Summary: Clinical Makeup Assignment

8 Clinical Makeup Assignment

The HESI Patient Review modules exposed me to three critical concepts in the nursing profession – cellular regulation, infection, and immunity. It did not stand as the terms, themselves, that were elaborated on, but rather, patient case scenarios that directly related to these three concepts. To create a foundation, I will provide a basic definition for the terms. Cellular regulation refers to,” all functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals (e.g., hormones, cytokines, and neurotransmitters) and the way each cell produces an intracellular response” (Giddens, 2017). To maintain homeostasis, within a cell, two primary functions must occur - cellular

reproduction and growth. During the process of replication and growth, it remains essential that an infection does not occur. An infection is, “the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen–antibody response” (Giddens, 2017). An infection can be described in a variety of customs - acute, chronic, localized, disseminated, and systemic - all of which describe a disruption in the body function, as a result of an invading microorganism. An infection, caused by an invading microorganism, is more likely to occur as a result of a weakened immune system. Immunity represents, “the normal physiological response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response” (Giddens, 2017). Immunity represents the body’s protection against infection, which can come in either innate or acquired form. Together – cellular regulation, infection, and immunity – serve as foundation to nursing care, as these terms can fit into the care plan of every patient a nurse will encounter.
The cellular regulation module focused on Mr. Sumo, a male diagnosed with symptomatic benign prostatic hyperplasia (BPH) for the past three years. Because the prostrate is located near the urethra, enlargement of the prostate causes urination complications, such as: hesitancy, intermittent voiding, urgency, nocturia, post-void leakage, and difficulty voiding. To decrease his urinary complications, Mr. Sumo plans to undergo a transurethral resection of the prostate (TURP), which involves removal of some prostate tissue to reduce its size. Although this module focused on benign prostatic hyperplasia, the bigger picture stands as cellular regulation in cancer. Prostate cancer is the most common occurring cancer in men, with early detection coming in two forms: a prostate-specific antigen screening and a digital rectal exam. Both early detection screenings are recommended for all men over 50 years old, as early detection presents the greatest chances for a therapeutic cure.
In the future, I can apply this knowledge into my nursing care not only through discussion of a transurethral resection of the prostate (TURP), but also about the importance of early detection in cancer diagnoses. In relation to a transurethral resection of the prostate (TURP), I will use my knowledge to educate future patients who are undergoing the treatment. My education would contain the following: bleeding is common immediately after TURP; alcohol, caffeine, and antihistamines make symptoms worse; serum sodium is usually monitored to detect TURP syndrome; bladder spasms are common for 24-48 hours; and, obstruction to the flow of urinary drainage can contribute to bladder spasms. In relation to a variety of patients, not merely cancer patients, this module taught me the signs of shock to monitor for – decrease in blood pressure, increase in heart rate, pallor skin color, and restlessness. While this module did focus on prostate cancer, it taught me valuable knowledge that I can apply to my future practice of cellular regulation.

The infection module focused on two cases – a male who suffered a LUQ stab wound and a male suffering from community acquired pneumonia (CAP). For the reflection, I will focus my attention on the main knowledge I gained from the stab wound victim. Infection, in relation to a stab wound, rests evident, as a weapon, such as a knife, retains several bacteria that could initiate an infection. During an emergency, a nurse first wants to ensure the patient’s ABCs – Airway, breathing, and circulation. Assessing for adequate airway and breathing take priority during an emergency because a patent airway is needed for oxygenation and bodily functions. Following, airway and breathing, a nurse next ensures circulation by checking pulse, skin color, and level of consciousness. These three components stand as the foundation for any further care; if the ABCs are not secure, the rest of the body organs cannot function. In the case of trauma, such as the eviscerated intestines that this patient suffered, it is recommended that the nurse covers the intestines with a moist sterile gauze, as replacing the intestines could cause further damage. By placing a moist sterile gauze over the exposed tissue, it providers a protecting barrier, to assist in the prevention of infection. In the case of the highly unsterile knife, although it is not sanitary, a nurse should not immediately remove the knife if the emergency department, as it could result in tissue damage and extensive bleeding. It is not only critical to understand the chain on infection, but it is also important to understand how this chain is implemented into patient care. While one seeks to avoid an infection, a thorough assessment is needed prior to jumping into action.
In the future, I can apply the concept of infection into my nursing care through educating patients on infection, preventing the spread of infection/standard precautions, and caring for patients who have already acquired an infection.

Through education, I will teach patients the importance of vaccinations, hand washing, and body hygiene. To prevent the spread of infection, I will implement my standard precautions and any isolation precautions that my patients are ordered. Standard precaution, a set of infection control practices used to prevent transmission of diseases, include personal protective equipment, needle safety, patient care equipment, and most importantly, hand hygiene. These standard precautions should be used with every patient encountered, as the most basic level of infection control. At an injury site, whether it be surgical or trauma, I will monitor and assess for signs of infection, such as: redness, yellow/green pus, swelling, tenderness, pain, warmth, and fever. When caring for patients, who already have an infection, I will monitor for signs of sepsis - fever, hypotension, increased heart rate, elevated blood glucose, confusion, and thrombocytopenia. Infections can occur to any individual, often standing as a diagnosis for patients. It is my job as the nurse to prevent infections, assess and monitor for deviations, and treat the infection when given

orders.
The immunity module focused on a male suffering from end stage AIDS dementia, which is dementia caused by an HIV infection, who is being cared for by his mother and girlfriend. AIDS dementia affects both the nervous and the mental systems, impacting an individual's cognition, behavior, motor coordination, and mood. Although the disease does not stand predictable or steady, one is capable of observing a progression of deterioration in the affected individual. The disease often begins with symptoms that could easily be overlooked by family members including: memory problems, confusion, reduced concentration, personality changes, and withdrawal. While these symptoms do dictate that a change has occurred, that do not point directly toward dementia, which could cause individuals to deem them to lifestyle choices or stress. As the disease progresses, greater alterations occur – needing help with ADLS, psychotic symptoms, memory loss, and flat affect. At points, it may appear that the dementia stabilizes, and it may for years, but in time, the disease continues to progress. Because no cure exists for AIDS dementia, patients, including the one in the module, may find themselves seeking out palliative and/or hospice care. During these stages, the goal is not longer to treat the AIDS dementia, but rather, the design is to increase patient comfort through decreasing symptoms. While one cannot become immune to dementia, this patient scenario represents immunity because it is caused by an HIV infection, an immunodeficiency that interferes with the body's ability to fight infections.
In the future, I can apply the immunity module to my patient care through two educational lessons – process of acquire immunity and caregiver strain. In immunity, there are two main forms - innate and adaptive. Innate immunity is the immunity that an individual is born with, which stands broad and nonspecific. Adaptive immunity is immunity that an individual does not have a birth, but rather acquires through other means. Adaptive immunity can be further broken down into natural and artificial. Natural immunity can be passive, in the form of a mother’s breastmilk, or active, through acquiring an illness. Artificial immunity can be passive, in the form of antibody transfers, or active, through immunizations. Despite the ways in which an individual acquires immunity, a healthy immune system is vital to an individual’s ability to rid the body of abnormalities.
When an individual is immunocompromised, such as AIDS dementia, there is an increased reliance on caregivers for advocacy, patient care, and decision making. In this module, an important challenge was brought to life – caregiver strain. When an individual is caring for an ill family member, they can become physically, mentally, and emotionally exhausted. Caregivers attempt to balance work, children, sick family members, and household responsibilities. Often, because these individuals are too busy caring for those around them, they forget to care for themselves. In my future, I will assess for caregiver strain and implement nursing interventions and therapeutic communication to ensure that not only that I am caring for my patient, but also caring for those closest to my patient. If an individual does not care himself or herself, they will not be able to care for those around them.
The three HESI Patient Review modules – cellular regulation, infection, and immunity – brought text book information to a patient care scenario. These modules allowed me to implement my knowledge into patient care, and perceive how the various aspects of an individual’s health impact one another. In the classroom, we often learn one concept at a time, rather than perceiving how the concepts interrelate and intertwine in patient care. These three terms, while obviously different, dictate nearly every hospital admission. In order to comprehensively and thoroughly care for my patients, I must first be able to understand the basic foundations of medicine and how they can impact my patient’s health.