Reason for Consultation:   High-risk pregnancy with late-term bleeding.

History of Present Illness:   Patient is a 23-year-old female. She is currently estimated to be at 175 days of gestation. She has had a 23-lb weight gain with this pregnancy. Amniocenteses at 20 weeks indicated male fetus with no evidence of genetic or developmental disorders. She noticed a moderate degree of vaginal bleeding this morning but denies any cramping or pelvic pain. She immediately saw her obstetrician who referred her for high-risk evaluation.

Past Medical History:   This patient is multigravida but nullipara with three early miscarriages without obvious cause. She was diagnosed with cancer of the left ovary four years ago. It was treated with a left oophorectomy and chemotherapy. She continues to undergo full-body CT scan every six months, and there has been no evidence of metastasis since that time. Menarche was at age 13, and her menstrual history is significant for menorrhagia resulting in chronic anemia.

Results of Physical Exam:   Patient appears well nourished and abdominal girth appears consistent with length of gestation. She is understandably quite anxious regarding the sudden spotting. Pelvic ultrasound indicates placenta previa with placenta almost completely overlying cervix. However, there is no evidence of abruption placentae at this time. Fetal size estimate is consistent with 25 weeks of gestation. The fetus is turned head down, and the umbilical cord is not around the neck. The fetal heart tones are strong with a rate of 130 beats/minute. There is no evidence of cervical effacement or dilation at this time.

Recommendations:   Fetus appears to be developing well and in no distress at this time. The placenta appears to be well attached on ultrasound, but the bleeding is cause for concern. With the extremely low position of the placenta, this patient is at very high risk for abruption placentae when cervix begins effacement and dilation. She may require early delivery by cesarean section at that time. She will definitely require C-section at onset of labor. At this time, recommend bed rest with bathroom privileges. She is to return every other day for two weeks and every day after that for evaluation of cervix and fetal condition. She is to call immediately if she notes any further bleeding or change in activity level of the fetus.

1.   Describe in your own words the treatment this patient received for her ovarian cancer.

2.   Describe this patient’s menstrual history.

3.   This patient has placenta previa. What procedure discovered this condition?

4.   Define each medical term presented in bold type in the patient’s consultation report.

A 47-year-old male patient, who is a house painter and whom you haven't seen in several years, presents

with chronic fatigue and mild chest pain frequently relieved by taking a break from painting. He's

married to a 47-year-old woman with multiple sclerosis and has two married children and one

grandchild living nearby. He also complains of frequent eructation, flatulence, and indigestion after

eating. He was told (when he weighed 30 lbs. less than he does now) that he could control his

hyperlipidemia by diet.

CC: "I'm always tired, and I have this annoying chest pain when I climb a ladder."

Past medical history: Anxiety, cholecystectomy, vasectomy

Vital signs: Blood pressure (BP): 146/88; height, 6 ft; weight, 242 lbs.

Lab results: TC 230; LDL 180; HDL 32

• What additional subjective data do you think the patient will share?
• What additional objective data will you be assessing for?
• What National Guidelines are appropriate to consider?
• What tests will you order?
• Will you be looking for a consult?
• What are the top 3 differential diagnoses and why? What is your final diagnosis? Give rationale.
• Are there any legal/ethical considerations in treating this patient
• What is your plan of care?
• Are there any Healthy People 2020 objectives that you should consider?

rom the health record of a patient undergoing foot surgery in the outpatient surgical unit:
Indication for Procedure: The patient is a 60-year-old female who has a persistently
ingrowing great toenail on the left foot that has had two past infections. The infection
is now clear and the patient presents for wedge resection of the toenail. She also
has pernicious anemia, Friedreich's ataxia, and heart disease. Because of these
conditions, a digital block will be used for the procedure.
Procedure: Wedge resection of toenail
Procedure Description: The patient is placed in the supine position, with the knees
flexed, and the left foot is flat on the table. The toe is prepped and cleansed. A standard
digit block is performed with 1 percent lidocaine using a 10-ml syringe and a 30-gauge
needle. Approximately 3 ml is instilled on each side of the toe.
After waiting 10 minutes, a sterilized rubber band is placed around the base of the toe.
The toe is resterilized and draped with the toe protruding. A nail elevator is slid under
the cuticle to separate the nail plate from the overlying proximal nail fold, The lateral
one fourth of the nail plate is identified as the site for the partial lateral nail removal.
A bandage scissors is used to cut from the distal end of the nail straight back beneath
the proximal nail fold. A straight, smooth, new lateral edge to the nail plate is created.
The lateral piece of nail is grasped with a hemostat and removed in one piece, pulling
straight out.

ICD-10-CM and CPT Code(s):

J.R. is a new registered dietitian nutritionist whose responsibilities at the medical center frequently involve nutrition interviewing, counseling, and community education. Many of her clients are from cultural and ethnic groups other than her own. They are mainly from UAE, India and Philippines. She is finding it somewhat overwhelming to understand the variety of unfamiliar foods that they eat. This also inhibits her ability to provide appropriate food alternatives as she counsels them on modifying their diets. She wants to increase her effectiveness as a counselor.

1- What cultural diversity information would be beneficial for J.R.?

2-What resources can you suggest for J.R.to assist in her counseling? Where would she find these resources?

3- What activities can J.R. plan in the community to educate these diverse groups?

4. What advice would you give to J.R. to make her efforts successful?

When considering your assessments, EXPLAIN HOW BURNS can affect fluid, electrolyte, and acid-base balances.

You are to complete a concise memo (1/2-1 page) where you explain what a nursing director is and what they do for your research paper. Use proper memo format Hint Microsoft office has numerous templates Explain your topic and at the end of your memo write a one-sentence thesis statement

1. Discuss the Penicillins in relation to effectiveness, safety, spectrum of antibacterial activity, mechanism of action, indications for use, administration, observation of patient response, and teaching of patients?

1. Describe characteristics of beta-lactamase inhibitor drugs.

Discuss the physiologic effects of corticosteroids and the pros and cons?

Case Scenario: A one-year old child is brought into the clinic for a high fever (greater than 101.4) chills, and a cough lasting five days. The child is lethargic, not eating or drinking. The mother states there was a flu bug in the home, so she thought the symptoms would be resolved but became concerned when the child was so lethargic that he would not eat or drink.

Question: What effect does age have on someone experiencing the same symptoms as the child?

Ciprofloxacin Injection:

a. comments and additional medication info

b. The therapeutic effect of the medication

c. The action of the medication

d. Side effect or Adverse reactions of the medication

e. The recommended dose ranges

f. Contraindication of the medication

g. Life-threatening considerations

h. nursing intervention

PLEASE DO NOT COPY AND PASTE