A 42-year-old patient with history of ulcerative colitis (UC) and anemia, went to the ED. While at the emergency room, he complaints of abdominal pain/swelling alongside blood in her stool which is watery which has been going on for some days now. Vital signs are (BP) of 90/56, heart rate (HR) 115 bpm, respiratory rate (RR) of 32, temperature of 101.9°F, oxygen saturation (O2 sat.) of 98% on room air, and a pain of 8/10 (using the verbal numeric pain scale) located in his left lower abdominal quadrant that is sharp, constant, and aggravated by movement. He states, “my stomach hurts so much I can barely take the pain”. he claims that he has been taking extra-strength Advil (ibuprofen 400mg) for the pain. His vitals were reassessed after 20 minutes showing a decrease in BP to 85/47, HR 130, RR 29, oral temperature of 101.9°C, O2 sat. 96%, and pain still at 9/10.

QUESTION

1. Which areas of our nursing assessment should we closely monitor and what are we looking for?
2. What are the major concerns with toxic megacolon related to bowel perforation?
3. What other possible diagnoses should be considered and ruled out?
4. What are the primary nursing diagnosis for this patient?

You are the nurse assigned to this group of patients. There are 2 RN’s (one is you: the charge nurse and a staff member, plus another RN), and you have an LPN and 2 nursing assistants. Plan your day/ evening. What is the priority for each patient and what tasks/ skills can be delegated to the LPN, the aid ant the other RN for each patient? Pt #1 Jennifer Hoffman

33-year-old female present to the Emergency Department. Has a history of asthma, with several ED visits in the last year. Presents anxious, coughing and chest tightness Peak Flow levels are decreasing Tracheostomy tube placed during last admission 3 months ago Vitals RR: 30 BP 138/84 HR: 92 Sat 89% RA Albuterol 2.5 mg/ 2.5 ml via trach Solumedrol 100 mg IV available 125 mg/2ml NSS 80 ml/hr Epi Pen prn Trach care q shift

Pt#3 Skyler Hanson 18 –year- old male in diabetic ketoacidosis three days ago. Transferred to the medical surgical floor after being in the ICU for three days. He had been on an Insulin drip and received IV hydration. RR: 18 BP 118/74 HR:78 Sat 99% RA D5W 150 ml/hr NPH insulin 22 units SQ Novalog Insulin 6 units SQ 1800 ADA diet Urine for ketones NKA Blood Glucose 650

Pt#4 Doris Bowman Patient is a 39-year-old who underwent a total abdominal hysterectomy with bilateral salpingoopherectomy. Tolerated the procedure well. Postoperative day 2. She has an abdominal incision covered with a 4x4 gauze dressing. Foley draining 200 ml clear yellow output. Arrives back from x-ray unresponsive. RR: 12 BP 124/84 HR: 92 Sat 88% RA LR 125 ml/hr Morphine Sulfate 2 mg IVP for pain Ondansetron hydrochloride (Zofran) 4 mg IVP Naloxone hydrochloride (Narcan) 0.4 mg/ml IVP PRN for sedation WNL

Pt #5 William Edwards A 65-year-old male with a history of HTN, CAD and NIDDM. Smokes a pack of cigarettes a day. He presented to the emergency department around 10 am after waking up around 7am with right sided weakness. Upon arrival he has slurred speech and right upper extremity flaccid. You are taking over care. RR: 36 BP: 180/90 HR: 95 Sat 88% RA NSS 75 ml/hr Labetalol 5 mg IVP Aspirin 325 mg CT scan r/o bleed HOB elevated 30 degrees WNL

Pt # 6 Liling Sung A 62-year-old who presented to the emergency department after her AICD fired 6 times in the past two hours. She has been stabilized in the emergency room. Transferred to the medical floor. The AICD was placed 2 years ago, after she went into ventricular tachycardia resulting in cardiac arrest RR: 16 BP: 109/58 HR: 110 Sat 100% 2L NSS 100 ml/hr Diazepam (Valium) 5 mg/IV prn Morphine Sulfate 2 mg IV prn Propranolol 25 mg PO WNL

Pt# 7 Charles Jones 68- Year –old male with a history of congestive heart failure, admitted to the intensive care unit from his family physician office after developing severe dyspnea, orthopnea, bilateral lower edema and 10 pound weight gain. Rales are noted in the posterior lobes bilaterally. O2 4 L NC History of hypertension, atrial fib and hyperlipidemia RR: 24 BP: 96/44 HR: 102 Sat 93% 4L Nesiritide (Natrecor) IV bolus 2 mcg/kg Nesiritide (Natrecor) IV maintenance 0.01 mcq/kg/min Lasix 80 mg IV BUN Creatine BNP Electrolytes

Pt#8 Tony Wallace 24-year-old male with sickle cell anemia with severe pain every 2-3 weeks. He presented to the emergency department 3 days ago with acute pain in left arm and left leg. He is receiving IV hydration and pain medication without control. RR: 18 BP: 116/72 HR: 82 Sat 97% Temp 97.8 NSS 120 ml/hr Morphine PCA 2 mg/hour

Pt #9 Bobby Davis 28-year-old presents to the emergency department 45 minutes ago with severe right sided flank pain. Smokes 1 pack of cigarettes a day. Pain has been intermittent for the past 2 day. Started vomiting earlier this morning. Was lifting weights earlier in the day thought he pulled a muscle when he heard something pop. RR: 18 BP: 148/88 HR: 90 Sat 100% Temp 98.8 NSS 125 ml/hr Morphine Sulfate 2 mg q hour Promethazine hydrochloride (Phenergan) 25 mg IVP Toradol 30 mg IV 32 French Chest tube to 20 CM suction Restart IV

Pt #10 Ruth Living ston 80-year-old female who fell at home. Presents with external rotation of the right leg. Fixation tomorrow RR: 20 BP: 150/76 HR: 88 Sat 96% RA Temp 98.9 NSS 75 ml/hr Morphine Sulfate 2 -4mg q hour Zofran 4 mg Place foley cath Pre Op

Pt # 11 Dale Mayman 51-year-old with known liver disease secondary to alcoholic cirrhosis admitted with increased confusion, Increased ammonia levels ETOH level elevated RR: 22 BP: 130/83 HR: 88 Sat 97% RA Temp 98.7 Lactulose 30 ml/day Haldol 5 mg IM for agitation Ativan protocol ETOH 350 Ammonia 200mcq/dl

Pt 12 Geraldine Yost 88 –year-old pt presents to the medical surgical floor as a direct admission from the nursing home. Pt is lethargic. Has received the first cycle of antibiotic in the ED. RR: 26 BP: 90/62 HR: 118 Sat 90% RA Temp 102.4 NSS 500 ml/hr Zyvox (linezolid) 600 mg q 12 hours Azitromycin (Zithromax) 750 mg IV Vancomycin 1g IV Tylenol 650mg via peg tube WBC 30

For the following case studies, develop a progression of transfer activities appropriate for progressing a patient from dependent to independent (as much as feasible) transfer status. Note transfer activity methods, amount, and type of assistance.

1. The patient is an 18-year-old male who sustained a complete T12–L1 spinal cord lesion in a motorcycle accident 2 weeks ago. Following surgery, he is wearing a thoraco-lumbar-sacral orthosis (TLSO). He has medical clearance to begin transfer activity training while wearing his TLSO.

2. The patient is a 23-year-old female with cerebral palsy presenting with spastic quadriplegia. While living with her parents, her father lifted her for all transfer activities. Following her recent college graduation, she is living in a group home for the first time. She ambulates by using a power wheelchair. The staff of the group home requests assistance in selecting appropriate transfer activities. The staff would like a program to assist her in becoming an active participant in her transfer activities. Would the transfer activity method selected be different if she was 5 feet tall weighing 250 pounds, versus 5 feet tall weighing 96 pounds?

when you see dark red bleeding and few clots in the catheter after TURP. what should the nurse do first

As a nurse, discuss the importance of these:

1)Assessment—gather information or data about the individual, family, or community.

2)Analysis and identification of the problem

3)Prioritizing Nursing Diagnoses

4)Selecting Interventions and Planning Care

5)Documentation

how does orems theory relate to labor & delivery, intrapartum care of a patient

Todd is a 44-year-old electrical engineer who works 50–60 hours per week. He is 5’9”, 233 pounds, with total cholesterol of 192 mg · dL–1, low-density lipoprotein (LDL) of 138 mg · dL–1, high-density lipoprotein (HDL) of 41 mg · dL–1, triglycerides of 200 mg · dL and blood glucose of 120 mg dL. Todd’s resting heart rate is 81 bpm and blood pressure is 144/86 mmHg. His waist and hip circumference measures are 42 inches and 40 inches, respectively.

Todd has never smoked, but usually has one to two glasses of wine with dinner. He reports no leisure-time physical activity and does not exercise on a regular basis (less than two sessions per month).

Todd denies all complaints of chest discomfort and shortness of breath at rest or with exertion; however, he has gained 20 pounds over the last 2 years. Todd’s wife reports he snores frequently and has difficulty waking up in the mornings. Further testing reveals that Todd has obstructive sleep apnea and is being treated with continuous positive airway pressure (CPAP).

A review of his family history reveals that Todd’s father had double-bypass surgery at age 53 and suffered a fatal myocardial infarction at age 62. Todd’s brother (42 years old) also is hypertensive and was recently diagnosed with type 2 diabetes, which is being treated with diet and physical activity recommendations.

Questions:

Known CV, metabolic or renal disease?

Absolute or relative contraindications to exercise testing?

Signs or symptoms suggestive of disease?

Moderate or vigorous intensity? Why?

Medical clearance needed? Why or why not?

Should they get medical clearance before progressing to higher intensities? Why or why not?

ACSM CVD Risk Factors? How many?

One day, an employee was coding an inpatient record at City Hospital. The physician's documentation was not

clear on a high acuity patient; therefore, the employee needed to query the physician for clarification. The employee knew

the answer to her question and was tempted to bypass querying the provider and just code the patient's

record based on what she knew. She was tired of all the querying!

1. Should the employee query the provider?

2. Is it acceptable for the employee to code the patient record since she knew the answer, and didn't want to

bother with the query?

3. What repercussions might there be if she doesn't query and the medical record doesn't support her

coding logic?

A 45-year-old female with a past medical history of Type II Diabetes Mellitus (last hemoglobin A1c of 12, currently on intensive insulin therapy), tobacco abuse (approximately 2 packs/day for the last 15 years), and thyroid cancer (anaplastic carcinoma, status post total thyroidectomy) presents to her family nurse practitioner with complaints of a sore throat, cough productive of thick sputum which appears “green,” and subjective fevers and chills (though her temperature has never been above 98.5 degrees Fahrenheit).

She states that her symptoms have been present for 1 week now and that they have gotten worse with time. She initially thought that she had a “head cold” since she gets them around this time of the year (summer) often, and she notes that she attended a family gathering at which she was exposed to a sick individual (her niece who has a strong history of Bruton’s X-linked agammaglobulinemia). Her cough, in particular, has been bothersome, as for the past few days, she has expectorated so much mucus that, per her own testimony, “she has run out of paper cups!”

Her vital signs were stable upon examination, but auscultation of the lungs did reveal significant crackles; a chest radiograph performed at the office was revealing of a right lower lobe pneumonia, and sputum cultures were revealing of Streptococcus Pneumoniae.

Please answer the following questions:

    Given the duration of her symptoms, what components of her immune system are most active at this time?

    What is the mechanism as to how her immune system develops antibodies for the specific pathogen in her sputum?

    What would be the difference between the way in which immunoglobulins will eradicate the pathogen versus the T cell receptor?

    How will her immune system (particularly the adaptive immune system) respond to a second infection with this particular Streptococcal species?

Module 10 Course Project - Final Submission

Prepare a two to three page written assignment that includes the following:

• Introduction to the assignment (sections of the assignment: caring, professional identity, and professional organizations/associations)
• Explain your belief of caring in nursing (self, nursing, environment, and profession)
• Describe your professional identity including your beliefs, values, motives, and experiences
• Discuss one to two professional organizations/associations you plan to be involved in during your nursing career
• Conclusion (reflect on the criteria of the assignment; caring, professional identity, and professional organizations/associations)
• Use at least two credible resources to support your findings. For example, one of the resources could be the website for a professional organization or association, and another resource could be a textbook. These resources must be integrated into the body of your paper using at least two in-text citations. Be sure to use proper APA format and style.

2. What type of health insurance do you have? Is it an HMO, a PPO, an ACO, or some hybrid form of MCO? Are you familiar with your deductible? What other details about your health insurance are important to you?  

Maria is a 21-year-old single mother. On the way to work, she drops off her 3-year-old daughter at a community day care center and picks her up on the way home. Because her income is low, Maria works at a second job from home in the evening and rarely goes out for social interaction. For the last several days, her daughter has been sick with influenza, so Maria has stayed awake throughout the night to care for her. One morning, while preparing her daughter’s breakfast, Maria realized that they had run out of milk and bread again. Maria sat down on the floor and began to cry

1. One of the effects of chronic stress is an impaired immune response. What are the physiologic mechanisms that will make Maria particularly prone to contracting her daughter’s illness?
2. Assuming the stressors are the same, how is it that someone might react differently than Maria? From what you know of her history, what are some factors affecting Maria’s ability to cope both physically and psychologically?
3. What are the signs and symptoms that would distinguish a person with posttraumatic stress disorder from an individual like Maria?

Discuss how disability insurance differs from workers compensation insurance.