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) White blood cells (WBCs) 39,000/mm3 (39 x 109/L) Monocytes 64% Lymphocytes 15% Neutrophils 4% Blasts 17% Hemoglobin (Hgb) 10.4 g/dL (104 g/L) Hematocrit (Hct) 28.7% Platelets 49,000/mm3 (49 x 109/L)

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.

Part 1: Marketing & Community Relations:

1. After reading chapter 16 of your textbook, you are to use the Internet and research a long-term care facility in your area.
2. After studying the organization, you are to address the following questions:

a. How does the facility “brand” its product?

b. Does the long-term care facility engage in community involvement?

3. Your initial response must be 250 words in length and posted on or before Wednesday.

QUESTIONS A 71-year-old ex-construction worker is admitted to a long-term care facility in his hometown. His wife and children are no longer able to provide him care at home since he suffered a brain attack (stroke). He has residual left-sided weakness and dementia. He is unable to walk unassisted and gets confused at times.

Based on Maslow’s hierarchy of human needs, how will each of his basic human needs is met in the long-term care facility?

Which of Maslow’s basic human needs takes priority on admission and why?

CAN YOU RELATE THOSE FIVE NEEDS TO THE QUESTION

How can the nursing staff include meeting Maslow’s human needs when providing ongoing care to this patient

A 48-year-old woman presents with a chief complaint of knee pain, with aching and stiffness on arising but easing up during the day. She does not engage in any type of exercise or activity. She is a grava 4, para 4 with a 10-year history of hypertension and a diagnosis of diabetes in the past 2 years. She calls it “sugar” and states that this condition is controlled with diet. She recently began working at a local Wal-Mart and has had to assist with shelving and loading of boxes.

CC: “My knee really hurts.”

Physical :

• Blood pressure, 154/94
• pulse rate, 88 beats/min
• RR 20/min.
• Afebrile
• Height, 5΄3΄΄; weight, 215 lbs. Her BMI 29.

The physical is remarkable for obesity and an erythematous rash under both breasts and in the groin. Her knee is tender and swollen. This patient is not new to your practice, but it is the first time that you have seen her. She lives with her husband, who is also overweight.

Questions:

1. Make a list of this patient’s problems. How would you prioritize these? Do you see her knee pain, hypertension, diabetes, and rash as all related to her weight?

2. What health promotion strategies are especially important for this patient at this time and why?

3. How will you manage this complex patient?

4. What Healthy People 2020 objectives are relevant?

5. What follow-up is needed for this patient? What patient education is important and how would you approach it?

6. Does voluntary weight loss, not associated with chronic disease or smoking, significantly lower morbidity and mortality in adults? What does the literature say?

7. What factors are important according to the current literature in helping individuals achieve a long-term commitment to fitness and exercise?

8.   What community-based approaches might help with obesity?

Scenario 1: You see a skateboarder going down a hill and suddenly lose control, crashing into the gravel on the side of the bike path. The skateboarder was wearing a helmet and did not hit their head on the ground when they fell. You walk over to the skateboarder to see if you can help them and notice them struggling to sit up and moaning in pain. You notice blood on the pavement and look to find a large deep gash on the skateboarder’s thigh that is spurting blood. You are first aid certified and want to help. (1) What are the initial steps you should take when responding to this emergency? (2) How would you determine what your plan of care would be, and how would you care for the victim? Describe in detail.

Scenario Continued: You have been applying pressure to the thigh with gauze pads, but the bleeding still continues and is still spurting. (1) With this new information how would you change your care? Describe in detail.

Scenario 2: You are playing a pickup game of basketball with your friends. During the game, one of the players trips over an untied shoelace and falls forward. As they are falling, they put their hands out in front of them to break their fall. They fall to the ground then yell in pain. You look over at them and they are sitting on the ground holding their arm close to their body. When you look at the arm you can see that their elbow is pointed at a weird angle and there is an obvious bump on the back of it. The athlete says that they felt a pop and they are unwilling to move their arm. (1) Describe in detail the initial steps you would take in this situation. (2) Explain how you would determine what your plan of care for the athlete should be.

Scenario Continued: You have determined that the athlete has dislocated their elbow and they need more medical attention. (1) Explain what steps you would take when giving care for the athlete. (2) When would you stop providing care for the athlete?

5-Gastrointestinal drugs are drugs used to treat upper and lower gastrointestinal disorders.
i.
Discuss briefly the mechanisms of action of TWO major classes of drugs used to treat
gastric/duodenal ulcers.
ii.
Prescribe in addition to the above, a non-pharmacological treatment for the same health
conditions

Chapter 7 Mental Health: Long Term and Acute Services.

What are some legal and risk management issues with providing mental health care? How do health care organizations address these issues?

Describe the details of the 1976 court case Tasaroff v. Regents of the University of California. How did this court case change mental health care practices and the responsibility of a provider’s duty to warn?

What is the closest NC state mental health institution? What is the difference between voluntary and involuntary commitment to a mental health institution? What requirements must be in place for a person to be “committed” to a state mental health institution?

A 22 year old woman reported to your health centre with a complaint of fever for 6 days. What questions will you ask the patient in the History of Presenting Complaints?

In this assignment, you will discuss concepts related to the importance of communication and related concepts in the profession of nursing. Follow the instructions below to complete your assignment:

• Introduce of the concept of communication with a purpose statement
• Identify and describe the phases of the nurse-patient relationship
• Evaluate effective and ineffective communication techniques
• Identify a strategy or strategies to becoming a successful communicator in nursing.
• Research this topic and integrate a current research article (within the past 5 years).
• Use scholarly APA format including title and reference page.
• Use correct grammar with clear and organized writing (do not use first person).
• Your assignment should be approximately 3-5 pages in length.

• Describe the key functions of the US health system, and analyze them within the context of open systems theory.

If the cost of a medical visit/ co-pay increases, how does this affect the demand for this item?