Nursing Assignment: Question and Answers

This document provides answers to nursing assignment questions related to the renal system, effects of alcohol, bone types, stress response, wound healing, and diabetes. It discusses the interventions and prevention strategies for each case study. The document also highlights the importance of quick treatment for psychotic symptoms and the treatment options for bipolar affective disorder.

Running head: NURSING ASSIGNMENT
Question and Answers
Name of the Student
Name of the University
Author Note

1NURSING ASSIGNMENT
Case study 1- John
A. The renal system commonly referred to as the urinary system comprises of the
kidneys, urinary bladder, ureter and urethra. The basic function of the renal system is
to eliminate all kinds of nitrogenous waste products from the body, control the blood
volume, blood pressure regulation and control the electrolyte balance and pH. The
renal tract as the principle system that helps in the expulsion of urine from the body.
In other words, urea that is carried to the kidneys through the bloodstream gets
removed along with other wastes and excess water in the form of urine, through
micturition (Hall 2015). The kidneys participate in urine formation by filtering the
excess water and wastes from the circulating blood. This urine gets passed down to
the urinary bladder through the ureter and is then expelled outside the body by
relaxation of the sphincter muscles that guard the urethra opening.
B. Drinking excess alcohol takes a toll on the physical health and affects the human body
in several ways. The use of alcohol might interfere with the communication pathways
of the brain, and will in turn affect the way his brain functions. These disruptions
might directly bring about an alteration in John’s mood and behaviour, thus making it
difficult for him to think in a clear manner. Drinking also has the probability of
damaging his heart, thus resulting in problems such as, cardiomyopathy, stroke,
arrhythmias, and increased blood pressure (Kemp and Quintana 2013). Heavy
drinking will also take a toll on his liver and result in several hepatic disorders
namely, cirrhosis, fatty liver or steatosis, alcoholic hepatitis, and fibrosis. The
pancreas might also begin the production of toxins that would eventually result in
pancreatitis, which is an inflammation of the pancreatic blood vessels that disrupt
digestion (WHO 2014). Another potential impact of alcohol on physical health is the
onset of cancer.

2NURSING ASSIGNMENT
C. One major intervention is behavioural treatment where John will be provided
counselling services for altering his drinking behaviour. The treatments will be
different, owing to the varied perspectives of alcohol consumption. While
detoxification would lead to withdrawal symptoms, different forms of psychotherapy
will help in limiting his drinking, thus lowering dependency rates. Drugs such as,
acamprosate will also facilitate stabilization of the brain chemistry by antagonizing
glutamate action, hence reducing relapse rates (Mann et al. 2013). The Sinclair
method can also be used for treating alcoholism by blocking positive reinforcement
impact of ethanol.
Case study 2- Phyllis
A. There are five main types of bones present in the human body namely, (i) long, (ii)
short, (iii) irregular, (iv) flat, and (v) sesamoid. The long bones have a shaft called
diaphysis that is longer than width, and a rounded epiphysis at end of the shafts. Short
bones have a cuboid shape with thin compact bone layer around the spongy interior.
Sesamoid bones are embedded in tendon and hold them away from bone joints. While
the flat bones have parallel layers of compact bones and are curved, the irregular
bones have bony sinuses that impart them the irregular shape. Bones are made up of
collage fibres, which have a tripe helical structure and act as nucleation sites for the
mineral crystals (Shier, Butler and Lewis 2015). Little amounts of
glycosaminoglycans are also bound to the protein and present around the fibre
bundles. Calcium and phosphate are the primary minerals, with the major component
being hydroxyapatite. The bearing surfaces are formed by the hyaline or articular
cartilages.
B. Phyllis is at an increased likelihood of suffering fracture due to her old age. With an
increase in age, individuals become frail and results in falls that create a long-lasting

3NURSING ASSIGNMENT
impact on the health and quality of life of older adults. The fact that she lives alone is
a risky situation, which when combined with her previous history of fall makes her
more susceptible of suffering a fracture. Depression has also been allied with falls and
fracture among the elderly (Iaboni and Flint 2013). Fear of falling and depression are
related with an upsurge in the impairment of body balance and gait. These directly
affect the sensory, motor and cognitive pathways. Furthermore, increased facture risk
in Phyllis can also be accredited to the fact that medications for depression such as,
serotonin reuptake inhibitors often increase the possibility of fragility fractures.
C. Prevention strategies would encompass keeping the flat free from any kind of clutter,
from the floors. The floor surfaces will not be kept slippery. Phyllis will be made to
put on low-heeled and supportive shoes. Adequate rubber mat in shower, lights in
stairways and grab bars will be installed in the home. Fracture management would
require bone immobilization with the use of plaster casts, or metal plates (Ungar et al.
2013). Another immobilization procedure might encompass the insertion of internal
metal rods at the centre of the long bones.
Case study 3- Kofi
A. Any kind of stressful situation results in a cascade of stress related hormones that are
responsible for producing physiological changes. Stressful incidents are also
responsible for increasing the heart rate and breathing rate, accompanied by tension in
the muscles and perspiration. In other words, stress refers to a psychological and
biological response that is experienced upon encountering threats that cannot be dealt
with adequate resources. The hypothalamus controls the stress response, which when
triggered signals to the adrenal medulla and the pituitary gland. These short term
responses are initiated by the ‘Fight or Flight Response’ with the help of the
Sympathomedullary Pathway (SAM). The Hypothalamic Pituitary-Adrenal (HPA)

4NURSING ASSIGNMENT
system controls long term response by stimulating the pituitary to secrete ACTH,
which subsequently stimulates corticosteroid production from the adrenal glands
(Braun et al. 2013). Circulation of epinephrine in bloodstream results in physiological
alterations such as, elevated heart rate, increased pulse and blood pressure, and
opening of the small airways in the lungs. Release of cortisol and ACTH keeps the
body on alert. Following passing of the threat, the levels of cortisol fall and the
parasympathetic nervous system reduces the stress response.
B. It is essential to get quick help for the treatment of psychotic symptoms owing to the
fact that delay in recognition of the signs and symptoms often result in a deterioration
of the health condition. Kofi might have developed stress due to a worrisome drop in
his academic grades. While problems in the neurotransmitters such as, glutamate and
dopamine might have contributed to development of psychotic symptoms, some risk
factors that might have increased Kofi’s likelihood of getting affected by the
condition include familial history of schizophrenia, and older parentage (Popovic et
al. 2014). Other factors which might have also played a vital role in the illness are
increased activation of the immune system, complications during his birth, abuse in
childhood and use of mind-altering drugs during the adolescent years.
C. Although the condition requires lifelong treatment, medications such as,
antipsychotics should be considered as the main treatment option. These drugs will
prove beneficial in controlling psychotic symptoms by affecting the dopamine
neurotransmitter. Second generation antipsycotics such as, aripripazole,
brexipiprazole, clozapine, and lurasidone, can also be administered owing to the
lowered risk of adverse side effects (Leucht et al. 2013). Following reduction of the
psychotic symptoms, the patient might also be subjected to social skills training,
family therapy, and vocational rehabilitation.

5NURSING ASSIGNMENT
Case study 4- Linda
A. The skin in humans is made up of two different layers namely, (i) superficial
epidermis, and (ii) deeper dermis. The epidermis is composed of different layers,
where the upper layer of dead cells is periodically and progressively replaced by new
cells that originate from the basal layer. The dermis forms a connection between the
epidermis and the hypodermis, and provides elasticity and strength due to elastin and
collagen fibres. The hypodermis, located deep in the dermis acts in the form of a
connective tissue that forms a connection of the dermis to the underlying structures.
The epidermis can be divided into different layers such as, stratum corneum, stratum
lucidum, stratum granulosum, stratum spinosum, stratum germinativum. Keratinocyte
cells present in epidermis are responsible for the manufacture and storage of keratin
protein that is present in nail, hair and skin (Miller, Griffin and Campbell 2013). The
colour of skin is predisposed by a plethora of pigments that include, carotene,melanin,
and haemoglobin. Melanin pigment gets transferred to keratinocytes through
melanosomes, a cellular vesicle.
B. Wound healing refers to a complex procedure where the skin and tissues underlying
the skin are able to repair them, following an injury. Wound healing comprises of
several steps namely, (i) haemostasis, (ii) inflammation, (iii) proliferation, and (iv)
maturation. Haemostasis is the initial body response for stopping bleeding. Following
achievement of haemostasis, inflammation would lead to swelling for controlling
bleeding and infection prevention. New tissues, usually pink coloured, are formed in
proliferation phase that cover the wounded region. This is followed by maturation
phase that encompasses complete closure of the wounds and typically begins three
weeks following the injury (Xie et al. 2013). The deep cut made by Linda with razor

6NURSING ASSIGNMENT
that has reached all way through her skin might create an effect on the muscle or fat
layer and create an impact on the healing process.
C. Steps would be taken to ensure that Linda is made to wear personal protective
equipment to avoid any kind of injury or wound that she inflicts upon herself, owing
to her state of mind. Controlling the bleeding would be the first priority that can be
achieved by applying direct pressure on the laceration sites, while holding them at a
level near the heart, for at least 15 minutes. All efforts must be taken to avoid
tourniquets. Following bleeding cessation, the lacerations and surrounding regions
will be washed with soap and warm water, succeeded by stitches at the site, if
required (Rui-feng et al. 2013). Stitching will prevent bacterial invasion and promote
wound healing. These will then be covered with tape and sterile gauze. Linda will be
administered ibuprofen or acetaminophen for pain relief and the dressings shall be
changed on a regular basis.
Case study 5- Fatima
A. Usually the human body breaks down all carbohydrates and sugar that has been
consumed, into glucose. The role of insulin hormone secreted from the Beta cells of
the islets of Langerhans in pancreas is to maintain glucose levels in the blood stream
and utilised for energy production. Type 1 diabetes is also referred to as insulin
dependent diabetes or juvenile onset diabetes as it begins in childhood. This
autoimmune condition occurs when the body attacks its own pancreas, with the help
of antibody and the damaged pancreas fails to produce insulin. The condition is often
thought of to occur due to genetic predisposition or false in the beta cell. The
condition also increases the likelihood of suffering from heart diseases and stroke.
Individuals with type 2 diabetes report insulin resistance (Holt and Kumar 2015).
Despite production of insulin from the pancreatic cells the body is unable to use it in

7NURSING ASSIGNMENT
an effective manner that results in a failure in lowering blood glucose levels to limits
that can be sustained by the body. Range of genetic and environmental factors are also
responsible for the onset of type 2 diabetes such as, familial history, obesity,
sedentary lifestyle, smoking, alcoholism, and polycystic ovarian syndrome.
B. Bipolar affective disorder is a severe mental condition that is associated with
increased risk of developing physical ailments such as, atherosclerosis, which refers
to hardening of the arteries, and other cardiovascular diseases. There is mounting
evidence for the fact that people suffering from bipolar affective disorder have above
average rates of increased levels of triglyceride or blood fat, increased cholesterol
levels and hypertension (Vancampfort et al. 2016). The current hypomanic symptoms
manifested by Fathima increased her likelihood of suffering from obesity, diabetes,
substance abuse, and other metabolic conditions, which are common with bipolar
disorder. She also carries an increased risk of early death due to these physical
ailments with life expectancy reduced by a minimum of 10 years (Crump et al. 2013).
Hence, the hypomania symptoms might make her resort to unhealthy lifestyle
activities, and prevent accessing appropriate healthcare services, which when
combined with the side effects of medications such as, mood stabilizer and
antipsychotic drug will take a toll on her physical health.
C. Psychotherapy can prove as an effective treatment for the condition. The primary goal
of psychotherapy would be to enhance regular administration of medicines and
eliminate substance abuse, while enhancing lifestyle and helping the patient recognise
basic symptoms of mania and depression. Psychotherapy would encompass
psychoeducation and cognitive behavioural therapy, which will increase knowledge of
the patient on the illness and will also help her to return to a completely functional
life. Lithium can be administered for stabilization of mood, in accordance to

8NURSING ASSIGNMENT
depressive and maniac episodes (Malhi et al. 2013). However, some side effects such
as, headache, tiredness, bloating, and muscle weakness might appear. Benzodiazepine
such as, clonazepam and lorazepam can also be administered for managing acute
agitation in the patient.
Case study 6- Nathan
A. The respiratory system refers to the biological system which comprises of organs and
structures responsible for exchange of gases. The respiratory surface is internalized in
the form of lung linings. Gaseous exchange occurs inside several air sacs called
alveoli, which have rich supply of blood vessels, thereby bringing the respiratory air
in close contact with bloodstream. The sacs are connected with the external
environment with the help of a system of hollow tubes or airways, the largest of
which is called the trachea. Trachea branches right at the middle of the chest to form
two main bronchi, which enter respective lungs and progressively branch into narrow
secondary and tertiary bronchi, forming smaller tubes, bronchioles that are connected
with the alveolar sacs (Hall 2015). The upper tract of the respiratory system comprises
of the nose, nasal cavity, pharynx and larynx. The process of respiration is controlled
by a dome shaped diaphragm, located at the bottom of the lungs that demarcates
between the abdominal cavity and the chest cavity.
B. Schizophrenia has been associated with an impairment in lung function and increase
susceptibility of suffering from pneumonia, COPD, and chronic bronchitis. Patient
suffering from schizophrenia demonstrate significantly reduced lung function values.
Nathan’s diagnosis exposes him to a series of risk factors associated with severe
medical comorbidity. Previous smoking history of Nathan has also increased his risk
of suffering from lung diseases such as, lung cancer, heart disease, oral cancer, and
stroke (Caponnetto et al. 2013). Smoking affects the air sacs and the large airways by

9NURSING ASSIGNMENT
increasing the size and number of the cells in the lungs which produce mucus. This
directly increases the secreted mucus amount, thereby clogging the lungs, impeding
circulation and resulting in respiratory diseases.
C. The most effective treatment comprises of administration of antihistamines
decongestant and glucocorticoids. Blocking the action of histamine in the central
nervous system, and loosening and thickening the mucus present in the lungs would
make it easier to cut off the accumulated mucus (Ridolo et al. 2015). Inhaled asthma
drugs when used in combination with steroids will also access bronchodialators and
help in management of respiratory illness. Nathan will be made to abstain from
tobacco. His schizophrenia will also be treated by medications such as, risperidone
that less severe than atypical antipsychotics and would likely reduce the psychotic
manifestations.
Case study 7- Pearl
A. The cardiovascular system helps in circulation of blood and transport of nutrients,
carbon dioxide, oxygen, hormones, and blood corpuscles in the body for providing
nourishments, stabilizing temperature, and fighting against diseases. Oxygenated
blood enters systemic circulation while leaving the left ventricle through the aorta
which distributes two different parts of the body for sending oxygenated blood.
Arteries often get branched into small arterials and finally into capillaries, which
combine to form venules and veins. The superior and inferior vena cava collect the
oxygenated blood from all body parts and send them to the right auricle for
oxygenation.
B. Bipolar disorder and its association with increased risk of cardiovascular diseases is
governed by oxidative stress, inflammation, and the brain-derived neurotrophic factor
(BDNF). Oxidative stress results in a dysfunction of the endothelium. The

10NURSING ASSIGNMENT
symptomatic phase of bipolar disorder will result in a decrease in the levels of BDNF,
thereby damaging the endothelial cells. This in turn will increase the risk of suffering
from cardiovascular events (Goldstein et al. 2015). Increase in weight will also take a
toll on the cardiovascular health of the patient, when compared to the general
population. Weight gain will trigger several inflammatory processes that would result
in structural and functional changes and the heart. Plaque formation and the artery
would trigger the onset of a heart attack (Laursen et al. 2013).
C. Pearl will be subjected to weight loss programs that would encompass bringing about
modifications in the eating habits and levels of physical activity. Abstaining from a
sedentary lifestyle and making dietary changes such as, cutting calories, making
healthy food choices, would prevent the position of cholesterol and facts. Behavioural
change such as, support group, counselling and prescription-based weight loss
medications would also prove beneficial in reducing the risk of suffering from
cardiovascular diseases (American Diabetes Association 2016). Depending on the
severity of the condition, Pearl might also require angioplasty for restoring the blood
flow. Administration of potent vasodilator nitroglycerine will also reduce myocardial
oxygen demand and the hearts workload.
Case study 8- Malaika
A. The insulin hormone plays a major role in regulating blood glucose levels, and lack of
insulin or inability to respond to it results in development of a metabolic disorder. The
impacts of insulin are initiated by attachments to receptors, located in cell membrane
that contains alpha and beta subunit. Two molecules join together to form a
homodimer, following which insulin binds to the alpha unit. Beta subunit gets auto
phosphorylated followed by phosphorylation of proteins inside insulin receptor
substrate, which activates a cascade of signal transduction and helps insulin lower the

11NURSING ASSIGNMENT
blood glucose level (Belfiore et al. 2017). It promotes transport of glucose by ATP-
dependent movement of GLUT4 glucose transporter.
B. Diabetes and schizophrenia have an association which can be accredited to certain
factors that contribute to comorbidities such as, susceptibility to the illness due to
autonomic hyperactivity, sedentary lifestyle and physical inactivity, cigarette
smoking, use of antipsychotics for treating mental disorder, and social health
determinants, like housing, food insecurity, and income (Vancampfort et al. 2013).
Her ethnicity can also be considered as the contributed factor owing to the fact that
African ethnic minorities often follow a lifestyle and adopt food patterns that increase
the amount of fat around their waist and also blood cholesterol levels, both of which
are responsible for diabetes onset (Attridge et al. 2014).
C. Interventions would include making her show adherence to a diet that is rich in
nutrition and fresh foods, including vegetables, whole grains, fruits, and low fat dairy
product. Refraining from consumption of excess alcohol, limiting intake of high sugar
foods and engaging in regular exercise would prove beneficial. Anti-diabetic
medications such as, metformin will also be administered in order to lower the blood
sugar levels (Garber et al. 2013).

12NURSING ASSIGNMENT
References
American Diabetes Association, 2016. 8. Cardiovascular disease and risk
management. Diabetes care, 39(Supplement 1), pp.S60-S71.
Attridge, M., Creamer, J., Ramsden, M., Cannings‐John, R. and Hawthorne, K., 2014.
Culturally appropriate health education for people in ethnic minority groups with type 2
diabetes mellitus. Cochrane Database of Systematic Reviews, (9).
Belfiore, A., Malaguarnera, R., Vella, V., Lawrence, M.C., Sciacca, L., Frasca, F., Morrione,
A. and Vigneri, R., 2017. Insulin receptor isoforms in physiology and disease: an updated
view. Endocrine reviews, 38(5), pp.379-431.
Braun, T., Challis, J.R., Newnham, J.P. and Sloboda, D.M., 2013. Early-life glucocorticoid
exposure: the hypothalamic-pituitary-adrenal axis, placental function, and long-term disease
risk. Endocrine reviews, 34(6), pp.885-916.
Caponnetto, P., Auditore, R., Russo, C., Cappello, G.C. and Polosa, R., 2013. Impact of an
electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a
prospective 12-month pilot study. International journal of environmental research and public
health, 10(2), pp.446-461.
Crump, C., Sundquist, K., Winkleby, M.A. and Sundquist, J., 2013. Comorbidities and
mortality in bipolar disorder: a Swedish national cohort study. JAMA psychiatry, 70(9),
pp.931-939.
Garber, A., Abrahamson, M., Barzilay, J., Blonde, L., Bloomgarden, Z., Bush, M., Dagogo-
Jack, S., Davidson, M., Einhorn, D., Garvey, W. and Grunberger, G., 2013. AACE
comprehensive diabetes management algorithm 2013. Endocrine Practice, 19(2), pp.327-
336.

13NURSING ASSIGNMENT
Goldstein, B.I., Carnethon, M.R., Matthews, K.A., McIntyre, R.S., Miller, G.E., Raghuveer,
G., Stoney, C.M., Wasiak, H. and McCrindle, B.W., 2015. Major depressive disorder and
bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular
disease: a scientific statement from the American Heart Association. Circulation, pp.CIR-
0000000000000229.
Hall, J.E., 2015. Guyton and Hall textbook of medical physiology e-Book. Elsevier Health
Sciences.
Holt, T. and Kumar, S., 2015. ABC of Diabetes. John Wiley & Sons.
Iaboni, A. and Flint, A.J., 2013. The complex interplay of depression and falls in older adults:
a clinical review. The American Journal of Geriatric Psychiatry, 21(5), pp.484-492.
Kemp, A.H. and Quintana, D.S., 2013. The relationship between mental and physical health:
insights from the study of heart rate variability. International Journal of
Psychophysiology, 89(3), pp.288-296.
Laursen, T.M., Wahlbeck, K., Hällgren, J., Westman, J., Ösby, U., Alinaghizadeh, H.,
Gissler, M. and Nordentoft, M., 2013. Life expectancy and death by diseases of the
circulatory system in patients with bipolar disorder or schizophrenia in the Nordic
countries. PloS one, 8(6), p.e67133.
Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F., Samara, M., Barbui,
C., Engel, R.R., Geddes, J.R. and Kissling, W., 2013. Comparative efficacy and tolerability
of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The
Lancet, 382(9896), pp.951-962.
Malhi, G.S., Tanious, M., Das, P., Coulston, C.M. and Berk, M., 2013. Potential mechanisms
of action of lithium in bipolar disorder. CNS drugs, 27(2), pp.135-153.

14NURSING ASSIGNMENT
Mann, K., Bladström, A., Torup, L., Gual, A. and van den Brink, W., 2013. Extending the
treatment options in alcohol dependence: a randomized controlled study of as-needed
nalmefene. Biological psychiatry, 73(8), pp.706-713.
Miller, W.H., Griffin, C.E. and Campbell, K.L., 2013. Structure and function of the
skin. Mueller & Kirk’s) Small Animal Dermatology, 7th edn. Elsevier Mosby, St. Louis,
Missouri, pp.1-56.
Popovic, D., Benabarre, A., Crespo, J.M., Goikolea, J.M., González‐Pinto, A., Gutiérrez‐
Rojas, L., Montes, J.M. and Vieta, E., 2014. Risk factors for suicide in schizophrenia:
systematic review and clinical recommendations. Acta Psychiatrica Scandinavica, 130(6),
pp.418-426.
Ridolo, E., Montagni, M., Bonzano, L., Incorvaia, C. and Canonica, G.W., 2015. Bilastine:
new insight into antihistamine treatment. Clinical and Molecular Allergy, 13(1), p.1.
Rui-feng, C., Li-song, H., Ji-bo, Z. and Li-qiu, W., 2013, July. Emergency treatment on facial
laceration of dog bite wounds with immediate primary closure: a prospective randomized trial
study. In BMC emergency medicine (Vol. 13, No. 1, p. S2). BioMed Central.
Shier, D., Butler, J. and Lewis, R., 2015. Hole's essentials of human anatomy & physiology.
New York: McGraw-Hill Education.
Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M.A., Ceccofiglio, A., Tesi, F. and
Marchionni, N., 2013. Fall prevention in the elderly. Clinical Cases in mineral and bone
metabolism, 10(2), p.91.
Vancampfort, D., Correll, C.U., Galling, B., Probst, M., De Hert, M., Ward, P.B.,
Rosenbaum, S., Gaughran, F., Lally, J. and Stubbs, B., 2016. Diabetes mellitus in people with

15NURSING ASSIGNMENT
schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large
scale meta‐analysis. World Psychiatry, 15(2), pp.166-174.
Vancampfort, D., De Hert, M., Sweers, K., De Herdt, A., Detraux, J. and Probst, M., 2013.
Diabetes, physical activity participation and exercise capacity in patients with
schizophrenia. Psychiatry and clinical neurosciences, 67(6), pp.451-456.
World Health Organization., 2014. Global status report on alcohol and health, 2014.
Retrieved from
http://apps.who.int/iris/bitstream/handle/10665/112736/9789240692763_eng.pdf;jsessionid=
0F3B800686CBE2939D81B05B3C3E8C16?sequence=1
Xie, Z., Paras, C.B., Weng, H., Punnakitikashem, P., Su, L.C., Vu, K., Tang, L., Yang, J. and
Nguyen, K.T., 2013. Dual growth factor releasing multi-functional nanofibers for wound
healing. Acta biomaterialia, 9(12), pp.9351-9359.