Case study

Chief Complaint

“It feels like an elephant is sitting on my chest! I’m too young to die!”

HPI

Larry Stanton is a 46-year-old man transported by paramedics to the ED of a large community hospital. He presents with severe, substernal chest pain for the last 6 hours. He states he was fine until about an hour after he ate breakfast. The pain radiates to his jaw and neck and is accompanied by N/V and diaphoresis. In the ambulance, his chest pain is unrelieved by three SL NTG tablets.

PMH

No significant past medical history

FH

Father with heart failure and Type 2 DM and questionable history of “mild heart attack” at age 42; mother alive with HTN. He has one sister who is 48, alive and well, and one brother who died suddenly at age 46.

SH

(+) tobacco × 20 years; drinks beer usually on weekends; states he hasn’t been to a physician since his appendectomy 10 years ago

Meds

Acetaminophen PRN and Pepcid AC PRN

Therapeutic Alternatives

3.a. What nonpharmacologic therapeutic alternative can also achieve the immediate goal in this patient? The nonpharmacologic therapeutic alternative for Mr. Larry is to initiate reperfusion

3.b. What is the role of glycoprotein IIb/IIIa inhibitors (GPIs) in the setting of PCI with coronary artery stenting, and how should these agents be used?

3.c. How should therapy with GPIs be monitored?

MEDICAL TERMINOLOGY REVIEW

For the following word parts, write the definition

1. phleb/o:

2. -otomy:

3. hepat/o:

4. -itis:

5. ven/i-:

6. -puncture:

7. syncop/o:

8. nos/o:

9. comi/o:

10. -al:

11. ante-:

12. cubit/o:

13. anti-:

14. -sepsis:

15. coagul/o:

16. glyc/o:

17. -lysis:

18. ped/o:

19. iatr/o:

20. hem/o:

21. hemat/o:

22. -oma:

23. inter-:

24. -stitial:

25. capillar/o:

26. thromb/o:

27. -sis:

28. derm/o:

29. plant/o:

30. palm/o:

31. -rrhage:

32. PPE:

33. ASCP:

34. HBV:

35. HCV:

36. HIV:

37. OSHA:

38. IAPS:

39. NCA:

40. NPA:

41. POL:

42. CLSI:

43. CBC:

44. EDTA:

45. SST:

46. PST:

47. PT:

48. APTT:

49. FDA:

50. POCT:

51. PKU:

• Student will answer all four of the following questions: (Must cite your sources for each question)
  • What are the implications of “mutual recognition for nursing” on nursing licensure?
  • What alternatives are available for demonstration of competency instead of attending continuing education seminars?
    • Which might be better?
  • What organization should credential and license advanced practitioners?

Grading Rubric to Achieve the Full 5 Points (See Grading Rubric for Complete Grading Breakdown)

• Demonstrates critical thinking. Student answers question(s) and relates key points to the discussion topic.
• Student uses Internet sources from acceptable research sites (see above) or course’s textbook to answer question(s)
• Answer met the required minimum of 150 words.

should dementia patients be involved in decision making or not

What is your take on our media's influence both social and public aspect regarding a client’s expectations placed upon nurses and revealing HIV status?

What is the rationale for a provider to order NGT insertion, NPO status, large bore IVs, CBC, Type and screen and EGD on a patient with GI bleed?

Why are areas of a healthcare system particularly vulnerable to ransomware and should be especially protected?  What might patients do to ensure their information is safeguarded?

Who are the key players possibly consulted for interprofessional collaboration for a patient with RA and OA?

What do the different presentations of GI Bleed mean? Eg. Hematochezia vs coffee ground emesis vs melena vs bright red vomit

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.

What is the “heart” of qualitative research?

. A toddler may react to stress in the family unit by returning to earlier behavior patterns. This is called

a) Progression      

b) Regression

c) Suppression

d) Denial

8. Prejudice is defined as the unfair treatment of people based on their group membership:      

a) True

b) False

Which type of qualitative research is the most flexible and widely used for applied research?