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Competency Appraisal 2014

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I. GIN EZ CASE
A patient is admitted in the emergency department. He came in due to body weakness,
sleeplessness, irritability, polydipsia and difficulty of urination. According to his history, he had
flu for the past 5 days having a temperature of 38.5 40 degree Celsius. His CBG upon arrival
is 359. Mr Gin Ez is a 54 year old government employee with four kids and 4 grandchildren.
Apart from his responsibility in their office, he manages a farm and a furniture business in the
province. He finances a poultry business as well. He was diagnosed of DM 1 year ago and HPN
since he was 45 years old. His blood sugar and HPN was controlled by diet, medications and
frequent visits to his physician every 3 months. His Creatinine, BUN, Glycohemoglobin, RBS,
Cholesterol and Triglycerides are checked every 3 months. However because he was too busy
with work he neglected going to the doctor for the past 7 months and was not religiously taking
his medications due to financial constraints.
When his laboratory results arrived, it revealed that creatinine and BUN were 4 times higher
than normal. His cholesterol and triglyceride is high as well as his HgbA1C. By that time, Mr.
Gin Ez is very irritable and is showing signs of confusion, hallucinations and difficulty of
breathing. X-ray revealed hemothorax and pneumothorax. The doctors decided that he will
undergo emergency intrajugular catheter insertion and closed tube thoracotomy insertion.

II. MODELS

a) Using the Dunns Health Grid, identify the health behaviours in the
situations which are applicable in the 4 quadrants.

ANSWER:
Protected Poor Health in a favorable
environment
His blood sugar and HPN was controlled
by diet, medications and frequent visits to
his physician every 3 months.
His Creatinine, BUN, Glycohemoglobin,
RBS, Cholesterol and Triglycerides are
checked every 3 months
High Level of Wellness in a favorable
environment
Competency Appraisal 2014

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Poor Health in an unfavourable environment
Mr. Gin Ez neglected going to the doctor
because he was to busy with work
He was not religiously taking his
medications because of financial
constraints
Emergent High Level of Wellness in an
unfavourable environment

Mr Gin Ez Mr. was diagnosed of DM 1 year ago and HPN since he was
45 years old which indicated that he has POOR HEALTH. Due to these
diseases, his blood sugar and blood pressure was affected and so he
controlled it by diet, medications and frequent visits to his physician every
3 months and also his Creatinine, BUN, Glycohemoglobin, RBS,
Cholesterol and Triglycerides are checked every 3 months which
explained his behaviors under PROTECTED POOR HEALTH IN A
FAVORABLE INVIRONMENT because he is an ill person with whose
needs are met by the health care system and who has access to
appropriate medications, diet, and health care instruction.

Gin Ez neglected going to the doctor for the past 7 months because he
was too busy with work and he failed to religiously take his medications
because of financial constraints. Mr. Ez was diagnosed with hypertension
9 years ago and diabetes milletus 1 year ago, therefore he has POOR
HEALTH. He is busy working in the office while managing a farm and
furniture business in the province. This is a stressful environment,
especially for a 54-year old person. The reasons listed above are why we
classified the said behaviors under POOR HEALTH IN AN
UNFAVORABLE ENVIRONMENT.


SOURCE: Wilkinson J, & Treas L. (2010) Fundamentals of Nursing - Volume 1:
Theory, Concepts, and Applications.F.A Davis, Philadelphia. Page 168.

b) Using Travis illness-wellness continuum, explain the behavior of Mr. Gin
Ez on why he was hospitalized.

Competency Appraisal 2014

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Mr. Gin Ez was hospitalized because of his behaviour which can be
correlated to the Travis Illness-wellness continuum as the arrow pointing to the
left .This is toward a premature death because there is a progressively
decreasing state of health in three steps namely signs, symptoms and disability.

Before when patient was religiously taking his medications, eating the
right diet and consulting his doctor, he was moving towards the high level
wellness of the right arrow. But due to factors like finances, priorities, perception
and role demands, he neglected going to the physician and medications were not
maintained which started the stage of Signs. Under this the HPN and DM I is not
managed so signs not initially felt by the client appears like increase in blood
glucose and blood pressure.

When the Signs are neglected further, condition persists and Symptoms
emerge in the forms of fatigue, polydipsia, vision loss, dizziness and chest pain.
These symptoms are due to the fact that with increase vascular resistance, there
is decreased blood flow to the kidneys so he had decreased urination and thru
RAAS activation a further increase in BP resulting to blood vessel destruction
and increase in myocardial workload. As for DM I, excess glucose molecules go
in the blood hence hyper viscosity (platelet aggregation) which go to body
system( brain, lungs etc) and parts like eyes (vision loss) and small
capillaries(decreased healing).

As time pass by, the integrity of the systems are degrading due to
continuous neglect leading to complications like Multi organ dysfunction hence
Disability when the client can no longer carry out normal function because the
body is severely compromised and unable to cope. It was very evident during
admission, for example we have elevated BUN and Creatinine which means an
acute renal failure; we also have elevated cholesterol level, triglylceride and
HgbA1C which are markers for possible acute coronary syndrome; confusion
which indicate decreased brain cell perfusion; hallucination which maybe caused
by electrolyte imbalances and DOB due hemothorax and pneumothorax.

Competency Appraisal 2014

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Because the client is rushed to the hospital and first aid measures are
done while procedures for dialysis and CTT will proceed we are preventing
possible death so the direction of the arrow for treatment paradigm is the neutral
point then the wellness direction thru surgery, medication, rehabilitation and
education.

SOURCES:
Travis, J.W. and Ryan R. S. (2014).The Illness-Wellness Continuum. Wellness
Associates,Inc.Retrievedfromhttp://www.thewellspring.com/wellspring/introductio
n-to-wellness/357/key-concept-1-the-illnesswellness-continuum.cfm.

De La Salle Lecture Ntes (2001).Promoting Wellness in Health and Illness.
Retrieved from http://www4.desales.edu/~sey0/health1a.html.

c) Using the theory of Leavell and Clarks Agent Host Environment
Model, explain the reason why he was hospitalized.

By using the Agent- Host- Environment model of Leavell and Clark, we identified
Mr. Gin Ez as the host, the environment and the host such as Age, Financial
capabilities and the likes as the factors that caused his hospitalization. These
factors are interrelated to each other which play an important role in a persons
health. Mr. Gin Ez was hospitalized because he was too busy working he
neglected his doctor plus he did not take his medicines religiously which
contributed to his hospitalization and produced complications. As we all know
medications can help in the wellbeing of a person. It can control the blood sugar
levels and blood pressure of Mr. Gin Ez. With regards to neglecting the doctor his
creatinine, BUN, glycohemoglobin, cholesterol, tryglicerides and the likes were
not monitored causing it to raise higher than normal. We also considered his age
as a factor because as we grow older we are vulnerable in developing disease
and complications.








Host:
Financial Capabilities
Age
Not taking mediations
religiously
Neglecting his doctor
Environment:
Too busy working
Agent:
Mr. Gin Ez
Government employee
Farm and furniture
manager
Poultry financer
Competency Appraisal 2014

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SOURCE: DeLaune S, & Ladner P. (2011) Fundamentals of Nursing Fourth
Edition:Standards and Practice. Delmar, Cenageg Learning, USA .Page 283.

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