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Question 1:

The oxyhaemoglobin dissociation curve shows how blood oxygen partial pressure affects haemoglobin binding. An equation for this curve is provided. This shows how readily haemoglobin may release oxygen for cell usage.

The case study reveals Anya's 98% SpO2, indicating high oxygen saturation. This suggests that a lot of the person's haemoglobin is firmly connected to oxygen and quickly consumed by cells. The case study did not provide plasma oxygen concentration (Dahl et al., 2020). The oxyhemoglobin dissociation curve shows the relationship between oxygen saturation and partial pressure of oxygen (PaO2). It shows how PaO2 levels affect oxygen saturation.

This indoor air has 98% oxygen saturation. This means 98% of Anya's blood hemoglobin is oxygenated. This test shows how well oxygen is transported from the lungs to body tissues.

The phrase "oxygen dissolved in the plasma" refers to the little amount of oxygen that is not connected to hemoglobin and is dissolved in the plasma. Because it may cross cell membranes, dissolved oxygen is essential for tissue oxygenation. Anya, who has a saturation level of 98% for oxygen, has most of her oxygen linked to her hemoglobin rather than dissolved in her plasma. In this case, plasma oxygen will be low (Dahl et al., 2020). Finally, Anya's high blood oxygen saturation indicates that oxygen is linked to hemoglobin and delivered to tissues. By making oxygen more available, this helps cells consume it. Plasma oxygen concentration may be low relative to hemoglobin oxygen concentration.

Question 2:

a) Orientation:

  1. Problem: A trouble with Anya's direction might be construed from her condition of sluggishness and changed level of mindfulness. 1. The statistics from Anya's evaluation show that she has an issue with orientation. They have been characterized as sleepy, and their score of 13 on the Glasgow Coma Scale (GCS) shows that their level of awareness and orientation has dropped (Acute neurological injury, 2016).
  2. The consequences of the neurological lesion on the brain may provide an explanation for the impairment of orientation that was observed. The brain is the organ that processes and integrates information received from the senses, in addition to overseeing preserving consciousness and awareness. Orientation problems may be the result of damage or anomalies in certain regions of the brain, such as the cerebral cortex or the limbic system. The tiredness and reduced alertness that Anya is experiencing may be the result of the consequences of viral or bacterial encephalitis, which may cause inflammation and damage to the brain tissue that is important in maintaining orientation (Intraoperative Neurological, 2020).
  3. Clinical Findings: The GCS score of 13 (E2V5M6) that Anya has given us reason to believe that they are less sensitive as well as aware of their environment.

b) Conscious state:

  1. Problem: The tiredness and changed degree of awareness shown by Anya are both indications that there is an issue with their conscious state. The findings of Anya's examination point to an issue with the subject's conscious state. They have a GCS score of 13, which indicates that they have a lower degree of awareness and are regarded as tired. The condition of cognizance is constrained by a few locales of the cerebrum, one of which is the reticular activating system (RAS), which is responsible for supporting excitement and readiness. Modifications in one's condition of mindfulness, like sleepiness or loss of awareness, might be the consequence of injury or breakdown in the rhinal apical sulcus (RAS) or in different pieces of the cerebrum that are engaged with the course of cognizance (Beck & Garcia-Rill, 2015).
  2. Clinical Findings: Anya's lethargy, resistance from empower assessment of understudies, and want to contact their mom are signs that her state of mind and level of mindfulness have changed. a state of lowered degree of mindfulness and expanded tiredness.

c) Strength and coordination:

  1. Problem: Anya has a difficulty with her actual strength and coordination, which is shown by her minor respective shortcoming. As per Anya's assessment results, she has a little shortcoming in the two legs. Even though they can handle and press fingers, there is some sign that they have some level of shortcoming.
  2. The motor pathways in the spinal cord and brain are answerable for controlling both the body's solidarity and its coordination. Shortcoming and an absence of coordination are two side effects that might result from harm or glitch in these circuits. It is possible that Anya's weakness is being caused by viral or bacterial encephalitis, which is influencing the circuits in her brain that control her motor functions. The precise deficiencies in strength and coordination will be determined by the site of the neurological lesion in its whole as well as its scope. Further research, such as imaging or a neurological test, may be required to identify the underlying cause and ascertain the precise extent of the deficiencies to evaluate whether further treatment is warranted (Beck & Garcia-Rill, 2015).
  3. Clinical Findings: The fact that Anya can still grasp and crush her fingers while having minor bilateral weakness indicates that her muscular strength and coordination are compromised.

Question 3

To frame it another way, the outcomes of Anya's examination show that she has difficulty orienting herself, being alert, keeping her strength, and synchronizing her actions. In addition to this, she has difficulty staying awake for long stretches at a time, which is a significant problem. The presence of these clinical symptoms is suggestive of the possibility of brain damage and dysfunction, which may be related with the encephalitis and viral or bacterial meningitis that is most certainly present. This is because the presence of these clinical symptoms is indicative of the likelihood of brain damage and malfunction. In addition, the manifestation of these symptoms raises the chance of encephalitis being the underlying condition. In addition, the manifestation of these symptoms raises the possibility that the individual who is affected with the ailment has suffered a brain damage in addition to malfunction as a result of the condition. There is a significant possibility that these conditions are linked to a significantly increased risk of developing any kind of brain injury. This is because the risk of developing any brain damage is significantly increased. This argument is founded on the realization that the possibility of sustaining a traumatic brain injury of any sort is greatly increased. According to the findings of research, a disruption in the neurological system may be the root cause of a number of symptoms, some of which include changes in mental state, a decreased degree of awareness, and physical weakness. This member of the team, much like your psychologist, is responsible for addressing the psychological and behavioral manifestations that are brought on by issues with the nervous system. Therapy is the most effective kind of treatment for these kinds of problems the vast majority of the time. However, if you need medicine to control symptoms such as sorrow or anxiety, the individual healthcare practitioner that you are seeing may be able to help you with acquiring such prescriptions. This is a movement specialist who can aid you with moving and walking in a way that is less taxing on your body and more pleasant for you. In physical therapy, work may also be done on joints and muscles that are in pain or are tight. This work may include stretching. This information was derived from the study that was conducted in the year 2020. These are only a few instances out of a much bigger pool of possibilities. In order to ascertain the specific source of the neurological anomalies as well as the degree to which they are disturbing, more diagnostic testing and possible treatment options are necessary. In addition to this, it is essential to evaluate the extent to which the issues they present are significant. In addition to this, it is of the utmost importance to carry out an investigation into the level of difficulty that they provide.

Nursing problem

Evidence to support the problem statement

Nursing intervention 1

Nursing intervention 2

Intended outcome

Altered level of consciousness

A changed degree of awareness might be inferred from Anya's tiredness as well as her GCS score of 13 (Altered level of consciousness, 2008).

On a frequent basis, make use of a standardized instrument such as the Glasgow Coma Scale or the AVPU (Alert, Voice, Pain, Unresponsive) scale to evaluate Anya's degree of awareness.

- Make sure that Anya is in a secure location so that she does not hurt herself because of falling or her altered state of awareness.

Anya's awareness level is expected to normalize and improve because of this procedure, as shown by a rise in her GCS score or her degree of alertness.

Inadequate pain management

The severity of Anya's headache is an 11, and if they open their eyes, it will go much worse very quickly (Goodman et al., 2018). Should they open their eyes, they should expect the headache to become much more severe.

Anya is required to take the pain medicine that has been recommended to her, which may include paracetamol; also, we need to keep a careful check on how well the medication works to reduce her headache. It is important that she get the medicine as quickly as is humanly feasible. Anya has to take the medication, and while it is in her body, its effects must be carefully monitored in order to determine how well it is working.

Provide non-pharmacological pain management measures, such as lowering the volume of the lights, making sure there is complete silence around them, and teaching them how to relax.

It is anticipated that Anya's pain will be well managed, which will result in a reduction in the intensity of her headache as well as an improvement in the degree of comfort she feels (Mack et al., 2019).

Risk of infection 

in the urinary tract

Anya has expelled 300 milliliters of pee but does not seem to have opened their bowels.

Encourage Anya to consume a suitable quantity of water so that she may stay hydrated and increase the volume of urine she passes.

Always be on the lookout for any indications of an infection in Anya's urine, including its volume, color, and consistency.

The desired result is to reduce the risk of urinary tract infections by encouraging healthy levels of hydration and monitoring the quantity and quality of urine output.

Emotional distress and feelings of shame

Anya has to be given emotional support and reassurance, and you also need to acknowledge their concerns while showing understanding for them.

It is important to educate and enlighten people about cold sores, their causes, the treatment choices available, and the management measures for outbreaks.

Anya's feeling of being supported, understood, as well as empowered about the management of their cold sores and the addressing of their emotional discomfort is the desired result (Mack et al., 2019).

These nursing concerns include Anya's altered awareness, the treatment of her discomfort, the possibility that she may have an infection in her urinary system, and her emotional agony. Anya's consciousness, ability to control pain, ability to avoid infection, and mental well-being should all improve as a result of effective medicines and monitoring.

Question 4:

a) Two risks associated with the Lumbar Puncture (LP) procedure are:

  1. Risk of infection: The LP operation may introduce bacteria or other pathogens into the central nervous system, causing meningitis or other dangerous diseases. A lumbar puncture, which is often referred to as a spinal tap, is a procedure that may be carried out in order to diagnose or treat an issue. During this therapy, the healthcare practitioner will insert a hollow needle into the area surrounding the spinal column in your lower back. This location is known as the subarachnoid space. Because of this, they will be able to withdraw some cerebrospinal fluid (CSF) or inject certain medications (Toohey, 2015).
  2. Risk of post-LP headache: CSF leaking from the puncture site following an LP may sometimes cause patients to have headaches as a side effect. As a result of this, you could get severe headaches, discomfort in the neck, as well as nausea. A headache after a lumbar puncture for diagnostic reasons, often known as a headache after a post-dural puncture, is a typical side effect. This syndrome is sometimes referred to by the acronym PDPH, which stands for post-dural puncture headache. This issue may also arise after a spinal anesthetic, or, more often, if a dural puncture is created accidently when placing an epidural catheter. Both of these scenarios are quite likely to result in the same symptoms (Tolebeyan, 2023). It is usual for the headache to be worse while the patient is standing up, and it is typical for the headache to improve when the patient is laying down. Secondary symptoms often seen include stiffness in the neck, sensitivity to light, nausea, and a perceived loss of hearing.

b) Two independent nursing assessments or interventions to manage the risks associated with the LP procedure and how they address the risks are:

  1. Pre-procedure assessment: Anya's medical history, including allergies and treatment responses, might assist uncover LP procedure risks as well as contraindications. This examination ensures Anya's safety and suitability for the surgery (Kim, 2022).
  2. Maintaining strict aseptic technique: By limiting infections from entering the central nervous system, proper hand cleanliness, sterile gloves, as well as equipment during LP reduce infection risk.

c) Two collaborative assessments or interventions to manage the risks associated with the LP procedure and how they address the risks are:

  1. Antibiotic prophylaxis: Targeting possible microorganisms with the use of prophylactic antibiotics before to the LP operation may be an effective means of lowering the patient's exposure to risk of infection. This is accomplished through collaboration with the medical team.
  2. Post-procedure monitoring: Working along with the medical staff to carefully watch Anya for any indications of infection or post-LP problems, such as headaches, neck discomfort, or feelings of sickness. Addressing any symptoms or concerns as soon as they arise will assist in the early detection and management of problems (Kim, 2022).

Incorporating these evaluations and actions allows for the appropriate management and reduction of the risks that are linked with the LP procedure. Some of these concerns include infection as well as headaches experienced after the surgery.

Question 5:

a) The pharmacological actions of acyclovir:

Acyclovir is an antiviral medicine that acts by preventing the reproduction of herpes simplex virus (HSV), which includes HSV1, the virus that is responsible for cold sores. Although it is not a cure for HSV infections, it may help control the symptoms, lessen the intensity and length of outbreaks, and stop the transmission of the virus (Herpes simplex virus, 2015).

b) Response to Anya's feelings of shame:

It is essential to provide Anya support and encouragement as she works through the difficult emotions of shame she is experiencing. You may tell Anya that HSV1, the virus that causes cold sores, is quite prevalent, and that a lot of individuals have outbreaks of the condition. Make it clear that having cold sores is not a reflection on either the person's personal cleanliness or their character, and that there is no need to feel guilty about it. Extend your compassion to Anya and reassure them that you will be there to support them no matter where their journey may take them.

c) Exploration of Anya's concerns and risks:

Spend some time investigating Anya's worries and responding to any questions or concerns she or she may have concerned their cold sores and the therapy with acyclovir. Talk about the possible downsides and upsides of taking the drug, including its function in containing outbreaks and halting the transmission of the virus, as well as any other relevant information. Disseminate information on the correct way to handle cold sores, including appropriate hygiene habits such as avoiding close contact with other people during outbreaks and not sharing personal goods such as lip balms or towels (Trivedi et al., 2022). Must assist ease their feelings of guilt, offer them with information, and enable them to manage their cold sores in a manner that improves their overall well-being if you provide knowledge, support, and address Anya's worries and dangers.

References

Altered level of consciousness: Pathophysiology and management. (2008). Neurosurgical Intensive Care. https://doi.org/10.1055/b-0034-76137

Acute neurological injury: Pathophysiology as related to therapeutic targets. (2016). Cellular Therapy for Neurological Injury, 18–57. https://doi.org/10.1201/b19533-6

Beck, P., & Garcia-Rill, E. (2015). Development and the ras. Waking and the Reticular Activating System in Health and Disease, 81–105. https://doi.org/10.1016/b978-0-12-801385-4.00005-7

Dahl, R. H., Taudorf, S., Bailey, D. M., Møller, K., & Berg, R. M. (2020). A method for modelling the oxyhaemoglobin dissociation curve at the level of the cerebral capillary in humans. Experimental Physiology, 105(7), 1063–1070. https://doi.org/10.1113/ep088615

Goodman, E., Anitescu, M., & Malik, T. M. (2018). Clinical consequences of inadequate pain management and barriers to optimal pain management. Oxford Medicine Online. https://doi.org/10.1093/med/9780190457006.003.0017

Herpes simplex virus 1 and 2 (HSV-1, HSV-2) infections. (2015). Diagnostic Pathology: Infectious Diseases. https://doi.org/10.1016/b978-0-323-37677-8.50011-5

Intraoperative Neurological Injury. (2020). Definitions. https://doi.org/10.32388/monjtc

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Kim, K. T. (2022). Lumbar puncture: Considerations, procedure, and complications. Encephalitis, 2(4), 93–97. https://doi.org/10.47936/encephalitis.2022.00045

Mack, K. M., Henry-Thomas, N. F., & Nolan, A. D. M. (2019). 2E.1. geriatric pain intervention pilot (G-pip) program: A geriatric resource nurse-led Pain intervention educational initiative. Pain Management Nursing, 20(2), 96. https://doi.org/10.1016/j.pmn.2018.11.017

Tolebeyan, A. S. (2023). Post-surgical CSF leak with inconclusive diagnostic studies: A case report. Annals Of Headache Medicine Journal. https://doi.org/10.30756/ahmj.2022.09.02

Toohey, S. (2015). Lumbar puncture. Lumbar Puncture. https://doi.org/10.18556/touchsurgery/2015.s0052/p1

Trivedi, A. A., Yang, J. Y., Johnston, J., & Sori, A. (2022). Septic shock due to candida and disseminated herpes simplex virus-1 (HSV1) after elective spinal surgery in an immunocompromised patient with chronic HSV1 infection. Journal of Surgical Case Reports, 2022(6). https://doi.org/10.1093/jscr/rjac273

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Acute Nursing Practice Assignment Sample

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