R.B. is a 65-year-old female who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8˚ F, pulse 98, respirations 18, blood pressure 148/84, and O₂ saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO₂ 90, PO₂ 92%, HCO₃ 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with two stent placements into the left anterior descending artery. A pulmonary artery catheter was placed and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the ICU.

• 12 Lead ECG:ST elevation
• Troponin:41.94
• Lung V/Q scan negative for pulmonary embolis
• Urinalysis: Dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones

5.   You obtain a set of hemodynamic monitoring values. Interpret these results.

6. Describe each of R.B.'s ventilator settings and the rationale for the selection of each.

7. How does PEEP lower cardiac output?

8. R.B. is started on intravenous dobutamine and sodium nitroprusside. How will these medications affect her hemodynamic status?

Read the Chapter 8 Nutrition Debate, “Antioxidants: From Foods or Supplements?” answer the questions below and post your responses to the Week 4 Discussion Questions thread on Canvas: -With everything you’ve learned in this chapter, how do you plan to ensure that you regularly consume appropriate levels of antioxidants?

-If a friend or family member decided to take antioxidant supplements as “health insurance,” what advice might you give them about this decision?

-Go to your local drugstore and research various brands of vitamin C, vitamin E, and beta-carotene supplements, recording the amount of each nutrient in the recommended dose. Estimate if, and how much, the recommended dose exceeds the RDA for each nutrient and list some potential long-term outcomes of taking exceeding amounts of these supplements.

A 52 year old African American female presents to your clinic. She is complaining of weakness, numbness and tingling in her feet as well as an itchy rash to her groin area. She states she was diagnosed with "sugar diabetes" (Type 2 diabetes) 6 years ago but she did not follow up with the recommendations for care from her previous provider. She states she doesn't like to go to the doctor because her dad had "a lot of health problems. He was always in the doctors office and it brings up bad memories." Her father died at age 60 from chronic kidney disease.

Additional history:

• Numbness and weakness present for one month
• Rash has been intermittent for years. Worse in the warm weather
• States her eyes are "tired" in the evening which makes it difficult watch television
• She denies chest pain, shortness of breath, edema, change in bowel habits, skin ulcers, difficulty walking, syncope or seizure
• 1. How would you describe the similarities and differences between type 1 and type 2 diabetes to this patient?

• 2.You tell to your patient her current symptoms may be present due to her diagnosis of diabetes which is not being adequately managed. How would you explain to her that her diabetes is contributing to her visual complaints, rash, and numbness to extremities?

  3. What treatment recommendations would you make for this patient? Consider pharmacologic (you do not have to be specific with the doses) and nonpharmacologic interventions, lifestyle recommendations and referrals.

• 4.Please list at least two scholarly references utilized in this assignment:

WHAT IS THE IMPACT OF MALPRACTICE ON THE RELATIONSHIP BETWEEN PATIENT AND PROVIDER?​

Location: Skilled Nursing Home Care Facility 0800

Report from charge nurse:

Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday's labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

Recommendation: You should complete a basic assessment, review the labs, perform a wound assessment and dressing change, and then reposition the patient to optimize venous return. Please provide patient education on improving venous return to prevent further stasis ulcers, and continue compression therapy with the use of elastic bandage and an antiembolism stocking.

Josephine Morrow

Documentation Assignments

1. Document the findings of a focused skin assessment of Ms. Morrow, including any findings that identify the presence of chronic venous insufficiency.
2. Document any abnormal laboratory results that are associated with the presence or status of Ms. Morrow's stasis ulcer.
3. Record the results of Ms. Morrow's Braden Scale assessment.
4. Document the characteristics of Ms. Morrow's venous stasis ulcer.
5. Document the dressing change and irrigation of Ms. Morrow’s wound.
6. Record patient education on ways to promote venous return.
7. Prepare 3 Nursing Diagnosis and their defining characteristics for Ms. Morrow's diagnosis.

Nursing shortages are a source of feared for many health care administrators. Describe what the nursing workforce is like where you live. (Your state board of nursing website is a good place to gain information.) Next, discuss what aspects are leading to an overall nursing shortage, and what steps are being done to counteract this shortage.

Give the possible ABO groups for the children of the following matings. Give all possibilities.

Father group O, mother group O ______________________________________________

Father group A, mother group O ______________________________________________

Father group B, mother group O ______________________________________________

Father group AB, mother group O _____________________________________________

Father group AB, mother group AB ____________________________________________

Father group A, mother group A ______________________________________________

Father group AB, mother group AB ____________________________________________

Father group A, mother group A

Define amorph and give an ABO example.

The location of the surgery department is usually such that it is easily accessible to and from the various surgical patient support departments, such as the intensive care unit (ICU), emergency Department (ED), Labor and delivery (L&D), and other various departments. Several design types are used in surgical services departments, depending on the facility. Please respond to the following question with a minimum of 300 words for your responses.

1. Which OR design plan features a clean central core surrounded by a series of ORs? Why is this plan favored? How does it facilitate traffic control and the prevention of surgical site infection (SSI)?
2. Name four ancillary departments in the hospital that directly support the operating room. Describe their function in relation to the operating room.

Name a at risk population group and relate two foundational Healthy people 2020 health measure to their health status? Describe how nurses could be better utilized within the community to support the health of this risk community members. Discuss specific roles for the BSN RN in the community setting related to the specific identified health issues in community of at risk population. Identify both advantages and challenges.

A 28 years old man who was exposed to weed killer in the basement of his apartment 3 weeks ago now came to a hospital complaining of having rashes, and experiencing shortness of breath, chest tightness, and coughing heavily. He is self employed, work seven days a week. He came because he had not been able to go to his primary clinic because of Covid-19. He does not have medical history that linked to what he is experiencing now. Because he works seven days a week on a homemade weed killer recipe that he made for living, he never thought of any side effect that could occur. The understanding of his work means so much to him.

After his checkup, The nurse followed up with him. He learned that he had asthma. The nurse warned him that he could be at very high risk of having complex issues of developing other illnesses if not treated on time. The nurse referred him back to his primary clinic to do a follow-up appointments to do more testing and offer some education on exercise that could lead to a healthier life.

I created this case scenario for practice. And need help developing (a) assessment (b) analyses (c) planning (d) implementation (e) Evaluation. I want to compare note and know my strength or weakness.

A 26-year-old woman in graduate school visits the family physician because for the past 3–4 months she has been experiencing gnawing pains in her upper-middle abdomen. When you ask her what seems to precipitate the pain, she is unable to say for sure. She says she feels the best in the early morning before eating. As the day progresses, she usually feels worse and takes Mylanta or Milk of Magnesia to relieve the pain. Sometimes, her pain is accompanied by severe diarrhea, and she has been tired, weak, and nauseous. In response to your question about stress, she tells you she is under extreme stress because she is preparing to defend her thesis for her Ph.D. She has been smoking more cigarettes than usual and drinking 6–8 cups of coffee each morning. In the evening, she often has a few glasses of wine to help her relax.

Critical thinking Questions

1. Based on this patient’s complaints, lifestyle, and use of OTC medications, what do you expect may be the cause of her initial complaint of upper-middle abdomen pain and her symptoms of fatigue, weakness, and nausea?

2. What diagnostic tests do you anticipate the physician ordering and for what possible diagnoses?

3. Instead of OTC antacids, what are the other choices for this patient to relieve her symptoms? Is there a class of medications you think might be the better choice for her? If so, what and why?

4. What type of teaching would you give the patient to better manage her problems?