Jorge Rios's family is without health insurance. He works two jobs, neither of which provides health insurance. Her earns a total income of slightly above the level which would make his eligible for Medicaid in his state. Jorge was born in the U.S., but his brother, who lives with the family, is undocumented. Jorge is now trying to pay off the bills for his brother's treatment when he was recently seen in the emergency department. How is the family affected by the issues in the U.S. health insurance systems and what are some of the options to obtain health care or health care insurance?

1. What is the most crucial step in venipuncture procedure? What must be done by the phlebotomist or Medical Technologist in order to avoid making an error for this step?
2. What are the complications encountered during blood draw and how will the phlebotomist should handle it properly?

1. Formulate a case-study on a patient with spinal cord injury at level C6.
2. Come up with five questions from the case study

1. List the sources of errors in hemoglobinometry.

2. Differentiate oxyhemoglobin, deoxygenated hemoglobin, carboxyhemoglobin and methemoglobin.

3. Give the clinical importance of hemoglobin determination.

1. Differentiate the shift to the left and shift to the right in differential WBC counting.

2. What are the common causes of neutrophilia?

3. List the common disease/s associated with increased monocytes, lymphocytes and basophil.

For lymphocytic Hodgkin and Non-Hodgkin Lymphoma, discuss the possible causes, types, mutations and the laboratory diagnosis of each type?

Case #1: Diabetes Insipidus Case Study

Case Scenario: BD is a 40-year-old Caucasian male brought to the ED following a head injury in a motorcycle accident.  BD was stabilized and sent to the ICU for observation.  On Day 3 in the ICU, BD’s vital signs and lab studies are reported to the day shift nurse as:

• B/P 84/54 P- 128 R-20 SaO2- 94% T- 99.2 (oral).
• Urine output for the past 24 hours: 8,050 ml.
• Na: 164 K: 3.2 Cl: 99

The night shift nurse reports that BD is more lethargic than last evening and has complaints of generalized weakness.  You begin your nursing assessment and note that he is pale and slightly confused.  BD is diagnosed with central diabetes insipidus.

1. Discuss the role of Antidiuretic hormone (ADH) in the development of diabetes insipidus.
2. Based on the report from the night nurse, what are your nursing priorities for BD?
3. Discuss the goals of management when treating diabetes insipidus. Include the nurse’s role.
4. Review the medication used in the treatment of diabetes insipidus. What medication should the nurse expect to see ordered in the treatment? What are the nursing implications while administering these drugs?

case study: A 46-year-old woman presented at the out-patient department with a vague history of persistent headaches, muscle weakness, tiredness, and loss of weight and energy. Clinical examination revealed a well-hydrated, thin, anxious, pale woman with a blood pressure of 150/95 mmHg, There was no specific signs or symptoms. She had four children and with the last , now aged six years, She had a “difficult birth” and developed a “kidney” infection. At the time of admission she was on antidepressant medication for an “anxiety-depressive” illness but she admitted to no other medication. The admission biochemical profile was

Plasma

Na​141​mmol/L​(132-144)

K​5.2​mmol/L​(3.2-4.8)

HCO3​18​mmol/L​(23-33)

Urea​14.5​mmol/L​(3.0-8.0)

Creat​0.28​mmol/L​(0.06-0.12)

Urine (24 hr)

Volume 2.6 L

Creat​5.1​mmol/L​

Na​67​mmol/L

Questions:

Q1. Explain the steps in which the specimen is collected, handled, and how the specimen is analyzed.   

Q2. Evaluate and explain the patient’s lab results.

Q3. Explain the lab tests and methods that you will carry out and use in order to diagnose the patient.

Q4. Explain how you would determine the acceptability of quality control test result data.

Q5. Discuss the importance of quality management on the laboratory operation during the various laboratory analytic phases.

Q 6. Illustrate and explain the critical pathways that you used to aid patient diagnosis.

Q 7. From the case study, explain how you would demonstrate ethical behavior, professionalism, and maintain patient confidentiality.

Asthma Case Study Assignment

9) Write (document) utilizing the information, medical history, vital signs, etc. presented on this case study BELOW, to communicate to other care providers who will also care for this same patient: [Hint: SBAR (Situation, Background, Assessment, Recommendation) and SOAP (Subjective, Objective, Assessment and Plan)

A) SBAR

B) SOAP

B) SOAP

History

Ms. B is a 19 year old competitive bronco rider seen in the emergency room because of shortness of breath. The dyspnea began during a particularly hard ride, which culminated in modest dust inhalation on the rodeo floor. She states that the tightness in her chest and shortness of breath were so severe that she had to eventually leave the rodeo and see medical help. She is now very uncomfortable, even at rest. During the past week she has had a cough productive of greenish yellow sputum, mild fever, malaise, and fatigue, but she did not feel seriously ill until the onset of dyspnea at the rodeo earlier in the day. She denies previous lung problems except for mild ‘wheezing’ in her chest, which has occurred off and on during the past several years. She denies the use of any prescription medications, or any previous episodes of dyspnea, chest pain, leg pain, hemoptysis, sinusitis, or allergies. Her family history is negative for lung disease.

Physical Examination

General: 19 year old, 66 inches tall, and 140 lbs. Patient alert but restless and in moderate respiratory distress, mildly diaphoretic, sitting up on the edge of the bed leaning forward with her arms braced on her knees; cough frequent and productive of small amounts of greenish sputum.

Vital Signs: Temperature 101.1 F, Respiratory Rate 38/min, Blood Pressure 170/95 mmHg, Heart Rate 140/min, Paradoxical Pulse 25mmHg.

HEENT: Sinuses not tender to palpation; nasal flaring with inspiration

Neck: Trachea midline and mobile to palpation; no stridor; carotid pulsations + + and symmetrical bilaterally with no bruit; no lymphadenopathy, thyroidomegaly, or jugular venous distention; sternocleidomastoid muscles tensed during inspiration.

Chest: Increased anteroposterior diameter with decreased expansion during breathing and mild abdominal paradox with respiratory efforts.

Lungs: Rapid respiratory rate with prolonged expiratory phase and polyphonic wheezing heard over entire chest during inhalation and exhalation.

Heart: Regular rhythm at 140/min; no murmurs, gallops, or rubs; point of maximum impulse in normal position.

Abdomen; Soft, nontender; bowel sounds present; no masses or organomegaly.

Extremities; No clubbing, cyanosis, or edema; pulses + + and symmetrical in all areas

Asthma Case Study Assignment

9) Write (document) utilizing the information, medical history, vital signs, etc. presented on this case study BELOW, to communicate to other care providers who will also care for this same patient: [Hint: SBAR (Situation, Background, Assessment, Recommendation) and SOAP (Subjective, Objective, Assessment and Plan)

A) SBAR

B) SOAP

B) SOAP

History

Ms. B is a 19 year old competitive bronco rider seen in the emergency room because of shortness of breath. The dyspnea began during a particularly hard ride, which culminated in modest dust inhalation on the rodeo floor. She states that the tightness in her chest and shortness of breath were so severe that she had to eventually leave the rodeo and see medical help. She is now very uncomfortable, even at rest. During the past week she has had a cough productive of greenish yellow sputum, mild fever, malaise, and fatigue, but she did not feel seriously ill until the onset of dyspnea at the rodeo earlier in the day. She denies previous lung problems except for mild ‘wheezing’ in her chest, which has occurred off and on during the past several years. She denies the use of any prescription medications, or any previous episodes of dyspnea, chest pain, leg pain, hemoptysis, sinusitis, or allergies. Her family history is negative for lung disease.

Physical Examination

General: 19 year old, 66 inches tall, and 140 lbs. Patient alert but restless and in moderate respiratory distress, mildly diaphoretic, sitting up on the edge of the bed leaning forward with her arms braced on her knees; cough frequent and productive of small amounts of greenish sputum.

Vital Signs: Temperature 101.1 F, Respiratory Rate 38/min, Blood Pressure 170/95 mmHg, Heart Rate 140/min, Paradoxical Pulse 25mmHg.

HEENT: Sinuses not tender to palpation; nasal flaring with inspiration

Neck: Trachea midline and mobile to palpation; no stridor; carotid pulsations + + and symmetrical bilaterally with no bruit; no lymphadenopathy, thyroidomegaly, or jugular venous distention; sternocleidomastoid muscles tensed during inspiration.

Chest: Increased anteroposterior diameter with decreased expansion during breathing and mild abdominal paradox with respiratory efforts.

Lungs: Rapid respiratory rate with prolonged expiratory phase and polyphonic wheezing heard over entire chest during inhalation and exhalation.

Heart: Regular rhythm at 140/min; no murmurs, gallops, or rubs; point of maximum impulse in normal position.

Abdomen; Soft, nontender; bowel sounds present; no masses or organomegaly.

Extremities; No clubbing, cyanosis, or edema; pulses + + and symmetrical in all areas

1. List and describe the life cycle stages of humans. Discuss the genetic, hormonal, and environmental factors influencing human growth and development. Describe the pattern of human brain growth. What is the importance of delayed brain growth in humans? What are pleiotropic genes and what do they help us to understand?