What are some ethical and legal implications of patient-centered care?

Which populations are most burdened by disease? Select all that apply.
A) Teenage women
B) People of sub-Saharan Africa
C) Middle-aged men
D) Children younger than 5 years old
E) Pregnant women

1. Why is clonidine considered a sympatholytic drug and not a sympathomimetic (i.e., a drug that activates the sympathetic nervous system)?

2. How does clonidine act to lower a patient’s blood pressure? What side effects would a nurse anticipate observing in a patient diagnosed with hypertension who has just been administered clonidine?

using 175 to 350 words for each explanation of each time period to discuss the evolution of health care facility design since the 1900s to the present.

Research a recent microorganism outbreak in the world. Examples of this could be Ebola or Legionella. Discuss the outbreak, predisposing or precipitating factors for the outbreak, the treatment, safety precautions, virility of micro-organism and the survival rates.

Adult trauma: Identify relevant data including pathophysiology, causative agent, levels of reactions as appropriate (mild, mod, level 1 – 4, etc.) What would they look like? What would vital signs look like? Mentation?

1. Diagnosis: Partial-thickness (second-degree) burns

Dylan DiSabatino is a 9-year-old Latino male who suffered partial-thickness burns on his right hand and fingers while playing with fireworks last Friday night.

a. Explain the pathophysiology of Partial-thickness (second-degree) burns

b. Explain the therapeutic regimen of Partial-thickness (second-degree) burns

2. Diagnosis:

. Wound infection, right foot, and heel

. Type 2 diabetes mellitus

Mathias Hedding is a 62-year-old white male with a history of type 2 diabetes mellitus and heart failure.

a. Explain the pathophysiology of Wound infection, right foot, and heel

b. Explain the therapeutic regimen of Wound infection, right foot, and heel

c. Explain the pathophysiology of Type 2 diabetes mellitus

d. Explain the therapeutic regimen of  Type 2 diabetes mellitus

• Identify 1 resource in your community that addresses the chronic disease management needs of the population.
• Who is involved in this community-based model for the care of adults? MDs, RNs, dieticians?
• Describe the role of nurses in this community-based model of care.

1. Read HealthyPeople's overview of Environmental Health and review its OBJECTIVES.

2. Choose 1 EH Objective. Why is this objective important to you? Give an example of an environmental health project of an organization that you think can help HealthyPeople reach the objective you have chosen.

You are working in a college health clinic when a client comes to you complaining of a variety of problems, including constipation, stomachache, and frequent colds. You find out that the client follows a vegan lifestyle but has done very little research into this type of lifestyle. In addition, she primarily eats in the dorm cafeteria, which seldom serves vegan dishes. Therefore, most days, she ends up eating dry cereal for breakfast and French fries for lunch and dinner.

Calculate the amount of daily protein that your client needs (she is within a healthy weight range for her age and height at 128 pounds).

a. 10 grams b. 15.9 grams c. 22 milligrams d. 46.5 grams e. 83 grams

Which of the following could be added to your client's daily breakfast cereal in order to add protein?

a. soy milk b. marine algae c. orange juice d. flax seed meal e. dried fruit

What is most problematic about your client's current diet?

a. It is too low in carbohydrates. b. It is too high in fiber. c. It lacks the variety that provides necessary nutrients. d. It cannot be sustained over time. e. It lacks meat and dairy products.

Which of the following would provide the greatest amount of protein for someone following a vegan diet plan?

a. 1 slice of whole wheat bread b. 1 tofu burger c. ½ cup cooked brown rice d. ½ cup cooked green beans e. 1 tablespoon peanut butter

Which of the following food pairs could be included in your client's diet to yield complementary proteins?
a. bagel with peanut butter b. tofu sautéed with peppers c. celery with almond butter d. black beans and rice e. soy yogurt with sliced peaches

Which of the following foods could your client add to her diet to ensure adequate levels of zinc?

a. flaxseed b. orange juice c. spinach d. eggs e. pumpkin seeds

11. List and explain three real nursing diagnoses and one at risk,
that can be used with the client-family facing the process of
loss and grief.

12. Indicate at least 5 nursing interventions for each of the
diagnoses listed in the previous question

Patient Profile

Z.Q., 74-year-old Hispanic man, came to the emergency department (ED) 7 days ago with shortness of breath. His wife stated that he had a history of hypertension, depression, and chronic obstructive pulmonary disease (COPD). The admission chest x-ray examination revealed dense consolidation of the left lower lobe. An arterial blood gas (ABG) at that time showed: pH 7.60, PaCO₂ 29mm/Hg, HC0₃ 32mmol/L, and PaO₂ 75mm/Hg. Z.Q. quickly deteriorated and subsequently was intubated. He has been in the intensive care unit for 3 days.

Subjective Data

• Z.Q. and wife have been married 45 years and live with a daughter and two grandchildren.
• They speak both English and Spanish.

Objective Data

Physical Examination

• Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%
• Height 5'6", weight 75 kg
• Patient localizes to endotracheal (ET) tube and is intermittently aroused, making several attempts to pull ET tube
• Orally intubated #7.5 ET tube, taped at 27 cm to lip
• Volume cycled ventilator at FIO₂ - 60%, in assist control mode of 14 breaths per minute, tidal volume 450, positive end-expiratory pressure PEEP 5 cm H₂O
• Breath sounds decreased in bases with bilateral crackles that do not clear after suctioning
• Brown-yellow secretions returned with suctioning
• Peripheral pulses weak at 1/4 with capillary refill greater than 4 seconds
• 2+ pitting edema in the bilateral lower extremities

Newly Obtained Diagnostic Study Results

• Arterial blood gas (ABG) pH 7.31, PaCO₂ 58mm/Hg, HCO₃ 28mmol/L, PaO₂ 54mm/Hg, EtCO₂ 38 mm/Hg
• Chest x-ray examination reveals diffuse white out in middle and lower lobes; endotracheal tube present with tip well above the carina; left subclavian central venous catheter is in the superior vena cava
• Computed tomography scan reveals alveolar opacities with increasing effusions in the gravity-dependent areas of the lungs

Case Study Questions:

1. You have read the patient’s profile and physical assessment data. What clinical data from this information is relevant and must be recognized as significant to you as the nurse? Student Must List at Least 7 answers
   1. Blood pressure 167/98,
   2. pulse 112,
   3. temperature 102.0°F,
   4. respirations 14,
   5. oxygen saturation 72%
   6. Peripheral pulses weak at 1/4 with
   7. capillary refill greater than 4 seconds
   8. 2+ pitting edema in the bilateral lower extremities

2. Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%

What are your nursing interpretations of the client’s presenting vital signs? What would be your initial assumption from your already learned knowledge – Student’s are to apply their own assumption/thinking, faculty want you to think on your own; see what you come up with. Student Must Address All Vital Signs:

• Temp = high- which might indicate infection, fever
• BP = High- hypertension
• Pulse á = high- tachycardia
• RR =   tachypnea
• O2 Sat â = hypoxemia

3. What would be your initial nursing priority that will guide the plan of care for Z.Q.?

The initial nursing priority are maintaining the airway, providing sufficient oxygenation (Breathing)and circulation. This process are often refer to as ABC. In Z.Q. case, maintain the airway, providing oxygenation and supporting hemodynamic function are prioritize.

4. What would be two prioritized nursing diagnoses for Z.Q. prior to providing client care? Include all 3 parts of nursing diagnosis. Student Must List at Least 2

5. Although Z.Q. speaks both Spanish and English, what would be two cultural aspects to consider in caring for the client? Student Must List at Least 2

6. What 5 prioritized nursing interventions will be initiated by you as the nurse based on your listed initial nursing priority in question 3? Student Must List at Least 5

7. Once treatment has been initiated, what relevant clinical assessment data would you need to closely monitor in detecting a possible change in status or complications? Student Must List at Least 4

How would you as the nurse, evaluate the effectiveness of your nursing interventions for Z.Q.? Student Must List at Least 4

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?