Reference no: EM133858537

Assignment:

Although self-esteem was generally high, leavers scored markedly less than other subject groups in the areas of personal and social self-esteem Leavers had little prior knowledge or experience of nursing before entering training and knew few nurses or doctors consequently, nursing failed to meet their expectations. Stress was identified as the major cause of attrition and the sources of stress are identified This study informed a major programme of stress-management training for student nurses which began in 1988 at the North Wales School of Nursing and which is currently under evaluation. It includes relaxation therapy, assertiveness training, and on-going group discussions which foster peer-group support and which explore the Stressors and coping strategies relevant to different stages of training and ward specialisms.

Question 1.  1. Why do conditions that cause retention of sodium, such as cardiac failure, result in low serum sodium?

2. What is meant by 'free water'?

Question 2. Why is there a difference in the pattern of oedema in nephrotic syndrome and cardiac oedema? How is it related to the interstitial spaces and all that? I am confused.

Question 3. Why is there a difference in the clinical presentation of oedema due to renal failure and oedema due to cardiac failure, and how is this related to the loose nature of the interstitial tissue in the periorbital area? The answer given was that it is because, in cardiac failure, there is orthopnoea and the most dependent portion in this case is the legs, which is why the oedema occurs there.

Question 4. What treatment is recommended for recurrent attacks of generalized swelling, with angio-oedema, in a middle-aged female patient?

Question 5. Is an osmotic diuresis, due to hyperglycaemia for instance, a cause of both hyponatraemia and hypernatraemia. Please explain how this can be the case.

Question 6. What is the mechanism of β2-agonists (albuterol) in correcting hyperkalaemia in emergency? How does it cause a shift of potassium?

Question 7. Why do we give sodium lactate along with sodium bicarbonate in acidotic patients? How does sodium lactate then act?

Question 8. How does hypochloraemia alone cause a metabolic alkalosis?

Question 9. I have read the part concerning acid-base imbalances and I would like to ask about two things:

1. Why is there a higher concentration of anions (18) on measuring the anion gap while there is a high concentration of immeasurable anions? I would have expected a higher concentration of cations because most of them are measurable.

2. Could you explain to me in more details how NaCO3 loss or HCl retention could lead to normal anion gap acidosis?

Question 10. What is the exact formula for calculating the serum anion gap?