(theoretical foundation of nursing)—name of the course

Also, write a summary reflection answering the following questions based on the readings and discussions throughout the course: 

• As an art and a science, how has your personal nursing philosophy unfolded?
• Have there been ideas that have challenged your personal values or assumptions?
• Have there been ideas that have caused you personal conflict and may lead to deconstructing those dispositions in a critical manner?
• What actions have you taken that illustrate your personal nursing philosophy?
• Describe your own definition of the concepts involving the meta-paradigm of nursing.
• Has your first written philosophy of nursing changed? In what ways? 

Your paper that includes both your philosophy and reflection together should be 2–3 pages in length, in APA format, typed in Times New Roman with 12-point font, and double-spaced with 1″ margins. If outside sources are used, they must be cited appropriately.

 

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Patient HL has nausea, vomiting, and diarrhea symptoms. However, before medication, it’s important for the care provider to understand HL’s medical history as the medication can impact on measures undertaken to improve their health. In this case, the patient has prescribed the following drug; Synthroid 100 mcg daily, Nifedipine 30 mg daily, Prednisone 10 mg daily. For instance, the prednisone prevents the production of discharge in the body which can cause inflammation. It can also suppress an individual’s immune system, and there is a necessity to comprehend why a patient needs this medication. The history showed the patient had Hepatitis C, which is a liver infection that can lead to acute inflammation of the liver. Long-term infection 

with the hepatitis C causes high blood pressure, yellow discoloration of the skin and eyes and many others. Prescription of Nifedipine drug lowers patient blood pressure and makes it easier for heart to pump blood around the body. Watery diarrhea, Nausea, vomiting, and hepatitis C can be due to intestinal infection. 

In this case, the patient HL is likely suffering from acute gastroenteritis which is the inflammation of the mucous membrane of the gastrointestinal tract and featured by vomiting. This disorder is common in children. In many cases, the gastrointestinal disease is caused by a virus which usually spreads from an individual to another or, through close contact with an infected individual, such as sharing food. For this reason, nurses and the child care have a high risk of viral gastroenteritis disease, especially if they do not clean their hands after coming contact with the infected person. 

Diagnosis for the Patient and the Rationale for Diagnosis.

The diagnosis can be made clinically. In this situation, the doctor will assess the abdominal pain, abdominal cramping, and loose stools. These assessment results are commonly linked to diarrhea. If gastroenteritis encompasses the large intestine, the colon is not able to engross enough water, and the patient’s stool becomes watery. Evaluation of defecation is also very significant. Samples should be taken from the patient to identify the pathogen and establish the immediate treatment of the disease. Samples should be cultured for the bacteria and tested for the pathogen. Quick diagnosis allows for the isolation of the patient to prevent nosocomial contagion, which is often used as an indicator of the efficiency of precautions to control contact infection. Diagnosis can also be made by educating the patient concerning perianal care after every bowel movement. The rationale for this is that the anal part should be carefully cleaned in order to prevent the irritation of the skin and spread of disease-causing microorganism. 

Drug Therapy Plan

Antimicrobial Agents

Nasogastric Rehydration (NGTR): The patient takes 25ml/kg/hr for 4 hours. 

For initial treatment of acute diarrhea infections like in the patient HL, rehydration should be included, which can be gained with oral electrolyte solutions. In this patient, antibiotic is required because the disorder is usually self-limiting (Rosenthal, & Burchum, 2018). Nasogastric Rehydration (NGTR) is a safe and actual way of rehydrating the patient; even after vomiting. It is recommended over the IV route. Any deliberation of antimicrobial therapy will be carefully considered against unintentional and potentially harmful outcomes. However, empirical and precise antimicrobial therapy can be considered in this situation. Moreover, treating gastroenteritis because of Shiga toxin creating Escherichia coli bacteria with antibiotics can upsurge the risk of hemolytic-uremic disorder.

Antiemetic Agents and Supplemental Zinc Therapy

Ondansetron wafer dose (drug dose)

 Weight Ondansetron wafer dose

 8 -15 kg 2mg

15-30 kg 4mg

> 30 kg 8 mg

The patient HL has a severe vomiting condition; therefore, there is a need to prevent further dehydration and to avoid the desire for IV therapy and frequent hospital admission. Ondansetron, a discerning serotonergic 5HT3 receptor adversary, has revealed to be a more effective antiemetic agent (Rosenthal, & Burchum, 2018). Also, the patient should be prescribed with Metoclopramide which has been confirmed to be more effective than the placebo. Zinc is an important micronutrient that usually guards the cells against oxidative injury. In this case, the patient has acute diarrhea; there is a substantial loss of zinc due to enlarged intestinal output. Giving the patient zinc supplements may increase the absorption of water. 

Students must post one interesting case that he/she has seen in the clinical setting via Discussion Board in the online part of this course. The case should be an unusual diagnosis, or a complex case that required in-depth evaluation on the student’s part. The case should be posted in the SOAP format, with references for the patient diagnosis, differential diagnoses (there should be at least 3), and the treatment plan. Notes will be graded as “pass/fail”. In order to receive grade points for SOAP notes, the notes must be approved by the deadlines specified on the course assignments page. The student will lose the opportunity for points on any SOAP notes not approved by the specified deadlines. The posting does not have to be written in APA format, but should be written with correct spelling and grammar. References should be in APA format. The selected references should reflect current evidence – dated within the past 5 years. See rubric in the syllabus section

 

Scenario 1:

Mrs. Smith is a 50 year old Caucasian woman who has 4 children ages 17, 15, 13, and 10. She was 33 with the birth of her first child. Her BMI is 25. She has no personal or family history of breast cancer. She lives with her husband in a suburban community. She is an elementary school teacher who is working part-time as a substitute so she can be home with her children. She has been healthy with no previous medical history. One year ago she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her health insurance would be expiring in the next month so she reluctantly decided to have a mammogram. She called for an appointment and they were unable to see her for another 2 months.

After waiting 2 months, her mammogram confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

• What are the primary concerns for the patient right now? Why?
• What are some of the expected medical surgical interventions?
• What further assessment will be needed?
• What pharmaceutical drugs are approved treatments for breast cancer patients?