Brad Johnson (BJ) is a 54-year-old diagnosed with pituitary adenoma He undergoes a transsphenoidal hypophysectomy to remove the tumor.

1. Before surgery, what conditions might BJ’s pituitary adenoma precipitated?

2. After surgery, he has huge urinary outputs of 500 to 600 ml/hr. What is the most likely cause of his high urine output? What other clinical data would support this diagnosis?

3. BJ receives subcutaneous Desmopressin (DDAVP) to manage his high urine output. What is the rationale for this therapy? How can effectiveness be assessed?

4. It is expected that after his transsphenoidal hypophysectomy, all of BJ’s anterior pituitary hormones will be deficient (panhypopituitarism). What type of hormone replacement will be needed?

John, 78 years old, is a sometimes homeless veteran. He is missing many teeth from years of no dental care. John receives a monthly retirement check but he has great difficulty meeting his monthly bills, let alone buying enough food, and this has caused many evictions. When he can afford them, John has his prescriptions filled for a diuretic (for high blood pressure) and a statin (for high cholesterol). John isn’t sure what his current weight is, but he has had to tighten his belt to the last notch over the past eight months. He has no family with whom he is still in contact, and he eats all of his meals alone. At a neighbor’s insistence, John is visiting the local senior center to eat lunch for the first time. The day he visits, each person is having a free nutrition screen completed by a program staff member.

Questions:

1. Using the “Determine Your Nutritional Health” checklist (p. 459), assess John’s nutritional status. What is his score?

2. Review the “DETERMINE: Warning signs of poor nutritional health” checklist shown in Table 18.5 (p. 458). Prioritize John’s nutrition problems based on this screening tool.

3. What parts of the nutrition education handout created by the University of Florida IFAS Extension (access at http://edis.ifas.ufl.edu/he944) should be used to provide nutrition education to John?

4. What should the local senior center registered dietitian do for John to help address the nutrition problems you identified in #2?

Maleah Brown is a 46-year-old Caucasian who goes to her primary care provider with a chief complaint of weakness. She tells the nurse that she saw a dermatologist a month ago, because her skin tone showed increased pigmentation. The dermatologist told her to stay away from tanning beds, because she has the type of skin that darkens quickly. She recently returned from a vacation in a very sunny, warm location. She states that she is very concerned about her skin and her extreme fatigue and weakness. During the physical examination, her vital signs are measured as BP 90/68, HR 90, RR 18, and T 98.9ºF. Her skin tone is a golden brown, and all her mucous membranes are golden brown. MB denies using a topical instant tanning lotion. She weighs 110 pounds and is 5 feet, 7 inches tall. She reports that she has lost 15 pounds in the past 5 weeks. Blood tests show a blood glucose of 68, Na 110, and K 5.

1. What pathophysiologic processes could explain the serum levels of glucose, sodium and potassium?

2. MB is diagnosed with primary adrenocortical insufficiency, or Addison’s disease. She is prescribed corticosteroid therapy. What are essential teaching points for dosing schedule, indications for increased doses, emergency administration, and identification of her condition to healthcare personnel?

3. MB is started on corticosteroid replacement therapy. One week later, she is admitted to the emergency department with hypotension, dehydration, weakness, lethargy, vomiting, and diarrhea. What is the most probable cause of these signs and symptoms?

4. Which treatment measures are likely to be used to resolve the cause of MB’s signs and symptoms?

Explain what is meant by the visual pathway. Include in your description of the visual pathway the blind spot, and what causes it.

Describe procedures to conduct Board and Shareholder meetings.

A 10-month-old girl was transported to the emergency department by paramedics. She has a history of fever and had a seizure at home. On arrival, the patient was not actively seizing, but she was apenic with an oxygen saturation of 75%. You position the head, open the airway, and, using the EC-clamp technique, you provide oxygen by a bag-valve-mask resuscitator. You suction the airway to remove oral secretions. At this time, the physician takes over manual ventilation and asks you to prepare for intubation. He would like an oral airway, with appropriate ETT size, stylet, and laryngoscope handle and blades. Using SOAPPIM, you prepare for intubation.

1. What size ETT, oral airway, stylet, and laryngoscope blades will you prepare for this patient?

   The patient is intubated without any adverse intubation-associated events.

2. How do you confirm endotracheal tube placement in the pediatric patient?

3. What other intubation device could have been used for this patient?

You tell a family that their child’s life could be saved with a treatment, but they refuse based on religious reasons. Do you (A)- perform the treatment without their permission or (B)- honor their request?  

• Summarize consequential (Utilitarianism) ethical theory in at least one paragraph.
• Summarize non-consequential (Deontology) ethical theory in at least one paragraph.
• Apply utilitarianism and deontology theory to scenario

You tell a family that their child’s life could be saved with a treatment, but they refuse based on religious reasons. Do you (A)- perform the treatment without their permission or (B)- honor their request? Summarize consequential (Utilitarianism) ethical theory in at least one paragraph. Summarize non-consequential (Deontology) ethical theory in at least one paragraph. Apply utilitarianism and deontology theory to scenario

Describe and discuss the clinical features you might find on examination of the hands of a patient with mild osteoarthrosis.

Discuss the phases of Paget’s disease and the expected pathological changes in bone

List down 6 drugs use for chemotherapy with their specific use and 2 common side effects of the medications and establish 2 nursing interventions FOR EACH to ensure pharmacotherapeutics of the drugs.

What moral questions surround human embryonic stem cell research? What is the main ethical (and legal) consideration with human embryonic stem cell research? What is the difference between embryonic and adult stem cells? Do adult stem cells have the same moral problems?

Discuss, using examples, how long-standing type 1 diabetes mellitus can affect the central nervous system.

Review the code of ethics for nurses. How does adherence to the code effect/influence your decision making as it relates to the ethical dilemma. You may include both professional and personal perspectives.