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Patient Home Visit: Case Study

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Patient Home Visit: Case Study

The major problems that can be identified from the patient home visit it is the social alienation of the patient, she is psychologically disturbed and with the lack of appetite the medicine will not be effective enough. She misses her husband a factor that increases the pain and the suffering that she is undergoing. She, however, points out that he used to smoke so often a factor that may be led to the condition that she is undergoing.

The discharge instructions have not been followed to the letter. There is no oxygen supply at the homestead since this was one of the discharging factors that would assist her to recover much faster at home. Lack of family to offer support also affects how the patient will cope with the ailment. The medications were not filled in time because her daughter works full time and she also has her issues to deal with.

For the betterment of the patient, it is vital that some questions should be addressed to improve the health of the patient. The nurses should be aware of all the medicines that the patient should be taking at a given time. As evidenced, the patient mentioned that a nurse who has visited earlier didn’t assess the medications that were not available.

Better and proper education should also be provided to the patient so that she can understand why some things are mandatory. Regarding the supply of oxygen in the house, she should be aware that the requirement is necessary, and it should be fixed immediately.

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Since the patient doesn’t have any family support, she should regularly be visited, or a nurse should permanently be at her home to guide her in the healing process. Psychologically, she should be involved in other activities that would make her concentrate on her health other than being psychologically being affected by those that she misses. The patient will be better if exercise is introduced into her life. Exercising rejuvenates an individual’s body energy, and this makes blood circulation to be efficient, and this will work well with the heart condition that she has.

Therapy and a holistic, multidisciplinary approach to the older people with heart conditions must be followed to the letter. It has been evidenced how effective the nurse visits have helped such kind of patients to cope with their conditions. Follow-ups by doctors and nurses are recommended, but they should be regular so that better techniques will be availed that will be used to improve the patient’s survival (Koelling et al. 2005)

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Patient Home Visit: Case Study

Dialogue

Nurse: “Good afternoon Sallae Mae, my name is Christine, and I will be your nurse today. I have learned that you are having issues with taking your medication?”

Mae: Yes I have not been consistently taking my drugs in the right procedure as prescribed, how can I do it better nurse?”

Nurse: All the medications that you have been prescribed with have significance in your healing. Take them at the time prescribed so that your health will improve. I also realize that you do not have oxygen supply as indicated in the discharge prescription?

Mae: “True, I don’t want any oxygen in this house, I am just tired all I think about is my late husband, and recently I have no appetite.”

Nurse: “That should not be the case mom, oxygen supply enables your breathing to be better and prevents polluted air into your systems. It will clean your lungs for healthy breathing and improve blood circulation. Hope you understand me, mom.”

Mae: “Yes I apparently dont blame you, but I can’t stop thinking about him when my only daughter doesn’t have enough time to come and check on me, nurse.”

Nurse: “I have a solution to that, I will volunteer to be visiting you after every two days, we start an exercise session so that you won’t be thinking about family members so much. I will also talk to your daughter to at least spare some hours and visit you. You will get better mom and all the best. I will visit you two days later and eat well never lose hope. Bye for now,”

Mae: “Bye nurse, take care too.”

References

Koelling, T. M., Johnson, M. L., Cody, R. J., & Aaronson, K. D. (2005). Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation, 111(2), 179-185.

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BRCA1 Gene of Breast Cancer

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BRCA1 Gene of Breast Cancer

If you were Rachel’s healthcare provider, what would you do? Provide a rationale for your response

All the patients in the healthcare sector are privy to patient confidentiality. Physicians are not required to release any information regarding their patient to anyone without their consent. The sole purpose of having patient confidentiality is to build a good relationship between the patient and the physician. It also prevents stigmatization of patients suffering from certain disease conditions (Stephens et al., 2012).

However, there instances where patient confidentiality is breached. This occurs in cases where there is concern or safety for other individuals. This means that the disease condition affects another party which has no information regarding the disease. In the case study, Rachel is predisposed to breast cancer since it has been established that she has the BRCA1 Gene of Breast Cancer (Stephens et al., 2012). Since the gene is inherited, there is a high likelihood that both her sisters may be predisposed.

Rachel does not want her sister to know that her sister has the disease condition (Bombonati & Sgroi, 2011). As already established patient confidentiality exists between Rachel and me. However, failure to inform the other party would significantly affect their health status (Bombonati & Sgroi, 2011). Thus, in this case, I would advise Rachel to talk to both her sisters since the case will not involve patient confidentiality. If Rachel does not do so, I would advise them to talk to a different genetic counselor with the hope that she changes her mind.

BRCA1 Gene of Breast Cancer

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Include the pathological processes associated with breast cancer. What role does the BRCA1 gene contribute to managing the patient’s care?

Breast cancer is a multistep process that is triggered with a defect in the cell cycle that regulates how cells divide in the breast. According to Bombonati & Sgroi (2011), breast cancer is made up of four steps. The first step after the dysregulation of the cell cycle processes is the formation of a flat epithelial atypia which is progress to atypical ductal hyperplasia. After some time, it progresses to ductal carcinoma in situ before finally moving the lethal stage that is known as invasive ductal carcinoma (Bombonati & Sgroi, 2011).Once the last stage has developed the disease starts to metastasize and establishes its blood supply and other important physiologic molecules.

BRCA1 gene has been implicated in the majority of the hereditary ovarian and breast cancers. Physicians normally look for this gene mutation through the family history. Once the physicians have established that patients have these genes, the patient is genetically tested, and if the results turn out to be positive, the patient undergoes prophylactic treatment which is used to prevent ovarian and breast cancer (Bombonati & Sgroi, 2011). The presence of the gene BRCA1 assists patients to know their disease state.

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BRCA1 Gene of Breast Cancer

Describe and explain the role of the BRCA1 and breast cancer 2, an early onset (BRCA2) gene in contribution as a risk factor for breast cancer.

Two genes that have been identified that predispose women to breast cancer. Genetic mutations in the germline of BRCA1 gene predispose 15-45% of all cases of hereditary breast cancer. It has also been associated with 60-80% of all the breast cancer cases in women.

Additionally, it has been associated with 20-40% 0f all the ovarian cancers. Mutations associated with the gene BRCA2 have been known to have a less incidence of breast cancer. The case is low compared to that of BRAC1 (Stephens et al., 2012). Anyone associated with the gene BRAC2 has a 6% incidence of developing breast cancer in their lifetime.

Analyze the risk factors for breast cancer and possible interventions to preventive health management for women and men.

Several factors increase the risks associated with mutations in the genes BRAC1 and BRAC2. Such factors include the presence of bilateral cancer in the same women, family history of breast cancer and cases of having a genetic mutation in the BRAC1 and BRAC2 gene in the family (Stephens et al., 2012). Other factors include alcohol consumption, radiation exposure, being overweight, environmental chemicals and postmenopausal weight gain.

The first preventive measure involves undergoing breast cancer screening that can detect the presence of the gene defects associated with BRAC1 and BRAC2. Several different types of tests are available. They include mammograms, use of biopsies, clinical breast exams, hormone receptor assays and magnetic resonance imaging (Stephens et al., 2012). Early detection is key to early treatment. The other factors are easily preventable. For example, physical activity reduces incidences of being overweight.

BRCA1 Gene of Breast Cancer

References

Bombonati, A., & Sgroi, D. C. (2011). The molecular pathology of breast cancer progression. The Journal of Pathology, 223(2), 308-318.

Stephens, P. J., Tarpey, P. S., Davies, H., Van Loo, P., Greenman, C., Wedge, D. C., … & Yates, L. R. (2012). The landscape of cancer genes and mutational processes in breast cancer. Nature, 486(7403), 400-404.

BRCA1 Gene of Breast Cancer

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Allergy: Patient History

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Allergy: Patient History

Donna’s symptoms suggest allergy rhinitis and a possible an allergic contact dermatitis. Donna complains of tenderness over maxillary sinuses and nares which are in conjunction with red, and with boggy moist mucosa and one-medium sized polyp on each side. All these symptoms suggest rhinitis, and an inflammation of the mucous membranes taking place in the nose (McCance & Heuther, 2014).

Other effects of allergens include the reddened clear and slightly swollen eyes with tearing that Donna presents with. Taking into consideration that Donna’s flaking erythematous rash is noted only on the flexor surfaces her arms, is it likely to be caused by direct contact with an allergen. A postponed sort IV extreme touchiness response Allergic contact dermatitis is and is appears localized, as opposed to widespread like atopic dermatitis (McCance & Heuther, 2014).

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Questions pertaining to both personal and family history include:

Any history of pet, seasonal, or environmental allergies?
Any history of respiratory issues?
Any history of asthma or asthmatic bronchitis?
Do these symptoms present around the same time each year?
Have you noticed an irritant that causes these symptoms to flare up?

Evidence suggesting that Donna doesn’t have an acute severe infection

Donna’s vital signs within normal limits, which shows hemodynamic stability; her lungs are clear to auscultation; and her postnasal drainage is clear. The presence of this evidence is not suggestive of an acute severe infection.

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Type of hypersensitivity reaction involved in Donna due to her allergic Rhinitis

As described in McCance and Huether (2014, p.56), allergic rhinitis is caused by inhalants such as dust, pollen, and mold. This is classified as a Type I hypersensitivity reaction. The most common allergies are type I reactions, which happen as a response to an exposure to an environmental antigen (McCance & Huether, 2014).

Reference

McCance, K., & Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, 7th Edition

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Rhinitis Patient Diagnosis Essay

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Rhinitis Patient Diagnosis

Richard presented to the healthcare facility with complaints of postnasal drainage, sneezing, rhinorrhea, and nasal congestion. These clinical manifestations are common in patient diagnosed with Rhinitis. Therefore, the Advance practitioner differential diagnoses are correct. Allergic rhinitis is most likely because patient complains of runny nose, sneezing, red itchy watery eyes, sore throat and nasal congestion (Kaliner, 2011).

This is confirmed by allergy test, nasal smear for eosinophils. It is important that the advance practitioner nurse requested for nasal smear as it helps confirm the presence of eosinophils in the nasal secretions. Presence of eosinophils indicates that the patient is diagnosed with allergic rhinitis. Blood test is also important to check for IgE antibodies which will help to confirm the diagnosis of allergic rhinitis (Dains, Baumann, & Scheibel, 2016).

Infectious Rhiniti is suspected because of patient’s signs and symptoms such as sneezing, rhinorrhoea, cough, and congestion. This is ruled out by the laboratory test findings. Non-allergic rhinitis is suspected nasal congestion, sneezing and runny nose. The immunological tests results rules out the likelihood infection (Kaliner, 2011).

Rhinitis medicamentosa is suspected due to presence of nasal congestion. This mainly occurs when the patient uses certain oral medications such as topical decongestants and some oral medications. These medications make the blood vessels to constrict causing nasal congestion. This is not likely because the patient denies use of oral medications and topical decongestants (Kaliner, 2011).

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Nasal speculum is also good as it helps visualize the patient’s nasal turbinate’s and mucosa. Presence of pale and boggy turbinates’ is an indicator of allergic rhiniti. However, I think further diagnostic tests should have been considered. This includes imaging tests such as CT scans to check if the patient has sinusitis, associated structural defects or chronic inflammation. Rhinoscopy should have been conducted as it would help to check for nasal polyps and associated complications (Ball et al., 2015).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical
diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Kaliner, M. (2011). Rhinitis. Philadelphia, Pa.: Saunders.

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Nutrition Assessment of Geriatric Patients

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Nutrition

Careful assessment of the patient is essential for the development and the successful diagnosis of the comprehensive treatment plans for the many nutrition issues. The geriatric patient’s assessment will be carried out using the Lawton instrument activities of daily living (IADL scale).The 75-year-old female patient presents some problems. The following activities preparation of food, handling medications, handling of cooking items such as gas and stove.

Using transportation and movement ability is also assessed using the IADL scale (Nykanen et al, 2012). The scores for the patient read lowest values as been 3 and highest to be six which implies poor physical and cognitive functioning (Naseer et al, 2015).

The patient is malnutrition thus has lost a lot of weight. The patient is independent in her activities of daily living, and the poor functioning has impacted the nutrition and hydration of the patient causing malnutrition (Nykanen et al, 2012). The patient experiences the low oral intake due to mild cognitive impairment to prepare meals and carry out other functions as assessed using the IADL scale (Graf, 2013).

The patient suffers from the coronary artery disease thus is at risk of also having the stroke medical condition. The patient has some dietary needs that have contributed to the malnourishment and also the high risk of developing the coronary artery medical condition.

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Vitamin deficiencies such as folate, vitamin B6 and B12 lacks in her diet (Graf, 2013). These deficiencies are associated with the cognitive inability of the patient. The vascular functioning of the patient is affected by the lack of these vitamins, thus causing malnutrition (Naseer et al, 2015).The patient is currently not attempting for any of the medical issues since the ability to handling medication has also been a major problem for the independent geriatric patient (Naseer et al, 2015).

The nutrition problem presented during the assessment of the patient can be solved through the supplementation using the B12 and B6 vitamins for the patient. Provision of a care giver for the patient will also reduce the high rate of independence. The elderly patient’s oral intake improves when there is the person to help in preparation of the meals and also carrying out other activities(Nykanen et al,2012).A diet with low fats contributes to eliminating the vascular risk factors. Nutrition intervention after the assessment of the patient improves the quality of life.

References

Graf, C. (2013). The Lawton Instrumental Activities of Daily Living (IADL) Scale. Try this: Best Practices in Nursing Care to Older Adults.

Naseer, M., Forssell, H., & Fagerström, C. (2015). Malnutrition, functional ability and mortality among older people aged &ges; 60 years: a 7-year longitudinal study. European journal of clinical nutrition.

Nykänen, I., Lönnroos, E., Kautiainen, H., Sulkava, R., & Hartikainen, S. (2012). Nutritional screening in a population-based cohort of community-dwelling older people. The European Journal of Public Health, cks026.

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