Identify and describe 2 observable impairments of a person with an acquired brain injury

Jennifer is 72 years old and has been confined to bed while she recovers from a hip fracture. Why does her doctor say she is at risk for developing a bladder infection? Describe the correlation between Jennifer's condition and a possible bladder infection.

confidence, communication and team building are most important leadership improvement areas why?

1. How is Tuberculosis treated?

2. What is Cipro used to treat? What are the adverse effects? What are the contraindications? What are the medication interactions?

3. Which medication is the first choice in treating C-Difficile infection?

4. What are the adverse effects of amphoterocin B? What monitoring would need to be done while on this medication? How is an amphoterocin B infusion reaction treated?

Explain the connection between law, policy, and the public’s health using a concept map and narrative

1. What are some nursing concerns for the patient on protease inhibitors?

2. What medication is used to treat Syphilis?

3. What is the most important thing that healthcare workers can do to help reduce the spread of infection?

Discuss your roles and limits within your scope of practice guidelines.(PMHNP)Are therr any times that you may feel those boundaries are not well defined?

Write an analysis describing how the selected medication class relates to the selected systems disorder. (Medication: Meropenem and system disorder: Meningitis)

• 300 words minimum.

• A strong connection and correlation are made between the selected medication and disease process.

You are a staff nurse working in an intensive care unit and assigned to care for a 75-year-old man who had coronary artery bypass graft surgery 4 days ago. The patient has a history of chronic obstructive pulmonary disease exacerbated by heavy smoking. His postoperative course has been difficult, and he has suffered a number of setbacks. The staff, despite their diligent efforts, have not been able to wean him off the ventilator since the surgery. He has required frequent suctioning throughout the shift, and he is being evaluated for the development of ventilator-associated pneumonia. Today, when returning from lunch, you observed that an experienced nurse was suctioning your patient. His secretions were thick, and you observed that the nurse was instilling saline into the patient’s endotracheal tube as she was suctioning him. The patient turned red and began coughing, and it was obvious he was in distress. You asked the nurse why she was instilling saline into his endotracheal tube. She replied that this was being done to loosen the secretions. You told her this was no longer an acceptable practice. She stated that she had lots of critical care experience and she didn’t care what anyone said, that the only way you could loosen the patient’s secretions would be to instill saline. She also said that would be the last time she would do something for one of your patients while you were at lunch. Questions

1. What tenets of the ANA Code of Ethics for Nurses (2001) can be applied to this particular situation?

2. What would be your immediate response to the nurse in this situation? Provide a rationale. a. If you are the staff nurse originally assigned to care for the patient b. If you are the charge nurse c. If you are the supervisor or the nurse manager

3. Identify at least one potential source for pre-processed evidence such as a clinical guideline.

4. What strategies would you use to search for evidence related to best practices for suctioning and whether the instillation of saline while suctioning is an acceptable technique?

6. Identify a source for grading the level of evidence located.

7. What are potential barriers to the utilization of research findings in this setting? a. The research itself b. Clinician c. Organization d. Presentation

8. What are potential resources in your institution to help with the translation of research into practice?

9. Who are potential community partners to assist with addressing this clinical practice problem?

10. Assuming that you located evidence to support the position that instilling saline into an endotracheal tube is ineffective, what would be included in a plan to translate research into practice in the intensive care unit? In the rest of the hospital?

11. What strategies would you use to determine whether indeed nurses and other healthcare professionals are adhering to the recommended practices for endotracheal suctioning?

12. What would you do if you found contradictory evidence regarding the instillation of saline before endotracheal suctioning such as increased dyspnea with saline instillation, but lower rates of ventilator-associated pneumonia?

Name: Fahad B                                  Word: Medical                       Bed: ICU bed #9

Age: 57 years                                     Physician: Mona, Khaled (unit A)

Fahad is a fit and healthy consultant surgeon. He arrived by ambulance to the ER unconscious after having a seizure in his house after a long sentry duty in the same hospital.

His wife reported that he experienced incomprehensible symptoms in the last two months like continues headaches, strange feeling in his head, imperiled vision, difficulty to recall his patient and colleges names and general weakness specially in his hands. Fahad was known of his linguistic ability but these days he lost the right words.

Neurosurgeon did MRI and found a big malignant Grade I (brain tumor). They put him under surgery and sedate him after that in the ICU by using benzodiazepines, opioid narcotics and propofol for 5 days to help him recovery. In the ICU the medical team monitor him closely. The ICU dietitian decided to start enteral nutrition as soon as possible. So, a gastrointestinal tube was fixed immediately.

Diagnosis:                   Malignant Grade I

Medical plan:             Brain surgery to remove the tumor followed intubation and sedation for 5 days. Radiation therapy is planned to be after the assessment.

Medical history:         No medical history

Smoking:                    Heavy smoker 3 backet/day   

Medication:                None  

Family history:          Mother (Breast cancer and Diabetes)

Marital status:           Married with 2 kids

Physical examination:

Abdomen:      Normal                       

Chest/lungs: Clear   

Skin:               Soft, normal bowel sounds, no-tender           

Edema:           Brain edema around the skull

Stool:             No

Urine:             Normal

Edema:           -ve      

Vital signs:

BP:                  140/80

Pulse:              70

Temperature:                                                37.2 ^OC

Height:                                                182 cm

Usual weight:                                     82 kg

Last weight before surgery:             79kg

Current weight after surgery:         unknown

Biochemical lab test (after surgery):

24hours recall (usual menu before diagnosis with cancer):

Breakfast: 1 cup Americano + 1 protein bar

Snack: 1 orange juice
Lunch: 1 cup laban+ 1 cup rice + grilled meat or chicken of fish +Dagoos (tomato sauce) + green salad (olive oil + lemon dressing)

Snack: 300ml Arabic coffee + 5 Dates

Dinner: 1 cup low fat yogurt + protein chips

Questions: (100 points)

1. What is the metabolic response to critical illness in human body? (10 point)

2. Write a PES statement according to his nutrition statues. (9 point)

3. Determine Mr. Fahad energy and protein requirements consider his stress and activity level. (Use BMR) (13 point)

4. Mr.Fahad can’t consume food while he is intubated, if you have 4 options of nutritional formulas, which one you would use and why? (10 point)
   1. Nutrition dense like Jevity (energy 1.5 Kcal/ml- protein 15g/235ml)
   2. Standard like Ensure (energy 1 Kcal/ml – protein 9g/220ml)
   3. Immune enhancing like Impact (energy 1 Kcal/ml- protein 14 g/250ml)
   4. Diabetes formula like Glucerna (energy 1 Kcal/ml- 9.9g/237ml)

5. How many cans (250ml) you will give Fahad in the nasogastric tube in 24h? (6 point)

6. What is the flow rate you will set the electronic pump on, in the first 48hr after surgery? (6 points)

7. Mr.fahad is intubated after surgery, what are the signs you have monitor to check his gastrointestinal tolerance. If you suspect a low tolerance how would you check it in the ICU? (10 points)

8. Mr. Fahad is not diabatic, what is the reason for the high blood glucose level? (10 points)

9. Radiation therapy is prescribed to Mr. Fahad, it known by its gastrointestinal side effects, list the effect and chose two side effect and write how to minimize it effect on him. (12 point)

10. If Mr.Fahad faced problem in breathing after the surgery and he is connected to ventilator, and his maximum temperature was 38.3C and his ventilation recorded is 10L/min. calculate Mr.Fahad energy needs by using penne state equation. (6 point)

11. In the recent year’s formula companies added omega-3 fatty acids, arginine, glutamine and antioxidants to the formula to promote healing after surgery. discuss what are the benefits? (8 point)

Imagine that you are asked to create a dissemination plan for a health promotion program. You have just learned that most of the stakeholders that you planned to present to are leaving the country in two weeks and will be gone for the next six months, so you must present your findings to them before they leave. Originally, you had three months to prepare your dissemination plan. Do you think that the plan should be disseminated as it would be if there were no time constraints, or do you believe you should create your plan differently now that there is a tight deadline? Explain your answer.

The subject is Public Health

1. Name and explain the four defects in Tetralogy of Fallot?
2. What is a Tet spell? What nursing interventions can the nurse administer?
3. What are the characteristics of coarctation of the aorta?

• What is the pathophysiology of Kwashiorkor?
• Explain the manifestations of Kwashiorkor.
• What treatment and nursing care would be given, to a client with Kwashiorkor?

Powerpoint slides for COPD with the given case study by using CRC.

Ms Aaliyah Abimbola

Background information for the assignment.

You are the RN on a morning shift on the respiratory ward of a large inner-city hospital. At 10:30 AM you receive a patient from the Emergency Department.

This is the hand-over you receive.

Your initial assessment findings on the ward for Ms Abimbola are as follows:

Medications

Metoprolol 100mg daily, Aspirin 100mg daily, Atorvastatin 20mg mane, Glibenclamide (Daonil) 5mg orally daily before breakfast, Salbutamol sulphate (Ventolin) 100mcg inhaler as required for symptom relief (1-2 puffs as required), Fluticasone propionate/salmeterol xinafoate (Seretide) 50/25 inhaler (2 puffs BD)

Current vital observations:

BP 142/96mmHg

HR 96bpm

RR 24 bpm

SpO2 93% on RA

T 36.7C

Health assessment findings:

Height 158cm, Weight 93kg,

Total cholesterol level - 5.2mmol/L

Fasting BGL - 9.6mmol/L

Inspiratory and expiratory wheeze. speaking in short phrases taking 2-3 breaths between each phrase before continuing to speak.

Alert and orientated to time, place, and person.

Further information you gather from her medical history and as part of her admission questions:

Ms Aaliyah Abimbola is a 56 year old female who emigrated from Africa 20 years ago. Ms Abimbola is a single parent with three female children (ages 14, 17 and 18) living in the inner-west of Melbourne.

Ms Abimbola went to her local health care clinic 2 weeks ago complaining of increasing shortness of breath and lack of energy. She says she was given some breathing medication (inhalers) by the doctor and told to take it easy for a few days. She has been struggling to get from the ground floor living area to the upstairs bedrooms without resting half-way to catch her breath. She says sometimes the medication helps her catch her breath but she still has to rest half way even with the medication.

Ms Abimbola has been working at the local flour mill since she arrived in Melbourne from Africa 20 years ago. She has never smoked but says the dust at the flour mill often makes her cough. Her job for the first 3 years was filling bags with flour until that process became fully automated. She then got promoted to running one of the flour grinding machines. 2 years later she got another promotion to shift supervisor in the milling and packaging section. She says her clothes were always covered in white dust at the end of every shift. "I used to look like a ghost at the end on my shift. We all did!" The flour mill made it mandatory to wear a mask and other protective equipment when you're working in the factory about eight years ago. However, Ms Abimbola has been working in the office for the last 6 years and no-one wears protective equipment in the office as it's not necessary. She says there's always a fine layer of dust on the paperwork in the office because the 'flour just gets everywhere no matter how often you clean or how careful you are."

Ms Abimbola is currently averaging 50 hours/week which means she needs to work on most weekends. Since the Covid 19 lockdown the factory has increased production to 24 hours a day 7 days a week. That means the office is also extremely busy. Ms Abimbola has always accepted any overtime on offer to help pay the rent for their house and cover the school fees for the Catholic school her children attend. She is adamant that she wants them to get a good education so they can make the most of the opportunities she never had in Africa. She has always been socially active within her Church community, but due to her increased working hours this has restricted her ability to attend mass and contribute to her community. She states that she needs to “prioritise any free time I have so I can spend it with the kids, especially my oldest who is doing VCE this year”. She has two close friends at church who help with looking after her children when she has to work late or on weekends.

Ms Abimbola states that she tries to exercise when she has time and walks to the train station every day to get to work. It used to take 8 minutes each way but lately it takes at least 20 minutes including rest stops to catch her breath. She also does a lot of walking at the flour mill taking paperwork to the production supervisors and picking up reports for processing. However, she has had to ask one of the younger staff to get the reports and deliver the orders more and more over the last year or so as she get's too short of breath when she walks too far too quickly.

Ms Abimbola has not spoken to her husband since she and the children left him 6 years ago. She says he used to work at the flour mill but was sacked for being drunk at work eight years ago. He had a hard time finding work so drank heavily and became violent. She took the children and left him after he hit the middle child for spilling his coffee. She doesn't know where he lives and has had no contact with him for over 4 years.

Family history

Her father died from a stroke in 2005.

Question

• Management of COPD in relation to Ms. Abimbola.