Application of Concepts from Nursing Caring Science

Instructions 

You will identify an issue that could potentially influence the growth and performance of an international company.

This issue will be identified by you. You can identify an issue by reading about what is happening in the international business environment.

Some examples of issues that would impact on an international business’s performance could be increased sales or new products launched by competitors.

Another example could be political instability in the main export market or country where you import most of your resources from.

New laws or regulations around how you package, sell or manufacture the products could also impact on the strategy moving forward. There is no strict requirement around what constitutes an issue.

Mr Kent is a 45-year-old African American male with a history of Type 2 diabetes hypertension and hyperlipidemia

Mr Kent is a 45-year-old African American male with a history of Type 2 diabetes hypertension and hyperlipidemia

Mr. Kent is a 45-year-old African American male with a history of Type 2 diabetes, hypertension, and hyperlipidemia. His renal function has slowly decreased over the past 4 years and his nephrologist has told him that his GFR has decreased to 15cc ml/min and will soon need renal dialysis for chronic renal failure.

Question:

How does chronic renal failure develop? 

A 28-year-old female comes to the clinic with a chief complaint of right flank pain urinary frequency and foul-smelling urine

A 28-year-old female comes to the clinic with a chief complaint of right flank pain urinary frequency and foul-smelling urine

A 28-year-old female comes to the clinic with a chief complaint of right flank pain, urinary frequency, and foul-smelling urine. The symptoms have been present for 3 days but this morning, the patient states she had a fever of 101 F and thought she should get it checked out. Physical exam noncontributory with the exception of right costovertebral angle (CVA) tenderness upon percussion. Urine dipstick shows + blood, + bacteria and + white blood cells. Renal ultrasound reveals right staghorn renal calculus and the patient was diagnosed with acute pyelonephritis.

Question:

How does a renal calculi calculus contribute to acute pyelonephritis? 

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow glomerular filtration rate autoregulation

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow glomerular filtration rate autoregulation

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow

Question:

What would be the most important concept of hormonal regulation that the APRN should address? 

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow glomerular filtration rate autoregulation

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow glomerular filtration rate autoregulation

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow

Question:

What would be the most important concept of autoregulation that the APRN should address? 

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow related hormones and glomerular filtration rate  

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow related hormones and glomerular filtration rate

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate.

Question:

What would be the most important concept of glomerular filtration rate that the APRN should address? 

A 64-year-old woman with long standing coronary artery disease presents to the clinic with lower extremity swelling abdominal distension and shortness of breath

A 64-year-old woman with long standing coronary artery disease presents to the clinic with lower extremity swelling abdominal distension and shortness of breath

A 64-year-old woman with long standing coronary artery disease presents to the clinic with lower extremity swelling, abdominal distension, and shortness of breath. Patient states she has a 30-pound weight gain in 6 weeks and is now requiring 3 pillows to sleep.

On physical exam the patient is a well-developed, well-nourished female exhibiting signs of respiratory distress with use of accessory muscles. Blood pressure 150/80, pulse 105, respirations 28 and labored. Body weight 89 kg. HEENT was unremarkable. Cardiac exam had an S1, S2 and S3 without S4 or murmur. Respiratory exam was positive for bilateral rales 1/2 up both lung fields. Abdomen was enlarged with a positive fluid wave. Lower extremities were remarkable for 3+ pitting edema.

Laboratory data was significant for an increase in K+ from 3.4 mmol/l to 6.1 mmol/l in 2 weeks, BUN increased from 18 mg/dl to 104 mg/dl, and creatinine increased from 0.8 mg/dl to 6.9 mg/dl.

CXR revealed congestive heart failure. The APRN calls the cardiologist on call who admits the patient to the hospital and orders a nephrology consult.

She was diagnosed with exacerbation of congestive heart failure (CHF) and acute kidney injury (AKI).

Question:

What type of acute kidney injury does the patient have and what factors contributed to this diagnosis? 

 

Hannah is a 19-year-old college sophomore who came to Student Health with a chief complaint of lower abdominal pain

Hannah is a 19-year-old college sophomore who came to Student Health with a chief complaint of lower abdominal pain

Hannah is a 19-year-old college sophomore who came to Student Health with a chief complaint of lower abdominal pain. She says the pain has been present for 2 months and she has had multiple episodes of diarrhea alternating with constipation, and anorexia. She says she has lost about 10 pounds in these 2 months without dieting. The abdominal pain has gotten worse in the last 2 hours, but she thought she had “the GI bug” like other students at her Synagogue had.

Physical exam-noncontributory except for the abdomen which was lightly distended with no visible masses. Normoactive BS x 4. Diffuse tenderness throughout but increased pain on deep palpation LUQ & LLQ. Slight guarding but no rebound tenderness or rigidity.

Rectal-tight anal sphincter and patient grimacing in pain during exam. Slightly + guaiac stool.

Based on her history and current symptoms, the APN arranges for a consult with a gastroenterologist who diagnoses Hannah with ulcerative colitis (UC).

Question:

How does ulcerative colitis develop in a susceptible person?  

 

A 23-year-old bisexual man with a history of intravenous drug abuse presents to the clinic with a chief complaint of fever fatigue loss of appetite nausea vomiting abdominal pain and dark urine

A 23-year-old bisexual man with a history of intravenous drug abuse presents to the clinic with a chief complaint of fever fatigue loss of appetite nausea vomiting abdominal pain and dark urine

A 23-year-old bisexual man with a history of intravenous drug abuse presents to the clinic with a chief complaint of fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and dark urine. He says the symptoms started about a month ago and have gotten steadily worse. He admits to reusing needles and had unprotected sexual relations with a man “a couple months ago”.

PMH-noncontributory.

Social/family history-works occasionally as a night clerk in a hotel. Parents without illnesses. Admits to bisexual sexual relations and intravenous heroin use. He has refused drug rehabilitation. 3 year/pack history of tobacco but denies vaping.

Physical exam unremarkable except for palpable liver edge 2 fingerbreadths below costal margin. No ascites or jaundice appreciated.

The APRN suspects the patient has Hepatitis B given the strong history of risk factors. She orders a hepatitis panel which was positive for acute Hepatitis B.

Question:

What are the important hepatitis markers that indicated the patient had acute hepatitis B? 

Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days

Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days

Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.

Physical Exam: 

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs

Resp-decreased breath sounds in both bases with poor inspiratory effort

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed.  Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis.

Question:

Explain how pancreatitis develops and the role alcohol played in this patient’s case.