Aureus) and Streptococcus pyogenes (S.
Pyogenes), or by a wide variety of exogenous bacteria. Bacteria gain entry into the
body in many ways: breaks in the skin, burns, insect bites, surgical incisions and
intravenous (IV) catheters are all potential pathways. S. Aureus cellulitis starts from a
central localized infection and spreads from there. Recurrent streptococcal cellulitis of
the lower extremities, seen in conjunction with chronic venous stasis or with
saphenous vein harvest for coronary artery bypass surgery, often comes from
organisms of group A, C or G. Cellulitis is also seen in patients with chronic
lymphedema resulting from elephantiasis, Milroy’s disease or lymph node dissection
such as that associated with mastectomy (Bystritsky & Chambers, 2018).
Clinical feature: Red area of skin that tends to expand and Skin dimpling.
i. Dehydration: Dehydration is a major cause of morbidity and mortality in infants and
young children worldwide. Each year approximately 760,000 children of diarrheal
disease worldwide. Most cases of dehydration in children are the consequence of
acute gastroenteritis. Acute gastroenteritis in the United States is usually infectious in
etiology. Viral infections, including rotavirus, norovirus, and enteroviruses cause 75
to 90 percent of infectious diarrhoea cases. Bacterial pathogens cause less than 20
percent of cases. Common bacterial causes include Salmonella, Shigella, and

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Escherichia coli. Approximately 10 percent of bacterial disease occurs secondary to
diarrheagenic Escherichia coli. Parasites such as Giardia and Cryptosporidium
account for less than 5 percent of cases (Ahmed, Qazi & Jamal, 2016).
Clinical feature: increased thirst and decreased urination
j. Haemorrhagic shock: Hypovolemic shock is the most common type of shock, with
very young children and older adults being the most susceptible. When heavy
bleeding occurs, there’s not enough blood flow to the organs in your body. Blood
carries oxygen and other essential substances to your organs and tissues. When heavy
bleeding occurs, these substances are lost more quickly than they can be replaced and
organs in the body begin to shut down. As your heart shuts down and fails to circulate
an adequate amount of blood through your body, symptoms of shock occur. Blood
pressure plummets and there’s a massive drop in body temperature, which can be life-
threatening.
Clinical feature: blue lips and fingernails and low or no urine output (Cannon, 2018)
k. Concussion: Motor vehicle accidents, falls, and sports injuries are common causes of
concussions. Any sport that involves contact can result in a concussion. Among
children, most concussions happen on the playground, while bike riding, or when
playing sports such as football, basketball, or soccer (Iverson et al., 2017).
Clinical feature: balance problems/dizziness and double or blurry vision
l. Myocardial infraction: Myocardial infarction (MI) usually results from an imbalance
in oxygen supply and demand, which is most often caused by plaque rupture with
thrombus formation in an epicardial coronary artery, resulting in an acute reduction of
blood supply to a portion of the myocardium.

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Clinical feature: pressure or tightness in the chest and pain in the chest, back, jaw,
and other areas of the upper body that lasts more than a few minutes or that goes away
and comes back (Sulzgruber et al., 2018).
m. Nephrolithiasis: Renal stones are crystalline mineral depositions that form from
microscopic crystals in the loop of Henle, distal tubules, or the collecting duct. This is
usually in response to elevated levels of urinary solutes, such as calcium, uric acid,
oxalate, and sodium, as well as decreased levels of stone inhibitors, such as citrate and
magnesium. Low urinary volume and abnormally low or high urinary ph also
contribute to this process. All of these can lead to urine super saturation with stone-
forming salts and subsequent stone formation .( Curhan et al., 2018)
Clinical feature: burning sensation during urination and persistent urge to urinate
n. Bacterial sepsis: bacteria (gram-positive and gram-negative) are identified as the
causative organism in approximately 90% of cases of sepsis, with gram-positive
bacterial and fungal infections increasing in frequency. The frequency of gram-
positive septicaemia (mainly caused by Staphylococcus aureus, coagulase-negative
staphylococci, enterococci, and streptococci) has surpassed that of gram-negative
septicaemia (mainly caused by Enterobacteriaceae, especially Escherichia coli and
Klebsiella pneumoniae, and by Pseudomonas aeruginosa). However, E coli remains
the most prevalent pathogen causing sepsis.
Clinical feature: patches of discoloured skin and chills due to fall in body
temperature.
Q2 a. List the eight (8) key principles of surgical nursing.
The key principles of surgical nursing are the following:

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 Assessment, planning, implementing and evaluating care using a nursing model or
framework.
 Managing fluid and electrolyte balance.
 Managing nutrition.
 Managing pain.
 Managing infection control.
 Managing wounds and wound care.
 Managing stress and anxiety.
 Managing possible altered body image (Williams & Hopper, 2015).
b. Explain briefly the following surgical procedures using correct surgical terminology.
a) Elective/emergency surgery: Elective surgeries may extend life or improve the quality of
life physically and/or psychologically. Cosmetic and reconstructive procedures, such as a
facelift (rhytidectomy), tummy tuck (abdominoplasty), or nose surgery (rhinoplasty) may not
be medically indicated, but they may benefit the patient in terms of raising self-esteem. Other
procedures, such as cataract surgery, improve functional quality of life even though they are
technically an "optional" or elective procedure (Bala et al., 2017).
Some elective procedures are necessary to prolong life, such as an angioplasty.
However, unlike emergency surgery (e.g., appendectomy), which must be performed
immediately, a required elective procedure can be scheduled at the patient's and surgeon's
convenience.
b) General, local, epidural and spinal anaesthetic and peripheral nerve block: Peripheral
nerve blocks (PNBs) possess many characteristics of the ideal outpatient anesthetic. They
provide site-specific surgical anesthesia and minimize the need for general anesthesia (GA).
By providing dense analgesia, opioid requirements are reduced, as are opioid-related side

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effects. A comfortable, symptom-free patient can be discharged home in a timely fashion. As
part of a multimodal approach to postoperative pain management, PNBs with long-acting
local anesthetic (LA) can provide prolonged analgesia. The placement of a perineural catheter
and subsequent continuous LA infusion at home can further lengthen the period of
postoperative analgesia (Desserud, Veen & Søreide, 2016).
c) Amputation: Removal of part or all of a body part that is enclosed by skin. Amputation
can occur at an accident site, the scene of an animal attack, or a battlefield. Amputation is
also performed as a surgical procedure. It is typically performed to prevent the spread of
gangrene as a complication of frostbite, injury, diabetes, arteriosclerosis, or any other illness
that impairs blood circulation. It is also performed to prevent the spread of bone cancer and to
curtail loss of blood and infection in a person who has suffered severe, irreparable damage to
a limb. When performing an amputation, surgeons generally cut above the diseased or injured
area so that a portion of healthy tissue remains to cushion bone. Sometimes the location of a
cut may depend in part on its suitability to be fitted with an artificial limb, or prosthesis.
d) Open reduction: Each ORIF surgery differs based on the location and type of fracture. In
general, a breathing tube may be placed to help you breathe while you are asleep. Then, the
surgeon will wash your skin with an antiseptic and make an incision. Next, the broken bone
will be put back into place. Next, a plate with screws, a pin, or a rod that goes through the
bone will be attached to the bone to hold the broken parts together. The incision will be
closed with staples or stitches. A dressing and/or cast will then be applied. General
anaesthesia may be used. It will block any pain and keep you asleep during the surgery. In
some cases, a spinal aesthetic, or more rarely a local block, may be used to numb only the
area where the surgery will be done. This will depend on where the fracture is located and the
time it will take to perform the procedure.

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e) Hip replacement: Total hip replacement surgery aims to relieve hip pain and increase hip
function by resurfacing the bones that meet at the hip joint. The surgeon removes the femoral
head and replaces it with an artificial one. This prosthetic femur head is shaped like a ball,
and fits perfectly into the rounded cup prosthesis that becomes the new socket of the pelvis.
f) Craniotomy: A craniotomy is a surgical procedure in which a piece of the skull is
removed so the surgeon may access the brain beneath, for the treatment of a variety of
neurological disorders. The cut-away portion – called the bone flap – may be small or large,
and is typically put back in place after surgery on the brain is finished and before the incision
closed. A craniotomy may involve the removal of a small or large section of your skull.
Although the procedure varies from patient to patient, depending on the condition to be
treated and the specific needs of the patient and surgeon.
g) Tonsillectomy: Tonsillectomy (ton-sih-LEK-tuh-me) is the surgical removal of the tonsils,
two oval-shaped pads of tissue at the back of the throat — one tonsil on each side.
Tonsillectomy with or without adenoidectomy is one of the most common surgeries
performed in the United States of America, with more than 300,000 tonsillectomies
performed annually. The most common indication for tonsillectomy is a sleep-related
breathing disorder (obstructive sleep apnea), followed by recurrent tonsillitis. Other possible
indications for tonsillectomy include peritonsillar abscess unresponsive to medical treatment,
persistent foul taste or breath caused by chronic tonsillitis not responsive to medical therapy,
unilateral tonsil hypertrophy presumed neoplastic, and hypertrophy causing dental
malocclusion or adversely affecting orofacial growth documented by an orthodontist.
h) Appendectomy: An appendectomy is the surgical removal of the appendix. It is a
common procedure that surgeons usually carry out on an emergency basis. The appendix is a
long narrow tube (a few inches in length) that attaches to the first part of the colon. It is

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usually located in the lower right quadrant of the abdominal cavity. The appendix produces a
bacteria destroying protein called immunoglobulins, which help fight infection in the body.
Its function, however, is not essential. People who have had appendectomies do not have an
increased risk toward infection. Other organs in the body take over this function once the
appendix has been removed.
i) Laparotomy: A laparotomy is a surgical incision (cut) into the abdominal cavity. This
operation is performed to examine the abdominal organs and aid diagnosis of any problems,
including abdominal pain. In many cases, the problem – once identified – can be fixed during
the laparotomy. In other cases, a second operation is required. Another name for laparotomy
is abdominal exploration. A common reason for a laparotomy is to investigate abdominal
pain, but the procedure may be required for a broad range of indications. The abdominal
organs include the digestive tract (such as the stomach, liver and intestines) and the organs of
excretion (such as the kidneys and bladder).
j) Hysterectomy: An abdominal hysterectomy is a surgical procedure that removes your
uterus through an incision in your lower abdomen. Your uterus — or womb — is where a
baby grows if you're pregnant. A partial hysterectomy removes just the uterus, leaving the
cervix intact. A total hysterectomy removes the uterus and the cervix.
Sometimes a hysterectomy includes removal of one or both ovaries and fallopian
tubes, a procedure called a total hysterectomy with salpingo-oophorectomy (sal-ping-go-o-of-
uh-REK-tuh-me). A hysterectomy can also be performed through an incision in the vagina
(vaginal hysterectomy) or by a laparoscopic or robotic surgical approach — which uses long,
thin instruments passed through small abdominal incisions.
k) Prostatectomy: Radical prostatectomy is an operation to remove the prostate gland and
tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph

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nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the
prostate. In traditional method of radical prostatectomy, the surgeon makes a vertical 8- to
10-inch incision below the belly button. Radical prostatectomy is performed through this
incision. In rare cases, the incision is made in the perineum, the space between the scrotum
and anus (Mungovan et al., 2017).
l) Cataract extraction: Cataract removal is surgery to remove a clouded lens (cataract) from
the eye. Cataracts are removed to help you see better. The procedure almost always includes
placing an artificial lens (IOL) in the eye. Cataract surgery is an outpatient procedure. This
means you likely do not have to stay overnight at a hospital. The surgery is performed by an
ophthalmologist. This is a medical doctor who specializes in eye diseases and eye surgery
(Mercieca et al., 2019).
Adults are usually awake for the procedure. Numbing medicine (local anaesthesia) is
given using eye drops or a shot. This blocks pain. You will also get medicine to help you
relax. Children usually receive general anaesthesia. This is medicine that puts them into a
deep sleep so that they are unable to feel pain. The doctor uses a special microscope to view
the eye. A small cut (incision) is made in the eye.
m) Internal bleeding due to trauma. For bleeding because of traumatic brain injuries, a
surgeon may create a hole in the skull. This can relieve pressure and reduce further injury to
the brain, process called Craniotomy. A craniotomy is the surgical removal of part of the
bone from the skull to expose the brain. Specialized tools are used to remove the section of
bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain
surgery has been done (Nahman et al., 2015).
Q3 Too Too Wadadi is a 16-year-old Maori boy from New Zealand who was rushed to
the Emergency department this morning with testicular torsion. After an initial blood

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work he was shifted to the operating room. The surgical procedure completed at 12
noon and the patient was shifted to the post-operative ICU.
What is the significance of holistic nursing care?
The American Holistic Nurses Association defines holistic nursing as “all nursing practice
that has healing the whole person as its goal.” Holism is more than certain actions performed
or words spoken to a patient. Holistic care is a philosophy; it’s a method to ensure care for all
parts of a patient. Holistic nurses are those that recognize and treat each individual
differently. Holistic nurses are often described by patients as those nurses that “truly care.”
While there is nothing inherently wrong with being task-oriented or goal-oriented in your
nursing care, if a nurse is overly task-oriented or appears severely rushed, it can leave
patients feeling like they are just a number or a diagnosis or worse, a burden. Every nurse is
guilty of having to rush at some point; we all know the dilemma of too many patients and not
enough time; too much charting and not enough time; too many family members to deal with
and not enough time. Between things like patient needs, fellow nurses, doctors, charting,
dealing with family members, and more, nurses have a lot to worry about. As nurses we must
find a way to balance all of the duties and responsibilities that come with the title. Once we
do this our duties and responsibilities become our privileges and success (Kinchen, 2015).
Outline the application of holistic nursing in the treatment of Too Too Wadadi
considering his age, gender and specific culture.
There are many easy ways to improve relationships with Too Too Wadadi and promote a
healthy psychological, emotional, and spiritual environment for his treatment:
 Learn his name and use it
 Make good, strong eye contact with him
 Ask how Too Too Wadadi is feeling and sincerely care