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1. Bridie is a 63-year-old woman who has spent the last three weeks in the hospital after a fall where she sustained a complicate fracture of her left tibia and fibula. A few days after discharge from hospital Bridie developed cellulitis of her right forearm associated with pain, redness, warmth and swelling.
a) Name the microorganism commonly associated with cellulitis and describe the general structure of this type of organism.
b) Explain the process of inflammation leading to pain, redness, warmth, and swelling.
c) Why would Bridie develop cellulitis? List two reasons and provide the rationale for your answer.
(12 marks)
2. Gerry is a 78-year old gentleman with a history of an Anterior ST-Elevation Myocardial
Infarction (STEMI) and Severe Left Ventricular Failure (LVF). Gerry has also smoked 15 cigarettes per day for the last 30 years. His additional history includes type II Diabetes Mellitus and hyperlipidemia. Gerry was admitted to the medical ward in the hospital last night with an exacerbation of his LVF, worsening breathlessness, and orthopnoea. It is now 0800 in the morning and you as his nurse come to check his blood pressure, pulse rate and SpO2.
a) Explain what is meant by the term “blood pressure” and describe the factors that determine blood
pressure?
b) What causes the ‘pulse’ and what is the origin of the heart sounds S1 and S2?
c) Explain the physiology behind the oxyhaemoglobin dissociation curve.
d) Explain what is meant by the term ‘SpO2’?
Furthermore, your buddy nurse asks you to:
e) Describe the process of gas exchange related to ventilation, external and internal respiration.
f) What factors influence the ability of oxygen to enter the blood from the lungs, and then enter the
tissues from the blood?
(18 marks)
3. Simon works as as a high-angle tree lopper. He presents to the Emergency Department after
falling more than 15 metres when his harness failed. He has sustained a large bruise and haematoma
on his right side, and presents with a sinus tachycardia and obvious difficulty breathing. After
assessment and a computerised tomography (CT) scan, the emergency physician tells you he has
fractured his right ribs 7 through 10, has a right pneumothorax, a lacerated liver and contused right
kidney. He also has haematuria.
a) Describe (NOT list) in detail five (5) functions of the liver? Why might liver injury lead to coagulation
problems?
b) Define and outline the criteria for normal sinus rhythm, and describe the autonomic control of heart
rate?
c) Why is Simon having difficulty breathing – explain your answer.
d) Why would Simon have haematuria? Describe the functions of the kidney.
(20 marks)
4. Arthur is an 81 - year old man with a medical history of type II Diabetes Mellitus, gout and
Atrial Fibrillation. Arthur was admitted to the medical ward in the Ritz Medical Centre last night with
severe diarrhoea and vomiting. As a result of his past medical history, Arthur has been taking oral
glibenclamide, digoxin and warfarin. It is now 0800 in the morning; you and your buddy nurse come
to check his vital signs. Your buddy burse asks you to:
a) Design a concept map that explains and describes the regulation of blood glucose levels.
In designing your concept map, you may use any number of freely available software programs on the internet
(e.g. mindomo, bubbl.us etc) or simply utilise features in Word. You must however upload your map WITH your
assignment submission as ONE document file in a form that is legible.
b) Explain in detail how diarrhoea and vomiting may affect the absorption and effect of Arthur’s oral
medications.
Solution
1. Bridie is a 63-year-old woman who has spent the last three weeks in the hospital after a fall where she sustained a complicate fracture of her left tibia and fibula. A few days after discharge from hospital Bridie developed cellulitis of her right forearm associated with pain, redness, warmth and swelling.
a) Name the microorganism commonly associated with cellulitis and describes the general structure of this type of organism.
Cellulitis is an intense contamination of the dermal and subcutaneous layers of the skin, frequently happening after skin injury. Cellulitis is portrayed by erythema, swelling, warmth, and delicacy over the influenced territory (Bailey and Kroshinsky, 2011). Cellulitis happens when certain sorts of microorganisms enter in to skin layers through the cuts. Cellulitis is regularly brought about by Staphylococcus (S aureus) and Streptococcus microorganisms.
Staphylococcus aureus is a gram-positive microorganism, which implies that the cell mass of these microscopic organisms comprises of a thick peptidoglycan layer. They frame circular states in groups in 2 planes and have no flagella. Discharges are various, yet incorporate surface related adhesins, exoenzymes, and capsular polysaccharides. The container is in charge of improved destructiveness of a mucoid strain. The focal courses of glucose digestion system are the Embden-Meyerhof-Parnas pathway and the pentose phosphate cycle. Lactate is the result of anaerobic glucose digestion system and acetic acid derivation and CO2 are the results of high-impact development conditions. S. aureus can uptake an assortment of supplements including glucose, mannose, mannitol, glucosamine, N-acetylglucosamine, sucrose, lactose, galactose and beta-glucosides.
b) Explain the process of inflammation leading to the pain, redness, warmth and swelling.
Inflammation, a reaction activated by harm to living tissues. A barrier instrument developed in higher life forms to shield them from disease and harm. Its motivation is to confine and wipe out the harmful operators and to uproot harmed tissue parts so that the body can start to recuperate. The reaction comprises of changes in blood stream, an expansion in porousness of veins, and the movement of liquid, proteins, and white platelets (leukocytes) from the dissemination to the site of tissue harm driving swelling. The intense irritation is normally causes unsavory sensations as far as agony and warmth of the influenced part. Because of gathering of couple of red blood cells through spillage from vessel, can appears to be in red shading. Tissue obliteration can likewise happen when the administrative components of the provocative reaction are deficient or the capacity to clear harmed tissue and remote substances is disabled.
c) Why would Bridie develop cellulitis? List two reasons and provide rationale for your answer
The causes of creating cellulitis incorporate wounds that tear the skin; diseases after surgery; long haul skin conditions, for example, dermatitis or psoriasis; bone contaminations underneath the skin (Bree, 2016). Bridie was admitted in the hospital due to fracture of bones and undergone for treatment. The probable reason for cellulitis includes the invasion of microorganism though the open part of skin in to skin layers and so on. Another cause could be bone infection underneath the skin.
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2. Gerry is a 78-year old gentleman with a history of an Anterior ST Elevation Myocardial Infarction (STEMI) and severe Left Ventricular Failure (LVF). Gerry has also smoked 15 cigarettes per day for the last 30 years. His additional history includes type II Diabetes Mellitus and hyperlipidaemia. Gerry was admitted to the medical ward in the hospital last night with an exacerbation of his LVF, worsening breathlessness and orthopnoea. It is now 0800 in the morning and you as his nurse come to check his blood pressure, pulse rate and SpO2
a) Explain what is meant by the term “blood pressure” and describe the factors that determine blood pressure?
The pressure exerted by blood on the walls of the vessels during the flow of blood and it is expressed as systolic blood pressure (occur when heart muscle is contracting and pumping oxygen-rich blood into the blood vessels) and diastolic blood pressure (occur during relaxation of heart muscles). The blood pressure is said to be normal when the systolic and diastolic blood pressures are 120 and 80 mm of Hg respectively (Hypertension, 2015).
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Alcohol: Regular over-consumption of alcohol can influence blood pressure significantly.
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Stress: Long-term, chronic stress elevates blood pressure by increasing the secretion of neurotransmitters such as nor-adrenaline
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Smoking: Smoking causes fringe vascular ailment (narrowing of the vessels that convey blood to the legs and arms), and additionally solidifying of the veins. Eventually it influences the blood pressure
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Diet: Consumption of diet with high fat can influence the elastic properties of blood vessel due to deposition and hence affects the blood pressure
b) What causes the ‘pulse’ and what is the origin of the heart sounds S1 and S2?
The contraction of heart muscle results in pumping of blood into vessel and these waves can be felt as pulsations in arteries close to the skin surface, such as those in the wrist and neck. The sound, S1 results from the closure of mitral and tricuspid valve whereas S2 results from the closure of aortic and pulmonic valves
c) Explain the physiology behind the oxyhaemoglobin dissociation curve
The hemoglobin-oxygen separation curve is a sigmoid bend, which relates the fractional weight of oxygen broke down in the blood to the rate immersion of hemoglobin. It permits us to see how hemoglobin eagerly ties to oxygen in the high fractional weights inside of the alveoli at the tissue level. The key is seeing how hemoglobin functions, and that there is agreeable tying meaning the more oxygen that appends to Hb, the more atoms it binds and the inverse happens when O2 begins to move far from the Hb. It clarifies why there is an 'elusive slant' once the Hb immersion falls lower than 92%. The coupling of oxygen to hemoglobin proceeds to some degree for weights underneath around 60 mmHg, as oxygen fractional weights diminish in this precarious zone of the bend, the oxygen is emptied to fringe tissue promptly as the hemoglobin's proclivity decreases.
d) Explain what is meant by the term ‘SpO2’?
Oxygen saturation (SpO2) is defined as the ratio of oxy-hemoglobin to the total concentration of hemoglobin present in the blood (ie Oxy-hemoglobin + reduced hemoglobin). It is an indication of reflection of the level of oxygen available in the individual blood. Oxygen saturation values obtained from pulse oximetry (SpO2) are one part of a complete assessment of the patient's oxygenation status and are not a substitute for measurement of arterial partial pressure of oxygen (PaO2,) or of ventilation
e) Describe the process of gas exchange related to ventilation, external and internal respiration.
Gas exchange in the lungs refers to an outer breath between the alveolar sacs outside of the body. As blood moves through the aspiratory vessels, O2 and CO2 diffuse in opposite direction in blood and alveoli. Every gas molecule diffuses down its own particular incomplete weight slope i.e., from greater to lower level. The fractional pressure of oxygen is 100 mmHg in lungs (alveolar sac) contrasted with just 40 mmHg in the pulmonary blood vessels. The fractional weight of CO2 is 40 mmHg in the alveolar sac and 45 mmHg in pulmonary vessels. The respective pressure of every gas equilibrates as blood courses through the pneumonic vessels. There exist a differential partial pressure of O2 and CO2. This oxygen-rich blood will then be conveyed to the tissues, where O2 is expected to make ATP as a wellspring of vitality.
The internal respiration is the procedures by which the gasses noticeable all around that has as of now been drawn into the lungs by outside breath are traded with gasses in the blood/tissues so that CO2 is expelled from the blood and supplanted with oxygen. The procedures of interior breath happen in the distal respiratory tree, which is depicted at the base of the page about the tracheo-broncial tree. Inner breath depends on "gasesous trade" "down a slope" (Sarkar, et al., 2015).
f) What factors influence the ability of oxygen to enter the blood from the lungs, and then enter the tissues from the blood?
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Partial pressure of oxygen (PO2): The measure of oxygen that can be broken down in the blood plasma depends straightforwardly on the PO2 of the air in the alveoli.
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High elevation on fractional pressure: Atmospheric pressure diminishes with expanding height. At lower environmental pressure implies less gas particles, and hence less oxygen atoms, are accessible. At the high elevations, the partial pressure of all the gasses is lower than adrift level.
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The surface range and structure of the respiratory film. The 300 million alveoli, secured with a thick system of pneumonic vessels, give a tremendous surface region to proficient gas trade. Also, the slimness of the respiratory layer builds proficiency.
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The fractional pressure between the alveoli and vessels. Productive gas trade requires coordinating alveolar wind stream to aspiratory narrow blood stream.
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The oxygen trade from blood to tissue relies on upon oxygen and carbon dioxide fixation in the tissue and the respective partial pressures
3. Simon works as a high angle tree lopper. He presents to the Emergency Department after falling more than 15 meters when his harness failed. He has sustained a large bruise and hematoma on his right side, and presents with a sinus tachycardia and obvious difficulty breathing. After assessment and a computerized tomography (CT) scan, the emergency physician tells you he has fractured his right ribs 7 through 10, has a right pneumothorax, a lacerated liver and contused right kidney. He also has haematuria.
a) Describe (NOT list) in detail five (5) functions of the liver? Why might liver injury lead to coagulation problems?
The liver directs most concoction levels in the blood and discharges an item called bile. Bile separates fats, setting them up for further assimilation and retention. The greater part of the blood leaving the stomach and digestion systems goes through the liver. The liver procedures this blood and separates, and makes supplements for the body to utilize. It likewise metabolized drugs in the blood into structures that are less demanding for the body to utilize. The basic capacities incorporates generation of bile (backings in assimilation) (Reshetnyak, 2013) and certain proteins for blood plasma; creation of cholesterol and extraordinary proteins to bring fats through the body. Liver stores the arrival of glucose as required; transformation of destructive alkali to urea; managing blood thickening
The liver plays a key role in the creation of clotting components and in addition RBC generation. A portion of the proteins integrated by the liver incorporate coagulation factors including fibrinogen, prothrombin, factor-V, VII, VIII, IX, X, XI, XIII, and in addition protein C, protein S and antithrombin. Since liver produces numerous factors, the injury can affect the production of clotting factors hence it poses coagulation problems (Palta et al., 2014)
b) Define and outline the criteria for normal sinus rhythm, and describe the autonomic control of heart rate?
Typical sinus rhythm is the name given to the ordinary musicality of the heart where electrical boosts are started in the sinoatrial (SA) hub and are then directed through the atrio-ventricular (AV) hub and heap of His, group branches and Purkinje filaments. This outcomes in a general, tight complex heart beat at 60-100 bpm. Each QRS complex is gone before by an ordinary P wave. P waves ought to be upright in leads I and II, reversed in aVR. The PR interim stays consistent. QRS edifices are<100 ms wide (unless a concurrent inter ventricular conduction postpone is available) (Farrar et al., 2012)
The pacemaker movement in regularly controls heart rate receptive to unconstrained changes in Ca++, Na+, and K+ conductance. Heart rate is diminished underneath the natural rate principally by actuation of the vagus nerve innervating the SA hub. Typically, very still, there is noteworthy vagal tone on the SA hub so that the resting heart rate is somewhere around 60 and 80 pulsates/min. The withdrawal of vagal tone and an initiation of thoughtful nerves innervating the SA hub can expand the heart rate. These activities are interceded by means of coursing catecholamine that follows up on β1-adrenoceptors situated on SA nodal cells.
c) Why is Simon having difficulty breathing ?
According to the CT scan, it was evident that the right ribs 7 through 10 were fractured. The intercostals muscles between the ribs help in enlarging the chest cavity and promote the respiration. The muscles contraction pulls the rib cage both upward and outward during inhalation. Due to fracture of ribs, Simon lost the contractility of intercostals muscles. Therefore, he was in difficulty in breathing.
d) Why would Simon have haematuria? Describe the functions of the kidney.
Kidney injury happens taking after an immediate effect to the lower back range. The accident causes the damage of kidney with an intense pain and blood in the urine hematuria) (Shoobridge et al., 2011). The functions of kidney include (i) discharge of waste for example, toxic substances overabundance salts, and urea, a nitrogen-based waste made by cell digestion system. (ii) Water level adjusting by changing the water discharge. (iii) Blood weight regulation by means of renin-angiotensin framework (iv) Red platelet regulation by means of erythropoietin creation and (v) acid-base balance by excretion.
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Place Your Order4. Arthur is an 81 - year old man with a medical history of type II Diabetes Mellitus, gout and Atrial Fibrillation. Arthur was admitted to the medical ward in the Ritz Medical Centre last night with severe diarrhoea and vomiting. As a result of his past medical history, Arthur has been taking oral glibenclamide, digoxin and warfarin. It is now 0800 in the morning; you and your buddy nurse come to check his vital signs.
a) Design a concept map that explains and describes the regulation of blood glucose levels.
When blood glucose levels are high, the pancreas discharges the hypoglycaemic hormone insulin, which animates glucose uptake by cells and glycogen arrangement in the liver, so that blood glucose levels are brought down. At the point when blood glucose levels are low, the pancreas discharges the hyperglycemic hormone glucagon, which invigorates glycogen breakdown and consequently builds the measure of blood glucose (Erika et al., 2009).
b) Explain in detail how diarrhoea and vomiting may affect the absorption and effect of Arthur’s oral medications.
Diarrhea is the reversal of the normal net absorptive status of water and electrolyte absorption to secretion. Such a derangement can be the result of either an osmotic force that acts in the lumen to drive water into the gut or the result of an active secretary state induced in the entrecotes. Vomiting forcibly propels the gastrointestinal contents to out. Therefore, any stuff that is present in GI tract cannot be absorbed due to short residence time. The nutrients also show low no absorption in such a harsh condition. Similarly, drugs that are taken by Arthur’s also not absorbed in to system and are either expelled out or evacuated via bowel
References
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Bailey, E & Kroshinsky, D (2011) Cellulitis: diagnosis and management. Dermatol Ther 24(2), 229-39
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Hypertension (2015) Retrieved from http://www.who.int/features/qa/82/en/
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Sarkar, M., Madabhavi, I., Niranjan, N., & Dogra, M. (2015). Auscultation of the respiratory system. Annals of Thoracic Medicine, 10(3), 158–168.
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Erika, Steven & Mia (2009) Periodontal Disease & Diabetes Retrieved from https://bohone09.wikispaces.com/Group+7
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Palta, S., Saroa, R., & Palta, A. (2014). Overview of the coagulation system. Indian Journal of Anaesthesia, 58(5), 515–523.
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Farrar, WS., Fyfe-Johnson, AL., Baechler, CJ & Dusek, JA (2012) Spontaneous normal sinus rhythm conversion using integrative medicine in atrial fibrillation. Global Advances in Health and Medicine, 1(2), 22–25.
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Shoobridge, JJ., Corcoran, NM., Martin, KA., Koukounaras, J., Royce, PL & Bultitude, MF (2011) Contemporary management of renal trauma. Reviews in Urology, 13(2), 65–72.
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Reshetnyak, VI (2013) Physiological and molecular biochemical mechanisms of bile formation. World Journal of Gastroenterology?: 19(42),7341–7360.
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Bree, N (27-Jan-2016) Cellulitis. Retrieved from http://www.healthline.com/health/cellulitis#Overview1
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