PUBH6005: Epidemiology Critical Appraisal Essay


This assessment addresses the following learning outcomes:

1.Apply common epidemiological concepts including incidence and prevalence of disease, mortality and survival and age standardisation.

2. Recognise the role of exposure to biological, behavioural, social and environmental risks in disease patterns.

3. Differentiate between different types of research designs, including observation and experimental and mixed methods designs.

4. Assess levels of evidence and make recommendations.
5. Interpret data arising from surveillance and research studies, including rates and ratios.
6. Understand the difference between association and causation, statistical and public health significance.
7. Analyse the role of epidemiology in screening and prevention programs, and assess the sensitivity and specificity of programs.
8. Critically evaluate epidemiological studies, including potential for bias, confounding and chance errors.
9. Identify key health indicators and sources of data.



More unmistakable use of hostile to disease specialists in the midst of the past 50 years has connected particular weight on frail minute creatures and may have favored the survival of safe strains. Existing information on against disease opposition outlines from pathogens hovering among organize based patients is significantly not precisely from hospitalized patients on whom rules are routinely based. We in this way assessed the association between the counter contamination obstruction case of infinitesimal life forms streaming in the system and the usage of hostile to microbial in the system, Fletcher  (2014). Electronic request recognized 974 examinations yet only 243 examinations were seen as met all requirements for joining by the two free investigators who removed the data. A binomial test revealed a positive association between against microbial use and check yet different backslide showing did not make any essential markers of study result. The meta-examination made an immense pooled chances extent of with a meta-backslide conveying a couple of basic pointers. Countries in southern Europe conveyed a more grounded interface among usage and check than various areas, Guyatt (2011).

Antimicrobial-Safe Microscopic Organisms In Light Of Pets As Stores

Assurance from Antimicrobial bacterial is a phenomenally complex issue including particular bacterial species, impediment instruments, exchange structures and vaults. Several examinations have displayed that antimicrobial use in sustenance creatures adds to the choice of antimicrobial block and positions risks to people in context of transmission of safe zoonotic life forms by techniques for the sustenance chain and wicked exchange of obstruction qualities from creatures to man. Regardless, two or three producers have beginning late researched the peril to human flourishing caused by the use of antimicrobials in sustenance animals, Kourouni (2016). Safe small living creatures may be gotten by people through option pathways, for example, individual to-particular transmission, natural associate and direct presentation with creatures. In a consistent give insights in regards to investigative appearing of antimicrobial check, Kourouni (2016) raised that the bit of sustenance creatures in the transmission of antimicrobial obstruction has been overemphasized in the honest to goodness composed work, with a following underestimation of non-foodborne wellsprings of transmission.

Plenitude Dreariness And Mortality Because Of Antimicrobial Opposition Attributes That Rose On Farms

Canines and Cats address potential wellsprings of spread of antimicrobial resistance because of the far reaching utilization of antimicrobial bosses in these creatures and their near to contact with people. The measure of canines and cats has generally reached out in present day society, with an ordinary people of in excess of 70 million in the EU countries. The relationship between buddy creatures and people has on an extremely fundamental level changed as the years progressed, with cats and canines being continuously in close contact with people. While in the past pooches if all else fails were kept up outside family units, today they are routinely kept inside houses. Close physical contact by achieving, petting and licking happens at high rehash in light of the present impression of family unit pets as bona fide relatives, Murray (2013).

In any given epidemiology Sensitivity, Specificity and Predictive values are to be taken into a serious consideration in all the test to be carried. With the scarce healthcare resources, there is need to evaluate the epidemiology with respect to the health.

Plant Concentrates And Phytochemicals On Anti-Infection Safe Microbes

According to Nathiya (2012), in their studies about the anti-bacterial, Despite the manner in which that pharmacological undertakings have made distinctive new unfriendly to ailment administrators over the most recent three decades, security from these arrangements by microorganisms has expanded. Right when all is said in done, minute living creatures has the hereditary capacity of transmitting and obtaining affirmation from drugs, which give medicinal heads to the use. From this sort of a reality, a reason for stress is prove, in light of all the quantity of the patients found inside the offices who have covered security, and because of emerging bacterial strains that are all multi-safe. Therefore, new diseases will bring about repairing centers acknowledging high rates of mortality.

For a vital bundle of time, plants have been a basic wellspring of fundamental things for keeping up human success, and particularly from the most recent decade, with more raised examinations for run of the mill medicines, Schmidt (2010). The ceaseless utilization of mixes from plats for the reasons for pharmaceutical has a little piece at any given moment reached out in Brazil. The World Health Organization demonstrates supportive plants being the best source to get meds gathering. People to a level of more than 75% in the influenced nations to utilize standard game plan, having mixes gotten in supportive plants. Thusly, plants of suck sorts should be investigated to a more plausible comprehend of their individual properties, capacity and security.

Phytochemical impacts were driven and seen as antimicrobial improvement of anticardia ruinous on S. aureus, Brevibacterium ammonia genes, Streptococcus mutants and Propionibacterium acnes. A brief span later, it was endeavored the bactericidal action of anticardia ruinous and total on methicillin safe strains of S. aureus (MRSA) and the synergistic impact of these mixes related with methicillin, Sirmans (2014).

Accordingly, a few examinations relating the usage of the plants as accommodating masters should be focused, especially those related to the control of hostile to contamination safe creatures. This present investigation’s point from the earliest starting point was the evaluation of the ability of moves found in the plants and phytochemicals on standard microorganism strains and multi-steady safe minuscule life forms, which were isolated from centers. Additionally, we investigated the synergistic effects of concentrates with antimicrobial activity in association with hostile to disease operators against drugs safe minute life forms, Sirmans (2014).

NRSG370 Assignment Clinical Integration


Candace Evans is a 42 year woman admitted to the operating theatre at 38 weeks gestation for an elective lower uterine caesarean section (LUCS) under spinal anaesthesia. The patient has been diagnosed with Placenta Previa.

Pre-Operative Nursing Assessment:

  • Current History: Second pregnancy, 38 weeks gestation;
  • Past History: Gestational diabetes with her first pregnancy 5 years ago, which resolved following the birth with no recurrence in this pregnancy, depression, anxiety, post-natal depression.

You are working in the post anaesthetic recovery room (PACU) on a morning shift and will receive Candace following her LUCS. Candace arrives in the PACU, following the uneventful birth of a male infant via LUSC with APGARS of 8 at 1minute and 10 at 5 minutes following birth. Intraoperative blood loss was estimated at 150ml.

PACU Assessment:

  • Dermatome level T3;
  • Pain 0/10;
  • Lower uterine dressing dry and intact;
  • In-dwelling catheter with 100ml of rose coloured urine;
  • Intravenous therapy of Oxytocin in CSL running at 250mL/hour;
  • Vital Signs: HR 88, BP 104/76, SpO297% on RA, Temp 36.9° Celsius.



Nurses with active clinical reasoning have an affirmative influence on patient results; on the contrary, those with destitute clinical reasoning will frequently flop to discover imminent patient worsening.  Faults in decision making and judgment are recognised to version for more than half of unreceptive clinical actions (Schug, Palmer, Scott, Halliwell & Trinca, 2015).  Clinical reasoning is a learning skill requiring active engagement and determination in deliberate practice as well as reflection, specifically on activities designed to advance performance.  This essay will concentrate on the given case study on Candace Evans, a 42 years old woman with an elective lower uterine caesarean section under spinal anesthesia. The paper will then explore through three care priorities identified in Candace’s scenario: her in-dwelling catheter with 100ml of rose coloured urine, vaginal blood loss and the blood clot. The identified three prime priorities will be examined and justified using Levett-Jones clinical reasoning cycle through executed inventions and to assist nurses to attain those objectives which lead to the finest conceivable results of the patients.

Properly managed recovery steps can avert symptoms associated with the caesarian section (Neal et al., 2010). Candace is presented to the recovery room with vaginal blood loss and some clots as well as an in-dwelling catheter with 100ml of rose coloured urine.  The past history of the patient includes gestational diabetes with her first pregnancy five years down the line, which resolved following the birth with no recurrence in this pregnancy, anxiety, depression or post-natal depression. There is clear evidence that Candace suffered from complications as a result of operations. It is normal for women to lose lochia after birth until the wombs renew its lining.  Following Candace’s caesarean operation, she is given intravenous therapy of oxytocin in CSL running at 250m/L/hour. This will encourage the uterus to contract, assisting it to shrink back to its normal size and reduce blood loss (Baaqeel & Baaqeel, 2013). Blood normally flows quickly and uninterrupted through veins. But, sometimes, the clot can form that either reduce the blood flows or stops it completely. A deep vein thrombosis is a blood clot in vein usually pelvis or leg, and its common cause is immobility during surgery (Stephens & Bruessel, 2012).  Candace shows vaginal blood loss and the patients also display vaginal pad soaked with franks blood and some clots.  Therefore, perioperative and recovery nurses can use their critical reasoning capabilities in executing approaches in managing intricate care and take full advantage of the aids for patients by lessening risks elements connected with multifaceted health concerns.

Perioperative caregivers use evidence-based practice to advance the physical wellbeing and uphold the blood count for the Candace by affecting various tactics and setting desired goals (Pant, Fong & Scavone, 2014). For me to realize those goals, I must work closely with her and midwifery for the best promising results.   Patient life can be upgraded by using patient learning after an operation which will enable the patient and midwifery gain more knowledge and skills in her compelling conditions.  The anesthetic may make one feel sick. Thus, a drip going into her veins will make sure enough fluid when she is not able to drink.  While the patient is drinking enough fluid and no longer feels sick, then, the drip will be removed and I will tell her to start eating.  After two to three days, if the patient will have problems with bowel, I can give medicine to open her bowels. It will be helpful for the patient to drink a lot of fluid, eat a high fibre diet such as fruit, wholemeal or granary bread, cereals and vegetables (Torloni et al., 2011). To improve the blood circulation and prevent further blood clots from developing, I will encourage the patients to walk with the compression boots to improve the circulation. However, the first day, I will encourage sit out of bed in her chair, even if it is for short period. I will encourage resting, however, it is crucial to start exercise as soon as possible. As a result of vagina bleeding, I will advise the patient to use sanitary towels instead of tampons as this may increase the risk of infection.  I will discuss with patients and midwifery on the issues she should check after returning home. If the bleeding becomes heavy or once she notices a smelly discharge, she should see the GP for a check.  Therefore, health care providers can offer means related to diet and education on diet regulation and workout. Realistic goals can be established for vaginal bleeding.  Exercise chart and diet plan could be implemented for the recovery of patients.

It is important to assess the efficacy of the approaches used and to ascertain whether the probable result is realised or not.  For this purposes, will use diverse tools and resources to appraise patient’s improvement.  In Candace’s case, the nurse can use diet controlling plan and discuss it with midwifery and patient herself to see how changing the lifestyle will affect her recovery position. Body mass index is important gears in measuring the body weight before and after recovery to assess the effectiveness of the exercise and diet plan.  Therefore, the above evaluation will back Candace to preserve the dynamic lifestyle and support her to use the idea in further managing of operation in future.

As earlier discussed, Candace was also diagnosed with the vaginal bleeding as a result of the operation.  Literature suggests that it is normal to lose lochia. However following the caesarian one will be given a drug which is a synthetic version of the naturally occurring oxytocin (Butwick, Coleman, Cohen, Riley & Carvalho, 2010).

NRSG370 Case Study On Clinical Reasoning Cycle


Discuss about the NRSG370 Case Study on Clinical Reasoning Cycle.



While provide nursing care to the patients, the nurses have to collect cues of the patient condition, process all the care related information collected from the patient and then arrive at an understanding of the presenting health issue of the patient so that adequate care measures can be taken for the patients (Mudd & Sloand, 2015). Followed by which the nurses are required to implement the planned intervention based on the verdict, evaluate the outcome of the care activities planned and then reflect on the entire process to improve the ability to provide individualized care services. The clinical reasoning cycle is an excellent framework that provides the nursing professionals with a systematic protocol with interlinked steps to follow and adhere to each of the care practice components mentioned above. As mentioned by Hunter and Arthur (2016), the nurses that have effective clinical reasoning skills have been reported to have enhanced positive outcomes associated with patient and hence it is necessary for the nurses to have a clear understanding of the clinical reasoning process. In this essay, I will attempt to explore the clinical reasoning cycle and apply this framework utilizing each of the components of the clinical reasoning cycle taking the assistance of a case study.

Considering the patient situation:

This case study represents the care of Mrs. Connie Brownstone as the patient under consideration. Connie is a 79 year old woman who had been admitted to the eme4regncy department of the health care facility due to the pressing health concern of respiratory distress. She had been brought in by her daughter due to the one day history of the patient suffering from shortness of breath which was not diminished or reduced by medication.

Collecting Care Cues:

As discussed by Dalton, Gee and Levett-Jones (2015), collecting care cues is one of the most important parts of the care planning procedure as it guides the care planning procedure and helps the nurses provide patient centred individualized care to the patients. There is a varied range information that the nurse has to collect in order to recognize the exact care needs of the patient, such as handover reports, patient history, patient charts, investigations results, medical assessments, and lastly undertaking new patient assessments (Hunter & Arthur, 2016). Her past medical history as mentioned in the case study is asthma, and she had been admitted to the ICU due to status asthmaticus and required endotracheal intubation and ventilation for two days. The past medical data of Connie also indicated that she had allergies to pollen and dust mite as well which can aggravate asthma attacks.

The triage nurse assessment data reveals that the vital signs of the patient includes RR 35, SpO2 90% (room air), HR 125bpm, RR 35, Temp 39.4° Celsius, BP 168/70; which indicates most imbalance in the homeostasis of the body in most cases (Teach et al., 2015). Next, the physical assessment data indicates that Connie had been suffering from Dyspnoea, extreme anxiety, and audible expiratory wheezing, which in this case indicates signs of considerable respiratory blockage; and hence, she had been considered as category 2. During the cubicle nursing assessment, the oxygen saturation rate and blood pressure of the patient reduced further indicating further complications in the patient. During the physical assessment indicated evident use of accessory muscles while breathing along with bilateral expiratory wheeze. The systematic investigation results carried out for her includes presence of hyper-expanded lungs and signs of abnormal ABG results as well.

Processing Information:

While processing the information collected, the nurses generally follow a step by step process of interpreting, discriminating, relating, inferring, matching and then predicting care needs from the information with respect to best available evidence (Dalton, Gee & Levett-Jones, 2015). In this case, Connie had been suffering from acute respiratory distress evidenced by the abnormalities in the vital signs and investigation results. First and foremost, the normal respiratory rate of adult is 12 to 20 minutes and in this case, Connie had almost double the respiratory rate and her oxygen saturation has also dropped to 89%, indicating at extreme oxygen insufficiency. Considering the heart rate and blood pressure, Connie had 125 bpm heart rate and 172/75 mmHg blood pressure; whereas the normal heart rate is 100 bpm and blood pressure is 120/80 mmHg. In explanation I would like to mention that during asthma exacerbation that leads to respiratory distress reduces the oxygen availability in the body significantly, as a result, the cardiac load increases in order to be able to meet the oxygen demand of the body which raises the heart rate and drops the blood pressure as well (Johnson, 2017).

However, the most important information is the presence of hyper-expansion in her lungs and her ABG test results. The ABG results indicated high blood pH, low PaCO2, low PaOand high HCO3. As per Reddi (2018), the investigation results of the ABG tests indicates alveolar hyperventilation and hypocapnia resulting from an acute episode of respiratory alkalosis. It has to be mentioned that Connie had been an asthma patient and susceptible to allergies caused by pollution. The respiratory alkalosis in patient can be caused due to the bronchial constriction and resultant alveolar hyperventilation. This has also led to hyper-inflation of her Chest and her wheezing is also indicative of bronchial constriction (Brinkman & Sharma, 2018).

Identifying And Prioritizing Care Needs:

There are various care needs that Connie is exhibiting which requires clinical intervention, however while providing emergency care  relief to a deteriorating patient, it is very important for the nurses to prioritizing the care needs by synthesis of facts and inferences.  The first and foremost care priority for the patient in this case will be the shortness of breath or dyspnoea which was also the presenting problem that the patient was admitted to the facility with. The second care priority for Connie will be the respiratory alkalosis and maintaining the acid base balance in the blood back to normal. The third care priority for Connie will be the high heart rate which can lead to cardiac emergency if adequate interventions are not given to the patient (Mudd & Sloand, 2015).

Establishing care goals:

Establishing care goals is an integral part of the clinical reasoning cycle as it allows the nurses to set up a benchmark or care outcome in accordance with the exact needs and preferences of the patient and be able to provide accelerated recovery progress for the patient. In this case, the first care goal will be to address the shortness of breath by reducing the respiratory rate back to normal and enhancing the oxygen saturation levels to at least 95-98% within the next 48 hours. The second care goal will be to reduce the blood pH and restore homeostasis in the patient within next 24-48 hours. The third care goal for me will be to address the high heart rate of Connie by reducing the present rate from 125 bpm to 100 bpm within the next 24 hours.

92445 Integrated Nursing Practice


Prioritisation of complex patient health issues

  1. Choose one of the case studies from the lab sessions in Integrated Nursing Practice State the case study that you have chosen including whether the assignment addresses part one (morning shift) or part two (evening shift) of the case

Identify a total of five patient health issues from the case study that nurses can address within their scope of practice. You may include ‘risk for’ or ‘potential for’ health issues.

Select the three highest priority patient health issues from the five health issues that have been identified.

  1. Rank the three patient health issuesthat were selected in part 1 in order of priority. Provide a rationale for the order of the rankings. The rationale must be supported with current
  1. Outline the nurse’s role in addressing the top three priority patient health issuesusing assessment, coordination of care and provision of care. Relate the discussion to regulatory frameworks of nursing and health department policies e.g. RN Standards for Practice, NSW health policy, National Safety and Quality Health Service (NSQHS) standards


In my assignment, I have decided to write about a case study about the patient transferred from the Emergency Department to the Respiratory Medical Unit. The scenario took place on 30th July 2018 at 10AM and that means it was a morning shift. The identity of the man was Jim Cooper and he was 68 years old. The patient presented on an early morning and had a medical history of productive cough for a week as well as SOB which seemed more than the usual level. His medication included GP for Oral AB. The patient further claimed that he had been sitting in his chair during the night and that it is becoming very difficult for him to care for himself while at home. The patient further claimed that he stays alone and that regular drinking assists him to calm down. The patient also noted that he feels lonely and that it has been getting him down of late. The past medical history include COPD that was diagnosed 5 years ago, reflux and finally Hypercholesterolemia. On assessment, the following signs were vital that necessitated admission at the Emergency department. The Heart rate was at 118 beats/min, the RR was at 36 breaths/min,SpOwas 88% RA-93% 2L ONP while the Blood pressure was at 146/92 mmHg. The oral temperature was 38C. Finally the Auscultation was characterized by scattered whizzes throughput both the two lung fields. The recommendations included treatment with oxygen, IV fluids, IVAB, Prednisolone and finally the physiotherapy.

Patient Health Issues

From the case study presented above, there arises several health issues which Nurses can address within their scope of practice. The health issues identified include:

  • Impaired social interaction
  • Possible alcohol withdrawal
  • Potential for hypoxia.
  • Compromised airway clearance

Ranking Of The Health Issues By Priority.

Compromised airway clearance is the first priority because COPD is an umbrella of different conditions that affect the airways and lungs like asthma. The condition according to studies, makes breathing very difficult (Sessa et al., 2017 p.126). The condition is characterized by inflammation in the air passages and this leads to narrowing of the same airways and this makes it difficult for oxygen to reach the lungs. It is the inflammation that compromise the airway clearance and that is why the initial step to manage the condition is improving or rather correcting on the compromised airways.

According to different studies, bronchodilators and corticosteroids are the ones used to reduce inflammation. There are different classes of bronchodilators and they include the beta-2 agonists, the anticholinergics and finally the methylxanthines (O’Donnell, 2008p.25). The mentioned drugs are usually introduced step by step beginning with the Beta-2 Agonists. The role of this drugs is to ensure that the airway muscles are smooth enough. The beta 2 agonists are also divided into short and long acting. An example of the short acting beta-2 Agonists are albuterol and the formoterol are the long acting beta-2 Agonists.

Anticholinergics are introduced after the beta-2 Agonists. The role of this drugs is to reduce inflammation by facilitating bronchodilation through blocking of the acetylcholine that is found on the postganglionic cholinergic nerves. An example of such a drug is the Tiotropium which is also called Spiriva and it is a long acting anticholinergic that has duration of over 24 hours (Giembycz, 2015). This is the only drug needed once on a daily basis. The final drug to reduce inflammation is the Methyxanthines. Studies have shown that this drugs prevent phosphodiesterase thus elevated levels of the cyclic adenosine monophosphate and this leads to bronchodilation (Chung, Lin, & Kao, 2015, p. 54). Studies though show that the corticosteroids have no value in handling COPD but they only reduce inflammation for subsequent management steps.

Potential for hypoxia is the second priority health issue and it is usually reserved to patients with hypoxia. According to studies, the oxygen therapy does not improve lung function but only boosts survival in patients with hypoxia. The objective of this process according to studies is to achieve an oxygen saturation level of around 90%.It is the arterial blood gas value and desaturation as well nocturnal desaturation that determine the oxygen prescribed.

Impaired social interaction is ranked third among the health issues. Patients suffering from COPD are known to have impaired social status and they should be assisted as well. According to studies, medical management cannot reduce symptoms of the COPD in any way and they can’t reverse the pathological changes as well. In this case, the health care providers often prescribe what is called pulmonary rehabilitation whose objective is to ensure that the patients improve on both their physical and the social functioning.

NRSG637: Foundations Of Specialty Practice 2


On successful completion of this unit, you should be able to:

Analyse anatomical, physiological, developmental and pathophysiological concepts related to complex health problems in their area of specialty practice;

Evaluate the science underpinning management (pharmacotherapy, non-pharmacotherapy) of complex health problems in the specialist clinical setting;

Critically analyse and apply the evidence underpinning curative, rehabilitative and/or palliative approaches to care for patients in their specialty practice.

On successful completion of this unit, you should have developed your ability to:

Think Critically And Reflectively.

Demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession.

Locate, organise, analyse, synthesise and evaluate information.

Demonstrate effective communication in oral and written English language and visual media.



This case study presents John Smith (pseudonym), who was admitted to the hospital 14 days ago. The main reason for his admission was that he had experience a fall and got injured as a result. He was admitted to the ward for management of the injuries he sustained. A diagnosis of rheumatoid arthritis was made after an x-ray was done He however developed hospital-acquired pneumonia which made him to be transferred to an isolation room for further management. This case study aims to provide all the necessary details pertaining the patient, therefore illustrating the particular anatomy, physiology, pathology of the rheumatoid, falls, pneumonia and other conditions of concern in his past medical history.

Patient History

Mr. Smith is a 72 years old male who has been admitted to the hospital and treated several times in the past due to conditions that comes as a result of his advancing age (see Appendix A). He is married to Jane and have four children who are working. He was admitted for the first time when he was 53 years old, where he was diagnosed with type 2 diabetes. This has however been managed with insulin or the past years.

Four weeks post admission he had fallen while heading to the house from parking however his wife held him since they were together. Two weeks later, he felt again while alone the house and injured his right arm severely. He got a cut which peeled most of the skin. He almost lost the function of it, however the doctor has reported that he will recover. He also reports to have been experiencing pain on his wrist joints which has greatly affected his activities of daily living. The main reason for seeking medical attention is that the pain on his wrist had been increasing and the wrist joint is swellon and stiff. He also feels pain on other joints. He was admitted accompanied by her wife, Jane. On admission, John’s temperature was 38.6?C, respiratory rate was 26 breaths per minute, pulse rate of 81 beats per min and a blood pressure of 126/81 mmHg. He was started on analgesics to ease his pain. A diagnosis of rheumatoid arthritis was made on admision after an X-ray was taken and the patient was started on treatment. Three days after hospitalization the patient started experiencing difficulty in breathing and chest pain. He was diagnosed to have acquired hospital acquired pneumonia which has been managed effectively.

Rheumatoid Arthritis Immunology Of Rheumatoid Arthritis

Rheumatoid arthritis is a long term autoimmune disease the commonly affect old people. It primarily affects wrist joints and manifest through pain and stiffness which worsen following rest. The joints may be warm, swollen and joints of both sides of the body are affected. Other body parts may also be affected by the disease resulting in a low count of red blood cell, inflammation around the hearth and lungs. Low energy and fever may also be present but they take up to even months to manifest. There is no known cause of rheumatoid arthritis but it is believed to be a combination of environmental and genetic factors. The presenting mechanism involves immune system of the body attacking the joints leading to the joint capsule being inflamed and thickened (Fassbender, 2013). Arthritis is the leading cause of falls especially in elderly (Huang, 2012). The disease cause falls because it decreases muscular strength because of pain, joint swelling and muscle atrophy. Diminished proprioception is another factor which causes falls. This is because of mechanical damage and bony deformities leading to reduced sensory information about arthritic joints. The patient therefore has impaired perception of limb position information necessary for safe movement.  Impaired balance due to reduced ability to detect and control postural sway can also lead to falls. Pain further compromises muscle function increasing risk of falls further.

Pathophysiology Of Rheumatoid Arthritis And Clinical Manifestation

The disease starts as a persistent cellular activation leading to autoimmunity in joints and other organs. Synovial membrane is the first site of the disease and that is where infiltration of immnune cells occurs as a result of swelling and congestion. The disease progresses in three phases; the initiation phase, the amplification phase and chronic inflammatory phase (Brunner, 2010).

The Initiation Phase

Genetic factors which cause adaptive immune response to change can lead to initiation of an immune response that is abnormal. Once this response is initiated it becomes permanent and chronic. Other factors that contribute are environmental and hormonal factors. This is explained by increased risk in women especially after child birth or after hormonal medication use. A positive feedback for antigens like IgG Fc attached to rheumatoid factor and citrullinated fibrinogen bound by antibodies to citrullinated peptides, overcomes the negative feedback that normally maintains tolerance.  People with rheumatoid arthritis have antibodies which are abnormally glycosylated and have been known to cause joint inflammation.

Amplification Phase

Symptoms may take many years before appearing but when the abnormal immune response become established the plasma cells derived from B lymphocytes produce rheumatoid factors and ACPA of the IgM and IgG classes in large amount. This leads to macrophages activation through Fc receptor and complement binding causing intense inflammation. The N-glycan antibody mediates binding of autoreactive antibody to the Fc receptor in people with rheumatoid arthritis. This antibody is altered in people with rheumatoid arthritis to promote inflammation. A local inflammation in a joint especially the synovium results with vasodilation, edema and entry of T-cells that are activated (CD4 and CD8 cells). The macrophages and dendritic cells at the synovial join expressing MHC class II since they act as Antigen Presenting Cells which establish an immune reaction in the tissues.

Chronic Inflammation

As the disease develops, granulation of tissue at the edges of the synovial lining, pannus with extensive angiogenesis and enzymes result damaging the tissue.  These result in thickening of the synovium, cartilage and underlying bone disintegration. Cytokines, chemokines and immune cells (T- cells, B-cells, macrophages and monocytes) attract and accumulate in the joint space. They cause bone degradation by triggering osteoclast production through signaling by the RANK pathway. Tumor necrosis factor also plays an important role in causing inflammation. Tumor necrosis factor alpha is a pro inflammatory cytokine that plays an important role in rheumatoid arthritis by regulating inflammatory response. If it is activated by B- or T-cells, it results in hypersensitivity reaction thus inflammation.

Diabetes may also have contributed to the fall that John experienced. Old people using insulin to control blood sugar are at risk of hypoglycemia. Hypoglycemia can cause blurred vision, dizziness and weakness therefore causing falls. Type 2 diabetes mellitus has been found to have strong genetic link. There is impaired insulin secretion and insulin resistance.

  1. Pathophysiology of pneumonia

Smith also acquired pneumonia after admission. Elderly people have lowered body immunity. This therefore put them in risks of getting infection like Pneumonia easily. John also had diabetes which has been found to lower the body immunity. The use of some medication contribute to low immunity. Smith acquired pneumonia as a nosocomial infection due to his low immunity.  Hospital-acquired pneumonia is usually caused by bacterial infection. When an organism, that is, bacteria reaches the lungs, they trigger an immune response (Singh, 2012). This causes the invading pathogen to be engulf by neutrophils and cytokines are released leading to inflammatory reactions. The lungs become hyperaemic. Fluid from the intravascular spaces enter into the alveoli and lung tissue since the capillaries become highly permeable. This causes the impairment of ventilation as the gaseous exchange space become small. Congestion of the lungs therefore occurs as a result of fluid shifting making the lungs appear hard and red

NRSG259-The Use Of Clinical Reasoning Cycle


Mr Dinh Nguyen is an 83 year old widower who was diagnosed with Multiple Sclerosis (MS) six years ago. Four years ago he was diagnosed with osteoarthritis– which is now controlled on medication.
The Nguyen’s migrated from Vietnam in 1976. Dinh lives alone in his own two story home where he has lived with his wife, Ngoc, until she died twelve months ago. Dinh has remained independent since then, however with his ongoing grief and increasing isolation he has noticed a marked decline in his health with ongoing worsening exacerbations of his MS. Dinh and Ngoc did not have children, thus Dinh has no immediate family. However, he has a brother, Bao and his family, living close by. Dinh, however does not want to involve them in his daily life as he does not want to be a bother to them
Dinh has a small income from his self-managed superannuation and is careful with his money. This allows him some measure of financial independence, however, because of reduced investment returns, finances are now only just covering his expenses. He tries to go on a holiday once a year, but was unable to this year due to his altered mobility.
Dinh has been experiencing some blurred vision, numbness in his face, and an “electric shock” type of feeling when he moves his head and neck, often travelling down his back and into his legs, impacting his movement and gait severely. This is making tasks such as cooking, showering, and dressing difficult, particularly bending down to do up his shoe laces. Dinh has also started to experience some episodes of urinary incontinence. Because Dinh perceives that his disease process is worsening, he is starting to wonder how he can face the uncertainty of his future.


The use of clinical reasoning cycle as developed by Levett Jones has been found to be extremely effective in dealing successfully with the complicated clinical scenarios in a convenient manner (Levett-Jones, 2013). The clinical reasoning cycle primarily based upon evaluating the condition of the patient based upon the collection of information, identification of the risk areas, undertaking decision about the interventions, setting goals, developing a care plan, evaluating the efficacy of the nursing goal based on the factors of evaluation and finally reflecting upon the clinical experience. The provided case study deals with the clinical scenario of 83 year old client, Mr. Dinh Nguyen and discusses about the intervention strategies based upon the practical use of the clinical reasoning cycle. The further sections of the paper would deal with identification of the physical health issues of Mr. Nguyen and critically proceed with designing an effective intervention with respect to all the steps that are followed in the clinical reasoning cycle. It is expected that this paper would successfully access the client and yield positive patient outcome.

The client Mr. Dinh Nguyen is 83 years old and immigrant from Vietnam. The client history reveals that Mr. Nguyen developed multiple sclerosis six years ago. The patient also reported to be affected with Osteoarthritis. However the condition of Osteoarthritis has been controlled to a considerable extent with the use of regular medication. The case study states that Mr. Nguyen lives alone and has been widowed twelve months ago on account of the death of his beloved wife Ngoc. It has also been reported in the case study that Mr. Nguyen does not have any children and although his brother and his family lives close by, he does not like seeking help from them. This is because the client does not want to bother his brother and his family with his physiological complications. The death of Mr. Nguyen’s wife has taken a toll on him and as a result he is finding it extremely difficult to manage the activities of daily living such as cooking, tying his shoe laces, showering and dressing up quite difficult for him. In addition Mr. Nguyen has also stated sensing a blurred vision, a sensation of a shock or tremor while he tries to move his head and neck. He also states that he is facing difficulty with urinary incontinence and a numbness in his face. On critically evaluating the medical history of the client and the medications that have been administered to the client, it can be said that the client has been administered medications which include the following:

  • Panadol Osteo 6/24 Oral prn (with a maximum limit of 6 dose per day)
  • Teriflunomide 14mg to be consumed orally daily
  • Prednisolone 25mg Oral BD (to be consumed orally in case of an exacerbation)

In addition to the above stated medications, no other medications have been prescribed to the client. On critically evaluating the information provided by the patient, it can be said that the patient is likely to need assistance with activities of daily living. It can also be said that on account of living in isolation, the client can be a potential victim of depression and age related emotional stress and trauma (Gallo et al., 2013).

On the basis of the information that has been collected from the case study, it can be said that the issues that Mr. Nguyen is facing with movement is primarily because of the effect of multiple sclerosis and old age related degenerative changes of the muscular tissues. Scientific evidences have revealed that with the onset of Senescence, negative consequences such as loss of muscular elasticity and degeneration are common (Rantakokko et al., 2013). The numbness in the face can also be related to as a symptom of multiple sclerosis (Galea et al., 2015). The blurred vision can also be related to as an age-related disorder. Evidences have revealed that after the age of 45, blurred vision due to development of cataract is extremely common in men and women (Zhang et al., 2013). The feeling of insecurity and fear can be related to the initial symptoms of depression associated with the negative impact of old age (Weiss Wiesel et al., 2015). The medications that are administered are primarily to help with pain relief and treat the relapsing symptoms of multiple sclerosis (Filippi et al., 2016).

The primary issue that has been identified on the basis of the present physical condition of the client is, assisting the client with activities of daily living. The case study characteristically mentions that the client is experiencing tremors at the back and in his legs that is making it difficult to manage activities such as cooking, dressing up or taking a shower. Scientific studies reveal that with advancing age the ability to manage activities of daily living independently gets impaired (Kalyani et al., 2014).

NURS5006 Contacting The Unit Of Study Co-Ordinator


› Choose a creative work (ie book, movie, series of artworks) that explores an illness experience as a central theme of the work.

› You will submit a piece of written work (2000 words) that explains:

› 1) how your chosen creative work reflects the illness experience as it is expressed in the qualitative research literature ie, what themes in the literature seem to resonate with themes in the creative work. You should reference a minimum of 8 qualitative articles to support your writing.

› how your chosen creative work captures elements of theories of subjectivity that are relevant to the particular illness (examples might be biographical disruption, emotionality, abjection, lived temporality, stigma, the disciplined body, etc.)

Under what paradigm do these ideas sit?

How do people reframe their lives around illness?

What is hospitalisation like?

How does illness affect the family?

Why do we need this content?

Why do we need this content?



An illness trajectory is known to focus on the experiences of an individual as they complete the journey of life after development of the illness. Though experiences of illness might be varying among individual, common themes emerge from such experiences on the basis of qualitative research studies.  The present assignment is based on a creative work, the movie ‘Still Alice’ that has an illness experience as a central theme. The essay aims to describe how the chosen creative work is a reflection of the illness experience as it is expressed in the qualitative research literature. The themes embedded in the creative work resonating with themes in the literature are highlighted. It further aims to highlight how the selected creative work captures the elements of theories of subjectivity relevant to the particular illness. A conclusion summarizes the main elements of the experience that would guide a nurse to understand such a person presented in the creative work at the centre of their care.

The movie ‘Still Alice’, directed by Wash Westmoreland and Richard Glatzer had been released in the year 2014. It is an adaption of the acclaimed novel of Lisa Genova in a faithful version, and has received numerous awards since its international release. The main character in the movie is Alice Howland who is a renowned linguistics professor at Columbia University, and is happily married to a physician, named John with three grown up children.  In retrospect the viewers realize that Alice begins to show the subtle signs of familial Alzheimer’s disease. When the 50 year old woman is diagnosed with early-onset Alzheimer’s disease, Alice and her family struggled to cope up with the distressing and vexing challenge. They face the gradual changes brought about by the terminal degenerative neurological ailment, slowly progressing to an inevitable conclusion. Along the path, Alice is found to be struggling to fight the inner decay, and find peace and love to make the living worthwhile. The film portrays how the once-vibrant woman faces the challenges of being self as long as possible, as her children watch helplessly. The viewers are able to follow the disease progression experienced by Alice, her deterioration, the strategies used for coping with the ailment and the effect on social relationships (Hepburn, 2015).

The primary focus of the movie ‘Still Alice’ is on Alzheimer’s disease and the movie has been successful in portraying multiple signs of the condition across the three distinct stages of it. Alzheimer’s disease is a common form of dementia that is known to cause memory impairment, along with decline in behavior and thinking ability. The impairment with the cognitive abilities are severe enough to cause interference with the daily activities of life. Alzheimer’s disease is known to account for almost 60 to 80 percent of all dementia cases (Solomon et al., 2014). Though aging is a risk factor for developing the condition, it is not to be considered as a normal part of aging. Alzheimer’s is a progressive disease and it worsens over time. While in the early stage the extent of memory loss is mild, individuals at later stage of the condition do not have the ability to respond to the surrounding environment (Yektatalab, Sharif, Kaveh, Fallahi Khoshknab & Petramfar, 2013).

Mild cognitive impairment in Alzheimer’s disease is the gentle decline in the individual’s cognitive abilities as the person develops a compromised ability to think. Though this is noticeable, it is not deliberating. It has been understood from literature that people suffering from mild cognitive impairment tend to experience forgetfulness as evident from misplacement of objects, forgetfulness regarding appointments and having difficulty in remembering individuals they meet (Prorok, Horgan & Seitz, 2013). In the film ‘Still Alice’, Alice is found to be referring to her condition as mild cognitive impairment at the initial stage. However, the symptoms that she demonstrates fit the accurately the profile for early stage Alzheimer’s disease. Though early stage Alzheimer’s encompasses all the signs applicable for mild cognitive impairment, they are much more intensified. The forgetfulness is more deliberating and frequent. People who suffer from early stage Alzheimer’s face significant issues planning and subsequently organizing tasks that make it difficult to perform the same. Nevertheless, individuals are aware of their personal details and other crucial aspects of their lives (Ilha et al., 2018).  While some health care organizations do not make a distinction between the two conditions, others do, and the movie has been found to be following the second model. The film has been successful in portraying accurately a number of signs of early stage Alzheimer’s. For example, Alice is found to be momentarily not able to think of a certain word during her presentation. Further, at the Christmas dinner, Alice reintroduces herself to her son’s girlfriend in spite of having introduced herself five minutes earlier. Further, Alice is found to be lost while going out to run in the neighborhood, and has moments of not knowing that is in the Columbia university campus where she has worked for years. In addition, she forgets a planned dinner date with her husband John.

Moving further with the movie, the characteristics of moderate stage of Alzheimer’s is highlighted through the experiences of Alice. As the first trace of this stage, Alice wears a bracelet that states ‘memory impaired’. The condition worsens to the degree that she is at high risk of getting lost. Alice is found to be repeating questions and is not able to remember where the bathroom is, leading her to wet herself. After watching her daughter Lydia in a play, Alice is not able to recognize her as her daughter. As pointed out by Lancioni et al., (2009), a person suffering from dementia is likely to suffer from confusion and forget places and environment. Certain section of the population is likely to have bladder problems that worsen over time. The film also shows that Alice has memories of her sister and mother who had died in a car crash long time back when she was eighteen years old. This is typical of patients suffering from Alzheimer’s since individuals retain memories of past events longer than those of recent times (Edmunds, 2018). Further, Alice engages in an argument with her daughter Lydia. Later on she apologizes and confesses that though she remembered she had a fight, she was unable to recall the reason for the same. According to Varela, Varona, Anderson and Sansoni (2011) during the moderate stage of Alzheimer’s, symptoms are much more accurate. Patients have increased difficulty in carrying out regular tasks and daily activities of life become complicated. Changes in personality traits might be evident.

The late or severe stage of Alzheimer’s is known to involve a distinct intensification of the symptoms suffered in the moderate stage. The most evident change is the increased loss of functions of the individual. Patients are known to fail to understand and recognize the present situations. Further, they might have decline ability to identify individuals, including self. There is a dramatic impairment in the ability of individuals to communicate with others. Along with gradual decline in the physical capability, there is loss of ability to maintain stable mental wellbeing status (Valgardsdottir, Olason, Hannesdottir, Gretarsdottir & Snaedal, 2013). The symptoms might be evident at a very later stage of the disease. Assistance is needed for carrying out daily activities of living such as eating, dressing and bathing (Kallmyer, 2012). The consensus is that patients suffering from later stages of Alzheimer’s and other forms of dementia are not to be left alone since they are at high risk of suffering adverse events (Karlsson, Sävenstedt, Axelsson & Zingmark, 2014). As a reflection of this stage, the scene can be pointed out where Alice is not able to keep track of time.

NSB236 Integrated Nursing Practice 3 – On Campus


The Assessment Tasks Requires You To:

Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case.

Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies: x One (1) priority of clinical care and; Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research.

Consolidate knowledge of key NMBA Registered Nurse Standards for Practice, National Safety and Quality Health Services Standards, and National Health Priorities to enable effective decision planning and action in a range of complex clinical situations across the lifespan.

Apply knowledge of anatomy, physiology and pathophysiology to support evidence based decision making associated with planning and action.
Demonstrate structured decision making and clinical reasoning to review a range of health situations, synthesise evidence and data, determine priorities and formulate plans of care and interventions in line with timeframes and agreed goals

Assignment Hints

This assignment requires you to critically consider the signs and symptoms associated with clinical deterioration in relation to the patient’s primary clinical diagnosis, with consideration to:

The change in health status associated with the primary clinical diagnosis;
How the patients clinical history may impact on assessment data and core interventions;
The identified clinical priority which should clearly emerge from your discussion of the primary health alteration.
The application of clinical data and research to identify three (3) core interventions and assessments that address the stated clinical priority.
Evaluation data supported by research to effectively determine success of the intervention. The SMART goals format may be of assistance in guiding you in structuring this.
Demonstration of your clinical reasoning for your selected case study.



Traumatic Brain Injury (TBI), the permanent or temporary damage to brain tissue that impairs brain functions, is a common occurrence in medical practice. The causes of TBI are varied ranging from impact falls, motor vehicle crashes, traumatic assaults to sports-related concussions among other causes (Vos, 2015).

This leads to reduced blood flow to the brain which will eventually activate the cytotoxic processes which will damage the brain tissue. There will be insufficient oxygen and glucose supply to the brain (Thiagarajan, Ciuffreda & Ludlam, 2011). This will lead to inadequate energy supply which causes influx of water, sodium ions and chloride ions hence cytotoxic edema with influx of Ca2+  leading to cellular injury of the brain tissue (Brorsson et al., 2011).

Functional changes in the body associated with TBI are numerous and varied depending on the severity as well as other factors such as age and sex (Crandall, 2011). Young children may experience completely different symptoms from adults. The most common changes within the pathological state include; cerebral edema, herniation, hyperemia, loss of consciousness, tachycardia, apnea, dilated pupils, raccoon eyes, unequal pupils and slurred speech. (Jarvis, 2018)

This paper aims to analyze the common symptoms associated with Traumatic Brain Injury, the priority of clinical care and the nursing interventions in reference to a medical case study. The medical case study is of one Mr. James Parsons. Mr. Parsons, as he was leaving a club at night, engaged in an altercation with a group of males at the front of the bar. He was punched in the face and lost consciousness immediately. This caused him to fall, hitting the back of his head on a pavement. He was rushed to hospital where an immediate surgery was carried out to remove a hematoma.

This paper will employ the knowledge gathered from this case study to recommend the appropriate care needed for the full recovery of Mr. Parsons as well as provide a basis for treatment of future patients with a similar condition.

Symptoms Of TBI Related To The Deteriorating Condition

Symptoms of Traumatic Brain Injury are varied and numerous depending on the severity of the case. The Glasgow Coma Scale, (GCS), is a counting system used to measure the level of consciousness in Traumatic Brain Injury (Koh, 2011). It works with on eye opening, oral response and finest mechanical response. A score of fourteen or fifteen shows slight TBI, a score of 9 to 13 shows modest TBI while a notch of 3 to 8 shows serious TBI (Castor & El Massioui, 2018).CT findings coupled up with other factors may also be an indicator of the extent of severity of the case ( Frey & Arciniegas, 2011).

In some cases, patients with initial low and moderate TBI show deteriorating symptoms. Mr.Parsons, in the given case study, shows a range of signs and symptoms related to TBI and the deteriorating condition.  Parsons registers an abnormally high rapid heart rate of 118 beats per minute, a clear indication of sinus tachycardia. He also registers frequent shortness in breath especially during sleep (Apnea) at a rate of 11 breaths per minute.

Parsons past medical history of   type one diabetes, smoking and social drinking could have also triggered the above symptoms. Visual evidence of raccoon eyes and a battle sign behind the ear indicate possible presence of a fracture in the skull. Loss of consciousness and sensitivity to light are also observed. The initial CT scan shows hematoma which was treated intra-operatively on arrival at the hospital.

The two major symptoms in Mr. Parson’s case, indicating a deteriorating condition that should receive immediate attention include the basal skull fracture and sinus tachycardia. Other causes for medical concern that should be looked into are shortness of breath and type one diabetes. These, if not monitored, could contribute to further deterioration of the patient.

Priority Of Clinical Care

Sinus tachycardia, raccoon eyes and battle sign should be monitored.  The abnormally high blood pressure should receive immediate care, to reduce it to normal levels so as to avoid any complications post operatively. Since Mr. Parsons recently left surgery, where the hematoma was removed, monitoring of the blood pressure is very essential to avoid further brain injury.  The battle sign and raccoon eyes are evidence of a possible fracture in the skull. This should also be monitored to ensure quick healing of the fracture.

Nursing Interventions

Mr. Parsons should receive adequate care so as to fully recover from the Injury. The major symptoms that are to be monitored are sinus tachycardia, basal skull fracture and apnea. Since Mr. Parsons is from an operation, he should be given coma inducing drugs to prevent him from suddenly waking up causing further brain damage. He can also be given diuretics so as to reduce the amount of fluid in soft tissue.

NURS1007 Dimensions Of Physical And Mental Health 2


Georgia – Anxiety Case Study

Georgia is a 22 year old university student who is feeling unable to cope with the stresses in her life at the moment. She is currently in her third year studying Psychology but has had to change from full-time to part-time this semester as she feels overwhelmed by the workload. She describes difficulty concentrating on her study and finds it very difficult to complete assignments on time. Whenever she has exams or assignments due she feels panicky and worries that she will fail the assessment. She describes feeling short of breath, can feel her heart pounding in her chest, and has a sense of impending doom.

Georgia lives alone in a small flat near to the university because she does not drive a car. She has attempted to get her driver’s licence in the past but found the driving test too stressful and when she almost had an accident during her second test, she decided not to try for it again.

Georgia describes feeling tense and anxious a lot of the time and lately she has had problems sleeping. Sometimes she lies awake for hours after going to bed and wakes feeling exhausted. Because she has been feeling so tired, she has not been going out for her usual walks in the early evening. Describes herself as quite fit usually. Weighs 59kg and is 168cm tall. HR 86; RR 22; B/P 110/75; T 36.7C.

Georgia’s parents live in the country about four hours away so she does not see them very often although she describes having a good relationship with both parents. She talks to her Mum by telephone most days. She has a 27 year old brother who is working as an executive in a large company in London. She has a few friends from high school who she meets up with from time to time although she has not seen them for three or four weeks because she has declined invitations to go out.

Georgia has not had a relationship for more than two years. She does not smoke or use illicit drugs. She occasionally drinks alcohol when she goes out with her friends. She describes feeling stressed and anxious for the past six months and her distress has become increasingly worse. She worries that she will become anxious and unable to cope “just like my mother”.

Develop An Discussion Focusing On The Chosen Person In The Case Study.

You are required to explore and critically analyse the information provided in the case study materials and address the following discussion points, linking them specifically to the chosen person:

  1. A sound understanding of mental health and mental illness.
  2. The nexus/relationship between mental health and physical health.
  3. A comprehensive understanding of personal recovery and what this means for the person in the chosen case study.
  4. Recognising and responding to the mental health needs of the identified person – what does the literature tell you about best treatments for someone with these symptoms?
  5. What are the  implications for the practice of health professionals (when working with someone with this illness).



The report brings out the discussion on the mental health nursing and the related aspects and concepts, it describes the rationale for the purpose of implementation of the nursing interventions to treat mental health issues. Mental health refers to the cognitive, behavioural, and emotional wellbeing and everyone aspires for a good mental health, as a goal of his or her life. Good mental health does not refer to the absence of mental illness only; rather it represents the person’s ability to deal with the stress of life. Mental health of an individual affects a number of aspects such as daily life, physical, and emotional health affecting the life’s activities. Mental illness refers to a number of issues affecting mental health of the individual. The case study of Georgia-anxiety has been used for describing as the case study, which describes these aspects. Thus, report in the later part discusses about the relationship between mental and physical health and implications of practice of health professionals and other aspects (Rogers and Pilgrim, 2014).

Mental Health And Mental Illness

Mental health refers to the state of psychological wellbeing of a person, depicting absence of illness or mental health disorder. It represents the state of the health of an individual in which the body functions at satisfactory level of emotional and behavioural adjustment. Mental health is a positive concept and results in the successful performance of mental function, which leads to productive activities, developing healthy, and fulfilling relationships with people, and strong capacity to deal with the change and normal stresses of life (Mereish and Poteat, 2015).

Mental health illness is a major concern in today’s scenario especially amongst adolescents, and older-aged adults. It includes a wide range of conditions affecting how a person feels, think, act, and behave in a particular situation. Mental health affects the physical health of the person, and may lead to higher risks of diseases and illness in the later years of life. In context to the case, Georgia suffered from the problems of mental health illness, suffered from the anxiety disorder as the symptoms in the case depicted shows her stress level, also she had panic attacks.  . Treatment or cure for mental health illness varies from person to person and nature of diseases and the associated problems. Identification of the effects or consequences of mental illness on the person may state about the feeling of hopelessness, or homelessness, or the occurrence of situation of poverty leading to long-term illness. Thus, mental health and mental illness are the terms, used interchangeably therefore, indicate a strong relationship between each other (Stein and Sareen, 2015).

Relationship Between Mental Health And Physical Health

Mental health and physical health are interrelated and exert an influence largely on health of the individual. Mental health and physical health has found playing a significant role in healthcare settings. With context to the given case study, Georgia a 22-year old girl, is unable to cope with the different stress of life and diagnosed with number of problems such as difficulty in focusing on her studies, short of breath, sleeplessness, fatigue, stress and mother anxiety. Aspects of mental and physical health fundamentally linked to each other affecting the person in numerous ways. Therefore, poor physical and mental state may affect the quality of life and may cause long-term illness in later years of her life. Thus, the relationship between the physical and mental health of the Georgia can be analysed in a number of ways given below (Kessler et al., 2015).

  • Poor mental health of a person found to be detrimental to physical chronic conditions of health. People with poor mental health are incapable to receive appropriate healthcare services, thus causing physical health issues.
  • Mental distress and problems related found to be responsible to disturb the homeostasis balance of an individual.
  • In addition, poor physical health leads to problems of mental health of the individual. The relationship between these terms exemplified as people with major mental problems or self-related distress, is likely, to die with cancer. The rates of such patients are found to be around 32%, thus, it can be determined that the mental health problems, affect the person physically (Mental health Foundation, 2018).

There are some of the factors that may affect the health condition of Georgia including income, inadequate access to healthcare services, therefore preventive measures must be taken to improve their health condition. Involving person in physical activities, access to nutritious food and healthcare services will help prevent her chronic condition. Poor mental health also affects the person’s decision-making ability and affects their work-life as well. They must be encouraged and provided social support, and sufficient opportunities to sustain basic standard of life. Lifestyle choice is other factors, which affects the person’s mental and physical conditions such as alcohol consumption, smoking, and other habits. As with the case, these negative forces found to be absent with Georgia’s health condition, but her health deteriorated leading to stress, facing difficulty in learning and remembering things easily. Thus she may face critical problems, if not improved timely therefore there is a description of personal recovery in health illness (Slade et al., 2014).

Role Of Personal Recovery

Discussing about the aspects and the issues associated with mental and physical illness, and their relationship it has been analysed that it is essential to ensure proper treatment to the person facilitating sound mental health of the individual. Thus, concept of recovery has been crucial to gain an understanding of the ways to ensure best treatment and wellbeing of the patient/individual. In the perspective of mental and physical health illness, recovery defines as gaining or retaining the hope for the recovery towards improvement in the present health condition of an individual. Personal recovery also emphasizes on understanding one’s own abilities, desires and disabilities, personal autonomy and being active with the life-processes. The process of personal recovery focus on the individual improves their health, living a self-directed life and striving to exploit their potential to attain personal goals (Baer, 2015).

A paradigm shift in the concept of recovery at health care settings has observed, as involving patient in personal recovery is important. Anxiety disorder refers to a number of different situations, panic disorder, social disorder, social anxiety disorder and several others. Georgia in the case also represented these symptoms, disorganised thinking, lack of confidence, understanding, and depressive moods. Personal recovery is effective in ensuring her health and state of wellbeing (Jacob, 2015).

NMIH107 Nursing Care Plan


Instructions: Structure your assignment so that it meets the following requirements:
1. Introduction. Serves as a “map” of the essay, outlining to the reader the key points contained in the body of the work.
2. Discussion of Activities of Living (AoL’s) related to the Case Study – Maintaining a Safe Environment, Eating and Drinking, Personal Cleansing and Dressing and Elimination
Choose 3 of the four AoL’s and discuss how they have been altered for Mr Manor.  Your answer must include the following:
An overview of how the three AoL’s may be affected
How you would assess Mr Manor’s in relation to the three identified AoL’s. Include in your answer what care you would provide Mr Manor
3. Nursing Care Plan. Using the Nursing Care Plan provided identify one issue related to each AoL (3 issues in total) that has arisen from the case study. You are required to formulate a plan/goal for improving each issue, identify strategies for meeting each plan/goal and then discuss what evaluative measures will be taken to determine if each plan/ goal was met.



Nurses have to provide an array of support services to the patients while they are availing the care services. Especially for the aged care sector, the nursing professionals often have to indulge in supportive assistance that even encompasses the activities of living for the patients as well (Ahmed et al., 2018). On a more elaborative note, it has to be mentioned that for the nurses that are practicing in the aged care facility, they have to address to the aged, frail and elderly patients that are suffering with chronic illnesses which often renders them incapable of completing their own activities of living and personal care needs.

Hence, the care providers, the nurses in most cases are associated with providing assessment and care interventions to support and assist the patient in completing the activities of living. The Roper, Logan and Tierney model of nursing that was coined in the year of 1980 which focuses entirely on the activities of living and providing systematic and comprehensive supportive assistance to the patients in achieving the AOLs (Holland, 2008). There are 10 different activities of living that had been listed in the model which each provides guidance for the nursing professionals to be able to provide adequate care. This assignment will utilize the Roper, Logan, and Tierney model of nursing and AoLs to address three disrupted AoLs in the patient from the case study chosen. The essay will discuss the activities of living associated with the case study, how the AoLs were affected, how it will be assessed and what care intervention can be provided to the patient followed by an extensive care of plan for the patient as well.

Discussion Of The Activities Of Living: 

The case study chosen for the assignment focuses on the patient named Mr. Keith Manor, who is an 86 year old admitted to the medical ward with complaints of gastroenteritis and dehydration. Elaborating more, it has to be mentioned that Keith had also been suffering with two day history of diarrhea and abdominal cramping. His current symptoms are pertaining of watery diarrhea, a mild temperature of 37.7degrees Celsius, abdominal pain, headache and mild dehydration. Along with that, the patient is also suffering with extreme fatigue or lethargy as well. Hence, from the key information that is provided regarding the patient and his present medical condition, it can be stated that a variety of different AoLs of the patient is affected. With the symptoms that Keith is exhibiting the first and foremost AoL, that seems to be affected drastically is eating and drinking.

Eating And Drinking:

First and foremost it has to be mentioned that eating and drinking is one of the most fundamental activities of living which everyone has to carry out in order to sustain the Metabolic functions of body (Roper, 2000).  In this case Keith had been suffering from extreme watery diarrhea abdominal cramp and pain headache mild dehydration and extreme fatigue. activities of Living outlines both the norms of the patient as well as any changes that can have occurred due to the current changes in his body function in and condition which are also accessed when the patient has been admitted into the ward.  Abdominal cramps can have a profound impact on the activities of daily living of a patient. It does not only affects the ability of the patient to continue eating and drinking as an activity of living on is on but it also affects the appetite of the patient which can also lead to the activity of living of eating and drinking to be impacted.  according to the authors for aging patients exhaustive health conditions such as diarrhea coupled with abdominal cramps can obliterate appetite and then also affect the ability of the patient to move around on his own or complete activities of living including even eating and drinking which can have a significant impact on the health and wellbeing of the patient (Amjad et al., 2016).

It has to be mentioned in this context that the case study information also reveals the patient has also been suffering from dehydration, the activity of living of eating and drinking is affected for the patient in this case can also deteriorate his hydration and can exercise with the condition for the patient concession his age and immunity status. On the other hand as discussed by authors extreme dehydration can even lead to fitting consequences for children and extremely aged individuals due to their compromised immunity and innate defense. Hence, the care providers providing assistance support to the patient will have to take into consideration addressing the activity review of eating and drinking too ensure optimal health and wellbeing of the patient and avoid the risk of any severe consequences (Huynh,  Nguyen, Liem & Tran, 2015).

Maintaining Safe Environment:

Another very important activity of living which can be potentially affected by the condition that the patient is suffering from is maintaining a safe environment. According to the Roper Logan theory model of nursing care, maintaining a safe environment is the first and most important activity of living which is listed in the model. As discussed by the authors of this model maintaining a safe environment is one of the most important activities that is the only totally independent activity of living, that the patient can often take for granted.  It has been argued that the impact of illness or a disability on a patient can have a deliberating impact on his or her ability to ensures safety and protect themselves from harm (Yoshimura, Uchida, Jeong & Yamaga, 2016). In this case, the patient named Keith Manor had been suffering from extreme diarrhea which had led to severe dehydration for the patient as well. Now dehydration is a very common concern which inversely can lead to fatigue and can enhance the risk of fall as well. Hence, maintaining safe Hence, maintaining safe environment is one of the most important concerns associated with the patient and is a plausible activity of living which is affected of the patient as well.

Personal Cleansing And Dressing:

Lastly, the third activity of living which is pertaining to be affected completely by the presenting health adversities which the patient in the case study, Mr. Keith Manor had been exhibiting is the personal cleansing. It has to be mentioned or acknowledged in this context that the personal cleansing and dressing is an activity of living which is intricately associated with self-care. As illustrated by the Roper, Logan and Tierney model of nursing care, the self-care activities including dressing and washing themselves which is a very important self-care activity to carry on with the daily living for an adult (McClelland, 2004). In this case, due to the extreme diarrhea and dehydration that the patient had been going through also requires multiple visits to the toilet and will require him to wash and dress himself considerable amount of times. Due to the fatigue and dehydration, the inability of the patient not being able to wash and dress himself on his own will also affect the emotional and psychological health of the patient due to the dependency and struggle. Hence, this is a very important activity of living which needs to be addressed adequately for the patient in this case study as well.

Strategies For Care To Be Provided:

Considering the care that will be provided to the patient in the case study, the aid of fluid therapy, fall risk management and self-care assistance can be considered. On a more elaborative note, it has to be taken into account that the first and most basic or important activity of living which had been identified for Mr. Keith had been eating and drinking which had been jeopardized in the case of the patent in the case study as well. This particular jeopardized activity of living can also be considered as the contributing factor leading to the sequence of events facilitating the dehydration in the patient and the resultant lethargy and fatigue. Considering the present condition of the patient, the most plausible care approach for him will involve fluid therapy, a balanced solution of necessary electrolytes to the help the restore the electrolyte balance in his body and retrieve the state of homeostasis so that Keith can regain his strength and start recovering fast. However, in this case, Keith is a very elderly man and the impact of his age and physically frail condition has to be minded while deciding on the electrolyte solution for the patient as well. On the other hand oral repletion of the fluids is also needed to be considered in this context as well. As mentioned by the Picetti et al. (2017), oral repletion of the fluids is preferred under all circumstances, although this type of intervention strategy is only effective in case of absence of severe symptoms. In case the patient is acutely dehydrated and is exhibiting extremely low concentration of mandatory nutrients, the only plausible rehydration strategy that can be employed is the intravenous fluid therapy. For the maintaining safe environment for Keith will require the addition of fall risk assessment. On a more elaborative note, the patient is fatigued and dehydrated along with being frail due to his age and his diarrhea. Hence, the risk of fall for him is crucial and hence the risk assessment is a very important intervention for him. Along with that, the care interventions in this case will also include modifying the physical environment of the patient taking into consideration the safety requirements that the patient will require (Oates & Price, 2017). Lastly, for cleansing and dressing, the care strategy that I will be incorporating will be supportive assistance by either myself or a community care nurse.

Nursing Care Plan:

Assess Plan Implement Evaluate
Factual data:

For the patient a few assessment data that will be needed to be gathered for Keith includes his medical history, medicine list, and known allergen or hypersensitivity.

For the first activity of living, the assessment will include vital signs, total blood count test and hydration assessment so that the exact nutritional state of the patient can be taken into consideration (Bail & Grealish, 2016).


The patient will also need a thorough pain assessment as well as he had been complaining of abdominal cramps when he had been admitted to the facility.

Based on the assessment data including the hydration data and nutritional status assessment, the patient will be either provided oral repletion or intravenous mode of fluid therapy (Forbat, Kunicki, Chapman & Lovell, 2017).

The patient will also be given the aid of hydration bundle considering his age and clinical condition.


The implementation section of the APIE care plan method emphasizes on the documentation that will be carried out by the nursing professional during implementing the care plan made for the patient (Johnson, Waldreus, Hahn, Stenström & Sjöstrand, 2015).


For the first activity of living, the nurse will need to document the bolus and infusion rates in case of intravenous fluid repletion (Forbat, Kunicki, Chapman & Lovell, 2017).


In case the patient is able to take oral fluid repletion method, the exact status of administration will need to be adequately documented as per the standard protocol.


Lastly, the vital signs of the patient will also be monitored frequently and periodically.

Considering the evaluation of care, the care outcome indicators will need to be assessed and evaluated.


The patient in this case after the fluid repletion therapy exhibited improvement in the vital signs (Forbat, Kunicki, Chapman & Lovell, 2017).


He seemed visibly better with much lesser abdominal pain, fatigue or lethargy.