CLINICAL SCENARIO:

Mr A.G. is a 76-year -old widower being seen in your outpatient clinic for a medication refill for his Parkinson’s disease. He is a retired railroad engineer who derives great pleasures from collecting railroad memorabilia and taking walks with his dog around the vicinity of his neighborhood. Mr. A.G. was diagnosed with moderate (Stage III) Parkinson’s Disease 2 years ago. He does not smoke tobacco nor drink alcohol. His PMH includes a femur fx at age 22, a cholecystectomy at age 47, and a transurethral resection of the prostate (TURP) at age 72.

Activity

1. List six things that you would assess to determine whether Mr. A.G.’s care can be managed in his home and explain. How might Mr. A.G. PMH affects his symptoms?

What are the most important organizations that work on global health issues? What functions do these organizations play? Why is it important that different actors cooperate to address global health concerns?

What are some of the future challenges that demand continued or strengthened collaboration in global public health?

St. Paul University Dumaguete

College of Nursing

NCM 107 – Intrapartum

Name : __________________________________Year Level & Section______________

1. Which of the following best defines the intrapartum period?

A. Time from complete cervical dilatation through delivery of the newborn.

B. Period from the onset of contractions through complete cervical dilation.

C. Period from the onset of contractions to the first 1 to 4 hours after delivery.

D. Time from the 28th week of gestation through 28 days after birth of the newborn.

2. Very Preterm birth are babies born alive at :

A. less than 28 weeks

B. 28 to 32 weeks

C. 32 to 37 weeks

D. 38 weeks

3. Pressure on the cervix stimulates nerve plexus causing release of oxytocin by maternal posterior pituitary gland. This is known as:

A. McRobert’s Maneuver

B. Crede’s prophylaxis

C. Ferguson’s Reflex

D. None of the above

4. Which of the following is true of the theory of labor:

A. An increase in progesterone allows estrogen to stimulate the contractile response of the uterus.

B. A decrease in progesterone allows estrogen to stimulate the contractile response of the uterus.

C. A decrease in estrogen allows progesterone to stimulate the contractile response of the uterus.

D. An increase in estrogen allows progesterone to stimulate the contractile response of the uterus.

5. Which of the following statement is true of the possible causes of the onset of labor. Select all that apply:

A. Uterine muscles stretch cause the release of prostaglandin.

B. Prostaglandin and oxytocin works together to activate contractions.

C. Placental aging triggers initiation of contractions.

D. Rising fetal cortisol levels increases progesterone formation and initiates contraction.

6. The true signs of labor includes the following except:

A. Rupture of membrane

B. Uterine contractions

C. Show

D. Lightening

7. The woman will experience an irregular contractions and is termed as _______ which will become stronger, longer and more frequent when labor is neat at hand,

A. True labor

B. Braxton Hick’s contractions

C. Chadwick’s

D. Goodell’s sign

8. Early morning, the woman experienced a leaking bag of water. Which of the following statement of the woman that is incorrect and need health teaching? Select all that apply.

A. “Sexual intercourse should be avoided.”

B. “I can still walk in the house and do household chores.”

C. “I will go to the hospital by tomorrow.”

D. None of the above.

9. Which of the following factors affecting labor is associated with the passageway?

A. Size of the head and its ability to mold to the maternal pelvis.

B. The presentation of the fetus in relation to the maternal pelvis,

C. The structure of the maternal pelvis.

D. The frequency, duration and strength of uterine contractions.

10. A typical female pelvis with rounded inlet:

A. Android

B. Anthropoid

C. Gynecoid

D. Platypelloid

11. The part of the fetus body which has the widest diameter:

A. Abdomen

B. Legs

C. Head

D. All of the above

12. Immediately, before expulsion, which of the following cardinal movement occur?

A. Descent

B. Flexion

C. Extension

D. External rotation

13. This refers to the relationship between the long axis of the fetal body and the long axis of the woman’s body.

A. Fetal attitude

B. Fetal lie

C. Longitudinal lie

D. Transverse lie

14. The hips are flexed but the knees are extended to rest on the chest. The buttocks alone present to the cervix. This statement describes:

A. Complete breech

B. Frank breech

C. Single footling breech

D. Double footling breech

15. During pelvic examination, a diamond shaped of the fontanelle has been palpated. The fontanelle palpated is the:

A. Anterior fontanelle

B. Posterior fontanelle

C. Anteroposterior fontanelle

D. Occiput fontanelle

16. The triangular shaped fontanelle usually closes when the infant is:

A. 2 months of age

B. 6 months of age

C. 12 months of age

D. 1 year and 6 months

17. When describing fetal position, the first letter of the series denotes which of the following?

A. Presenting part of the fetus

B. Side of the maternal pelvis

C. Size of the maternal pelvis

D. Type of fetal delivery

18. The labor and delivery nurse performs Leopold’s maneuvers. A soft round mass is

felt in the fundal region. A flat object is noted on the left and small objects are

noted on the right of the uterus. A hard round mass is noted above the symphysis.

Which of the following positions is consistent with these findings?

A. Left occipital anterior (LOA)

B. Left sacral posterior (LSP)

C. Right mentum anterior (RMA)

D. Right sacral posterior (RSP)

19. The fetus assumes this position during labor: the spinal column is bowed forward, the head is flexed forward that the chin touches the sternum, the arms are flexed and folded on the chest, the thigh are flexed onto the abdomen and the calves are pressed against the posterior aspect of the thigh. This indicates that:

A. The fetus has good flexion.

B. The fetus has moderate flexion.

C. The fetus is in partial extension.

D. The fetus is in complete extension.

20. While performing Leopold’s maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the following is a reasonable conclusion by the nurse?5

A. The fetal position is transverse.

B. The fetal presentation is vertex.

C. The fetal lie is vertical.

D. The fetal attitude is flexed.

21. The nurse is assessing the fetal station during a vaginal examination. Which of the

following structures should the nurse palpate?

A. Sacral promontory

B. Ischial spines

C. Cervix

D. Symphysis pubis

22. When performing Leopold’s maneuvers, the nurse notes that the fetus is in the left occiput anterior position. Where should the nurse place a fetoscope best to hear the fetal heart beat?

A. Left upper quadrant.

B. Right upper quadrant.

C. Left lower quadrant.

D. Right lower quadrant.

23. A woman has just arrived at the labor and delivery suite. In order to report the

client’s status to her primary health care practitioner, which of the following assessments should the nurse perform? Select all that apply.

A. Fetal heart rate.

B. Contraction pattern.

C. Contraction stress test.

D. Vital signs.

E. Biophysical profile.

24. A nurse is teaching a class of pregnant couples the most therapeutic breathing technique for the latent phase of labor. Which of the following techniques did the nurse teach?

A. Alternately panting and blowing.

B. Rapid, deep breathing.

C. Grunting and pushing with contractions.

D. Slow chest breathing

25. The nurse auscultates a fetal heart rate of 150 on a client in early labor. Which of the following actions by the nurse is appropriate?

A. Inform the mother that the rate is normal.

B. Reassess in 5 minutes to verify the results.

C. Immediately report the rate to the health care practitioner.

D. Place the client on her left side and apply oxygen by face mask.

26. The nurse documents in a laboring woman’s chart that the fetal heart is being “assessed via intermittent auscultation.” To be consistent with this statement, the nurse, using a Doppler electrode, should assess the fetal heart at which of the following times?

A. After every contraction.

B. For 10 minutes every half hour.

C. Periodically during the peak of contractions.

D. For 1 minute immediately after contractions

27. While evaluating the fetal heart monitor tracing on a client in labor, the nurse notes that there are fetal heart decelerations present. Which of the following assessments must the nurse make at this time?

A. The relationship between the decelerations and the labor contractions.

B. The maternal blood pressure.

C. The gestational age of the fetus.

D. The placement of the fetal heart electrode in relation to the fetal position.

28. An obstetrician is performing an amniotomy on a gravid woman in transition. Which of the following assessments must the nurse make immediately following the procedure?

A. Maternal blood pressure.

B. Maternal pulse.

C. Fetal heart rate.

D. Fetal fibronectin level.

29. The fundal height of the woman is 30 cm and the fetus is engaged. What is the estimated fetal weight?

A. 2790 grams

B. 2945 grams

C. 3000 grams

D. 3100 grams

30. A patient is in transition phase. How frequently should you check or assess the perineum?

A. Every 5 minutes

B. Every 15 minutes

C. Every 30 minutes

D. Every 60 minutes

11. The part of the fetus body which has the widest diameter:
A. Abdomen
B. Legs
C. Head
D. All of the above

12. Immediately, before expulsion, which of the following cardinal movement occur?
A. Descent
B. Flexion
C. Extension
D. External rotation

13. This refers to the relationship between the long axis of the fetal body and the long axis of the woman’s body.
A. Fetal attitude
B. Fetal lie
C. Longitudinal lie
D. Transverse lie

14. The hips are flexed but the knees are extended to rest on the chest. The buttocks alone present to the cervix. This statement describes:
A. Complete breech
B. Frank breech
C. Single footling breech
D. Double footling breech

15. During pelvic examination, a diamond shaped of the fontanelle has been palpated. The fontanelle palpated is the:
A. Anterior fontanelle
B. Posterior fontanelle
C. Anteroposterior fontanelle
D. Occiput fontanelle

16. The triangular shaped fontanelle usually closes when the infant is:
A. 2 months of age
B. 6 months of age
C. 12 months of age
D. 1 year and 6 months

17. When describing fetal position, the first letter of the series denotes which of the following?
A. Presenting part of the fetus
B. Side of the maternal pelvis
C. Size of the maternal pelvis
D. Type of fetal delivery

18. The labor and delivery nurse performs Leopold’s maneuvers. A soft round mass is
felt in the fundal region. A flat object is noted on the left and small objects are
noted on the right of the uterus. A hard round mass is noted above the symphysis.
Which of the following positions is consistent with these findings?
A. Left occipital anterior (LOA)
B. Left sacral posterior (LSP)
C. Right mentum anterior (RMA)
D. Right sacral posterior (RSP)

19. The fetus assumes this position during labor: the spinal column is bowed forward, the head is flexed forward that the chin touches the sternum, the arms are flexed and folded on the chest, the thigh are flexed onto the abdomen and the calves are pressed against the posterior aspect of the thigh. This indicates that:
A. The fetus has good flexion.
B. The fetus has moderate flexion.
C. The fetus is in partial extension.
D. The fetus is in complete extension.

20. While performing Leopold’s maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the following is a reasonable conclusion by the nurse?5
A. The fetal position is transverse.
B. The fetal presentation is vertex.
C. The fetal lie is vertical.
D. The fetal attitude is flexed.

MANY PEOPLE WHO READ ABOUT THE TUSKEGEE STUDY ONLY NOTICE THE RACE OF THE STUDY SUBJECT. ARE THERE LEGAL AND ETHICAL CONSIDERATIONHERE THAT APPLY TOANY GROUP OF POTENTIAL RESEARCH PARTICIPANTS? DO YOU THINK THE TUSKEGEE EVENT COULD OCCUR TODAY? WHY OR WHY NOT.

What’s the point of college? Do you think college does anything more than just give you a degree that your employer uses to prove that you can stick to something? Does it teach you anything useful? (About life, love, ethics, values, problem solving, communicating with others, etc.) Will you use the knowledge you gain from individual classes?

A 48-year-old man is referred for management of elevated cholesterol. He has history of obesity, hypertension, and hyperlipidemia. He had a non–ST-segment elevation myocardial infarction one year ago with drug-eluting stent placement in his right coronary artery. His current medications include aspirin 81 mg daily, lisinopril 20 mg daily, and metoprolol XL 50 mg daily. His physical exam is notable for a body mass index (BMI) of 32 kg/m2 but is otherwise unremarkable. His blood pressure is 135/85 mm Hg.

A recent lipid panel shows the following:
• Total Cholesterol: 226 mg/dL
• Triglycerides: 154 mg/dL
• High-Density Lipoprotein Cholesterol (HDL-C): 39 mg/dL
• Friedewald-Estimated Low-Density Lipoprotein Cholesterol (LDL-C): 156 mg/dL
• He has a normal creatinine and normal liver enzymes.
• His TSH and vitamin D levels are within normal limits.

He was advised to lose weight and referred to a weight loss counselor. He also started rosuvastatin 20 mg daily but developed severe aching in his thighs and calves’ muscles. He discontinued the medication with resolution of his aches. Then, he started atorvastatin 20 mg daily but again developed aching in his thighs. Similar aches occurred on a red yeast rice/CoQ10 combination and intermittent dosing of simvastatin 20 mg weekly and rosuvastatin 5 mg weekly. His creatine kinase levels were never elevated during his episodes of muscle aches. He is not willing to try any more statin therapy.

Questions:
1. What food will be highly recommended to the patient? Explain by citing its implications to the human body.

2. What other antihyperlipidemic drug would you recommend to the patient who refuses to take statin as his medication drug? Why?

Red Yoder Introductory Monologue Script

I understand you want to hear my story; well I’m not much for talking, but I can give you the highlights. There’s a lot that’s happened over my 80 years.
From the top. My name is Sherman Yoder, but I answer to “Red.” No one around here even remembers my real name. I was born in this house in the downstairs bedroom. Mom had already delivered six kids and there was no way I was waiting for Dad to finish feeding the hogs and get Mom to town before I come out. Mom used to love to tell that story.

Dad bought this farmhouse and the first hundred acres right before he went off to WWI. The folks saw good times and bad in this ol’ place and so have I. All my brothers and sisters left the land as soon as they could. I was the only one of the lot to care about this place and want to carry on what Dad started. I really haven’t gone far from this spot in my entire life. The one time I got it in my head to try something different; I wound up in Korea with an Army uniform on. I was glad to get back to this place after that stint and here I’ve been ever since.

Married the neighbor girl Bessie when I got back. Her dad wasn’t so sure that it would work out since she was 8 years younger than me and she intended to go off to the state college. We sure did prove him wrong; we celebrated our 50th anniversary the week before Bessie died. The ladies at the church had the hall all decorated up and we brought Bessie home from the hospital for the afternoon. She was bound and determined to live for that day; no way did she want her friends to go to that much work for her to not show up. I couldn’t believe it when the ladies had to prepare for the reception after we buried Bessie in that same hall one week later. We had such a good life together. That was 10 years ago.

I don’t do much of the farm work anymore. Our son Jon takes care of the crops and the few animals we have. I still go out to the hen house every morning to collect the eggs. I’m a little stiff in the morning, but I get loosened up enough to walk out to gather some fresh eggs to go with my bacon for breakfast. I get in to town at least once a week; on Monday morning me and my buddies meet at the VFW for our coffee and donut break. I get caught up on all the town gossip and we laugh and bellyache about what’s going on in the world.

Three weeks ago I celebrated my 80th birthday. My daughter in law, Judy, organized a big “to do” at the church after the Sunday service with cake and ice cream and all the fixins’ for my party. I had a big piece of cake but skipped the ice cream. Doc Baker was there and I knew he would scold me about too much sugar. Six months ago he told me I had diabetes and I started taking a pill for it, but a few weeks ago he put me on insulin. I figure I should be able to eat what I want; come on, I’m not going to live forever, and it was my favorite cake, German chocolate. I ate it in the kitchen so the Doc wouldn’t see me; wouldn’t you know, his office nurse Helen came in the kitchen with a load of dishes just as I was putting the last bite in my mouth. She just winked at me and smiled.

After the party I went out to the mall with Jon and the grandkids. I’m not one for shopping much, but I needed a new ink cartridge for my printer and the computer store is the one place I like to look around in. Too bad we parked clear on the other end of the mall so the kids could go by their favorite stores for Grandpa to buy them a little something. Jon got real mad at me when I asked if I could sit and rest for a while, so I just kept walking. I guess my new shoes were a little tight; I didn’t feel anything but when I got home there was some blood on my sock, and then I saw a sore on my big toe. It must not be too bad since it’s not hurting except when I try to put my shoes on.

I showed the sore to Jon and Judy the other day and Judy said she would call the doctor to see what she should put on it. Jon gets so irritated when I need extra help; I hope I can just continue to soak my foot in hot water to clean it out. Judy was a nursing assistant out at the old folk’s home for many years; I’m hoping she will be able to help me with this. I like the idea of the home nurses coming out here as long as my VA benefits pay for it. That way they can see that I’m doing just fine living here on my own.

I was searching on the Internet for the best way to treat this sore; there are so many sites that talk about foot sores if you’re a diabetic. Some of those pictures are pretty scary; I can’t sleep at night thinking about what could happen if this doesn’t heal. Of course I haven’t slept through the night for years. Even the couple of beers I have at night when I’m on the computer don’t seem to be helping anymore. Judy sometimes gives the kids Benadryl to help them sleep so I’ve been taking a couple when I go to bed; they seem to help me sleep a little better.

As a matter of fact, I need to wrap this up now. I promised Jack, my grandson in college, that I’d Skype him in a few minutes. He just started the agronomy program at the university. I love to hear about what he’s learning and give him encouragement to come back to the farm.

Questions:

1. What are Red's strengths?

2. What are your concerns for this patient?

3. What is the cause of your concern?

4. What information do you need?

5. What are you going to do about it?  

6. What is Red experiencing?

Ethico-Legal Considerations in the Care of Older Adults

1. What is the republic act of senior citizen in the Philippines? Explain in detailed.

2. What are the rights of senior citizen in the Philippines set-up?

3. How can you help the older adult to alleviate depression?

4. What are the signs that death is near?

Determine the quantity of sodium chloride that is required to make the following prescription isotonic.

Rx Apomorphine Hydrpchloride...................1%

Sodium chloride..................................q.s

Purified water ad.................................100 mL

Make isoton. sol. Tf 1% of Apomorphine Hydrpchloride= 0.08 C

Choose a disorder of the Immune System and a drug therapy to treat it. Detail the drug, side effects, drug-drug interactions, food-drug interactions, and any teaching needed for the patient.

PLEASE BE DESCRIPTIVE AND ANSWER EVERY QUESTION. PLEASE CITE YOUR SOURCE

Write a latter holiday to the people that are in nursing home.

Tell them what the world is like today?

What they are missing with COVID?

Wishing we could see them?

How the holidays are going to be different this year?

Answer all the questions and do not make it super short use lots of details.

George Palo is a 90-year-old male who has been diagnosed with early stage dementia. George's wife Anna died two years ago and he moved into a small one-bedroom apartment in a retirement community, independent living setting. George has five children, but only his oldest daughter Maggie lives nearby. George has been relatively healthy over his long life with the exception of high blood pressure which is controlled with medication. He is very independent and loves to be outdoors, walking his golden retriever, Max. Maggie and her siblings are trying to support their dad's independence as long as possible, but are cognizant of his age and concerned about his overall safety.

1. Discuss the clinical manifestations evidenced during your assessment. How would you explain these manifestations?

2. Explain the nursing management considerations for this patient. Discuss the knowledge guiding your thinking.