NURS2096 Medical and Surgical Nursing 2

Case detailsJohn King is 60 years of age and is a male patient who is admitted post diagnosis of multiple myeloma. He presentedwith a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a decompression of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are present in xrays of the skull, vertebrae and ribs. The patient has hypercalcaemia. The patient’s uric acid level is elevated. The patient has orders for zoledronic acid, lenalidomide, allopurinol, calcitonin, ibuprofen and oxycodone.Question Set AAnalyse the case and respond to the below two questions in the essay1)Explain thepathophysiology of multiple myeloma and the pharmacodynamicsactions(what the drug does to the body) of the various medications ordered to treat the patient’s symptoms.2)After the decompression of the spinal fracture surgery is completed what acute medical and nursing management shouldbe provided?Support your management ideas with best practice evidence.4 weeks following John’s dischargefrom the rehabilitation unit, he presents to EDwith complaints of burning and urgency when urinating for the last 3 daysand noted that the urine was strong in odour and cloudy. But today John has developed severe pain and the inability to urinate since the night before. The patient is slightly tachycardic, hypertensiveand has a fever of 37.8°C.Question set B Analyse the case and respond to the below two questions in the essay1)Explorethe pathophysiology of urinary retention, linking to the patient’sgiven historyin the last 3 days since developing urinary symptoms.2)What would be the ED acute medical and nursing managementof urinary tract infection and retention? Support your management ideas with best practice evidence.Eighteen months intoremission formultiple myeloma, John isadmitted tothe medical wardwith increased shortness of breath, fatigue, and decreased level of consciousness. John previously had a longterm alcohol problem, but his wife said he had twelve months of sobriety following the spinal fractures and multiple myeloma diagnosis but started drinking again six months ago. Upon arrival to the unit, he is somnolent and responds only to shouting and shaking. Upon arousal, he is only able to state his first name. His wife accompanies him to the unit and describes that he has become increasingly restless over the last three days, and she is concerned for his safety. Additionally, he has not eaten or taken in any fluids in 24 hours.Question set CAnalyse the case and respond to the below two questions in the essay1)Correlate the patient’s presenting clinical manifestations to the pathophysiology of hepatic encephalopathy.2)What is the acute medical and nursing management of this patient?Support your management ideas with best practice evidence
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