Client Profile

Nisha is a 14 year old with sickle cell anemia. She lives with her mother and grandmother in a rural neighborhood. Nisha has experienced several “sickle cell crises”, however, they seem to have become more frequent since she became an adolescent. Nisha is enjoying her summer break from school. She is active in softball and enjoys shopping with her girlfriends.

Case Study

Nisha’s mother brings her to the hematology clinic at the hospital with complaints of severe

generalized pain following a softball game in which she pitched seven innings. She is admitted to the medical pediatric unit. Her vital signs are: temperature, 37.6° C (99.7° F); pulse 110

beats/minute; respirations, 30 breaths/minute; and blood pressure, 96/70. She weighs 110 lb. Her complete blood count reveals: hemoglobin, 9 g/dL (low); hematocrit, 24%; white blood cell

count, 12,000 cells/ mm3 ; and platelet count, 140,000 cells/ mm3 . Her oxygen saturation is

89%.

Questions

1. What other assessment data would be helpful for the nurse to have to prepare Nisha’s care plan?
2. Discuss the following orders for Nisha and explain why is each is important? Vital signs q4h. Notify health care provider of temperature > 38° C (100.4° F) Regular diet Strict bedrest Complete blood count with differential in the morning Urine for urinalysis (U/A) and culture and sensitivity (C/S) Chest x-ray IV fluids of 5% dextrose in water with 0.45% normal saline to infuse at 175 mL/hour PCA morphine sulfate 1.5 mg continuous and 1 mg every 8 minutes, PCA dose Acetaminophen 650 mg q4h PO for temperature > 38° C (100.4° F) Oxygen at 2 L per nasal cannula titrating to maintain oxygen saturation > 94%
3. What nursing interventions would be appropriate in meeting Nisha’s needs?
4. After 4 days of treatment, Nisha’s intravenous fluids and medication are discontinued and her pain assessment reveals a pain level of 1/10. When the nurse enters Nisha’s room, Nisha is sitting quietly in a chair at the bedside and seems sad. Discuss your impressions of Nisha’s condition based on her level of growth and development.
5. Discuss the teaching priorities for Nisha before her discharge from the hospital after her crisis is resolved.

Client Profile

Ashlee is a 4 year old preschooler who lives with her parents and two older siblings in a suburban environment. She attends preschool five mornings a week and enjoys playing with her 5 year old sister and 7 year old brother. She is very active and enjoys playing outside, riding her tricycle, climbing on the family's jungle gym, and playing on the swing set. Her vocabulary consists of approximately 1,500 words and she speaks using four or five word sentences. Her parents are very attentive to their children and spend each weekend doing "family activities". During the week, her parents work, and Ashlee and her siblings stay with their grandmother after school. Their grandmother lives in the same neighborhood. In the evenings, the family eats together and maintains an evening schedule that allows for family play time.

Case Study

During the past 2 months, Ashlee has been less active than usual and has begun taking one or two naps in the afternoon. Her grandmother and parents think she looks pale, reasoning that it is because of her high activity level, until her interest in going outside to play decreases dramatically. When they take her temperature, it is elevated so they administer acetaminophen without effect. At this point they decide to take her to see her pediatrician. Although the health care provider found Ashlee's manifestations consistent with an upper respiratory infection, the pediatrician is concerned and decides to admit Ashlee to the hospital for tests to rule out leukemia.

Questions 1. Her admission vital signs are: Temperature: 38° C (100.4° F) Pulse: 120 beats/minute Respirations: 28 breaths/minute Blood pressure: 100/60 And her admission complete blood count reveals: Hemoglobin: 11 g/dL Hematocrit: 31% Erythrocyte count: 4.6 million Platelet count: 100 (x103 mm3 ) White blood cell count: 23.0 Neutrophils: 16% Lymphocytes: 10% Monocytes: 5% Eosinophils: 1% Basophils: 0.03%

1. Discuss the significance of Ashlee's vital signs and laboratory findings.

2. The tests confirm a diagnosis of acute lymphocytic leukemia. How do you explain this to Ashlee’s parents? They ask you her chances of survival?

3. Identify at least 4 nursing priorities for Ashlee.

4. Discuss the factors that affect Ashlee's prognosis.

5. Ashlee's chemotherapy regimen is started and the oncologist prescribes that she receive ondansetron 2.5 mg IV prior to chemotherapy and the same dose every 4 hours for 24 hours. In addition, she prescribes lorazepam 0.84 mg IV q6h PRN for breakthrough nausea. Discuss these prescriptions including drug classifications, when medications should be administered, special considerations when administering drugs, and safe dosage for Ashlee, who weighs 16.7 kg (36.7 lb).

6. Discuss Ashlee's level of growth and development and how her treatment may impact this.

7. How would you work with Ashlee's parents to help prevent complications associated with her growth and development?

Compare and contrast a cyclooxygenase-2 (COX-2) inhibitor and other NSAIDS. Please this response should be at least 250 words in length. And make sure you cite your references used in APA format please. Thank you.

Collaborate with community members, community liaisons, and members of the healthcare team to develop health promotion and prevention planning for individuals, families, and groups across the lifespan in community settings. Describe experiences that met this course objective.

1. Perform a comprehensive assessment of a community in relation to its health needs, health policies and resources. Describe experiences that met this course objective.

Formulations and dosages for specific treatments, for Antibiotics: Macrolides, Aminoglycosides, Tetracyclines and Glycopeptide antibiotics.

1. Use evaluation results to influence the delivery of care, allocation, and distribution of resources and to provide input into the development of policies to promote health and prevent disease. Describe experiences that met this course objective.

*While talking to your mother, who is a nurse, she related an interesting story about a 14-year-old patient that she saw in the early 1980s when she worked in a gynecology office. When the young girl first presented, she vomited in the waiting room. She stated that she had been feeling ill the night before and that she had also been having an unusually heavy menstrual flow. She also complained of chills and a diffuse rash on her arms and legs, and she reported having a fever. Upon getting her to the examination room, your mother checked her temperature and blood pressure while the doctor asked her some questions. He asked her if her neck was stiff, to which she answered no; he ordered a lumbar puncture, anyway. At this point, she was starting to look dizzy, and her blood pressure was 80/55. The doctor asked her if she’d ever had sexual intercourse, to which she answered no. The patient’s mother also confirmed that she was up to date on all her immunizations. This young girl was eventually admitted into the hospital for treatment. Your mom mentioned, as an interesting aside, that several days after she was admitted, the skin on the palms on her hands began to slough off.

1. What kind of infectious diseases come to mind when a widespread rash is seen as the primary complaint? (Hint: Why had the doctor asked about her sexual history? Why did he ask about her immunizations?)

2. Her rash was diffuse, with well-separated bumps that were maculopapular. Was it likely to be chicken pox? Why or why not?

3. The cerebrospinal fluid obtained from the lumbar puncture was clear—no evidence of bacteria. This ruled out another infection. Which one?

4. The doctor then asked the patient about her menstrual history and practices. She began menstruating at the age of 12 and reported that her last period began four days ago. She reported that she mainly uses tampons during her period. What infection do you think the doctor had in mind by asking about menstruation? Briefly describe this infection and the likely pathogen that causes it.

5. Your mother says that if you see a patient with these symptoms once you start practicing as a physician’s assistant, it is less likely to be the same infection as what this young girl experienced. Why?

. As a License Practical Nurse Student .Identify potential Interview questions and how to conduct your self in an interview.

Type up several questions and responses that you may be asked in an interview. Add questions that you might ask in an interview and their relevance to the job you are seeking.

Reflect on the course using these course learning objectives:

1. Define the history and scope of public health nursing including the core competencies of the nurse in public health settings.
2. Incorporate evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan
3. Collaborate with community members, community liaisons, and members of the healthcare team to develop health promotion and prevention planning for individuals, families, and groups across the lifespan in community settings.
4. Perform a comprehensive assessment of a community in relation to its health needs, health policies, and resources.
5. Utilize technologies to inform, communicate, and enhance the health of individuals, families, and groups in public health settings.
6. Apply evaluation results to the delivery of care, allocation, and distribution of resources
7. Provide input into the development of policies to promote health and prevent disease.

1. The ICU nurse prepares to administer a dobutamine (Dobutrex) drip. The patient weighs 176 lbs. The safe dose range for this medication is 2.5-10mcg/kg/min. The medication preparation delivered by pharmacy is 250mg in 500mL of D5W.

1. What is the safe dose range for this patient? Express your answer in mg.
2. The drip is started at 60mL/hr. Would this be an acceptable action? Explain why or why not.

2. The nurse is preparing to administer a 500mL 0.9% NaCl IV fluid bolus at 250mL/hr. The IV tubing contains a Micro Drip set with a drop factor of 60gtts/mL. In order to administer the fluid bolus at the correct rate, how drops per minute must the nurse observe in the chamber?

Abdominal and Neurological Assessment

1. How long do you listen for bowel sounds in each quadrant? If there are no sounds, what might this indicate? If the sounds are hyperactive, what might this indicate?
2. Why do you assess for bruits and what may be causing this?
3. Which sounds are normally heard during percussion of the abdomen? When would these findings be abnormal?
4. When assessing pupillary response, what nerves are you assessing and what do these nerves control?
5. List five reasons for a non-reactive pupil?

Clinical Assignment

You are caring for a 68-year-old male who has been hospitalized for extreme constipation. He is having bowel movements now, but he has had a poor diet that contributed to his constipation problems. His wife died 9 months ago. He eats mostly canned soups and processed lunch meats on white bread because he does not cook much. He sometimes gets fast food, such as hamburgers or fried chicken. He likes meat but does not eat vegetables or fruits. He tells you they go bad before he can eat them all, so they are a waste of money. He mostly drinks soft drinks throughout the day.

Critical Thinking Questions:

• How will you determine the effectiveness of the current treatment for constipation?
• What nutritional concerns do you have for this patient?
• How will you help him manage this issue?
• How will you help this patient prevent rehospitalization for constipation in the future?