MAKE A NURSING CARE PLAN FOR " IMPAIRED SKIN INTEGRITY RELATED TO FREQUENT SCRATCHING AND DRY SKIN

CAse scenario

MT is a 4 year old male that was referred from Dermatology to our allergy clinic at Steve Biko Academic Hospital on the 7th of July 2014.

Further history and symptomatology
 The rash started at 1 year of age and worsened as time went on.

 The rash was extremely itchy and the child was constantly scratching the affected areas.

 The child’s quality of life was affected as the child often wakes up at night to scratch the affected areas.

 The child was seen in Dermatology since February this year, he had received 4 courses of oral prednisone for a week and had been started on cyclosporine a month before presenting to us in the allergy clinic. The mother did report that there is a temporary response to the oral prednisone initially but the rash soon recurred. She had not noticed an improvement after cyclosporine had been commenced.

 There were no specific food items that the child avoided or disliked and there were no particular foods that made the rash worse.

Family history:
No family history of atopy

Birth history and Road to Health Chart:
The patient was born at term via normal vaginal delivery with no complications post delivery

Surgical History:
None

Medical History:
The patient is HIV negative and has had no previous admissions to hospital
He is not on any chronic medication.
In terms of the allergic march, there were no overt food allergies as an infant on history. The child did not display evidence of allergic rhinitis or asthma on history.
  

Feeding history:
The child was exclusively formula fed until 7 months of age at which weaning to solids had commenced.

On Examination
This is a healthy looking 4 year old child, with no evidence of allergic facies.
Anthropometry Within normal limits, no evidence of failure to thrive
ENT examination No inflamed turbinates
Eyes No evidence of conjunctivitis
Skin hyperpigmented, lichenified diffuse rash involving the flexural surfaces of the elbows and knees. Severe dermatitis of the scalp, neck, trunk and lower limbs
The rest of the systems were within normal limits.

Assessment
1. Severe atopic dermatitis refractory to conventional treatment
Discussion and plan:
This child had severe atopic dermatitis which affected his quality of life. There seemed to be no particular food allergens implicated. Skin prick tests were deferred due to severity of the skin lesions. Due to the early onset
of presentation together with the fact that it was refractory to conventional treatment- an FX5 screen was performed which revealed no positive food allergens.
The cyclosporine was discontinued and the child was admitted for wet wraps. The wraps were changed every 48 hours and a dramatic improvement was noted. No foods were excluded from the diet. After just two sets of wraps, there was a dramatic improvement as depicted below.
The child was subsequently discharged with education on pharmacological and non-pharmacological measures to control atopic dermatitis.
Non pharmacological measures included the avoidance of soaps during lukewarm baths, the use of emollients, avoidance of woollen clothing, keeping skin well covered and protected in addition to other measures.
Pharmacologically, the child was discharged on a moderately potent steroid agent for the body and a mild agent for the face. The importance of weekly or twice weekly topical steroid use for maintenance therapy was also stressed.

Wet wrap therapy

Atopic dermatitis is a chronic inflammatory skin condition that generally begins during infancy and is the most common skin disease in children under the age of 11 years. Potential causes include irritants such as soap and detergents, food allergens, contact allergens, and skin infections.1
The aim of topical therapy is to protect the skin from scratching and environmental factors and to suppress the inflammatory changes and infection if present. Emollients inhibit water loss and provide a protective coating; they are recommended in all patients with atopic dermatitis. Additionally, emollients may reduce the need to use topical corticosteroids.2
Wet wrap therapy refers to wet bandages applied over emollients and/or topical steroids. The use thereof is indicated in acute flares of atopic dermatitis in cases that are severe and refractory to conventional topical corticosteroid treatment. The main advantages of wet wrap therapy is that it rehydrates the damaged skin, reduces itching and erythema, cools the skin, and enhances the penetration of topical medication utilised. It also provides a physical barrier against scratching, which in turn prevents secondary infection. However, wet wrap therapy is time consuming and there is a risk of enhancing the systemic side effects of topical corticosteroids.3 Wet wrap therapy has been shown to be more beneficial if topical corticosteroid added to the emollient and the side effect profile minimal if used for less than 14 days

Your clinical assignment is for:

• M.H., age 72; diagnosis: pneumonia
• F.S., age 52; diagnosis: leg ulcer
• J.P., age 78; diagnosis: abdominal hernia repair

1) It is 9:45 am. If J.P. needs to be ambulated three times a day, M.H. needs his antibiotic given at 10 am, and F.S. needs her dressing changed this morning, in what order would you do these tasks?

2) How did you make this decision?

I need guidance to resolve this case study, please. I do not know how to start!!!

Medical Computing Solutions, Inc (MCS) designs and manufactures medical grade all-in-on computer systems developed specifically for application in healthcare environment. Medical grade computer systems are developed to meet standard requirement, such as IEC 6060, as well as others that make them a better fit than the consumer grade computers for medical applications, i.e. ruggedized, easily cleanable for infection control, etc,

MCS customers include hospitals, clinics, private practices, laboratories, etc. MCS portfolio offers several standard computer platforms the customers can choose from, as well as highly customized solutions that are tailored to specific customer specifications. One of MCS standard platforms is the Base-Care Platform (BCP), which has been popular with small and medium size clinics and private practices. While BCP sales have been growing, there are a number of competing platforms that are available from competitors.

MCS products are sold through a channel-partner firm (sales-rep) that also offers other brands of medical all-in-one systems. The sales-rep receives the order from MCS distribution center within 3 days after notifying it, provided that the stock is available. Since competition is fierce, backorder is not a viable option for BCP. In such case, MCS simply loses the amount of business.

Below are some key data for BCP:

• BCP retail price is $1800 per unit
• BCP cost per unit is $600
• BCP manufacturing + ship cycle time (lead time) is approximately 1 month
• MCS incurs ordering costs of $70 each time an order is placed for BCP
• Monthly inventory carrying costs for BCP are $10 per unit
• MCS wants to maintain a 97% service level with its BCP customers

Assume we are now approaching the end of this year. A demand forecast for BCP in the upcoming year has been prepared-see-below table-and will be used to make an inventory plan for BCP.

1. Choose an appropriate inventory model to recommend managing inventories for next year. Specifically, articulate what model you have chosen and why it is an appropriate model to use in this case. Show details of your work, i.e. describe the model/approach, and show the equations, if any, that you use.
2. Determine the reorder point (ROP).
3. Determine the total annual inventory costs. Show details of your work, i.e. describe the approach, and show the equations, if any, that you use.

Identify the steps needed to perform suctioning on a patient with a tracheostomy tube..

Discuss risk factors associated with infection related to a tracheostomy tube and hospitalization.

What are the guidelines for implementing airborne, droplet, and contact precautions?

Provide a description pertaining the principles of the ELISA Dipstick, tubex test, and typhidot method. Give its references.

#1. The mother of a 10-year-old girl has brought her to the clinic based on concerns expressed by the school nurse. The teacher has noted times when the girl appears to be daydreaming; however, after the nurse witnessed a few of these incidents, she has recommended the child be evaluated for absence seizures. The mother is not totally convinced that is true, however, is willing to find out.

A. How would you respond to this mother?

B. What patient centered care will be appropriate here?

C. What safety measures should the parents be encouraged to follow?

#2. You are assessing a child's vision and notice the child is unable to correctly answer her questions when shown the Ishihara color plates. When questioning the mother, you discover that the child has not understood the colors but the mother has just assumed the child was slow.

A. How would you proceed?

B. What care would you provide in this case?

C. How will you know the nursing care plan was effective for this child?

#3. The parents have brought their 3-year-old son to the clinic for an evaluation. They are concerned something is wrong because he cannot seem to move like he used to and is having difficulty climbing up and down the stairs.

A. How would you respond?

B. What patient-centered care should you develop?

C. You recognize that this patient will need assistance from other departments. Which additional team members will be able to assist this patient and his family?

#4. A mother has brought her 4-year-old daughter to the emergency department. She didn't realize her husband had sprayed the lawn with a pesticide and allowed their daughter to play in the yard. She now comes in with complaints of nausea, vomiting, difficulty breathing, and confusion.

A. How would you respond? What are you initial interventions?

B. How can you help the family?

C. What are some nursing diagnoses that would be appropriate for this situation?

#5. The parents are in denial demanding a second opinion. The physician has just informed them their 2-year-old son has a glioblastoma. Devastated, they ask the nurse, "How can this happen to us?"

A. How would you respond?

B. What are some nursing diagnoses you would identify in this situation (more than 1 please)

C. What are some expected outcomes related to your nursing diagnoses? (should have an outcome for every diagnoses)

Case Scenario: A 65-year-old man presents at the ER with a high temperature, extreme pain in his right hip, and an open wound at the site of the pain. He had a hip replacement seven days ago without incident. The doctor asks for a culture of the wound drainage, x-ray, and immediate admittance to an ICU. Diagnosis is osteomyelitis.

2. Question: Who is most at risk for this disease and why? Include in your answer specific facts, data, examples, and other information drawn from your textbook and at least one other supplemental source.

How did Covid 19 impact Personal Protection Equipment (gloves, mask, gowns) - PPEs?

How did Covid 19 Impact nursing home staff?

How did Covid 19 impact residents and families?

How did decisions by NYS (Department of Health and/or the Governor) impact nursing homes?

What is the fiscal state of NYS nursing home as of Sept 1, 2020?

Describe 2 examples of quality and/or safety data that is in the EHR, mandated by regulatory agencies, that improve patient safety ,or quality, without compromising efficiency . Please consider alternative ways data could be collected by other than the frontline clinician. Include references.

HART NOTE-JOHN SMITH

S:        This is a 54-year-old male who presents with fatigue. He also has headaches. Because of a history of some visual field deficits during his headaches, his ophthalmologist ordered an MRI of the brain. I reviewed the films and did not see anything but the expected post-surgical changes of the brain. Lab tests show that he does have some residual function of the pituitary gland, so his endocrinologist only placed him on testosterone patches and thyroid hormone replacement (Synthroid). He also has a history of depression, which could explain the fatigue and headache, or they could be due to low thyroid replacement levels.

O:        HEENT: Normal. Lungs: Clear to auscultation. Cardiovascular: Regular rate and rhythm, without murmurs, rubs or gallops. Abdomen: Nondistended, nontender. Extremities: No edema.

A:        1. Fatigue. Possibly hypothyroidism. Will check T3, T4, and TSH levels.

            2. Headache, possibly within the context of depression. He is on a rather low dose of an antidepressant drug at this time.

            3. Hypopituitarism.

P:        1. Will obtain an FSH, LH, free and total testosterone, and baseline ACTH.

            2. Follow up in 1 week

Edward Norton, MD

I need to answer these question please

1.  Divide endocrinologist into its word parts and define each part.

2. Divide hypopituitarism into its word parts and define each part

3.  What is the abbreviation for thyroid-stimulating hormone?

4. Besides the physician who dictated this report, what two physician specialists have recently seen this patient?

9.  Why is the patient taking Synthroid?

10. The patient’s fatigue, headache, and visual field defect could be signs of a recurring tumor in the brain. What test has already been done to look for a tumor?

How can the Community Health Nurse use Social Marketing tools to educate her population on specific health conditions? Identify the health condition and detail the integration of social marketing

1. What sort of health issues would you expect are common among care managers?
2. What immediate measures might be taken to relieve the stress and health issues from which the care managers suffer?
3. Management is considering fundamental changes to the role of the care managers, their goals, compensation, and their work environment? Should the care managers be involved in such discussions? What suggestions would you make?
4. Can you identify other jobs that have similar working conditions and issues?

Identify an additional challenge or stigma not included in the post that you would like to have. Provide rationale as to why you feel that challenge or stigma is essential to consider as well.

I will be discussing Parkinson's Disease (PD). "PD introduced by James Parkinson in early 1800s is described as shaking palsy" (Trevisan, 2019, s. 7.1). Further observation now describes PD as some form of Paralysis. Parkinson's symptoms can range from depression to dementia. There are five stages to Parkinson's Disease. Stage one is where one may experience mild symptoms, whereas Stage five is more intense where one may not leave their bed. Although PD is rarely genetically passed down, research shows that environmental triggers cause PD. Unfortunately, there is no test for PD diagnoses, which leads to misdiagnosis. The issue with PD is that the symptoms are often mistaken with older age. As mentioned, there is no test, so doctors examine the problems and apply the process of elimination. The Americans with Disabilities Act (ADA) "prohibits discrimination from people with disabilities" ("Americans with Disabilities Act | U.S. Department of Labor", n.d.). Under ADA, one with a disability can apply for Employer Assistance and Resource Network in Disability Inclusion (EARN) for free. EARN educates employers on the hiring process of an employee with a disability. EARN also provides a website for job seekers with known disabilities. "Social Security pays monthly benefits to individuals who are unable to work for a year or more due to a disability" ("How You Qualify | Disability Benefits | SSA", n.d.). Under social security, you have to meet their definition of disability, and they require one to have worked long enough and recently. The issues with these acts are the diagnosis of PD. PD is often delayed in diagnosing. Which means that one may not even know they have the disease. The problem is that a person may not even realize they qualify for these acts. A person may not even be allowed; they are unaware of having the disease. Unfortunately, one may go years without knowledge of their condition resulting in negative outcomes for the patient. These adverse outcomes range from quitting their job due to their illness or possibly being laid off due to lack of knowledge from the employer. An employer may mistake an employee's disease with lack of work resulting in firing and hiring someone with more motivation.

what foods should patients avoid on this diet?:

Low sodium, low cholesterol, low carbs, high fiber, low fiber, high protein, low protein, high potassium, low potassium