Scenario

A.H. is a 70-year-old retired construction worker who has experienced lumbosacral pain, nausea, and upset stomach for the past 6 months. He has a history of heart failure, high cholesterol, hypertension (HTN), sleep apnea, and depression. His chronic medical problems have been managed over the years with benazepril (Lotensin) 5 mg/day, fluoxetine (Prozac) 40 mg/day, furosemide (Lasix) 20 mg/day, potassium chloride (KCl) 20 mEq (20 mmol) bid, and atorvastatin 40 mg each evening.

A.H. has just been admitted to the hospital for surgical repair of a 6.2-cm abdominal aortic aneurysm (AAA) that is now causing him constant pain. On arrival to your floor, his vital signs (VS) are 109/81, 61, 16, and 98.3 ° F (36.8 ° C). When you perform your assessment, you find that his apical heart rhythm is regular, and his peripheral pulses are all 2+. His lungs are clear, and he is awake, alert, and oriented. There are no abnormal physical findings; however, he has not had a bowel movement for 3 days. His electrolytes, blood chemistries, and clotting studies are within normal range, except his hematocrit is 30.1%, and hemoglobin is 9 g/dL (90 g/L).

1. A.H. has several common risk factors for AAA in his health history. Name and explain 3 factors.

2. How is testing used to diagnose an AAA?

7. During your assessment, you note a pulsation in A.H.’s upper abdomen, slightly left of the midline, between the umbilicus and the xiphoid process. True or False: You must palpate this mass as part of your physical assessment. Explain your answer.

CASE STUDY PROGRESS

A.H.’s aneurysm resection is successful, and he maintains normal leg movement and sensation. However, for the first 2 postoperative days he is delirious and needs one-to-one nursing care in the intensive care unit. After he becomes coherent and oriented again, he is transferred back to your floor.

9. What assessments do you need to make specific to his postoperative care?

10. List 6 problems that are high priorities in A.H.’s postoperative care.

11. When you perform A.H.’s abdominal assessment, you do not hear any bowel sounds when auscultating his abdomen. What should you do?

1, Identify nursing priorities/standards of care for these interventions

Administer Wrist Restraints/Standards of Care:

Nursing Standards of Care:        

Rationale:

Case Study on Basal Nuclei

A 55 year old man is seen by a nurse practitioner as his family reports that he has tremors at rest and difficulty walking. On evaluation, it is observed that he had difficulty initiating walking and stopping. He has a mask-like facial expression and displays no signs of dementia or depression. He is diagnosed with Parkinson’s disease. The patient is prescribed a course of L-Dopa to treat his disorder.

1. Which masses of gray matter are not able to perform their functions optimally, resulting in this

     patient losing proper muscle control?

2. Which structure in the midbrain secretes dopamine that affects skeletal muscle control?

3. What is the role of dopamine in the maintenance of resting muscle tone and muscle

     recruitment for movement?

4. The basal nuclei receive synaptic input from the primary motor cortex and sends their output to the

     thalamus which relays this information back to the motor areas of the brain. What would happen to

     muscle control if a person suffers a stroke that damages the basal nuclei?

5. Why are Parkinson’s patients not given dopamine but L Dopa, which is then converted to

     dopamine in the brain?

Identify the roles of thiamin, riboflavin, and niacin in energy metabolism and other body functions. pleas type it at least 10 sentences

Discuss the roles of iodine, chromium, manganese, and sulfur in energy metabolism please type and at least 20 sentences.

List six employment laws and select one to describe in-depth. US HEALTH SYSTEM

What are the certain factors alter folate digestion, absorption, and balance. please type at least 20 sentences.

Discussion Board Week 4 Day 1

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A. Explain what it means to serve as the patient’s advocate.

B. Discuss the importance of advocating for the patient.

C. Why is treating patients with dignity and respect important?

D. Why is trust a key to preventing lawsuits?

E. What may you write about your clinical assigned patient on Facebook?

F. How is the HIPAA Privacy Rule different from the Security Rule?

What are the adverse health effects to having low folate in the body. please type , at least 20 sentences

INFORMED CONSENT It has been maintained that patients have a right to complete information about their conditions. But... What happens when the diagnosis reveals a genetic disorder that can have known harmful effects on their children? Should the spouse automatically be told about this result? Should the children be told? Do other relatives have the right to know this information? Who is the "patient" in these situations? Is it the one who has been tested? Is it the one who will be affected if they don't have the information?

What guidelines do you think should guide healthcare providers when it comes to such information being disclosed?

MY ANSWER:

Patients have a right to full disclosure of their medical conditions, even if that disorder could potentially have harmful effects on their children. In that case, I believe it is the healthcare provider's responsibility to thoroughly explain the situation. Including providing statistics for the patient and any tests that can be done to tell if the children have the disorder. I believe the spouse should be aware of the potential for a genetic disorder but feel that it should be the responsibility of the patient to tell the spouse. The provider should ask the patient if the patient wants the spouse to attend the visit to learn more about the disorder. Some couples knowing that there is a high potential for a genetic disorder may change their mind about having children. If the children are old enough to understand the scope of the genetic disease they should be informed of the situation as it could potentially have negative effects on their health. However, a child may not fully understand the potential for a genetic disorder and knowing could cause further fear and issues. Again, I believe it is the responsibility of the parents to discuss concerns with their children when the child is old enough to understand. I don’t think relatives need to know unless this is something that the patient wants to disclose to a relative. The patient is the person that came into the office with the issue. The children could choose to be patients at some point. Guidelines for information disclosure is providing accurate up to date info along with statistics and ways to get more answers for the patient.

PLEASE GIVE THOUGHTS TO THE FOLLOWING:

• Do you agree with these suggested guidelines? Why or why not?
• Which ethical principles are at play here?
• Were those principles incorporated in your peer's posts?

Mrs. Shaw is a 54-year-old client who has been admitted with hypertensive crisis and tachycardia. She was diagnosed with hypertension 2 years ago and until now has been controlling her blood pressure with a thiazide diuretic. In taking Mrs. Shaw’s health history, you learn that Mrs. Shaw has recently started taking pseudoephedrine in oral form for sinus congestion, along with a phenylephrine nasal spray for nasal congestion. Mrs. Shaw tells you, “I don’t understand it; I have been taking my blood pressure medication regularly, as always. It has kept my blood pressure under control for 2 years. Why am I having these problems now?”

1. Explain the relationship between the pseudoephedrine and phenylephrine and Mrs. Shaw’s hypertension. What should the nurse teach Mrs. Shaw regarding the use of these drugs?
2. What additional adverse effects related to the pseudoephedrine and phenylephrine might the nurse expect to see in Mrs. Shaw?
3. Mrs. Shaw suddenly develops pulseless ventricular tachycardia, and resuscitation is begun. The physician orders vasopressin 40 units instead of epinephrine during the resuscitation. What rationale would the physician have for ordering the vasopressin?

A nurse is discussing culturally competent care at a nursing staff in-service. Which of the following information should the nurse include when discussing clients' cultures?

A. Nurses should focus on clients cultures, rather than their ethnicity when providing care

B. Nonverbal communication is important in a few cultures

C. Nurses should expect clients to adapt to the care provided regardless of culture

D. Culture plays no role in determining when a client will seek medical care

What is health care coverage convergence? What evidence of convergence can be found in the histories of health care in Great Britain and China?