a. Alice Jacobs, 48 year old African American female with BMI=30. ½ ppd smoker. Initial blood pressure: 180/76

1. Describe the assessment and diagnosis of hypertension. Prioritize at least three main interventions for hypertensive clients?
2. Create a 24 hour diet recall for your patient. Analyze diet according to calories, proteins, fats, carbohydrates. Now create a diet to promote normotension in your patient.
3. Create an exercise profile for your patient. Discuss current activity. Now prescribe an exercise program designed to promote normotension in your patient
4. Create a medication profile for your patient. Identify at least one antihypertensive to help promote normotension. Discuss why your chosen medication would be appropriate for your specific patient.

Not more than ten sentences,Discuss the influence of family on developing a lifestyle.

How does management in nursing practice differ from management in general?

What tasks are common to both leadership and management.

What are the major leadership styles? Which style is optimal to use in which situation?

1. Not more than ten sentences, discuss the influence of family on developing a lifestyle.

2.Not more than ten sentences, discuss cultural influences across the lifespan and in health and illness

1. Mrs. Abby has a chronic wound that is contaminated. The tissues surrounding the wound have not been further damaged and the healing of the patient’s wound is not impaired. How should you approach caring for this patient and her wound?

A. The patient should receive advanced wound care and systemic antibiotics to prevent infection.

B. The patient should receive local wound care. Silver dressings should be used to address the contamination within the wound to prevent progression to overt infection.

C. The patient should receive local wound care. Wound cleansing with an antiseptic is indicated to address wound contamination.

D. The patient should receive local wound care. Vigilance is required but treatment of the contamination is not warranted.

2. Mr. Green has a large wound that had been healing appropriately. Yesterday, Mr. Green began to complain of new pain. At today’s assessment, you note an increase in purulent exudate, pocketing, and bridging. Based on these findings, the patient’s wound care plan should focus on managing/treating:

A. Wound colonization

B. Localized wound infection

C. Spreading wound infection

D. Systemic wound infection

3. Proper technique for performing a wound culture includes:

A. Cleansing the wound and applying antibiotic cream prior to swabbing

B. Swabbing the area with the largest collection of exudate

C. Culturing the site beneath crusts, which have been removed

D. All of the above

E. None of the above

4. You are part of the multidisciplinary team caring for Mrs. Wiley, a diabetic patient with a non-healing wound that has become infected with a biofilm. Which of the following is most likely to be the planned course of treatment for the patient’s infection?

A. Topical antimicrobials and wound management

B. Systemic antimicrobials and wound management

C. Regular debridement, antimicrobials, and wound management

D. Wound management, antimicrobials, and negative pressure wound therapy

Explain how the compensatory mechanisms for heart failure work to maintain cardiac function. What occurs if these mechanisms begin to fail?

How can mislabeling subjective and objective claims negatively impact the quality of a person’s thinking. You might try thinking of claims you could hear in a hospital or another work-related environment. If a person has confused objective with subjective or fact with opinion, what is the solution?

Evidence-based public health, according to Brownson, may include (partial credit):

Conducting sound program evaluations

Relying solely on expert advice and scientific data.

Consideration of contextual challenges and opportunities for implementing public health practice

Giving value to one's own personal experience

Considering data gathered from key informants in the community.

Hypertension

E.W. is a 40-year-old African American male, who has had difficulty controlling his HTN lately.

He is visiting his primary care provider for a thorough physical examination and to renew a

prescription to continue his blood pressure medication.

PMH

• Chronic sinus infections

• Hypertension for approximately 11 years

• Pneumonia 6 years ago that resolved with antibiotic therapy

• One major episode of major depressive illness caused by the suicide of his wife of 15 years,

5 years ago

• No surgeries

FH

• Father died at age 49 from AMI; had HTN

• Mother has DM and HTN

• Brother died at age 20 from complications of CF

• Two younger sisters are A&W

SH

The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal

aunt. He has not spoken with his son for four years. The patient is an air traffic controller

at the local airport. He smoked cigarettes for approximately 10 years but stopped

smoking when he was diagnosed with HTN. He drinks “several beers every evening to relax”

and does not pay particular attention to the sodium, fat, or carbohydrate content of the

foods that he eats. He admits to “salting almost everything he eats, sometimes even before

tasting it.” He denies ever having dieted. He takes an occasional walk but has no regular

daily exercise program.

Patient Case Question 1. Identify six risk factors for hypertension in this patient’s

history.

Meds

• Hydrochlorothiazide 50 mg po QD

• Pseudoephedrine hydrochloride 60 mg po q6h PRN

• Beclomethasone dipropionate 1 spray into each nostril q6h PRN

Patient Case Question 2. Why is the patient taking hydrochlorothiazide and what is the

primary pharmacologic mechanism of action of the drug?

Patient Case Question 3. Why is the patient taking pseudoephedrine hydrochloride and

what is the primary pharmacologic mechanism of action of the drug?

Patient Case Question 4. Why is the patient taking beclomethasone dipropionate and

what is the primary pharmacologic mechanism of action of the drug?

All

Rash with penicillin use

ROS

• States that his overall health has been fair to good during the past 12 months

• Weight has increased by approximately 20 pounds during the last year

• Denies chest pain, shortness of breath at rest, headaches, nocturia, nosebleeds, and

hemoptysis

• Reports some shortness of breath with activity, especially when climbing stairs, and that

breathing difficulties are getting worse

• Denies any nausea, vomiting, diarrhea, or blood in the stool

• Self-treats occasional right knee pain with OTC extra-strength acetaminophen

• Denies any genitourinary symptoms

Patient Case Question 5. What is the most clinically significant information related to

HTN in this review of systems?

Physical E xam and Lab Tests

Gen

The patient is an obese black man in no apparent distress. He appears to be his stated age.

Patient Case Table 5.1 Vital Signs

Average BP 155/96 mm Hg (sitting) Ht 5!11"

HR 73 and regular Wt 221 lb

RR 15 and unlabored BMI 31.0

T 98.8°F

Vital Signs

See Patient Case Table 5.1

Patient Case Question 6. Identify the two most clinically significant vital signs relative

to this patient’s HTN.

HEENT

• TMs intact and clear throughout

• No nasal drainage

• No exudates or erythema in oropharynx

• PERRLA, pupil diameter 3.0 mm bilaterally

• Sclera without icterus

• EOMI

• Funduscopy reveals mild arteriolar narrowing with no nicking, hemorrhages, exudates, or

papilledema

Patient Case Question 7. What is the significance of the HEENT examination?

Neck

• Supple without masses or bruits

• Thyroid normal

• (#) lymphadenopathy

Lungs

• Mild basilar crackles bilaterally

• No wheezes

Heart

• RRR

• Prominent S3 sound

• No murmurs or rubs

Patient Case Question 8. Which abnormalities in the heart and lung examinations may

be related and why might these clinical signs be related?

Abd

• Soft and ND

• NT with no guarding or rebound

• No masses, bruits, or organomegaly

• Normal BS

Rectal/GU

• Normal size prostate without nodules or asymmetry

• Heme (#) stool

• Normal p e n i s and testes

Ext

• No CCE

• Limited ROM right knee

Neuro

• No sensory or motor abnormalities

• CNs II–XII intact

• Negative Babinski

• DTRs $ 2%

• Muscle tone $ 5/5 throughout

Patient Case Question 9. Are there any abnormal neurologic findings and, if so, might

they be caused by HTN?

Laboratory Blood Test Results

See Patient Case Table 5.2

Patient Case Table 5.2 Laboratory Blood Test Results

Na 139 meq/L RBC 5.9 million/mm3 Mg 2.4 mg/dL

K 3.9 meq/L WBC 7,100/mm3 PO4 3.9 mg/dL

Cl 102 meq/L AST 29 IU/L Uric acid 7.3 mg/dL

HCO3 27 meq/L ALT 43 IU/L Glu, fasting 110 mg/dL

BUN 17 mg/dL Alk phos 123 IU/L T. cholesterol 275 mg/dL

Cr 1.0 mg/dL GGT 119 IU/L HDL 31 mg/dL

Hb 16.9 g/dL T. bilirubin 0.9 mg/dL LDL 179 mg/dL

Hct 48% T. protein 6.0 g/dL Trig 290 mg/dL

Plt 235,000/mm3 Ca 9.3 mg/dL PSA 1.3 ng/mL

Patient Case Question 10. Why might this patient’s GGT be abnormal?

Patient Case Question 11. Identify three other clinically significant lab tests above.

Patient Case Table 5.3 Urinalysis

Appearance Clear and amber in color Microalbuminuria (%)

SG 1.017 RBC 0/hpf

pH 5.3 WBC 0/hpf

Protein (#) Bacteria (#)

Urinalysis

See Patient Case Table 5.3

Patient Case Question 12. What is the clinical significance of the single abnormal

urinalysis finding?

ECG

Increased QRS voltage suggestive of LVH

ECHO

Moderate LVH with EF $ 46%

Patient Case Question 13. What is the likely pathophysiologic mechanism for LVH

in this patient?

Patient Case Question 14. What does the patient’s EF suggest?

1. What nursing care should be provided for the patient as she arrives on the
   medical-surgical unit?

explain why religion and spirituality are important in health care. Provide at least one example from your readings where you have seen how religion and spirituality have been helpful in health care.