Scenario 2: It is now 11:30 pm. You are caring for a client with an indwelling urinary catheter (14fr). You are emptying the collection device and measure a total of 130mL of cloudy urine. You enter the amount and notice that there has not been any other output charted since 3pm, which was 275mL. You check the tubing for any kinks and do not find any. The Foley remains secured and in place. The client’s abdomen is distended and firm over the suprapubic area. The client complains of tenderness with palpation and communicates an urge to void. You notify the on-call physician (Dr. Watt) at 11:49 pm and receive an order to irrigate the catheter with normal saline PRN for decreased urine output. After irrigating the catheter with 50mL NS, urine flows into the collection device. You empty 280mL of dark yellow urine. The patient reports relief of pain and no longer has the urge to void. You also note that the suprapubic region is no longer distended.

Document the following:

• Physician notification •

Telephone order •

Nursing intervention and any other information you feel is necessary to include.

For this assignment, you are to write a 3-5 page paper (At least an outline)

What ethical issues are often faced in long-term care, and how are they resolved? Include examples.

Question 3: In 400words choose three  ethical principles from the list to answer the case study below,  Nonmaleficence, Beneficence, Mills Harm principle, Mills principle of liberty, Greatest Happiness principle, communitarianism, Principle of Utility and personhood

An elderly gentleman who lives alone arrives for his appointment with his middle-aged son who reports that his father is becoming increasingly forgetful and is having trouble taking care of himself. He has not been eating well and has lost weight. The son states that he would like to have his father moved to a facility rather than continue to live on his own.

The patient is on multiple medications including medication for congestive heart failure and diabetes. The patient states that he wants to “stop taking all those stupid and expensive drugs!”   The patient’s son tells his father that he needs to “take his medicine or he will die”. The patient states, “I’ve lived long enough. I would rather die than move to a damn nursing home!”

The patient’s Mini Mental Status examination is within the normal limits . You have concerns that he may be at risk and are unsure of what you should in regard to the patient’ s request to be taken off his medications. What should you do and why?

An elderly gentleman who lives alone arrives for his appointment with his middle-aged son who reports that his father is becoming increasingly forgetful and is having trouble taking care of himself. He has not been eating well and has lost weight. The son states that he would like to have his father moved to a facility rather than continue to live on his own.

The patient is on multiple medications including medication for congestive heart failure and diabetes. The patient states that he wants to “stop taking all those stupid and expensive drugs!”   The patient’s son tells his father that he needs to “take his medicine or he will die”. The patient states, “I’ve lived long enough. I would rather die than move to a damn nursing home!”

The patient’s Mini Mental Status examination is within the normal limits . You have concerns that he may be at risk and are unsure of what you should in regard to the patient’ s request to be taken off his medications. What should you do and why?

View the movie: "Miss Ever Boys". Individually, analyze how the principles of beneficence, respect for human dignity (or respect for persons), and justice were violated during the Tuskegee Study.

In your analysis consider:

1. Did the study involve vulnerable subjects?
2. Why did the "boys" not receive penicillin when it became available?
3. How did the physician defend his refusal to allow the "boys" access to penicillin?
4. How did participation in the study alter their lives and health?
5. What was more important: a group of individuals being negatively affected in a study or the scientific knowledge that could be gained.

1. What are the three non-carbohydrate sweetening agents that have been approved by the American Diabetic Association? Indicate their sweetness when compared to sugar.

2. What are the trade names for these artificial sweeteners?

3. What are the other expanded options for diabetics?

4. Can you add any additional artificial sweeteners and their sweetness and properties?

Mandy is a 10-year-old female with cystic fibrosis who weighs 62 pounds and is 51 inches tall and is considered low active.

1-Calculate Mandy’s estimated energy requirement given her DRI and medical condition using the following information (5 points) EER for Girls 9 through 18 Years EER = 135.3 – (30.8 ´ age [y]) + PA ´ (10.0 ´ weight [kg] + 934 ´ height [m]) + 25 kcal PA = 1.00 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary) PA = 1.13 if PAL is estimated to be ≥ 1.4 < 1.6 (low active) PA = 1.26 if PAL is estimated to be ≥ 1.6 < 1.9 (active) PA = 1.42 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

2-Calculate Mandy’s protein requirement given her DRI and medical condition (5 points). EER DRI Table

3-The estimated calorie requirement for an individual with cystic fibrosis is two to four times the usual recommendation. How would one know the appropriate calorie level to recommend initially? (5 points)

4-Research nutrition recommendations for cystic fibrosis that can assist an individual with meeting her high calorie and protein requirements (i.e., use the text and reputable websites). What advice could you provide to a patient?

1, introduced you to new information about pregnancy and birth in the US? Please provide examples.

2, Have your opinions or views of childbirth and pregnancy in the US changed? If so, how? If not, why?

3, How does that impact your view of your role in childbirth and women’s health?

To understand pandemics, one must not only understand the organism, mode of transmission, the infectious disease curve, and the course of the illnesd; one must also understand transmissibilty and severity of illness. using SARS-CoV-2/COVID-19 address the concepts of influenza and explain how the resulting pandemic unfolded.

A biomedical sensor does not seem to give correct information. List some potential causes for this problem.

Explain briefly the main challenges in modeling blood flow in the body.

A 25-year-old female heard about the ketogenic diet and stopped eating carbohydrates, including fruits, vegetables and all grains for about the last 3-4 months. She has noticed redness around her mouth, cracking in the corners of her mouth and her tongue appears big and red.

What vitamin(s) deficiency may be present? What led to your conclusion? (5 points)

She still wants to lose more weight and is not willing to stop the ketogenic diet. What recommendations would you make? (5 points)

Goro Oishi

INTRACEREBRAL HEMORRHAGE

Glasgow Coma Scale

•Mr. Oishi's level of consciousness remains impaired with a Glasgow Coma Scale score of 4. No verbal response. Does not open eyes. Pupils unequal and sluggishly responsive to light. No spontaneous movement

•Decerebrate rigidity of extremities to painful stimuli on right side. Unresponsive on left side.

•Shallow respiratory effort. No cough or gag reflex. Clear oral secretions suctioned as needed to keep airway clear. On 2 liters of oxygen by nasal cannula with Spo2 94%.

•Peripheral IV of D5NS with KCL at 100 ml/hr, site without redness or edema. NPO. Family at bedside. Family requests palliative care only.

•Urine output decreased with only 200 ml voided since 0700. Peripheral IV of D5NS with KCL infusing at 100 ml/hr, site without redness or edema

•Physical assessment unchanged. 2 liters flow oxygen by nasal cannula continues. SpO2 decreased to 88% at 1100. Temperature remains elevated at 101.2 F.

•Last dose of Acetaminophen received at 0700. Palliative care continues. Family at bedside.

•Urine output decreased with only 200 ml voided since 0700. Peripheral IV of D5NS with KCL infusing at 100 ml/hr, site without redness or edema.

•Neurological assessment with altered findings at 1130. Left pupil fixed and dilated. Blood pressure increased and SpO2 remains decreased at 88%.

•Oxygen administration increased at 1115 to 4 liters flow by nasal cannula without improvement in oxygen saturation. Increasingly labored respiratory effort. Positive Babinski reflex. No urine output since 1000

•Palliative care continues. Family at bedside.

TREATMENT

•Emergency treatment of intracerebral hemorrhage focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid.

•Surgery

•Clipping

•Coiling

•AVM surgery

•Stereotactic radiosurgery

1. Goro Oishi exhibited all the following risk factors for stroke except:

A.    diabetes mellitus.

B.    hyperlipidemia.

C.    hypertension.

D.    heavy alcohol consumption.

2. Which information in Goro Oishi's record would help determine whether his stroke was hemorrhagic or thrombotic?

A.    Increasing difficulty speaking

B.    Numbness and weakness on his left side

C.    History of hypertension

D.    Sudden onset of a severe headache

3. When Goro Oishi arrived in the Emergency Department, he displayed no verbal response, had no eye response to painful stimuli and no movement of the left extremities, and demonstrated abnormal posturing and extension on the right side when exposed to painful stimuli. Based on these data, his Glasgow Coma Scale core would be:

A.    3.

B.    4.

C.    5.

D.    6.

4. In the ED, Goro Oishi's pupils were unequal (L>R), with sluggish reaction to light. This indicates:

A.    damage to the pons.

B.    early pressure on the oculomotor nerve.

C.    irreversible coma.

D.    damage to the trigeminal nerve.

5. Which of the following nursing actions is instituted in response to Goro Oishi's increased ICP?

A.    Maintaining patient in heads-up position

B.    Turning and positioning every 2 hours

6. Which of the following is Goro Oishi at risk for because of continuing increased ICP?

A.    Cerebral edema

B.    Hypothermia

C.    Seizures

D.    Sensory overload

C.    Hydrating adequately with IV fluids

D.    Administering pain medication for headache

7. The nurse arranges for hospice care for Goro Oishi, knowing that this care is indicated in this instance because:

A.    family members are in conflict about what treatments should be provided.

B.    the family is unable to provide home care for Mr. Oishi.

C.    this will provide support while Mr. Oishi is dying.

D.    this will treat Mr. Oishi's pain and suffering

8. Before his hospitalization, Goro Oishi was on a combination of oral amlodipine and benazepril. What was the purpose of this medication?

A.    To manage hypertension

B.    To relieve angina

9. Before his hospitalization, Goro Oishi was on atorvastatin 20 mg. What piece of information from his history would signal possible adverse effects in the of this medication?

A.    Hypertension

B.    Increasing stress levels

C.    Alcohol abuse

D.    66 years of age

C.    To reduce congestive heart failure

D.    To improve heart rhythm

10. The order reads "1.0 g/kg of 25% solution." Goro Oishi weighs 165 lb. How many grams of mannitol are needed?

A.    50 g

B.    75 g

C.    100 g

D.    165 g

11. How was the mannitol administered to Goro Oishi?

A.    Intravenously, through a filter

B.    Intramuscularly, deep in a large muscle

C.    Subcutaneously, with care taken to rotate sites

D.    Route depended on the severity of the patient's condition

12. After mixing the IV nitroprusside drip, the nurse should do which of the following?

A.    Place the IV bag in an opaque wrapper.

B.    Let the solution sit for 10 minutes before administration.

C.    Give the medication immediately.

D.    Allow the solution to turn slightly blue before administration.

13. The order reads "Nitroprusside sodium 50 mg in 250 cc D5W to titrate systolic B/P <140 >110." How many mcg per milliliter of nitroprusside are contained in a 250-cc solution?

A.    0.2 mcg

B.    2 mcg

C.    20 mcg

D.    200 mcg

14. The order reads "Famotidine 20 mg IVPB q12h." The nurse decides to add the solution to the primary IV of 1000 cc of D5NS with 20 mEq KCl set at 100 cc/hr. Which of the following is a true statement concerning the nurse's actions?

A.    This is a bad decision; IV famotidine is incompatible with KCl.

B.    This is a good decision; this will deliver a steady dose of famotidine over a 12-hour period.

C.    This is a bad decision; famotidine should be delivered rapid IV push for best effect.

D.    This is a good decision; this will eliminate an unnecessary IV line

15. The order reads "IV D5NS with 20 mEq KCl @ 100 cc/hr." How many mEq of KCl are being delivered per hour?

•A.    2 mEq

•B.    5 mEq

•C.    10 mEq

•D.    20 mEq

16. An IV of D5NS with 20 mEq KCl was ordered. Nursing interventions include the following except:

A.    assess site for phlebitis and/or infiltration.

B.    measure urinary output.

C.    give KCl by slow IV push.

D.    monitor IV flow rate.

17. Which of the following nursing diagnoses is the lowest priority for Goro Oishi's end-of-life care?

A.    Risk for injury

B.    Risk for aspiration

C.    Self-care deficit: total

D.    Altered nutrition: less than body requirements

18. Which of the following factors in Goro Oishi's history plays an important role in his end-of-life care?

A.    Recent heavy drinking binges

B.    Age of 66

C.    Zen Buddhism religion

D.    His response to nitroprusside

SUBJECT: NURSING

Depression, or major depressive disorder is the leading cause of disability in patients 15-44. It negatively affects the way you think, the way you feel and the way you act towards society. Some symptoms of depression includes feeling sad, trouble sleeping, changes in appetite, feeling worthless and suicidal thoughts. As nurses, its important understand how depression affects the mind and it's reason for onset. " Distinguishing between grief and depression is important and can assist people in getting the help, support or treatment they need." (Torres, 2020). Although, I've never personally treated someone with depression I understand that there are many ways treatment for these patients can go array. Psychotherapy combined with medication suits most depressed patients best, this allows them to decipher their problems and come up with ways to mediate them. Just providing medication without therapy can be one reason a treatment plan is unsuccessful.

Some nursing interventions that could be helpful are encouraging the client to express their feelings, this allows the nurse to further understand their patient and allows the client to deal with overwhelming emotions. Antidepressant are prescribed to patients to help modify brain chemistry, they include SSRI's, TCA's and MAOI's. Overall, I believe that patients who only receive medication without some sort of therapy are not safe, they are a great risk for harming themselves because the medication may promote energy before affecting the mood. Referring patients to a psychiatrist will be in the best interest for the patient.

Respond to the above post  and explain in 5 paragraph if you agree or disagree with how they would handle a client who was having those symptoms. If you do not agree with the post, please provide how they could have approached the client differently.

Bipolar disorder is a mental illness marked by extreme shifts in mood. Symptoms can include an extremely elevated mood called mania. They can also include episodes of depression. Bipolar disorder is also known as bipolar disease or manic depression. (Health line, 2018).

People who suffer from this condition find it very frustrating and have a difficult time adjusting to daily life without treatment. They have episodes of mania and depression that can last weeks to months at a time. During the mania phase they are euphoric and do things to maximus level and the opposite during the depression phase.

In order to establish a therapeutic relationship with this type of disorder you have to be open minded and nonjudgmental. This way you can encourage treatment. Helping bipolar disorder patients includes teaching them what to expect during their phases and helping them be compliant with their treatment. Medications they will be on include anticonvulsants, antipsychotics, and SSRI’s which will help with treating their symptoms. They should also seek psychotherapy in order to be aware of their disorder.

Respond to the above post  and explain in 5 paragraph if you agree or disagree with how they would handle a client who was having those symptoms. If you do not agree with the post, please provide how they could have approached the client differently.