CYP2803 Formative And Summative Assignment Sample

Introduction

The study is based on a case study where the patient is only 12 years old and has the “problem of asthma”, her mother had brought her for treatment. In this study, the discussion is based on the “pathophysiology” and interpretation of the nursing goals with the help of SMART analysis. A brief description had been made of patient care management, where the nurse's role had been interpreted thoroughly. The study concentrated on the easy understanding of the overall purpose of the assessment in the form of the “A-E assessment framework”. However, the study describes the “nursing problem” using the PES tool, with the critically analysed works of literature of different scholars to gather their points of view (Sulistiyawati and Pendet, 2020). The two nursing problems that had been identified to discuss within the study are “Medical administration and Pharmacologic Support” and “Providing Patient Education & Health Teachings”. At the end of the assignment, the evaluation had been performed on the care concept.

The patient is “Nina” who is a 12 years old girl who was brought to “Children A&E”, her mother complained about her health condition “Nina” is suffering from “Dyspnoea, chest tightness and wheezing”. Her past stories as explained by her mother had cold symptoms and often requires relief by using a “salbutamol inhaler”. It had also been observed that her family record states her mum had asthma, and his father is a smoker but he does it outside the house. As per the guidance of Nmc, (2023), the patient's information will be kept confidential during and after the research study, abiding by the rules and regulations of the UK government ensuring the knowledge of essential guidance.

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Pathophysiology

The term “pathophysiology” refers to the study of the functional and physical changes that happens within the human body that often intervene during the process of the disease. The term is divided into “patho” which refers to the process that involves physical changes that are observed and the term “physio” which refers to the change which includes function during the disease process. In this case of a disease, it had been observed the process includes the observation of changes both physical and functional (Yamauchi and Ogasawara, 2019). The role of the nurses using the pathophysiology in assessing the health condition and the desired stage of the disease. With the help of the process, further treatment can be made where it involves the components such as “aetiology, treatment implications, pathogenesis and clinical manifestation”. The discussion of the pathophysiology relates to the patient's condition which had been studied in the context where the patient is suffering from the asthma disease which had been a major problem in her daily life (Carpaij et al. 2019). However, the pathophysiology assessment is required with the treatment process to help her cure the suffering and within this process, the role nurse is also vital in caring for the child. The patient “Nina” had been prescribed “paracetamol 500mg po”, “prednisolone 30mg po” and “salbutamol 5mg (nebulised)”. The plan that the nurse will be following to treat her is in maintaining airway of patency, maintenance of secretions of expectoration, and understanding of the therapeutic regime management and the causes of the disease (Liu et al., 2020).

Assessment Framework

The role of the nurse in managing “patient care” is a vital part of the treatment process, where the patients fully or partially depend on the nurse for motivation and further care after the treatment. Nurses undergo certain courses and training which they focus to continue in their practice (Cheng, 2021). The role of the nursing practice within the care plan is not so easy to perform, they had to face challenges in their daily life practice and with the treatment of patients. However, they perform their best to help the patient in curing properly. To make the nursing practice more authentic and without any such error it is required to plan with evidence-based information of the patients. There are five steps in the process of nursing which include:

• Assessment refers to the data collection which implies the information of the patients and then organizing all the evidence with the data to make it represent to the doctor which helps easy interpretation of any such treatment (Kytikova et al. 2019). This is performed by mentioning the dates and organizing the overall schedule of management.
• Nursing Diagnosis refers to the identification of the factors of the cause of the disease the patient had been suffering through (Vasileiadis et al. 2019). The details of the past problems of the patients are vital in ordering the assessment.
• Planning refers to the after-identification stage where all the data and information have been gathered and the collaborative stage with the patient. The planning process is linked with the nursing diagnosis where their goals are measurable.
• Implementation of the actions which are planned to execute.
• Evaluation is the final stage where all the past activities provide the reassessing methods.

The role of the nurse does not end with the five steps where the most important factors within the process involve the behaviour which requires being professional with a proper degree and well-trained (Varkonyi-Sepp et al. 2022). The major importance had been stressed “communication” which is a vital part of the nursing process, more the clear communicative action of the nurse will be the interaction with the patient. This represents cultural awareness, caring demonstration and compassion towards the duty.

A-E Assessment Framework:

Assessment	Treatment
A- Airways	To identify the voice of the patient and the sound of breathing.	Tilt the head and lift the chin and the suction of oxygen of about 15 l/min.
B-Breathing	To identify the rate of the respiratory system which must be about 12 to 20 per minute (Resus, 2023). To feel the chest movement, percussion of the chest, and auscultation of the lung. The oximetry of pulse (97-100%).	Must seat comfortably and the breath must rescue by inhaling medications (Resus, 2023). The use of bag-mask ventilation. The tension of decompression “pneumothorax”.
C- Circulation	To identify the colour of the skin, the refill fill time of the sweating capillary of about less than two seconds. The rate of the palpated pulse of about 60 to 100 min. The blood pressure and auscultation of blood measures systolic 100 to 140 mmHg. The monitorization of the electrocardiography.	Bleeding needs to be stopped, legs should elevate and the access of infuse saline intravenously.
D-Disability	The AVPU is the level of consciousness which includes alertness, the responsiveness of voice, responsiveness towards pain and unresponsive factors. The movement of the limb and pupillary light reflex blood glucose.	problems of circulation in the breathing, and treating the airways (Resus, 2023). The position of recovery for hypoglycemia which contains glucose.
E-Exposure	The identification and understanding of skin temperature exposure.	The cause is suspected in the treatment.

Figure 1: A-E Assessment Framework Analysis

(Source: Resus, 2023)

The patient Nina requires the above-mentioned assessment from the nurse where every step is required to cure her in all ways (Cicutto et al. 2020). However, the assessment of the patient includes the following treatment. However, this will help in curing all her respiratory problems.

Nursing problems

PES Format of Nursing Problem Analysis
Problem	Asthma
aetiology/ Cause of the Problem	The cause of the problem is because of the genetic issue of whether the patient's mother had asthma as per the history. Her father is a smoker but he does it outside the house.
Signs and symptoms	Coughing intermittent, wheezing expiratory, recession subcostal, with a temperature of 38.2 C. The rate of heartbeat is 100 bpm with the rate of respiration is 40. The saturation of oxygen is about 92%. Facing nasal congestion While speaking she catches her breath.

Figure 2: PES Format of Nursing problem analysis

(Source: Cicutto et al. 2020)

Nursing goals

• The patient will understand the verbalised cause and management of the therapeutic regimen.
• The patients must be free of the respiratory symptoms of the disease.
• The patient in the end should not conclude the experience of compromises of respiration and further complications.

SMART Analysis of Nursing Goals Concerning Nursing Problems

SMART ANALYSIS
S-Specific	The goal of the nurse is specific to obtaining the patient's well-being. Providing all the treatment, knowledge and practices in the treatment of the patients.
M-Measurable	The outcome of the patient will be measured when the patient's experience will satisfy him with the treatment he receives from the nurse and the management. However, when there is no symptoms or signs of any disease.
A-Attainable	The diagnosis of the nurse in gathering, and organizing the patient's details and mitigating the procedure of treatment.
R-Relevant	The methods and steps are important which will provide the nurse with professional knowledge.
T-Timely	The goal requires time as per the period required for each patient.

Figure 3:SMART ANALYSIS

(Source: Pelgröm, 2021)

Critical Analysis of the Interventions of Nursing for each problem of Nursing identified

Illustrating the problems of nursing formulating the plan of care that is proof subjected and dependent to the knowledge of the nurse and In the clinical making of the decision. It contributes to the improvement of the service of the health of the user. In this scenario, the patient who has Asthma, “her mother has escorted a girl of “12 years” of age” to the A&E of children with issues of wheezing, dyspnoea, and tightness of the chest. It requires interventions from the perspective of the nurse taking into consideration the policies, ration, and guidelines, and also the process of outcomes and the process of nursing to the patient (McCall, 2020). Significance will be put down on two of the identified problems of nursing that “a nurse” perhaps identifies while doing prior assessment and the “interventions” that are connected to the problems identified in supporting the girl patient Nina. Controlling homeostasis, and protecting the service user's life and the intervention must be evaluated and reassessed in confirming the criteria of success arranged in the plan of care. Analysis of the Interventions utilizing the knowledge of nursing that is proof depending on until there have been some sites of improvements.

Two of the identified problems of nursing for the interventions of nursing are the Administration of Medical and Support of pharmacologics; Providing Education to Patients & Teachings of Health (Barba et al., 2022).

Administration of Medical and Support of pharmacologics is “one of the” identified problems for the girl patient Nina in the scenario suffering from Asthma. From the assessment, Nina has expiratory wheezing, intermittent coughing, a temperature of 38.2 degrees centigrade, subcostal recession, a heart rate of “100 bpm”, a saturation of oxygen of “92%”, and a respiratory rate of “40”, nasal congestion and running nose.

As stated by Dumas et al., (2017) in the scenario, Nina suffers from Asthma and cannot be administered with all particular drugs that have been given by the nurse. However, sometimes nurses give inadequate amounts of drugs to the patient. For example, administration with “Anticholinergic drugs” that inhibits and blocks the “neurotransmitter acetylcholine” activity at both synapses of the peripheral and central nervous system, hence blocking the “action” of the “parasympathetic nervous system” which indulges the actions, which are involuntary of the “smooth muscle” which has been found in the “lungs”. Another particular drug not relevant to the asthma patient is the administration of “Beclomethasone” which inhibits the mechanisms of bronchoconstriction and causes a decrease in the activity and number of cells of inflammatory, which significantly reduces the “airway hyperresponsiveness” (Braunthal and Brateanu, 2019).

However, as confined by Jacobsen et al., (2016) the “pharmacologic therapy” for asthma comes after the gradual approach, utilization of the medications which have been quick-relief for the relief of immediate symptoms and medications of long-acting for the control long-term (NMC, 2018). On the other hand, the medication of Anti-inflammatory is important for controlling of persistent asthma because of the reason of underlying inflammation. It is essential in noting that the medications perhaps have practical side effects with the use of long-term. Significantly inhalers of “pressurized metered-dose” (pMDIs), inhalers, are the route that has been preferred for the administration of the medication allowed for the delivery that has been targeted (Tan et al., 2020).

Another aspect has been the treatment perceived benefit in which Nurses perhaps spend quality time with Nina in the explanation of the essential of adherence to medication and critically analyzing the various risks linked with “non-adherence”. However, as opined by Thompson et al., (2013) if Nina believes in the information that has been given to them to be “true”, then Nina is more likely in taking the pieces of advice from the nurses very seriously. Lastly, another aspect is the cost of medication in which the Nurse perhaps assists Nina in taking advantage of the methods in reducing the cost, which has been “out-of-pocket” of the “medications”. This can indulge in purchasing drugs of generic, online ordering of medications, coupons and plans for finding discounts, and applying for the assistance of federal financial (Wagner et al., 2021).

The other interventions for nursing for the administration of medication indulge in providing positive “reinforcement” in which the notes of the “Million Hearts pamphlet” provided by the professionals of healthcare significantly provide reinforcement which has been positive while patients taking their doses of medication successfully (NMC, 2018). It can efficiently modify the beliefs of the patient and behaviours in supporting greater adherence. However, small praise perhaps can go a “long way”.

Providing Education to Patients & Teachings of Health is “one of the” identified problems for the girl patient Nina in the scenario suffering from Asthma. From the assessment, Nina has expiratory wheezing, intermittent coughing, a temperature of 38.2 degrees centigrade, subcostal recession, a heart rate of “100 bpm”, a saturation of oxygen of “92%”, and a respiratory rate of “40”, nasal congestion and running nose. As stated by Victora et al., (2016) inequalities in education have been connected back to “underinvestment” in prior education of low quality and early education, which is preserved by the values of lower home and poverty of concentrated. The diseases control prevention and centres define, literacy as the individual health circumstances in which an individual has the ability in finding, understanding, and utilizing services and information in informing the decisions which are related to health and the plan of action for Nina herself (Moreno et al., 2020).

However, on the other hand, as stated by Waldrop et al., (2014) the lower attainment of education contributes in limiting the literacy of health, which directly affects health. The problem associated with providing Education to Patients & teaching of Health is in the link of education with the exercise environment in which the system of healthcare becoming more progressively complicated in which prospective nurses encounter with high challenges in the practice of the healthcare environment. The different modifications of the system of healthcare are because of the failures recognized in the system of healthcare and uncontrolled with disintegrated funding (Ng and Lee, 2019). Similarly, as stated by the other problem associated with providing Education to Patients & Teachings of Health is “curriculum enhancement” in which the modification of continuous curricula is an important phenomenon in the academia of nursing in order in leveling the learning ability with the enhanced practice of professional. Nursing master's endeavors in exposing students to different experiences of learning in making sure that the student receives exact knowledge of information by the way of multiple channels. These strategies actually take an abundance of energy and time from the educators of nurses and perhaps overlook more challenges (Grasselli et al., 2020).

Similarly, as stated by Rhee et al., (2011) the other problem associated with providing Education to Patients & Teachings of Health is nursing as part of the workforce of integrated healthcare in which there are different obstacles in instituting effective teams of incorporated, indulging the absence of task perception shared and practice of inter-professionals among providers. In functioning coherently as members of teams, students require to be very prepared in delivering care of inter-disciplinary and in taking part in teams of inter-professionals.

However, as stated by Victora et al., (2016) the other interventions in assessing present and past therapies, indulging the response of Nina to them. In acknowledging what effective interventions are required. Asthmaticus status or the episode of asthmatic of acute severe is resistant in appropriating the therapy of outpatients and is an emergency of medical that needs the management of the hospital aggressively. On the other hand, as stated by the other interventions in assessing knowledge of Nina of the triggers of asthma exposure to the environment and “irritants” which play a major role in the symptoms of exacerbations (NMC, 2018). Hence, in Nina having persistent asthma, the utilization of testing of skin or the testing of invitro in assessing sensitivity to the allergens of perennials indoors is very much important.

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Evaluation of Care and Conclusion

The care that has been discussed in the context of the study where had made the priorities to certain requirements of the patients. The case which had been studied in this context defines the improvement in the pattern of breathing and the exchange of plans. The airways maintain patent and the reduction of airway inflammation. The administration of the medical facilities and the support that is required from the Pharmacy (Farkhadovna and Khaydarzhonovna, 2023). The provision of the rest of promotion and improvement. The education provided to the nurse must require to be efficient and the teachings related to the training. However, the study refers to the understanding of the case study which had been focused on within the context. The description of the pathophysiology and the patient's care. The overall study was analysed with the help of the SMART tool analysis. The framework of the assessment included all the key points within the context of the study. The A-E assessment framework had been prepared with the study to experience and visualize easily. The study also mentioned a few works of literature under which the study highlighted the concept of the scholars. However, the study concludes with the evaluation of the care discussed in the context. Overall, the study is a helpful assessment which focuses on nurse practices and the mitigation strategy for curing a disease like asthma.

References

Journals

• Bond, S., Merriman, C. and Walthall, H., 2020. The experiences of international nurses and midwives transitioning to work in the UK: A qualitative synthesis of the literature from 2010 to 2019.International Journal of Nursing Studies,110, p.103693.
• Bridgeman, M.B. and Wilken, L.A., 2021. Essential role of pharmacists in asthma care and management.Journal of Pharmacy Practice,34(1), pp.149-162.
• Carpaij, O.A., Burgess, J.K., Kerstjens, H.A., Nawijn, M.C. and van den Berge, M., 2019. A review on the pathophysiology of asthma remission.Pharmacology & therapeutics,201, pp.8-24.
• Cheng, S.L., 2021. Immunologic pathophysiology and airway remodeling mechanism in severe asthma: focused on IgE-mediated pathways.Diagnostics,11(1), p.83.
• Cicutto, L., Gleason, M., Haas-Howard, C., White, M., Hollenbach, J.P., Williams, S., McGinn, M., Villarreal, M., Mitchell, H., Cloutier, M.M. and Vinick, C., 2020. Building bridges for asthma care program: a school-centered program connecting schools, families, and community health-care providers.The Journal of School Nursing,36(3), pp.168-180.
• Farkhadovna, M.Z. and Khaydarzhonovna, K.S., 2023. PHYSIOTHERAPY IN THE TREATMENT OF SICK CHILDREN WITH BRONCHIAL ASTHMA.Confrencea,4(04), pp.466-474.
• Henderson, C. and Bell, S., 2021. Non-medical prescribing students: assessment and supervision of learning in practice for nurses and midwives.British Journal of Nursing,30(18), pp.1074-1076.
• Kytikova, O., Novgorodtseva, T., Denisenko, Y., Antonyuk, M. and Gvozdenko, T., 2019. Pro-resolving lipid mediators in the pathophysiology of asthma.Medicina,55(6), p.284.
• Levy, M.L., Fleming, L., Warner, J.O. and Bush, A., 2019. Paediatric asthma care in the UK: fragmented and fatally fallible.British Journal of General Practice,69(685), pp.405-406.
• Pelgröm, A.T., 2021.Breathing patterns of asthma patients during cycling ergometry(Master's thesis, University of Twente).
• Sulistiyawati, A. and Pendet, N.M.D.P., 2020. Respiratory Rate Difference Before and After Pursed Lip Breathing Exercise on Asthma Patient in Pulmonary Polyclinic, TNI AU DR. M. Salamun Bandung Hospital.Basic and Applied Nursing Research Journal,1(1), pp.12-15.
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• Varkonyi-Sepp, J., Freeman, A., Ainsworth, B., Kadalayil, L.P., Haitchi, H.M. and Kurukulaaratchy, R.J., 2022. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome.Journal of Personalized Medicine,12(9), p.1435.
• Vasileiadis, I., Alevrakis, E., Ampelioti, S., Vagionas, D., Rovina, N. and Koutsoukou, A., 2019. Acid-base disturbances in patients with asthma: a literature review and comments on their pathophysiology.Journal of clinical medicine,8(4), p.563.
• Yamauchi, K. and Ogasawara, M., 2019. The role of histamine in the pathophysiology of asthma and the clinical efficacy of antihistamines in asthma therapy.International journal of molecular sciences,20(7), p.1733.
• Wagner, R., Heni, M., Tabak, A.G., Machann, J., Schick, F., Randrianarisoa, E., Hrab? de Angelis, M., Birkenfeld, A.L., Stefan, N., Peter, A. and Häring, H.U., 2021. Pathophysiology-based subphenotyping of individuals at elevated risk for type 2 diabetes. Nature medicine, 27(1), pp.49-57.
• Ng, S.Y. and Lee, A.Y.W., 2019. Traumatic brain injuries: pathophysiology and potential therapeutic targets. Frontiers in cellular neuroscience, 13, p.528.
• Grasselli, G., Tonetti, T., Protti, A., Langer, T., Girardis, M., Bellani, G., Laffey, J., Carrafiello, G., Carsana, L., Rizzuto, C. and Zanella, A., 2020. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. The lancet Respiratory medicine, 8(12), pp.1201-1208.
• Braunthal, S. and Brateanu, A., 2019. Hypertension in pregnancy: Pathophysiology and treatment. SAGE open medicine, 7, p.2050312119843700.
• Barba, L., Paolini Paoletti, F., Bellomo, G., Gaetani, L., Halbgebauer, S., Oeckl, P., Otto, M. and Parnetti, L., 2022. Alpha and beta synucleins: from pathophysiology to clinical application as biomarkers. Movement Disorders, 37(4), pp.669-683.
• Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., Cannon, M., Correll, C.U., Byrne, L., Carr, S. and Chen, E.Y., 2020. How mental health care should change as a consequence of the COVID-19 pandemic. The lancet psychiatry, 7(9), pp.813-824.
• Tan, B.Y., Chew, N.W., Lee, G.K., Jing, M., Goh, Y., Yeo, L.L., Zhang, K., Chin, H.K., Ahmad, A., Khan, F.A. and Shanmugam, G.N., 2020. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Annals of internal medicine, 173(4), pp.317-320.
• Liu, Q., Luo, D., Haase, J.E., Guo, Q., Wang, X.Q., Liu, S., Xia, L., Liu, Z., Yang, J. and Yang, B.X., 2020. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. The Lancet Global Health, 8(6), pp.e790-e798.
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Websites

• Nmc, 2023. The Code Professional Standards of Practice and Behaviour for nurses, midwives and nursing associates. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on 22nd June, 2023]
• Resus, 2023. The ABCDE Approach Resuscitation Council UK. available at: https://www.resus.org.uk/library/abcde-approach [Accessed on 22nd June, 2023]