Explain the mechanisms for how these stressors, both individually and collectively, induce a short-term or prolonged response to stress.

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Case study: Betty
Betty an 80‐year‐old lives alone in her own home. She is active, attending the local
senior citizens club. She receives meals‐on‐wheels and has assistance with her house
keeping once a week. She has been unwell for a few days experiencing decreased
appetite and episodes of angina that have responded to sublingual ANGININE.
Betty has a history of angina, peripheral vascular disease and congestive heart
failure. Her regular medications include an ACE inhibitor, selective beta blocker and
digoxin.
Betty’s family doctor referred her to hospital with dehydration. It is also noted she
has cellulitis to her left leg. She was admitted to the medical ward. On day three
Betty experiences shortness of breath with some chest pain that is not relieved by
ANGININE. Clinical examination reveals acute pulmonary oedema.
Clinical assessment reveals:
Temperature 37.9 degrees Celsius
RR 36 breaths/minute
HR 120 beats/minute
BP 180/110 mmHg
SpO2 88%
Urine output < 30 mL/hour (<0.5mL/kg/hr)
Bilateral peripheral pitting oedema, with cellulitis left lower leg
Chest auscultation reveals crackles and she is coughing pink frothy sputum
Management includes:
Bilevel
noninvasive
ventilation at 60% oxygen, Rate 16 breaths/minute
IPAP 10 cm H2O, EPAP 5 cm H2O
ECG and cardiac monitoring
IV normal saline decreased to 42 mL/hour
IV FRUSEMIDE
Subcutaneous CLEXANE
Indwelling catheter
CXR reveals
atelectasis and pulmonary oedema
Betty is transferred to the HDU
First ABG ABG after 30
minutes
pH 7.3 7.3
PaO 60 mmHg 100 mmHg
PaCO 55 mmHg 50 mmHg
HCO 24 mmol/L 24 mmol/L
Base excess ‐2 ‐2
And here is the essay questions, needs to be attended in 3 parts:
Assessment 2: Short answer essay – Betty
1500 words +/- 10%
Weighting 30%
The purpose of this assessment is to enable you to demonstrate your knowledge of the neurohormonal basis of the stress response through application to a case study.
These short answer questions incorporate the case study of Betty and your responses must relate to the clinical manifestations identified for this patient. Please note: nursing care and management are not the focus of this assessment.
You must complete all three parts.
Click here to open the case study.
Part A (500 words)
Betty is exhibiting signs and symptoms of a number of acute and chronic stressors. Pain is one of the most significant stressors and poses major challenges for nurses.
Betty is experiencing multiple types of pain.
•List the potential causes of Betty’s pain and identify the types (or mechanisms) associated with each cause
•Explain the physiological processes by which Betty’s pain will act as a stressor
•Describe the likely outcome if Betty’s pain remains unrelieved.
Part B (500 words)
As well as pain, Betty is also experiencing multiple other stressors.
•Identify two other stressors that Betty is experiencing based on her signs and symptoms
•Explain the mechanisms for how these stressors, both individually and collectively, induce a short-term or prolonged response to stress.
Part C (500 words)
Various factors, including the medications she is taking, will modify Betty’s response to stressors.
•List the medications Betty is taking that would influence her body’s ability to mount a stress response.
•Explain the mechanism of action and potential impact of these medications on the stress response. Include in your answer the physiological impact of Betty’s ACE inhibitor and beta blocker medications providing evidence of this from the clinical data.
The prescribed text book for the subject is Marieb, E, N and Hoehn, K, N 2014, Human anatomy and Physiology, 9th edn, Pearson Education Limited, United states of America
The assignment needs to focus on stress response and be quite specific in regards to types of pain and neurohormonal responses.

.What clinical manifestations are present in Ms. G?

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Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.
Subjective Data
•Complains of pain and heaviness in her leg.
•States she cannot bear weight on her leg and has been in bed for 3 days.
•Lives alone and has not had anyone to help her with meals.
Objective Data
•Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
•Left leg red from knee to ankle
•Calf measurement on left 3 in > than right
•Temperature: 38.9 degrees C
•Height: 160 cm; Weight: 83.7 kg
Laboratory Results
•WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
•Wound culture: Staphylococcus aureus
Critical Thinking Questions
1.What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2.Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
3.What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
4.What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Certification Plan

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Begin to develop a plan to pass the Certification Exam.:
(1). Write an Explaination of Why you selected AANPC Certification Exam
My exam is  (AANPC Certification Exam).
(2). Compare your home state’s laws in regards to Advanced Practice Nursing
Practice to an alternate state with a less or more restrictive practice environment.
(3). Consider the differences in certification exams options for your specialty (FNP)
(4). Reflect on how to approach relocating licensure from one state to another
Write a 3-page paper which summarizes the following:
(5). Identify the certification exam you selected and explain why
(6). Outline your plan for passing the appropriate National Certification Exam
(7).  Describe the NP Practice environment for your home state OF (TEXAS) highlighting restrictions or limitations for practice
PLEASE FOLLOW THE ABOVE 7 HEADINGS ACCORDINGLY

Essay

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In each case, answer the questions at the end of the case and give researched references to support your assertions; also, explain what would be the ethical course of action and the legal requirements for action in the case.

 

Case One

 

Mrs. Lewis was head nurse on a medical surgical floor in a community hospital with 250 beds. Over the course of 6 months, she noticed that all patients admitted from the Shady Rest Nursing Home had signs of severe injuries other than those connected with the admitting diagnosis. There appeared to be patient abuse in the nursing home. Mrs. Lewis investigated discreetly and found no explanation possible except abuse. In accord with the obligations of the law in her state, she reported the matter to the Department of Welfare Bureau of Inspection.

 

The Welfare Department investigated immediately, found proof of abuse, and threatened to close down Shady Rest if there were any more recurrences. Mrs. Lewis was overjoyed until her hospital administrator, bypassing the director of nursing, called her in and warned her that she would be fired if she reported any other instances of abuse. Shady Rest sent the hospital a lot of business, and good relations had to be maintained.

 

Mrs. Lewis was even more shocked when she discovered that the administrator was a golf partner of the owner of Shady Rest and was doing an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a lawyer, who threatened the hospital with exposure and with penalties that would follow if one of its employees failed to follow the reporting provisions of the law on abuse in nursing homes.

 

Did Mrs. Lewis act correctly? What should she have done if she could not have afforded to consult with a lawyer? In what ways can whistle-blowers protect themselves? Must the art of intimidation be part of the toolbox of healthcare professionals in order to protect their patients? Is power an appropriate consideration in healthcare ethics?

 

Case Two

 

On a July weekend, Mrs. Allesfertig, nursing supervisor of the whole hospital, discovered that the intensive care unit was seriously understaffed. She pulled two nurses with previous ICU experience off other floors to bring the unit up to strength in view of the extreme level of acute care needed. On the following Monday, Dr. Bestknabe, who has overall responsibility for the ICU unit, closed the unit for further admissions until the staffing had been worked out on a permanent basis.

Should the new staffing policy give the nurses authority to refuse to admit patients when the staff is not sufficient to handle them? (In some hospitals, nurses have this authority.) Can any policy take precedence over the professional judgment of trained ICU nurses?