Questions
Mrs. Pringleis a 62-year-old female experiencing diffuse bone pain over the past several years after menopause....

Mrs. Pringleis a 62-year-old female experiencing diffuse bone pain over the past several years after menopause. She has a history of fractures to her left hip and wrist. She states, “The pain is becoming worse and it is keeping me from doing my daily activities.” She currently complains that any weight-bearing activity causes her severe discomfort. She is not taking hormone replacement or any other medication. She has been using a soy herbal supplement and vitamin E 400 IU daily. She knows the importance of preventive healthcare. She is up to date on all her gynecological exams, and past mammograms have been normal as have her health maintenance exams. She does not smoke or use alcohol. Her system reviews are unremarkable excluding today’s complaint.
Her family history reveals that her mother had a history of anxiety, osteoporosis, non-insulin dependent diabetes and hypertension. Her father has hypertension but is in otherwise good health. There is no history of breast disorders or arthritis, thyroid or any other metabolic disorder.
She lives alone in a one-story house. She has three children and one grandchild. Her daughter lives in close proximity to her so she is able to enjoy visiting and caring for her 3-year-old grandson occasionally. She has no exercise routine and admits to a somewhat sedentary lifestyle. She admits to eating a vitamin-poor diet.
Mrs. Pringle experienced menopause around the age of 47 when her menstrual periods stopped. Her previous physician recommended no hormone replacement because she was not suffering from any menopausal symptoms. However, she now reports having “hot spells” at different times
throughout the day with some trouble sleeping for the past 3 months. She also complains of some vaginal dryness that she admits is bothersome.
Her chief complaint is severe back pain and the inability to do simple chores such as lifting grocery bags and her grandchild without pain.
Upon physical exam, she is afebrile with unremarkable findings with exception to the musculoskeletal system. She weighs 132 pounds and is 5 feet 5 inches. At her last exam 8 months ago, she was 5 feet 6 inches.
Upon palpation, guarding and tenderness are present in the cervical, thoracic and lumbar spine with limited range of motion. No spasticity, rigidity or flaccidity is present. She has active range of motion in all joints, with no edema, redness or heat present in joint areas. She exhibits notable guarding and rigidity performing range of motion of lower and upper back areas.
There is also noticeable guarding with some limitation of movement at the cervical spine area. She is able to endure the exam with noticeable painful expressions on her face when asked to do range of motion with back, guarding and tenderness noted at cervical spine area. There is no presence of dowager’s hump. She has no evidence of herniation or disc displacement upon inspection. No scoliosis or lordosis is present. Her preliminary urinalysis and CBC are unremarkable. Her symptoms indicate post-menopausal osteoporosis.
To confirm the diagnosis and rule out other medical conditions, lab tests were obtained to assess hormone, calcium, vitamin D, blood cholesterol levels and thyroid function. Also ordered were a sedimentation rate to check for arthritis, an X-ray of her back and a dual energy X-ray absorptiometry (DEXA) scan to rule out injury. DEXA scan is the gold standard in diagnosis of osteoporosis.
Diagnostic tests revealed a lack of estrogen and calcium. The X-ray of her back showed degenerative changes but no disc dislocations or herniations. The DEXA scan showed a T score of -2.9. A T score greater than -2.5 confirms a diagnosis of osteoporosis and indicates hormonal
treatment should be initiated.
Study Questions:
1.What treatment/smight youexpect to help address the lossof bone mineral density of Mrs. Pringle and reduce the risk of hip fracture?
2.How will you set your treatment goals tocomply with the Mrs. Pringlestated goal of ‘bothering vaginal dryness’?
3.Develop a nursing care plan according to your identified priority plan of care.

In: Nursing

what are the five task of implementation planning

what are the five task of implementation planning

In: Nursing

Considering the NMBA Code of Conduct principles 3.2 and 3.3, discuss three (3) considerations you would...

Considering the NMBA Code of Conduct principles 3.2 and 3.3, discuss three (3) considerations you would apply when gathering information from Fei Hong and her family during admission, planning for discharge or when conducting an assessment.
Response:

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Health and fitness 1. background/introduction 2. Etiology 3. Epidemiology 4. Signs and symptoms 5. Treatment modalities...

Health and fitness

1. background/introduction

2. Etiology

3. Epidemiology

4. Signs and symptoms

5. Treatment modalities

6. Medical, Pharmacological and Nursing management

7. summary/conclusion

In: Nursing

Case Study about Carbohydrate -Related Medical Problem (Diabetes Mellitus) Patient History: RX, a 6-year-old girl in...

Case Study about Carbohydrate -Related Medical Problem (Diabetes Mellitus)
Patient History: RX, a 6-year-old girl in previously good health, has noticed that, in the past
month, she is increasingly thirsty. She gets up several times a night to urinate, and finds herself
gulping down large amount of water. At the dinner table, she seems to be eating twice as much
as she used to, yet she has lost 4 kilograms in the past month. In the past three days, she has
become nauseated, vomiting on three occasions, prompting a visit to her pediatrician.
Laboratory Results:
 Fasting blood glucose level = 445 mg/dl
 blood pH level = 7.23
 Hb A1C = 9.5%
 C-Peptide Test = 0.4 ng/ml
 urine = tested positive for glucose and for acetone / acetoacetate/ beta hydroxybutyric
acid
Based on the given case, answer the following guide questions:
1. What is the relationship between Diabetes and Carbohydrates? How are carbohydrates
contributing to the patient’s diagnosis of high blood glucose level?
2. Compare and contrast the two main types of Carbohydrates. Which among the two types
can cause the biggest jump in your blood sugar and why?3. Diabetes is a metabolic disease that impacts the body’s production and/or utilization of
insulin. In Type 1 diabetes the body fails to produce insulin; whereas in Type 2 diabetes
the body produces insulin (and sometimes excessive amounts of it) but for a variety of
reasons the insulin does not function as it should. Now, give two reasons and explain why
insulin is beneficial especially for diabetic patients.
4. Explain why her blood-glucose level is elevated?
5. Why is her blood pH level decreased?
6. RX has a fruity odor to her breath. Explain why.
7. Explain why RX is urinating so frequently.
8. How is RX's condition like that of starvation? Address the role of glucagon in your
answer.
9. Based on your answer in no. 2, what foods will be highly recommended to the patient?
Explain.
10. Do you believe that you can adjust your diabetes drugs to ‘Cover’ whatever you eat?
Why?

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How to educate a patient. on performing Kegel exercises

How to educate a patient. on performing Kegel exercises

In: Nursing

describe the value of a mission statement to the program planners and the consumers of the...

describe the value of a mission statement to the program planners and the consumers of the program

In: Nursing

What do you think the future of health policy will look like in the U.S.?

What do you think the future of health policy will look like in the U.S.?

In: Nursing

Discuss what strategies you could implement to create an evidence-based practice culture in your workplace. What...

Discuss what strategies you could implement to create an evidence-based practice culture in your workplace. What steps can you take after leaving school to continue your evidence-based practice learning?

In: Nursing

What do you believe happens during the final scene of the story between the brothers at....

What do you believe happens during the final scene of the story between the brothers at. the jazz club?

In: Nursing

Discuss the chemically impaired nurse/health care professional. Identify behaviors and actions that may signify chemical impairment...

Discuss the chemically impaired nurse/health care professional. Identify behaviors and actions that may signify chemical impairment in an employee or colleague. What risk factors result in an increased risk for chemical addiction in the nursing profession. What are your personal feelings/ experiences regarding the chemically impaired nurse/health care professional. How would your personal feelings affect your ability as a manager to address a chemically impaired employee.

In: Nursing

A 47-year-old man was admitted to the hospital because of exertionally-related angina with coronary definition revealing...

A 47-year-old man was admitted to the hospital because of exertionally-related angina with coronary definition revealing a totally occluded right coronary artery and 80 % obtruse marginal stenosis. He was an avid hockey player and had attributed the chest pains to the sport. 1 month later, the chest pains persisted and he was admitted to the hospital for further observation.
Patient Referral:
Patient was sent to the Cardiovascular department for surgery. Percutaneous coronary intervention with deployment of a drug eluting stent and commencement of clopidrogel was administered.
Post-surgical observations:
After 1 month, the patient’s right coronary was totally occluded and the stents were replaced. 9 months after the replacement, the patient still experienced chest pains, but coronary angiography revealed no instent stenosis.
Further information from patient:
Patient no longer felt the chest pains, and presumably went about his usual routine. However, 2 years later, the patient presented with post prolonged ischemic chest pain with myocardial infarction.
Patient referral:
Patient sent for coronary angiography.
Angiography results:
A thrombus in the circumflex stent which was re-dilated and a further drug eluting stent was deployed.
Patient reaction to treatment:
2 years later, while playing a vigorous game of hockey, further chest pain and presentation revealing thrombus in stent to circumflex artery which was ballooned and the side branch protected using a stent. Patient referred for molecular testing.
Molecular testing results:
CYP2C19 genotype performed.
Results: *2/*2 homozygote representing a poor clopidrogrel metabolizer.
Treatment regimen:
Patient subsequently ceased clopidogrel and commenced prasugrel. After 3 months of new treatment, patient no longer showed ischemia.


Question：

1. To which group of pharmacokinetic genes did the biomarker belong that the physicians chose to help them properly treat the patient? What function do the genes in this group perform in the body?


2. List the 3 metabolism states for the gene utilized and the associated genotypes. What was the patient’s genotype and metabolism status?


3. What changes would you have made in this patient’s treatment if you could go back to the initial presentation in the hospital?

In: Nursing

12. Describe a picture rehearsal and what are the advantages of using imagery-based scenes 13. How...

12. Describe a picture rehearsal and what are the advantages of using imagery-based scenes

13. How do u feel about Autism and how will it help a future physical therapist's career?

In: Nursing

1. How does the electrical current pathway differ between monopolar and bipolar? 2. Why might a...

1. How does the electrical current pathway differ between monopolar and bipolar?

2. Why might a patient’s jewelry be hazardous in the OR?

3. What are the safety precautions to be considered with the placement of the patient return electrode?

4. What are the three properties of laser light which are different than normal light?

5. How is distention achieved in minimally invasive procedures and why is it necessary?

6. What types of trocars are used for laparoscopy and what are their advantages?

7. Why are angled rigid endoscope used and in which types of procedures would they be preferred?

8. Which types of human motions or movements are surgical robots able to replicate?

9. What are the reasons for creating hybrid rooms within the operating room suite?

In: Nursing

A 22- year-old woman presents to the ED with complaints of bladder fullness , incomplete bladder...

A 22- year-old woman presents to the ED with complaints of bladder fullness , incomplete bladder emptying , and severe pain in her right flank. She rates the pain a 9 on a 0-10 numeric pain scale. Patient states she has a history of kidney stones . She also states when she is able to void, it burns and has a foul odor . Vital signs: HR 85 , BP 120/80 , RR 16, SPO2 98% on RA, temp 100.9 (oral). Pt takes the following medications : Hydrochlorothiazide (HCTZ ) 25 mg PO daily , Detrol LA 2 mg PO daily Lab results : CBC : WBC 26 Urinalysis : WBC (too many to count), Bacteria (5+, large), Leukoesterase (+) Positive , Protein (-) negative , Ketones (-) negative.
Assessment? Diagnosis? Evaluation ? Implementation ? Planning?

In: Nursing

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