Question: - 1 Identify the likely disease process responsible for the patient’s manifestations. Explain the evidence to support your interpretation.
The likely disease process for this responsible for this patient’s manifestation is acquired immune deficiency syndrome (AIDS). Supporting evidence from case study includes a HIV ELISA positive accompanied by a 5-day fever history, dyspnea, productive cough, and right sided pleuritic chest pain. Even though she does not admit to experiencing any chills, vomiting, headache or rashes there she experienced two pneumonia episodes within the past three years According to her reported history these pneumonias were not associated with any specific infection or disorders in her immune system especially since they were resolved effectively with antibiotic therapy (Case study notes, 2013).
Further the patient gives a history of not being in good health recently. Often she felt fatigued; did not want to eat and experienced some 17-pounds unexplained weight loss within the past 6 months along with occasional night sweats. Importantly, she has had several sexual partners with whom she engaged in unprotected sex. Also she complained of persistent vaginal yeast infection (Case study notes, 2013).
The physical examination reveals an ill-looking thin female who coughs occasionally bringing up sputum with and an oral temperature 101.2 degrees Fahrenheit. Seborrhea was observed around the nose, cheeks, and scalp. There was also evidence of thick cheesy exudate around the pharynx on the soft palate and tongue. Cervical adenopathy was detected upon palpation. Lungs fields revealed dullness to percussion, increased tactile fremitus, inspiratory crackles and egophony over the right lower lobe (Case study notes, 2013).
People infected with the HIV virus could progress into AIDS as a sequel of the disease. The rate at which this occurs depends on the person immune system ability to maintain normal C-T cell levels. However, a fall in these levels develops symptoms of opportunistic infections which target the lungs, vagina, mouth and lymph glands producing the manifestations observed the patient depicted in this case study (Daar et.al, 2013).
Question 2: Provide 3 prioritized NANDA nursing diagnoses for this patient with the rationales for the prioritization. Develop a nursing care plan for this patient’s #1 priority diagnosis using the table below. For the diagnosis include “related to” and “as evidenced by” statements as appropriate. State the outcomes in measurable terms and have meaningful timeframes. Use a professional nursing care plan book to answer this question.
Three prioritized NANDA nursing diagnoses are:-
- Ineffective health maintenance
- Risk-prone health behavior
- Ineffective protection
Rationales for Prioritization
Ineffective health maintenance is the related to the number one priority diagnosis as evidenced by the patient not admitting to many apparent irregularities in her health, which indicates that, perhaps, she was not paying attention to these issues. They include denying to have experienced chills, headache, vomiting; or rashes. Even though she had pneumonia twice in the past three years they could not be related to any other physical dysfunction, which shows lack of knowledge to basic health practice (NANDA Nursing Diagnosis, 2013).
Risk-prone health behavior is ‘related to’ number two priority diagnosis ‘as evidenced by’ this client being engaged in unprotected sex with several partners for many years. Obviously, it might be due to failure of taking action towards preventing exposure to disease. This is also ‘related to’ ineffective protection ‘as evidenced by’ the client appearing malnourished having lost weight creating more disturbance of eroding in the body’s defenses (NANDA Nursing Diagnosis, 2013).
Nursing Care Plan # 1
Nursing Care Plan # 11
Nursing Care plan # 111
Question 3: Choose ONE disorder from this week’s reading (i.e., cancer, immunity, infection) and describe its significance including; incidence, prevalence, costs, morbidity, mortality, and other appropriate issues. Be sure to identify the disorder, the population associated with the data, and the year(s) of data.
Cancer is described a malignant neoplasm. From a pathological perspective it is classified a tissue growth regulation disorder whereby there is alternation in the gene mechanism responsible for organizing cell reproduction. According to scientists two types of genes regulate cell growth and differentiation. Oncogenes are directly associated with cell reproduction and growth whereas tumor suppressor genes hider survival by altering cell division. Diagnosis is through screening/test such as X-rays, blood cultures CT scans and endoscopy (Dubey & Powell, 2008).
Importantly, cancers are classifieds according to the cell type. These include carcinoma; sarcoma; lymphoma/leukemia; germ cell tumor and blastoma. Further epidemiological studies reveal that in 2008 about 12.7 million cancers were diagnosed. By the year 2010 approximately 7.98 million of those diagnosed died. Precisely, cancers are responsible for about 13% of deaths annually. One point four million deaths occur from lung cancer; 700,000 from liver; 740,000 stomach cancer; 460,000 breasts and 610,000 colorectal cancers. Essentially, invasive cancers cause the most deaths in developed countries and are the second highest cause in developing nations (Dubey & Powell, 2008).
Currently as in the case of many other diseases most cancers are incurable. However, with early detection, surgery and aggressive chemotherapy the prognosis in most patients has been improved. When patients live longer with the disease their care could become costly to relatives as well as the health care system. For example, in 2007 studies reveal that the cost of treating cancer in the U.S. was approximately $226.8 billion. A further study showed where people who are uninsured and minorities due to lack of regular screening tend to be diagnosed when cancers have progressed into the late stages. As such, it is more costly to treat. Incidentally, a 2009 study revealed that 32% of Hispanics were uninsured as well as 10% of children 17 years and younger (Jemal et.al, 2011).
References
Bulechek, G. Butcher, H. Dochterman, J., & Wagner, C. (Eds.). (2013). Nursing interventions classification (NIC) (6th ed.). St. Louis, MO: Elsevier.
Daar, E. Little, S., & Pitt, J. (2001). Diagnosis of primary HIV-1 infection. Los Angeles County
Primary HIV Infection Recruitment Network. Ann. Intern. Med. 134 (1): 25–9.
NANDA Nursing Diagnosis (2013). The Complete list of NANDA Nursing Diagnosis for
2012-2014, with 16 new diagnoses. Retrieved on September 30th, 2013 from
http://www.kc-courses.com/fundamentals/week2process/nanda2012.pdf
Carpentino-Moyet, L. (2010). Nursing Diagnosis. Application to Clinical Practice (2010, 13th
ed.). New York Lippincott Williams & Wilkins.
Dubey S., & Powell, C. (2008). Update in lung cancer 2007. Am. J. Respir. Crit. Care
Med. 177 (9): 941–6.
Jemal, A. Bray, F. Center, M. Ferlay, J.Ward, E., & Forman, D. (2011). Global cancer
statistics. CA: a cancer journal for clinician, 61 (2); 69–90.
