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.

Utilizing the ideas parts of your proposed design Proposal and other associated assignments, consider the following scenario: An academic researcher wants to conduct a study on the distribution of various medications over the past 10 years.

1. what steps are required before the researcher can obtain any data?

Development Goals & Environmental Health

In your opinion, what are the top three Sustainability Development Goals (SDGs) to be addressed in the next 15 years?

• Explain your rationale for your selections.

What are some of the measurement tools called and what do they do? EEG-

ERPS-

FMRI-

PET-

NIRS-

Development Goals & Environmental Health

What environmental health concern would you prioritize for your proximate community? Are those priorities different? Why or why not?

A leader's personal bias may impact their ability to manage conflict with an employee. Have you witnessed leader bias in your workplace? How did the leader's bias influence the outcome of the conflict? If you were the leader, how would you manage your own personal bias?

Active learning template nursing skill

Skill name oral care

Description of skill

indications

considerations nursing intervention ( pre, intra, post )

outcomes/ Ealuation

Client education

potential complication  

nursing intervention

how can you provide opportunities for a client to identify and express any issues or concerns? (250 words)

(Please answer for age care worker)

According to the State Board of Nursing in Louisiana, what is the Registered Nurses responsibility in treating a patient’s pain? – Cited references