Wednesday, December 11, 2019

Risk For Imbalanced Nutrition Less Than Body Requirements

Question: Discuss About The Risk For Imbalanced Nutrition Less Than Body Requirements? Answer: Introducation: Philippa is a 36-year old woman diagnosed with the left breast cancer that is metastatic. The metastases are in the lymph nodes of the left axilla, both the lungs and the liver. However, the primary lesion was removed by surgery three years ago but it was aggressively metastatic as it was related to BRACA1 gene. It was two months ago that she developed the axillary, hepatic and pulmonary metastases. She lives with Alice, who is her partner and two children, an 11-year-old girl known as Catherine and a 7-year old boy known as Geoffrey. At a multinational corporation, Philippa was working as a financial manager but ceased after the confirmation of the metastases. Following this, she had to resign from work. Philippas partner works from home as an interior designer but the condition of the partner is overwhelming demanding much time. She is the only person who can care for Philippa and the children. Philippa is experiencing symptoms and signs such as an itching skin, anorexia, abdominal swelling, fatigue, oral thrush, xerostomia, and shortness of breath on exertion. Alice helps in the management of these manifestations. Currently, Philippa is on medications as follows: Oral solution of Nystatin, 1ml after every six hours per day Metoclopramide 10mg after every 8 hours and has to be taken 30 minutes before having meals. 2 puffs of salbutamol inhaler four times per day. 10mg of prednisolone two times a day. Aim: The aim of this poster is to prioritise five nursing issues that arise from Philippas assessment and identify two most critical ones based on the severity as an effect to the patient and Maslows hierarchy of needs. Nursing issues: Ineffective breathing patterns Imbalanced nutrition, less than body requirements Risk for electrolyte and fluid imbalance Risk for impaired integrity of the skin Risk for complicated grieving (MacAvoy, Moritz, 2013) The two main nursing issues to be considered are; ineffective breathing patterns and imbalanced nutrition, less than body requirements. Ineffective Breathing Patterns. The metastases from the primary lesion of the left breast reached Philippas left and right lungs. As such, both of them have cancerous cells that impair the respiratory function of the lung parenchyma. This is confirmed by Philippas shortness of breath on exertion, cough and dry mouth, oral thrush and fatigue, which result from ineffective breathing ("Respiratory System", 2015). The three major nursing issues that must always be assessed first even during resuscitation are the airway, breathing and blood circulation because they are essential for delivery of basic nutrients to the bodys vital organs such as the liver, the kidneys, the heart and the brain. Because Philippa has shortness of breath, the amount of air delivered to the alveoli is lower and subsequently, the vital organs will receive less oxygen (Bockov, Mare?kov, Zapletalov, 2015). This can be identified by taking the saturation rates of oxygen in the blood. Additionally, the impaired pattern of breathing triggers a physiological response that forces Philippa to breathe through the mouth. When oral inhalation is prolonged, further xerostomia shall be witnessed and mouth sores develop. Additionally, Philippa has oral thrush due to the xerostomia and reduced functions of the lungs. Prednisolone is prescribed to prevent further inflammation of the mouth and other parts of the body (Tanser, 2017). T he shortness of breath also causes a straining effect on Philippas diaphragm and the intercostal muscles. Consequently, she developed the fatigue as witnessed on assessment. Because the Philippas lungs are neoplastic due to the metastases, there is need to prioritise and stabilise her breathing because. e any further delay would lead to respiratory arrest and eventual death. Again, this is the reason she is on salbutamol inhaler to dilate her airway (Smith, 2012). Additionally, nystatin is given to prevent the spread of metastatic cells (Sambo, Tumia, Bradaschia, Pavat, Szymska, 2016). Risk For Imbalanced Nutrition, Less Than Body Requirements. Philippa is at risk of lacking vital nutrients such as glucose, electrolytes, proteins, vitamins, water among others in the body. Various reasons underlie this fact. First off, she has reduced appetite, a dry mouth and a swollen abdomen. Lack of appetite results in the refusal to ingest food and therefore, the absorptive sites of the gastrointestinal tract are less active. The body will not receive energy that is required for cellular respiration and other activities. Furthermore, water is not also taken. Water is vital for blood formation, dilution of toxins and excretion of substances through urine and faeces. Essentially, every body organ needs water for all functions. Again, Philippa has a dry mouth, indicating that saliva is insufficient (Hogan, Gingrich, 2014) The saliva is necessary for lubrication of food for easy peristalsis and digestion. Therefore, a dry mouth will not facilitate swift digestion. One of the major reasons the patient has fatigue is due to the loss of appetite and subsequent deficiency of energy in the body. Philippas swollen abdomen is due to the cancerous cells in the liver. As such, there is impairment of the hepatic functions of detoxification, haematopoiesis, bile manufacturing, clotting factor-formation, protein synthesis, storage and release of glycogen, production of immune factors, clearance of bilirubin among others (Patel, Abate, 2013). Bile salts play a vital role in emulsification and because Philippas liver has cancerous cells, this role is deterred in the duodenum (Heatley, 2013) . The swollen abdomen also may cause pain after eating because there is pressure in the hepatic portal vein that takes nutrient-rich blood to the liver resulting from hepatomegaly (Heatley, 2013) Nutrients play important roles in the body and should always be available to the body. For instance, the brain does not utilise any other form of sugars apart from glucose. If glucose is not available, then cerebral functions are impaired and may eventually cause coma (Lippincott, 2013) Moreover, these nutrients are needed to create energy that is used during movement, basal metabolic rate, cell division, immunity, cognitive functioning, increase in body size among others. Therefore, if they are not consumed, then all the above functions are affected and may lead to eventual death. Therefore, necessary and effective remedies need to be established to help Philippa regain the nutrients needed for her body to function effectively. For instance, a large-bow cannula can be introduced to administer Ringers lactate, glucose, and normal saline to the blood (Lippincott, 2013) Again, a nasogastric tube may be introduced to administer food supplements directly to the stomach. Conclusion Philippa was diagnosed with metastatic breast cancer that spread to the lungs, axillary lymph nodes and the liver. Additionally, she is currently on medications that are sustaining her. The major nursing issues identified in her case includes ineffective patterns of breathing, imbalanced nutrition, less than body requirements, risk for fluid and electrolyte imbalance, risk for complicated grieving and risk for impaired skin integrity. Much focus was on the patterns of breathing and imbalanced nutrition. Breathing is important for delivery of oxygen to the tissues. On the other hand, nutrients are vital for creation of energy, enhancing metabolic functions, body building, strengthening the immunity and other functions. Therefore, prompt and effective measures have to be taken to enhance Philippas functionality and battling of cancer. References Bockov, S., Mare?kov, J., Zapletalov, J. (2015). Content validation of the diagnosis Ineffective Breathing Pattern.Kontakt,17(1), e24-e31. Heatley, R. (2013).Gastrointestinal and hepatic immunology(1st ed.). Cambridge: Cambridge University Press. Hogan, M., Gingrich, M. (2014).Pathophysiology(1st ed.). Boston: Pearson. Lippincott, W. (2013).Brunner and suddarth's textbook of medical -surgical nursing 12th ed. + nursing diagnosis, ..(1st ed.). [Place of publication not identified]: Wolters Kluwer Health. MacAvoy, S., Moritz, D. (2013). Nursing diagnoses in an oncology population.Cancer Nursing,15(4), 264-270. Patel, P., Abate, N. (2013). Body Fat Distribution and Insulin Resistance.Nutrients,5(6), 2019-2027. Respiratory System. (2015).Pathology International,5(3), 214-216. Sambo, L., Tumia, P., Bradaschia, S., Pavat, P., Szymska, K. (2016). H07From scientific evidence to clinical practice in cancer patients: NANDA-I: imbalanced nutrition: less than body requirements (00002) and care planning.Annals Of Oncology,27(suppl_4), iv81-iv81. Smith, I. (2012). Chemotherapy in metastatic disease: an overview.Breast Cancer Research,9(S1). Tanser, A. (2017). Patterns of breathing in health and disease.Thorax,25(2),

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