Create a 7-day dinner menu that meets recommendations by the Dietary Guidelines. Include serving sizes, and identify any allergen restricted from the menu i.e. milk--

Bariatric Surgery Case Study

Mr. McKinley is admitted for a Roux-en-Y gastric bypass surgery. He has suffered from type 2 diabetes mellitus, hyperlipidemia, hypertension, and osteoarthritis. Mr. McKinley has weighed over 250 lbs since age 15 with steady weight gain since that time. He has attempted to lose weight numerous times but the most weight he ever lost was 75 lbs, which he regained over a two-year period. He had recently reached his highest weight of 434 lbs, but since beginning the preoperative nutrition education program he has lost 24 lbs.

Height: 5'10" Weight: 410 lbs

McKinley, Chris, Male, 37 y.o. wt

Allergies: NKA

Pt. Location: RM 703 Admit Date: 2/23

Patient Summary: Patient is a morbidly obese 37-year-old white male who is admitted for Roux-en-Y gastric bypass surgery tomorrow morning. Patient has been obese his entire adult life with highest weight 6 months ago at 434 lbs. He has lost 24 lbs since that time as he has been attending the preoperative nutrition program at our clinic.

History:

Onset of disease: Lifelong obesity

Medical history: Type 2 diabetes mellitus, hypertension, hyperlipidemia, osteoarthritis

Surgical history: R total knee replacement 3 years previous

Medications at home: Metformin 1000 mg/twice daily; 35 u Lantus pm; Lasix 25 mg/day; Lovastatin 60 mg/day

Tobacco use: None

Alcohol use: Socially, 2–3 beers per week

Family history: Father: Type 2 DM, CAD, Htn, COPD; Mother: Type 2 DM, CAD, osteoporosis

Demographics:

Marital status: Single

Number of children: 0

Years education: Associate’s degree

Language: English only

Occupation: Office manager for real estate office

Hours of work: 8-5 daily—sometimes on weekend

Household members: Lives with roommate

Ethnicity: Caucasian

Religious affiliation: None stated

Admitting History/Physical:

Chief complaint: “I am here for weight-loss surgery.”

General appearance: Obese white male

Case Questions

1. Discuss the classification of morbid obesity.

2. Describe the primary health risks involved with untreated morbid obesity. What health risks does Mr. McKinley present with?

3. What are the standard adult criteria for consideration as a candidate for bariatric surgery? After reading Mr. McKinley’s medical record, determine the criteria that allow him to qualify for surgery.

Understanding the Nutrition Therapy

4. On post-op day one, Mr. McKinley was advanced to the Stage 1 Bariatric Surgery Diet.

This consists of sugar-free clear liquids, broth, and sugar-free Jell-O. Why are sugar-free foods used?

5. Over the next two months, Mr. McKinley will be progressed to a pureed-consistency diet with 6–8 small meals. Describe the major goals of this diet for the Roux-en-Y patient. How might the nutrition guidelines differ if Mr. McKinley had undergone a Lap-Band procedure?

6. Mr. McKinley’s RD has discussed the importance of hydration, protein intake, and intakes of vitamins and minerals, especially calcium, iron, and B12. For each of these nutrients, describe why intake may be inadequate and explain the potential complications that could result from deficiency.

III. Nutrition Assessment

7. Assess Mr. McKinley’s height and weight. Calculate his BMI and % usual body weight. What would be a reasonable weight goal for Mr. McKinley? Give your rationale for the method you used to determine this.

8. After reading the physician’s history and physical, identify any signs or symptoms that are most likely a consequence of Mr. McKinley’s morbid obesity.

9. Identify any abnormal biochemical indices and discuss the probable underlying etiology. How might they change after weight loss?

10. Determine Mr. McKinley’s energy and protein requirements to promote weight loss. Explain the rationale for the method you used to calculate these requirements.

IV. Nutrition Diagnosis

11. Identify at least two pertinent nutrition problems and the corresponding nutrition diagnoses.

V. Nutrition Intervention

12. Determine the appropriate progression of Mr. McKinley’s post-bariatric-surgery diet. Include recommendations for any supplementation that you would advise.

13. Describe any pertinent lifestyle changes that you would view as a priority for Mr. McKinley.

14. How would you assess Mr. McKinley’s readiness for a physical activity plan? How does exercise assist in weight loss after bariatric surgery?

VI. Nutrition Monitoring and Evaluation

15. Identify the steps you would take to monitor Mr. McKinley’s nutritional status postoperatively.

Write a response on a Professional Issue within Nursing of your choosing. Select a minimum of two (2) research articles from scholarly, peer-reviewed (refereed) journals regarding the Professional Issue and its relevance to current nursing practice. The assignment can compare and contrast the different sides to an issue, provide support to one side of an issue, or to create an action plan of how to manage a situation. Use critical thinking to analyze and evaluate the issue chosen. The articles must be current to within the past seven (7) years.

Some examples of Professional Issues within Nursing include, but are not limited to: • Access to healthcare • Nurse to Nurse Bullying • Disparities in healthcare • Health insurance coverage, health care financial concerns or fiscal responsibility • Importance of orientation to retention of nurses • Infections (CAUTI, sepsis), staffing needs, and scheduling practices and other safety concerns • Malpractice or other legal responsibilities • Withdrawing treatment vs. Advanced directives and other ethical concerns • The move toward more community care and other community concerns • Ideas on how to deal with conflict or have difficult discussions, how to use therapeutic communication in the workplace, giving specific examples.

Identify differences between resources and access to care, limitations etc related to minor care and adult care when it comes to Diabetes diagnosis?

Identify the transition from child related treatment into the adult health care system. Reference resources like hospital or outpatient programming related to your area. Address negative behaviors you might see related to a minor having a chronic disease as well as behaviors as an adult?

Describe the philosophical beliefs that drive quantitative research (positivists paradigm). How do these philosophical beliefs shape quantitative research?

Please be detailed- this is in regards to nursing research.

Name 3 causes of infant mortality. For each cause, suggest 2 or more public health measures aimed at reducing that risk. Discuss the barriers for achieving health equity for each cause.

Describe an injury that you, or your family member has sustained. Analyze the injury using host, agent, and environment.

Bridget is a 39 year-old female G1P0 and 24 weeks gestation with a history of Type II diabetes mellitus, who presents to her prenatal appointment for a routine scheduled visit. Her BMI is 34 and her most recent Hemoglobin A1C 9%. When discussing her recent A1C results, Bridget admits to being noncompliant in her diabetic treatment. Prior to her pregnancy Bridget managed her diabetes by taking Glyburide 5mg daily and diet control. As a result of Bridget’s history of noncompliance and an increase in her A1C, the physician switched her to insulin for the remainder of her pregnancy.

1. Identify the primary goal when caring for a pregnant woman with pregestational diabetes. (3 points)

2. Explain the standard of care in monitoring blood glucose levels in pregnancy. (2 points)

3. As the nurse, how would you counsel Bridget about her diabetes, regarding her noncompliance? (5pts)

4. Explain two (2) fetal and/or neonatal risks and complications associated to the mother’s poor management of her blood glucose levels. (5 points)

A student nurse is preparing a paper on coronary artery disease, including the risk factors and the clinical presentation. The paper must include a review of common antianginal agents: nitrates, beta-blockers, and calcium channel blockers.

1. What are the therapeutic actions, indications, and pharmacokinetics for nitroglycerin?
2. What are the indications and pharmacokinetics for metoprolol?
3. What are the therapeutic actions for diltiazem?
4. What are the considerations for the older adult for the use of antianginal agents?
5. What are the important teaching points for patients receiving antianginal nitrates?

Patience is 29 years old and has been HIV positive for 9 years. She has remained asymptomatic and is not taking antiretroviral medication. Recently she was at the drop-in clinic to talk to a public health nurse about having a baby through artificial insemination. She said she had met a man who wanted to marry her and have children with her, but she was concerned about the baby contracting her HIV infection. Her latest blood tests indicated her CD4⁺ count was 380/µL. The nurse referred her to the physician to discuss antiretroviral therapy during her pregnancy.

1. Outline the factors that increase the chance of HIV transmission from mother to infant and how transmission occurs.
   
2. Patience was told that after she became pregnant she would begin HAART therapy. Describe what this therapy is and what particular antiretroviral medication would be particularly useful to her during her pregnancy. What concern is there about administering certain antiretrovirals early in the pregnancy?
   
3. Individuals infected with HIV are prone to contracting opportunistic infections. Define opportunistic infection and outline the risk factors that leave an individual with HIV infection prone to contracting this type of illness.
   

Case Scenario: “lapay”
Mr. Lopez, a 60 y/o teacher, presents with a history of a sudden onset of acute upper central abdominal pain radiating to his back. The nurse attending Mr. Lopez asked about how it started. He stated that “this morning after breakfast, I had sudden, severe pain in my abdomen and I vomited a couple of times, but the pain still persists. It hurts here, above my belly button, and feels like it goes
straight through to my back.”

On the client’s past medical history, he had an appendectomy at age 25 and tonsillectomy at 7. He was also diagnosed with hypertension 5 years ago and pre-diabetes 6 months ago. When asked about pertinent family history, he willingly disclosed that he had a sister, 45 yo, was diagnosed with cholelitihiasis 2 years ago, a brother who is 54 yo had a cholecysytectomy 5 years ago for acute
cholecystitis and cholelithiasis and mother who is 80 yo had also underwent cholecystectomy for acute cholecystitis and cholelithiasis 13 years ago.

Mr. Lopez admits to drinking whiskey most evenings but denied that he was never a smoker. The client also stated that he has no known allergies and currently taking Aspirin 325mg every day, Propranolol 30 mg every day and Hydrochlorthiazide 25 mg every day.

Upon PE, vital signs reveals a blood pressure of 110/60 mmHg, HR of 110 bpm, RR of 24 cpm, body temperature of 38.4 OC and a pain scale of 8 out of 10. Upon auscultation, no murmurs or extra cardiac sounds were noted, both lungs are clear and palpation of the abdomen, tender in the mid-epigastrium with guarding and rebound tenderness.

Study Questions:
1. How is the case of Mr. Lopez associated with pancreatitis?
2. What are the other possible differential diagnosis to be ordered for Mr. Lopez?

A 64-year-old woman with multiple sclerosis (MS) is hospitalized. The team feels she may need to be placed on a feeding tube soon to assure adequate nourishment. They ask the patient about this in the morning and she agrees. However, in the evening (before the tube has been placed), the patient becomes disoriented and seems confused about her decision to have the feeding tube placed. She tells the team she doesn’t want it in. They revisit the question in the morning, when the patient is again lucid. Unable to recall her state of mind from the previous evening, the patient again agrees to the procedure.*

Explain your answers: Has the woman given her informed consent? Should she be judged competent? Should her final agreement to the procedure be sufficient to establish informed consent, or should her earlier waffling and confusion also be taken into account?

Leukemia Case Study

C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her neck and chest about 6 weeks ago. The rash became generalized, spreading to her head, abdomen, and arms, and was accompanied by polyarticular joint pain and back pain. About 2 weeks ago, she experienced three episodes of epistaxis in 1 day. Over the past week, her gums became swollen and tender and she was severely fatigued. Because of the progression of symptoms, she sought medical attention. Lab work was done, and C.O. was directly admitted to the hematology/oncology unit under the care of a hematologist for diagnostic evaluation. Skin biopsy showed cutaneous leukemic infiltrates, and bone marrow biopsy showed moderately hypercellular marrow and collections of monoblasts. Her lumbar puncture specimen was free of blast cells. The final diagnosis was acute myeloblastic leukemia.

C.O. is to begin remission induction therapy with cytarabine 100 mg/m²/day as a continuous infusion for 7 days and idarubicin 12 mg/m²/day IV push for 3 days. She is scheduled in angiography for placement of a triple-lumen subclavian catheter before beginning her therapy.

Laboratory Test Results

Complete Blood Count (CBC)

12. What type of bone marrow transplant will she have? Briefly describe this transplant process.

13. Name 4 priority problems C.O. will face in undergoing a bone marrow transplant. Put a star next to the most important priority

14. What is the most important intervention post-transplant?

A.            Giving analgesics for postprocedural pain

B.            Monitoring for signs of infection and bleeding

C.            Weighing her daily and offering small, frequent meals

D.            Offering emotional support to C.O. and her family during recovery

15. What type of isolation will C.O. need? Outline the guidelines for maintaining this type of isolation.

16. Undergoing a bone marrow transplant is challenging. Describe how you would provide emotional support to C.O. and her family.

17. Name 3 complications C.O. will be at risk for after the transplant.

18. Describe graft-versus-host disease.

19. True or false. If the transplanted cells do not engraft, C.O. will die unless another transplant is tried and successful. Defend your response.