Joyce Jones, age 45, was admitted to the emergency room following a major automobile accident in which her husband was killed. She had massive abdominal injuries and a fractured femur. She was taken immediately to surgery for repair of a lacerated liver and perforated ileum. She had two units of blood during surgery and two units while she was in the recovery room. The fifth unit of blood was discontinued in surgical intensive care because she developed a transfusion reaction.

   On the day after surgery, her urine output declined to 10-20 ml/hr. Increasing her fluid intake with plasma expanders and blood did not increase her urine output. Lab results indicated an elevated urinary sodium, BUN 70 mg/dl, and serum creatinine 4 mg/dl.

   Her urine output stabilized at 20-25 ml/hr on the third day after surgery. She was diagnosed as having acute tubular necrosis.

   Because of a persistently elevated serum potassium and severe hypertension (BP 190/120), she was started on hemodialysis using an external cannula. She resented all the “plumbing” in her body and expressed a desire to die.

Questions:

1. What clinical indicators that Joyce is in the oliguric phase of acute renal failure?
2. How could you assist Joyce in dealing with her depression?
3. What are the usual indications for using hemodialysis in the management of acute renal failure?    
4. What is the nursing care of the external cannula when not in use?
5. What is the goal of medical and nursing management of this patient?

Henry Baer, below, with his mother, Violet Cunningham. Baer, 39, died from an antibiotic-resistant staph infection after his bloodline had become disconnected during a dialysis treatment. (Photo courtesy of Karen Gable) Henry Baer went in for his third dialysis treatment on New Year's Eve day in 2005. It turned out to be his last. He was only 39, but years of diabetes and high blood pressure had caused Baer's kidneys to shut down. Built-up waste and fluid were causing his limbs to swell and making him short of breath. He was sent for what's called in-center hemodialysis, the most common type of dialysis, at a beige-toned clinic near his home in Prescott Valley, Ariz. His first two sessions were pretty normal. A patient-care technician hooked Baer to a machine the size of a filing cabinet, connecting it with plastic tubing to the catheter in his chest. He sat in a lounge chair, still as stone, for about four hours as the machine, whirring gently, moved his blood through a specialized filter, then returned it, cleansed of toxins. It was uncomfortable and boring. "Sis, this isn't for me," he told his older sister, Karen Gable, vowing to make himself a viable candidate for a kidney transplant. Just over two hours into his next session, Baer's incoming bloodline "became disconnected," a federal inspection report says. The attending technician panicked, "yelling and screaming hysterically." Blood sprayed onto Baer's shirt, pants, arms and hands. Then, "contrary to emergency standing orders," the report continued, she reconnected the line to Baer's catheter, infusing him with "potentially contaminated blood." By the time Mike Wright, Baer's boss at a local car dealership, picked Baer up after the treatment, he was complaining of nausea. Over the next two days, Baer spiked a fever. His wife found him in bed, having a convulsion. He was taken to the hospital, where tests later showed that his catheter had become infected with antibiotic-resistant staph. The infection moved swiftly to his heart and brain. He died a few days later, on Jan. 7, 2006, leaving behind a 2-month-old daughter.

Questions: 1. What is venous needle dislodgement (VND)?

2. What causes VND?

3. What are the consequences of VND?

4. What are the risk factors for VND?

5. How do you prevent VND?

In your own words please answer these questions.

What is cultural humility? Why is it important? How can you practice cultural humility in your individualized organizations?

1. What should provide the majority of calories during an infant’s first year of life?

2. MLO8 How, when, and in what order should solid food be introduced to infants?

3. MLO8 When should cow’s milk be introduced to infants or toddlers?

4. MLO8 What should infants not be allowed to consume?

1. What are four benefits associated with children who eat breakfast?

2. MLO9 What are five at risk nutrients for young children?

3. MLO9 How many times might a new food need to be offered to a child before it is accepted?

4. MLO9 What are three responsibilities of adults who are charged with feeding young children?

Your assignment is to develop a therapeutic relationship with a well elder in the community to learn about the aging process, and to develop skill and experience with the nursing process. This will be the foundation for assessing elderly individuals who are ill. You will assess the communication and safety needs of the well elder, and you will keep a self-reflective journal documenting your experience with the assessment process, and evaluating your use of the nursing process.

Create a proposed statistical analysis for the research proposal of "The benefits physical activity has on stress"

Which two Acts set legislative guidelines about how information should be collected, disclosed, used and stored and what do these Acts cover?

d) Do citizens have obligations toward health-care professionals who put themselves at risk to treat them during outbreaks of highly hazardous communicable diseases? If so, what are these obligations, and what are their limits? If not, why not? Provide justification for your reasoning and apply at least one ethical principle from the course to support your point. Describe the principle(s) as well as the answer that it would lead to in this case.

Description

Mr. Bryan is a 29-year-old married man who came to the medical office because, over the last three years, he has progressively increased the size of his shoes, and he has resized his wedding ring three times. He says his feet and hands have grown. He has also noticed that his face has turned coarse. He was a very active man and practiced sports, but now he fatigues just by walking, and feels weakness in his muscles and stiffness in his joints. He is depressed because in the last few months he has been experiencing erectile dysfunction, which is affecting his relationship with his wife. He feels he is losing his vision as well.

Mr. Bryan does not drink alcohol, smoke, or use any recreational drug. His mother suffers from diabetes mellitus type II, and his father suffers from hypertension.

On physical examination we found:

Remarkable Signs

• Head: Enlarged and coarsened facial features, prominent superciliary arches, prognathism
• Neck: Thyroid is visible and palpable
• Thorax: Barrel appearance
• Abdomen: Hepatomegaly. Splenomegaly.
• SOMA: Enlargement of the hands and feet. Generalized arthralgia.

Remarkable Signs

• Integumentary system: Thick and oily skin. Numerous acrochordon disseminated throughout the body.
• Cardiovascular system: Blood pressure 150/100. Radial pulse 72.
• Digestive system: Megaloglossia. Diastema.

provided, respond to the following questions:

1. The patient refers to muscle weakness. Mention some common muscular diseases, and explain them briefly, including their prognoses.
2. Is Mr. Bryan at risk of suffering from diabetes mellitus? Why? How many types of diabetes mellitus are there? What are the differences between them?

caring for you.list,mindmap,or draw activities that hel9 you to refuel and re energize

CASE STUDY 2:

Sammy is a newborn boy at 32 hours of life. His birth weight was 8 pounds. He was born via normal spontaneous vaginal birth at 40 weeks of gestation to a 26-year-old G1. There were no maternal prenatal issues. Labor and delivery were complicated by a prolonged second stage of labor, which eventually progressed to spontaneous birth. The Apgar scores were 6 and 8, and the infant was taken to the nursery for an observation period; he received IV fluids but did well and so was discharged to routine care in the mother’s room at 12 hours of life. Sammy was noted to have facial bruising and a cephalhematoma, which were attributed to the prolonged second stage of labor. All newborn blood work was normal. The group B strep culture was negative. Maternal blood type is A positive. Exclusive breastfeeding was initiated at 12 hours of life. On physical examination, Sammy has some jaundice evident on the chest and torso.

1. What risk factors does Sammy have for hyperbilirubinemia?

2. The pediatrician orders a bilirubin level, and the total serum bilirubin level is 7 mg/dL. A repeat level is ordered in 8 hours. Does this result indicate a dangerous level of hyperbilirubinemia?

3. What are the risks to the newborn with elevated bilirubin levels?

4. Sammy’s repeat total serum bilirubin was 5 mg/dL at 40 hours of life, and the pediatrician has given discharge orders for this evening when Sammy will be 48 hours old. What education is appropriate for Sammy’s parents at this time regarding jaundice?

NO PHOTOS PLEASE

In the Musculoskeletal System and Connective Tissue chapter of ICD-10-CM, what is the difference between a pathological fracture and a traumatic fracture? Give an example of a scenario for coding a pathological fracture. Along with your example, provide the ICD-10-CM code(s) that would be assigned for the scenario. Be sure to follow coding guidelines and instructional notes, and assign the appropriate 7th character if needed.

Create a discharge instructions sheet for a patient who is s/p TURP, include medications