Answer To: NUR231 Assessment Task 3 – Case study (50%) Assessment Name Case study Goal In your future role as a...
Sunabh answered on May 26 2021
NUR231 ASSESSMENT TASK 3 – CASE STUDY
Table of Contents
Introduction 3
Relevant Pathophysiology Evident From the Case 3
Discussion of the Prescribed Medications and Their Mechanism of Action 4
Prioritised Interventions for the Case 6
Conclusion 7
References 9
Introduction
The current case study discusses Jolene, 35 year old and lives with Jack. As presented in task 2, Jolene already had a history of asthma and grave’s disease; therefore, she used to consume respective medications for every disease. However, case study presented in task 3 reflects that Jolene had a compound fractured tibia, fibula and a blunt force head trauma due to motorbike accident. Despite of all the surgical implications and treatment, Jolene was reported to suffering from a pulmonary embolus and DVT, 3 months after the surgery. Moreover, 12 months ago, she was diagnosed from traumatic epilepsy and currently she is pregnant. Therefore, this task will discuss the pathophysiology of diseases along with the medications and prioritised interventions for Jolene.
Relevant Pathophysiology Evident From the Case
Jolene is only 35 years old; however, she presents numerous medical complication at the same time. She already had a history of asthma and Graves’ disease even before facing the motorbike accident. However, motorbike accident led to fractured tibia, fibula and a blunt force head trauma. Surgical treatments allowed her to retrieve the mobility; however, she suffers from post-operative chronic leg pain. Pain that persists even after complete recovery is considered as chronic pain. It would be essential to consider that pain at the surgical site after fracture might persist for few to few months.
However, some might experience pain for longer durations even after the healing of fracture and soft tissue around it (Abalos et al. 2018). This is majorly because of the fact that, fracture might have led to nerve damage, development of scar tissue, which could cause chronic pain. Further, women starts experiencing osteoporosis, that is leaching of calcium from bone, as an outcome of which, bones become thin and does not recover properly; therefore, the plates and pin might not be stable and can cause chronic pain (Abalos et al. 2018). Prinsloo, Flynn and Prime (2019) presented that 18 out of 20 subjects suffering from tibial diaphyseal fracture reported pain even after orthopaedic surgery and most of them were neuropathic pain.
As supported by Majuta et al. (2015), sustained blockage of nerve growth factor significantly attenuated chronic pain after orthopaedic surgery. Therefore, it is evident that chronic pain might be due to nerve damage or blockage. Pulmonary embolism (PE) suffered by Jolene could also be due to fracture because, deep vein thrombosis (DVT) often develops in the legs and then travels to lungs, which causes blockage and chest pain.
Epilepsy is a disorder, which results into abnormal brain activity, cause seizures, sensations and loss of awareness. Trauma can easily induce epilepsy conditions and cause seizures (Pitkanen & Immonen, 2014). There is a shift in balance between inhibitory and excitatory neurotransmission, where excitatory neurotransmitters might be produced in excess; thus leading to seizures and loss of muscle control. Pitkanen and Immonen (2014) presented that traumatic epilepsy could be easily induce due to brain injury and 10-20% of symptomatic epilepsy occurs due to brain injuries. Post-traumatic epilepsy (PTE) is also known as acquired epilepsy, occurs majorly due to brain damage, which could have occurred due to numerous possible reasons.
There could be two possible types of brain injuries resulting from Blunt force head trauma, concussion is caused due to shaking of brain and on the other hand, contusion results into direct brain injury (Wright, 2017). Considering Jolene, motorbike accident and blunt force head trauma could be considered as a potential reason behind traumatic epilepsy and seizures. As supported by the study presented by Keret et al. (2017), out of 290 children who suffered from traumatic brain injury (TBI), 85.7% developed epilepsy while 3.7% developed Posttraumatic seizure (PTS). Therefore, it could be evidently considered that Jolene suffered from traumatic epilepsy due to contusion caused by Blunt force head trauma, which was resultant of motorbike accident.
Discussion of the Prescribed Medications and Their Mechanism of Action
It would be essential to consider that Jolene reflects numerous medical complications at the same time and each of these medical issues requires attention. Likewise, Jolene is also pregnant, because of which medications prescribed for every diagnosis would have to be monitored for any side effects. Currently, Jolene has been taking anti-thyroid medication with beta-blockers for Grave’s disease, which is safe even during pregnancy. Propylthiouracil (PTU) could be prescribed to Jolene during the first trimester. Methimazole could also be prescribed for Grave’s disease; however, during pregnancy it might lead to birth defects if taken early during pregnancy.
Jolene has also been prescribed for Ventolin, Serevent and Atrovent as bronchodilators for...