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Assessment Details
    Qualification Code: Title
    HLT54115 – Diploma of Nursing
    Assessment Type
    Assessment 1 Underpinning Knowledge/Questions
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    HLTAAP003 Analyse and respond to client health information
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Assessment 1 Underpinning knowledge questions
    Instruction to Students:
· Answer the questions below in the spaces text box provided.
· Ensure all references are documented under each individual question.
· Answers are to be typed or for written submissions, use black or blue ink and ensure your name is attached to the responses.
Case Scenario 1
Mr Bolton is a 46-year-old male who has been admitted with dehydration, shortness of breath and dyspnoea over the last two days which has got progressively worse. He has no other significant past medical history. Vital signs are: T 37, R is 26, P 84, BP 130/90 and his SpO2 is 93%. The doctor orders a chest X-ray which shows consolidation of fluid on his left lower lung and ABGs. The doctor diagnoses pneumonia and prescribes oxygen at 6l via a Hudson mask and normal saline intravenous fluids for dehydration.
1. How does the diagnosis of left lower lobe pneumonia compromise the stages of respiration and gas transport to cells, tissues and organs? (Min 200 for the entire table)
    External respiration
    The cellular exudates replace the air in the alveoli. This comprises of lymphocytes, neutrophils and fibrin. The infection usually is found to spread in pleura and hilum. The capillary walls that are present surrounding the alveoli are found to be congested.
    Internal respiration
    The macrophages are found to enter in the alveolar spaces with the phagocytosis of the leucocytes that are laden with bacteria. The tissue, which is consolidated, is re-aerated with infiltration of fluids resulting in the generation of sputum. Fibrinous inflammation can occur within the pleural space.
    Gas transport
    The alveoli consisting of a fine mesh of capillaries involving in the gaseous exchange. In this case, the alveoli were filled with pus as well as fluid exudates that will prevent in the gaseous exchange and transport from the lungs. This condition is known to be consolidation and collapsing of the lungs.
2. Why has the doctor ordered an arterial blood gas and how will the blood results determine respiratory acidosis or alkalosis? (Min 50 words)
    The arterial blood gas test or ABG analysis helps in the determination of the oxygenation and pH status of the body. It will allow the doctor to obtain information related to the oxygen supplementation, which helps in demonstrating the presence of acute hypoxemia in the patient. In case of this patient, the blood test will help in determining the retention of the sodium chloride and mineral acid as well as diminution of the carbon dioxide in the blood to analyse the respiratory acidosis or alkalosis.
3. Why is shortness of breath and dyspnoea common symptoms of pneumonia and where is the respiratory control centre located? (Min 100 words)
    The shortness of breath or dyspnoea occurs when the alveoli fail to work efficiently and the lung is unable to extract an adequate amount of oxygen from the air. This results in excessive tightening of the chest, difficulty in breathing, suffocation and air hunger. The medulla oblongata is known to be the primary control centre for respiration that is responsible for sending a signal to the muscles involved in the control of respiration. The medulla consists of two regions that are involved in the control of the respiration process.
4. What impact will the administration of oxygen have on Mr Bolton? (Min 100 words in total for table)
    Situation
    Impact
    a) How does the administration of supplementary oxygen help to maintain homeostasis?
    The administration of the hypoxemic and supplemental oxygen assists restoration of the oxygen balance in blood when the body is not able to carry out the gaseous exchange. Mr Bolton will be relieved of symptoms like fatigue, shortness of breath and dizziness due to pneumonia.
    b) What impact will this have on the respiratory rate?
    In the case of Mr Bolton, the supplemental oxygen will assist him in coping up with the breathlessness that usually increases the respiration rate of the patient. The oxygen supplement will help the patient in reducing the effort while breathing. It will also help in reducing carbon dioxide production.
    c) What impact will this have on the SpO2?
    SpO2 being the fifth vital signs of the body, with the supplemental oxygen the percentage of the oxygen in the bloodstream will be maintained. Thus, even though Mr Bolton suffers from acute dyspnoea, the SpO2 can be maintained around 98%.
5. Why might Mr Bolton have been dehydrated and how will the intravenous fluids assist in hydrating the body? (Min of 100 words)
    With the onset of pneumonia, resulting in the acute infection in the lower lobes of the respiratory system may cause dehydration in the patient. Mr Bolton had dehydration due to a decrease in thirst and appetite caused by pneumonia. Further, dehydration might have occurred due to fever caused during pneumonia. Intravenous infusion assists in increasing the blood flow in the lungs. This will also help in the reduction of the reflex spasm in the pulmonary vessels that reduces the blood flow. Hence, through intravenous fluid administration will also help in controlling volume depletion in the blood.
6. How will homeostatic mechanisms (osmosis, diffusion and active transport) maintain a constant level of body fluids for Mr Bolton? (Min 300 words for the entire table)
    Homeostasis
    In the case of Mr Bolton who suffers from excessive dehydration, the body will try to maintain a stable internal environment. Under such a circumstance, there will be a reduction in the sweat or urine production. Since the doctor has prescribed for an administration of the intravenous fluid administration, it will help in maintaining the body fluid level in Mr Bolton.
    Osmosis
a) Which is the main positive electrolyte in the maintenance of normal osmotic pressure in the extracellular fluid (ECF)?
b) Which is the main intracellular ion that maintains intracellular fluid osmotic pressure?
    
Sodium is one of the most predominant cations that will help in maintaining the osmotic pressure within the body. It allows in maintaining the gradient in between ECF and ICF for the maintenance of hydration.
Potassium is the most essential intracellular cation, which is bound to the cell proteins helping in the maintenance of the fluid volume in blood.
    Diffusion
    Diffusion of the essential solutes will help in maintaining osmotic balance through optimal concentration of non-electrolytes and electrolytes. Through the administration of the fluid in Mr Bulton, the diffusion of the essential ions will be maintained.
    Active transport
    The active transport will help in maintaining the concentration gradient in the cell. The intravenous fluid administration in Mr Bulton will ensure that the larger molecules are transported so that the concentration...