HLTAAP002: Confirm Physical Health Status - Mrs Chan - Mr Marconi - Mrs Thompson - Miss Walker - Mrs Nguyen - Peter Jackson - Case Study Assessment Answer

Subject Code: HLTAAP002

Case Study Assessment Answer

Assignment Task: HLTAAP002 Scenario 1 – Mrs Chan Mrs Chan has been bought in by ambulance following a fall at home, where she fractured her hip. She believes she fell around 10 pm last night and was unable to get up to seek help. Her daughter found her still on the floor this morning at 6.00am and called the ambulance. Mrs Chan’s past medical history includes:

• Urinary incontinence
• Osteoporosis
• Compression fractures to her spine due to osteoporosis
• Removal of a Stage II melanoma in 2006

Regular medications:

• Fosamax
• Vitamin D
• Calcium
• Fentanyl patch
• PRN Endone

Question 1 When Mrs Chan is admitted to the hospital, she is found to have mild hypothermia.

• Explain what hypothermia is and at least three factors that may have caused this in her case.
• Define homeostasis and name the three components that make up any biological homeostatic control mechanism
• Describe at least four different changes that would occur in Mrs’s Chan’s body to regain temperature homeostasis.

Further Information: Mrs Chan had a Stage II melanoma removed in 2006 and the tissue was sent to pathology for testing.  The pathology report came back stating the tumour showed signs of dysplasia. Question 2

• The four major types of cellular adaptation are hypertrophy, hyperplasia, metaplasia and dysplasia.  Briefly describe each of these types of cellular adaptation
• Define atrophy
• What does the term ‘surgical insult’ mean?

Question 3 Part of the ENs role is to assist in referring clients care to the appropriate people within a multi-disciplinary team.

• List six (6) different professions that may be part of a multi-disciplinary team.
• Which part of the team has the role of interpreting test results in order to formulate a diagnosis?
• Why does the EN need to know the purpose of blood collection?
• Can an EN disclose pathology results to their client? Give a reason for your answer.

Scenario 2 – Mr Marconi Mr Marconi is a 76-year old man who has hypertension, hyperlipidaemia and congestive heart failure. He is brought in to the Emergency Department at 06:00.  On arrival, Mr Marconi states that he has chest pain when breathing in, he is coughing up yellow phlegm and he feels exhausted.  His left arm has a shallow wound that Mr Marconi said he got while weeding his garden two days earlier. His vital signs include:

• Respiratory Rate: 28 bpm (shallow with pain on inspiration)
• SaPO2: 91% (2L O2)
• Blood Pressure: 105/70 mmHg
• Pulse Rate: 105 bpm
• Temperature: 38.9 degrees C
• BGL: 4.5mmol
• Weight: 78 kg
• Height: 174 cm

His current medications include Atenolol, Ramipril and Lipitor. He has no known allergies. Question 4 Describe the process of coronary artery atheroma formation - include the following in your answer:

• Describe the steps of atheroma formation:
• Name three factors that trigger endothelial inflammation
• How do high and low-density lipoproteins contribute to atheroma formation?
• What is the role of macrophages in relation to atheroma formation?
• The patient is taking Atenolol and Ramipril. Describe in simple terms (that a patient could understand) how these two medications work in treating ischaemic heart disease.

Question 5 You are asked to clean the wound on the patient’s arm.

• Explain the structure and the function of the skin and the problems associated with a break in the skin such as this wound.
• You notice that the patient’s skin appears thin and like ‘tissue paper’. Explain what may have caused this.

Question 6 The patient wears reading glasses.  Explain degenerative changes that occur in the eye as we age and how this may have resulted from Mr Marconi’s need to wear glasses. Scenario 3 – Mrs Thompson Sarah Thompson is a 65-year-old woman who presents to her GP clinic for an annual checkup.  She was diagnosed with Type II Diabetes Mellitus (T2DM) in 2009: Weight: 95kg Height: 164cm BMI 36 Mrs Thompson also has hyperlipidaemia and hypertension, and she is taking Metoprolol and Rosuvastatin daily. Question 7 Discuss Type 2 diabetes – include the following in your answer:

• What body systems and/or organs can be affected by T2DM?
• Name five risk factors for developing T2DM:
• Describe appropriate treatment for a patient such as Mrs Thompson who has T2DM
• Which part of the cell makes ATP (adenosine triphosphate) needed for cellular energy
• What is required to ensure a cell remains healthy?

Question 8 Define hyperlipidaemia and explain the associated risks and causes of this condition. In your answer identify the roles of high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. Scenario 4 – Miss Walker Miss Walker is a 46-year-old female who presented to the emergency department with shortness of breath which has got progressively worse over the last two days. She has no other significant past medical history. RR:   26 SpO2:  93%. The doctor orders a chest X-ray which shows consolidation of fluid on his right lower lung. The doctor diagnoses right lower lobe pneumonia. Question 9 Relate the diagnosis of pneumonia to two stages of respiration - external respiration and gas transport.

• Describe what occurs during normal external respiration.

• Describe what occurs during normal respiratory gas transport. Discuss how O2 and CO2 are transported in the blood

• Differentiate between pulmonary ventilation, internal respiration and cellular respiration.
• Briefly explain what respiratory acidosis and respiratory alkalosis are:

Question 10 Describe the steps involved in the homeostasis of respiratory rate - include the following in your answer (in 200 words):

• Name two (2) respiratory gases detected in the blood?
• Where is the respiratory control centre located?  What is the stimulus that causes the respiratory control centre to increase respiratory rate?
• Why would the patient have an increased respiratory rate if they are suffering from pneumonia? You need to explain the physiology behind why having pneumonia causes increased respiratory rate
• How does the administration of supplementary oxygen help to maintain homeostasis of respiration?
• What impact would the administration of supplementary O2 have on the patient’s respiratory rate? What impact would the administration of supplementary O2 have on the patient’s SpO2?

Question 11 Later in your shift, you find the patient crying. She tells you that she has been crying a lot lately and feeling sad since her husband asked her for a divorce. Explain psychological health as it relates to the patient and who you could refer them to. Scenario 5 – Mrs Nguyen Mrs Nguyen is a 75-year-old woman who is bought into the GP clinic by her daughter Rosemary. Mrs Rosemary says that her mother has complaining of painful urination and her mental state has become confused over the past 24 hours. The RN asks you to perform a urinalysis test. Question 12

• Explain how you would prepare for a urinalysis test?
• You assess the results of a urine dipstick test – list two (2) signs would you expect if a UTI was present?
• What symptoms could the patient be experiencing if she has a UTI?
• A urine test is then ordered for culture and sensitivity. Describe what each of these tests are evaluating and how the results relate to medication prescription
• Explain how the patient’s age could impact on the urinary system?

Mrs Nguyen also has had some dental problems, and lets you know that she is getting dentures in the next month or so. Question 13

• List five (5) oral health diseases
• What is the term used to describe people with teeth and without teeth

During an assessment, Rosemary shows you Mrs Nguyen’s medication webster pack. She is concerned that there are three days of medications missing and she thinks that her mother may have forgotten that she had taken her pills and took another dose. The medication list on the Webster pack lists the drugs as: Serepax: 10mg  at night Metoprolol: 50 mg twice per day Aspirin: 100mg in the morning. Metformin: 500mg BD List three (3) body systems that may be affected by the accidental ingestion of these medications.  Scenario 6 – Peter Jackson Ruth and Michael Jackson have been trying to have a baby for the past five years.  In November 2016, Ruth gives birth to a son, Peter.  48 hours after birth, Peter undergoes the standard neonatal screening test, which helps to identify those infants at risk of rare, but serious medical conditions such as phenylketonuria, hypothyroidism and cystic fibrosis. Peter is found to have cystic fibrosis (CF), an autosomal recessive condition that affects mostly the lungs, but also the pancreas, liver, kidneys and small intestine. Question 14

• Discuss the difference between having the disease of CF compared to being a carrier of CF from a genetic perspective.

Further Information: At three months, Ruth and Michael take Peter to the paediatrician for a follow-up.  The paediatrician notes FTT (failure to thrive) on Peter’s medical record.  She explains to Jackson’s that this means Peter has poor weight gain, and that he will need a high-calorie diet and enzyme supplementation for the rest of this life.

• Explain how CF causes failure to thrive and how this may impact on Peter’s biological maturation
• Why does Peter need a high-calorie diet and pancreatic enzyme supplementation?
• How does CF contribute to malabsorption of nutrients in a teenager?

 Further Information: Ruth is worried about Peter’s future and how long he is likely to live.

• What is the life expectancy of a patient with CF, compared to a non-CF patient?  How has current treatment affected this, compared to a patient diagnosed with CF twenty years ago?

You are talking to Ruth during a routine visit to the GP. She says that her husband Michael has taken up scuba diving. Ruth doesn’t understand much about scuba diving and is concerned that her husband may be injured, leaving her to care for Peter.

• List three (3) common emergencies experienced by divers.

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