Mr. and Mrs. T. are naturalized Americans. They were born and raised in Japan and moved to the United States 20 years ago. Mrs. T. is 45 and teaches kindergarten. Mr. T. is 54 and runs an import store. Their son, Ritchie, 16 years old, was born in the United States. He is a sophomore in high school, where he plays baseball.

Mr. T. started having some chest pains 2 years ago and was diagnosed at the clinic with mild angina. He takes nitroglycerin (NTG) 0.3 mg SL when he feels any discomfort. His chest pain is usually exertion related. Lately, he has had to take the NTG more often. He has an appointment with the cardiologist next week.

The paramedics put an oxygen cannula on Mr. T. and start an IV in his left arm. They give him a baby aspirin to chew, contact the local hospital, and prepare Mr. T. for transport. Upon arrival in the ED, Mr. T.’s heart rate is 110 beats/min, and he is diaphoretic.

Mr. T. was quickly triaged in the ED with a preliminary diagnosis of acute inferior wall MI. The hospital is in a rural area, and the weather is severe. Ground transport to the nearest hospital able to do PCI is 2 hours. Therefore, a decision is made to administer thrombolytics. Within 1 hour, Mr. T. was started on reteplase.

One day after the thrombolytic therapy, Mr. T.’s cardiac rhythm suddenly dropped to 40 beats/min, and he became very dizzy and breathless.

One month after Mr. T.’s revascularization, he develops chest pain and visits the cardiologist. He is having T-wave changes in the anterior leads. He is referred to as the tertiary care center for additional testing. He undergoes cardiac catheterization and angiography, and a lesion of the left main coronary artery is found. He is scheduled for a CABG.

Mr. T. had the CABG. It was difficult to get Mr. T. weaned from the cardiopulmonary bypass machine. A decision was made to insert an Intra aortic balloon pump (IABP).

Mr. T. required the IABP for 24 hours, at which time it was weaned and removed. The remainder of his postoperative course was uneventful, and he was discharged home 6 days after surgery.

Answer the following questions:

Who has observed resuscitation efforts?

What observations were made?

What perceptions of care were noted?

Related to the case study in the cardiovascular lecture:

What nursing care was done prior to starting reteplase?

What is the nursing care associated with a patient receiving reteplase?

What complications must be assessed during and after the administration of the medication?

7.2. The following documentation is from the health record of a 34-year-old male patient.

Admission Diagnosis: Sickle cell pain crisis.

Discharge Diagnosis: Sickle cell pain crisis/Staph (Staphylococcus) aureus bacteremia.

Secondary Diagnosis: Sickle cell disease, priapism, chronic lower back pain secondary to sickle cell diagnosis, mild persistent asthma, gastroesophageal reflux disease (GERD), and grade 2 hemorrhoids.

Consults: None.

Procedures: PICC line placement, and transesophageal echocardiogram (heart and aorta).

Hospital Course: The patient is a 34-year-old African-American male with a history of sickle cell disease who presented with back pain and whole body pain, a remote history of some diarrhea and nausea, and some fevers and chills. Blood cultures taken on admission and during his first night as an inpatient grew four out of four bottles of S. aureus. The patient received 1 gm of ceftriaxone in the emergency department and received approximately six days of vancomycin IV as an inpatient. Thereafter he was switched to Ancef 1 gm IV q.8 hours.

To find a source for the patient’s Staph. bacteremia, a transesophageal echocardiogram was done which did not show evidence of any cardiac vegetations. Because the patient had Staph. bacteremia of unknown source, Infectious Disease was consulted. As per their recommendation, the patient is to be on five weeks of IV Ancef.

At the time of admission, the patient was placed on a PCA pump. He was rapidly weaned off this and he was also placed on some oxygen and was bolused with fluids and kept on maintenance fluids. The patient’s clinical status improved rapidly. He was soon weaned off the oxygen, fluids, and pain medications.

At the time of discharge, the patient is afebrile and stable. A PICC line was placed in order to ensure access for the next five weeks, during which he will receive his IV antibiotics. The PICC line was placed percutaneously into the superior vena cava. Home care and home IV teaching was arranged for the patient and his family.

Follow-Up: Hematology was contacted and follow-up will be arranged within the next two weeks. Follow-up will also be arranged with Infectious Disease in five weeks. Home medications include folate 1 mg p.o. q.d.; Flexeril 10 mg p.o. b.i.d.; Ancef 2 gm q.12 IV times five weeks; Phenergan 12.5 mg p.o. q.4 p.r.n. nausea; and Zantac 150 mg p.o. b.i.d. The patient was told to return for fevers, chills, sweats, nausea, vomiting, or bone or muscle pain.

Disposition is to home with home care.

Code Assignment Including POA Indicator

ICD-10-CM Principal Diagnosis:

ICD-10-CM Additional Diagnoses:

ICD-10-PCS Procedure Code(s): ___________________________________________

The code numbers are listed in the Alphabetic Index. why not code directly from it?

Appendix

Client education Type diabetes

How you educate client ?

How to tell

How to manage

1.What is the structure of a narrative? Mention and briefly explain
those components.

2. Summarize what a description consists of and what elements should be present in
it's the same.

1. 2011 Pediatric Nutrition Surveillance

The Pediatric Nutrition Surveillance System (PedNSS) is a child-based public health surveillance system that describes the nutritional status of low-income U.S. children who attend federally funded maternal and child health and nutrition programs. PedNSS provides data on the prevalence and trends of nutrition-related indicators. It uses existing data from the following public health programs for nutrition surveillance:

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC);

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program; and

Title V Maternal and Child Health Program (MCH).

Most of the data are from the WIC program that serves children up to age 5.

1. In New Mexico, information was collected on 15,139 children. Of these, 11,627 had been breastfed. What is the prevalence of breastfeeding in this sample?

2. Information was also collected for 1,915 infants on the Navajo Nation. The prevalence of being breastfed for at least six months was 37.1%. How many of these infants had been breastfed for six months?

3. Data on obesity for 3,480,880 children 2 – 5 years of age were also collected nationwide. In this sample, 501,247 were classified as obese using CDC growth charts. What is the prevalence of obesity in this group of children?

4. If data were available for all children 2 – 5 years of age throughout the United States not just those in these public health programs, do you think the prevalence of obesity would be different? Why or why not?

I. When assessing Susan on your shift she complains that her left calf is sore. You notice redness and swelling on her left calf.

 A. What do you think this is?

 B. What test will be ordered?

  C. What are some of the treatments that the Dr. will prescribe?

  D. Why are womwn prone to this in the postpartum period?

II. Sara is breastfeeding and is in for her 2 week check- up. She tells you she is "not feeling well and that her left breast is red and painful.

 A. What doe Sara have?

 B. what are some treatments for this?

 C. Can she continue to breastfeeed?

Differing Parenting Styles

Lisette and Joel are a couple in their 20s. They have a 2-week-old baby boy and have come in for a well-baby check of their healthy infant. Joel is carrying the infant with Lisette trailing behind. When the nurse inquires how things are going at home, Lisette becomes tearful and Joel looks away. As the nurse questions them further, it becomes evident that the couple differ in their perception of how the baby should be cared for. Lisette was raised in various foster homes after being taken from her abusive mother at age 3 and has no relatives who are involved in her life at the present time. Joel comes from a large, affectionate family who are thrilled with the new baby and visit frequently and while there take over care of the baby. Lisette has been feeling overwhelmed by the care of the infant and often just lets him cry in his crib. Joel and his family always pick up the baby immediately when he cries.

What can the nurse do to help this couple
What specific interventions may be helpful?
How can Joel’s family help?
What other resources are important for this family?

When we think of healthcare, what are your fears? Do you have any phobias? What are some challenges you think you will face with angry or aggressive clients?

which finding requires immediately intervention when planning care for an adolescent with cystic fibrosis?     a.poor weight gain.                                                                 b.chest pain with dypsnea.                                                     c.delayed puberty.                                                                    d.large,foul smelling, bulky stools

Order: Doxycycline 50 mg IVPB in D5W 100 mL over 1 hr

Drop factor: 15 gtt/mL

What is the rate in gtt/min?  ______________________________

Order: Erythromycin 200 mg in 250 mL D5W to infuse over 1 hr

Drop factor: 10 gtt/mL

What is the rate in gtt/min?  ______________________________

• Describe what a fluid and electrolyte imbalance is and how this is important to the function of the body?
• Pick a fluid or electrolyte imbalance and describe how the patient would present, in addition to the treatment (nursing and expected medical)?

You should include a minimum of 3 scholarly references