Nursing Assessment: Etiology and Clinical Features of Acute Health Problems

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.