In "a beatiful mind film", what are John Nash’s priority problems and appropriate nursing diagnosis to address these problems? What nursing actions should you take to address the client’s priority nursing diagnosis?
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Patient S is a white woman, 43 years of age, and mother of three small children. She has a long-standing history of significant obesity with little success in dieting over the years. At 5'3", she is obese, weighing 220 pounds. Her fat distribution is "apple-shaped" and consequently, her waist-hip ratio is more than the 0.8 normal range. In addition, Patient S lives a fairly sedentary lifestyle and does not have a regular exercise program. Her dietary habits do not take into account basic recommendations for cardiac nutrition.
Patient S has a previous history of MI 1 year ago. Today she presents to the ER with complaints of chest pain and nausea. Her ECG is unremarkable, she has an elevated troponin with ongoing intermittent left side chest pain that she describes as "sharp and intermittent".
She reports that she did not comply to the cardiac rehab program post cardiac event 1 year ago stating, "I have been lethargic and unmotivated since then". The patient goes on to tell you that she has been unable to return to work due to ongoing symptoms of depression. Patient S is not seeing a psychiatrist in the community. She is not taking any medication currently. She reports her symptoms of depression that surfaced following her MI have been persistent but have not worsened over time.
What is the priority nursing intervention at this point?
1. |
Using interview or standardized measurement tools identify psychological distress |
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2. |
Call Mrs. M's daughters and demand they stay with Mrs M at all times despite her declining their offer |
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3. |
Refer Mrs M. to a psychiatrist for further assessment |
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4. |
Assess Mrs. M's return to work capacity |
In: Nursing
Patient S is a white woman, 43 years of age, and mother of three small children. She has a long-standing history of significant obesity with little success in dieting over the years. At 5'3", she is obese, weighing 220 pounds. Her fat distribution is "apple-shaped" and consequently, her waist-hip ratio is more than the 0.8 normal range. In addition, Patient S lives a fairly sedentary lifestyle and does not have a regular exercise program. Her dietary habits do not take into account basic recommendations for cardiac nutrition.
Patient S has a previous history of MI 1 year ago. Today she presents to the ER with complaints of chest pain and nausea. Her ECG is unremarkable, she has an elevated troponin with ongoing intermittent left side chest pain that she describes as "sharp and intermittent".
She reports that she did not comply to the cardiac rehab program post cardiac event 1 year ago stating, "I have been lethargic and unmotivated since then". The patient goes on to tell you that she has been unable to return to work due to ongoing symptoms of depression. Patient S is not seeing a psychiatrist in the community. She is not taking any medication currently. She reports her symptoms of depression that surfaced following her MI have been persistent but have not worsened over time.
What is the priority nursing intervention at this point?
Although patient S did not fully commit to the cardiac rehab program in the past what is one nursing intervention that may assist her currently?
1. |
Offer individual and small group education and counseling regarding adjustment to heart disease |
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2. |
Suggest she get more exercise in on a daily basis |
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3. |
Encourage Mrs. M to return to work |
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4. |
Teach Mrs M. how to assess her blood pressure and heart rate at home |
1 points
QUESTION 3
Cardiac rehab includes education, exercise and counseling for both patients whom have had a cardiac event and those at risk. Which category does this patient fall into?
1. |
None of the cardiac categories |
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Lower-risk following an acute cardiac event |
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3. |
No prior event but unfavorable risk profile |
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4. |
Patient with stable heart failure Cardiac rehab is contraindicated for patients
2 points QUESTION 5 Identify the priority cardiac risk factor in this case study.
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Mrs. S is learning about how to exercise cardiac event. Which of the following statements is accurate?
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Exercise post cardiac event should commence once the patient is discharged home |
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2. |
An exercise schedule will be prescribed based on the cardiac event. |
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3. |
The exercise a patient is prescribed is largely based on their previous level of activity |
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4. |
Exercise is not recommended for at least 1 month post bypass surgery. |
1 points
QUESTION 7
What are the two forms of exercise tests performed in patients following an acute cardiac event?
1. |
Walking and running test |
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2. |
Pace and Trace test |
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3. |
Submaximal and symptom-limited exercise testing |
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4. |
Stress test |
What is the best definition of functional capacity?
1. |
Maximum ability of the heart and lungs to deliver oxygen and the ability of the muscles to extract it. |
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2. |
The patients ability to exercise on a regular basis |
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3. |
The patients ability to complete prescribed exercise without assistance |
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4. |
The patients capacity to reduce overall cardiac risk |
1 points
QUESTION 9
What is the definition of Myocardial Ischemia?
1. |
A cardiac event involving an area of the myocardium |
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2. |
A heart attack |
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3. |
A cardiac event that may limit a patients exertional capacity by causing limiting angina, dyspnea, or fatigue. |
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4. |
Chest pain not yet diagnosed What is the purpose of risk stratifcation?
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Nursing education is adopting e-learning and simulation experiences for the students. Two junior-level nursing students, Gene and Linda, are discussing the merits of this type of nursing-focused learning.
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Question?
How would a public health nurse participate in building healthy public policy for identified nutrition issues for young children aged (0-6years) and their breastfeeding parents in early year schools? (e.g., support development of healthy policies or practices in community placement).
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Discuss the role of having a detailed timeline in place when implementing a new plan into an organization. How often should the implementation plan be revisited? Will ongoing changes occur during an implementation? How could you plan for unforeseen changes?
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1. A patient's order for IV fluid states that NS is to be infused. Which of the following fluids should be given? A. 0.9% Sodium Chloride B. 0.45% Sodium Chloride C. 0.225% Sodium Chloride D. 5% Dextrose 2. A patient's order for IV fluid states the D5W is to infused. Which of the following IV fluids should be given? A. 5% Dextrose with Normal Saline B. 5% Dextrose with Lactated Ringer's Solution C. 5% Dextrose with 0.45% Sodium Chloride D. 5% Dextrose 3. What complications are associated with the administration of IV fluids?
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Topic Religion
Instructions Essay should include: • Introduction and explain the impact of religion to the elderly care , two(2) pages
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Nurses have direct interaction with the community so nurses can promote and educate people about the importance of living healthy and choosing a healthy lifestyle is very important.
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Read the narrative below describing a scenario that occurred in a hospital Emergency Room. Identify at least 4 incidents/problems that occurred in the narrative. Explain why and how you think they are incidents/problems. Then, offer suggestions on how to solve each incident/problem.
James is an ER triage nurse at Trillium Health Partners in Mississauga, Ontario. On Monday, April 24th, 2020, James reported working as usual at 7:00am. On this particular, he was working with his RN colleague Melissa, who had to take a double shift because Richard (the RN who typically works Mondays) was ill. At roughly 8:30am, a patient by the name of Charles Becker entered the ER, grasping his right shoulder. He approached James’ desk.
“Hi there,” remarked Charles, who was seemingly in pain.
“Hi. What brings you to the ER?” asked James.
Charles explained that he was involved in an accident at home whereby he fell from his porch and landed on his shoulder, which he thinks is now dislocated or broken.
“Ok, let me take your temperature and blood pressure,” said James, preparing the instruments.
“Nurse, can I please have some Tylenol or something. It really hurts,” inquired Charles.
“I will go double-check with the doctor,” assured James. “No fever, so that’s good. Your blood pressure will show in a second”
Just then, Melissa joins them in the room, hunting intently for her eyeglasses that she left there earlier.
“Hey Melissa,” says James, “do me a favour and record Charles’ blood pressure. I have to quickly ask the doctor something.”
Rushed, Melissa notes 133/88. It actually read, 188/98. Normal blood pressure is roughly 120/80. She then remembers leaving her glasses in the bathroom when she washed her face.
“Hey Doctor Fleming,” says James. “Quick question for you. There’s a-“
“Mr. James,” Doctor Fleming interrupts, “do you not see that I am reading an MRI report? As a nurse, you should recognize the importance of not distracting us physicians when doing important duties such as these.”
James is furious and embarrassed at the same time. He remains silent and begins to walk away.
“Wait,” Doctor Fleming remarks. “What is it now that you are here?”
“An ER patient is requesting medication for pain. Looks like he dislocated his shoulder. Can I give him anything in the meantime?”
“Acetaminophen is fine James,” responded the doctor. “I am going to go speak with the radiologist upstairs for a minute. I’ll be back in a few.”
James returned to the triage area. He gave Charles two extra-strength Tylenol caplets and a bottle of water. Charles returned to the waiting room.
After 15 minutes, Melissa calls out, “Charles, you are next.” Charles rises from his chair and quickly collapses to the ground. He begins to violently seizure.
Melissa runs towards Charles, calling out “James, get over here please.” James joins Melissa with some medical instruments to attempt to settle Charles.
“What the hell happened?” James claims, as he straps the blood pressure machine cuff on Charles. “195/125! He is in hypertensive crisis! How can this be? Melissa, what was his bp earlier?”
Melissa responds, “I don’t remember exactly, but something stable like 130/85. Wait, let me just check the machine’s memory data.” 188/98.
“If it was that high to begin with, then… oh no… the Tylenol! Acetaminophen will increase blood pressure,” James stated with fear in his voice. James and Melissa knew that Charles needed medication to quickly lower his blood pressure before any organ damage began.
“Okay, I’ll get Doctor Fleming in the back,” Melissa remarked.
“He’s not there. He went upstairs to radiology. We don’t have time Melissa. Just get the clonidine and captopril now!” yelled James.
Melissa stuttered, “B-b-b-but James… we can’t. You know that… I mean, look what just happened because we didn’t double-check.”
Just then, Doctor Fleming turned the corner from the elevator exit. He ordered the administration of clonidine and captopril. Charles came out of the seizure and was immediately admitted for continued care.
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