what should you do is a patient who uses a walker tells you there are steps in his house?

You are working in A&E where you are allocated to assess and care for . Mr Smith is a 35-year-old man who became unwell with community acquired pneumonia (CAP). Smith went to his local GP a week ago with a fever, difficulty breathing and a productive cough. At that time, the GP diagnosed Smith as having pneumonia and prescribed a course of oral antibiotics. When the GP assessed John today, he appeared lethargic and drowsy, and stated that he is nauseous and feels “achy all over”. The GP called an ambulance to take Mr Smith to hospital because the antibiotics had not worked, and he was now in acute respiratory distress.

John has a past history of rheumatoid arthritis and is on 25mg oral prednisolone to manage this chronic inflammatory disease.

Your assessment of Mr Smith reveals the following information.

General appearance: pale, diaphoretic, lying against the raised back of the bed (high Fowler’s).

Vital signs: temperature 38.6°C, RR 26 bpm, HR 115bpm, BP 94/65 mmHg, SpO2 92% on RA,

Neurological: lethargic and drowsy, GCS 14. (eye opening to speech, oriented to time, place & person, obeys commands).

Respiratory: Obvious use of accessory muscles. Difficulty speaking to answer questions. Bronchial breath sounds in both bases & course crackles to mid-zones bilaterally. Productive cough (thick, green sputum).

Laboratory and other investigations: CXR shows consolidation in bilateral lower lobes. Blood culture results sent by his GP are positive for pneumococcal. His serum lactate results have come back as 3.4 mmol/L (normal < 1mmol/L), and his WBC is 16.0 x 109/L (normal 4.5-11 x 109/L). C-reactive protein (CRP) 57mg/l

Medical orders: John is diagnosed with sepsis and acute respiratory failure. He is ordered an IV fluid resuscitation bolus, broad spectrum IV antibiotics, 2L O2 via NP to maintain SpO2 > 95%, close monitoring of vital observations and urine output.

Question:

Describe how each of these aspects of the information presented above has led to the diagnosis of sepsis and acute respiratory failure.

Presentation history (2):

Nursing Assessment (3):

• Physical appearance:

• Vital signs:

• Diagnostic tests (2): Blood tests:

Question 2

After reading the case study, you are required to identify three (3) priority nursing problems and provide your rationale for making each of these a priority.

Question 3

After identifying three (3) priority nursing problems in the previous question, you are required to formulate a goal to address each priority nursing problem.

Question 4

After formulating the goal for each priority nursing problem in Question 3, you are required to describe three (3) nursing interventions with rationale that you will implement to achieve each goal.   

Consider the criteria of causality described by Hill. How would you use these criteria to determine whether the experience of racism causes higher rates of chronic illnesses?

6. You can expect most children in the 5-year-old class to exhibit very similar abilities in their language and physical development (T/F)

8. Objectives and procedures should be aligned with one another (T/F)

14. In a brainstorming group time, the children identify what they know, what they want to know, and how they would like to find out (T/F)

15. Activities within the body of the group time should vary from one day to the next (T/F)

18. One way to assist children in developing self-discipline is to encourage them to make some of the rules themselves (T/F)

care for this patient. Two (2) actual problems and One (1) potential
problem.
DUE: 16 th OCTOBER 2020

Orthopedic Nursing
Patient Scenario
Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining
of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive
motion was painful, and active movement was impossible secondary to pain. The patient has
several chronic medical problems including as DM, Hypertension and Ischemic Heart
Disease. Treatment in the Accident and Emergency Department was centered around her
diagnosis of a fractured right femur. She lives in a nursing home, although she was
independently ambulant. She has now been admitted to your Orthopedic Unit for further
management.
Chief Concern:
 Severe, sharp pain on movement 9/10
 Inability to bear weight, sit-up or ambulate
PHH (Past Health History):

 appendectomy age 15, fractured clavicle age 19.
 laminectomy (L4‐5) 17 years ago due to a work related injury.
Medications History:
 acetaminophen 500 mg PO q6h
 Insulin 70/30 12units SC, AM and PM
 Enalapril 10mg PO BD
 Atenolol 25mg PO OD
 Aspirin 81mg PO OD
 Calcium 600mg PO OD
Physical Exam:
 BP 160/94 P 103 regular R 24 T 37.2
 Conscious and alert but appears anxious, GCS 13/15
 Height 188 cm, weight 118 kg
 IVF in progress, 0.9% Nacl to left anti-cubital fossa
 Skeletal Traction to right leg with 15 pounds weights in place
 Urinary catheter in situ, on free drainage
 TED stocking

in place to left lower limb
Labs:

XRay:

X-ray shows a transverse fracture
of the femur. The break is a
straight horizontal line across the
shaft.

Social History:
 Trinidadian born, graduated form 5 high school
 worked on an assembly line in manufacturing company; is physically demanding
 smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
 recently lost a long‐time friend at the nursing home to cancer
 spouse died 8 years ago (MI)
 no children, 1 sister alive she lives abroad
Family History
 Mother died of heart disease
 Father died of prostate cancer
Assignment
1. What are the patient priorities?
2. Identify and involve an inter-professional team that will be required to provide
holistic care for Mrs. Jane.
3. Briefly explain how a femur fracture is diagnosed.

1,Provide an explanation as to how severe dehydration can cause Acute Kidney Injury (AKI)

2, Describe four (4) nursing interventions in the direct post-angiogram period for a patient who had an angiogram via the right radial artery.  

3,Outline the three (3) actions of insulin on the metabolism of glucose.

Orthopedic Nursing
Patient Scenario
Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining
of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive
motion was painful, and active movement was impossible secondary to pain. The patient has
several chronic medical problems including as DM, Hypertension and Ischemic Heart
Disease. Treatment in the Accident and Emergency Department was centered around her
diagnosis of a fractured right femur. She lives in a nursing home, although she was
independently ambulant. She has now been admitted to your Orthopedic Unit for further
management.
Chief Concern:
 Severe, sharp pain on movement 9/10
 Inability to bear weight, sit-up or ambulate
PHH (Past Health History):

 appendectomy age 15, fractured clavicle age 19.
 laminectomy (L4‐5) 17 years ago due to a work related injury.
Medications History:
 acetaminophen 500 mg PO q6h
 Insulin 70/30 12units SC, AM and PM
 Enalapril 10mg PO BD
 Atenolol 25mg PO OD
 Aspirin 81mg PO OD
 Calcium 600mg PO OD
Physical Exam:
 BP 160/94 P 103 regular R 24 T 37.2
 Conscious and alert but appears anxious, GCS 13/15
 Height 188 cm, weight 118 kg
 IVF in progress, 0.9% Nacl to left anti-cubital fossa
 Skeletal Traction to right leg with 15 pounds weights in place
 Urinary catheter in situ, on free drainage
 TED stocking in place to left lower limb
Labs:

XRay:

X-ray shows a transverse fracture
of the femur. The break is a
straight horizontal line across the
shaft.

Social History:
 Trinidadian born, graduated form 5 high school
 worked on an assembly line in manufacturing company; is physically demanding
 smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
 recently lost a long‐time friend at the nursing home to cancer
 spouse died 8 years ago (MI)
 no children, 1 sister alive she lives abroad
Family History
 Mother died of heart disease
 Father died of prostate cancer
Assignment instruction;
1. Briefly describe three (3) classes of medications used in the treatment of patients with femur fracture:  Pain relief  Antibiotic  Anti-inflammatory

2. What is the nursing considerations/management for this patient?

3. Develop a plan of care for Mrs. Jane, (utilize 2 actual and 1 potential nursing diagnosis, short and long term goals, nursing intervention, evaluation).

Choose one of the following categories of violence described in your text and describe it; include key risk factors and prevention strategies in your answer: ● assault and homicide ● gang-related violence ● hate crimes ● school violence ● workplace violence

23. Close contact with families leads to family identification with the program and appreciation of teacher efforts (T/F)

24. Young children who enter school with high self-esteem are unlikely to lose it when overly challenges with academic tasks or racial bias (T/F)

25. Children in the primary grades automatically are more difficult because of their increasing wish for independence (T/F)

27. Since academic learning is so important in the primary grades, teachers should strictly limit time spent in primary physical activity (T/F)

30. Collaborative teaching means one teacher plans the lesson and gathers the materials and the other teacher teaches the lesson (T/F)

31.Themes should be addressed once per year (T/F)

35.Themes should last about one week each (T/F)

39. Teachers should give reasons for why some behaviors are acceptable and others are not every time they talk to children about behaviors (T/F)

Select the type of prevention the following activity/action best represents. Washing your hands often:

Select the type of prevention the following activity/action best represents. Thyroid screening test in a 50 year old woman at her annual exam.

Select the type of prevention the following activity/action best represents. Insulin injections used daily in a person diagnosed with diabetes:

Question 1: Describe 3 different strategies for data collection and give examples for each type of assessment or data collection. 

Question 2: Describe the difference between independent, dependent and collaborative nursing interventions. Give an example of one of each type. 

Hospital President Jose Vasquez, in a virtual online call with journalists, a recording of which was reviewed by Forbes, said the hospital has been given extra personnel from the state and federal governments but still has insufficient resources, and is “establishing an ethics committee as well as a triage committee that is going to be in charge of reviewing each one of these cases that need hospitalization.” He said if a patient, particularly someone with a significant underlying medical condition, needs “mechanical ventilation to survive we have to start making a triage evaluation and [determine] who has a better chance to use, in a beneficial way, all of the resources versus who is a patient that because of chronic medical illness does not have the chance to survive.” Vasquez said some badly ill Covid-19 patients have been transferred to hospitals outside of the county, and in some cases outside of the state, a pattern he said is not sustainable and could lead to “those patients who most certainly do not have any hope of improving going ...thousands of miles away dying alone in a hospital.” Answer the following: Based on this situation if you were Jose Vasquez – what would you do? What options are available that may alleviate the situation? In Chapter 8 we learned about life and death issues, would any of those help in this situation? If so, which ones and how would they help?