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.

Consider this theory: Papadopoulous and Taylor Model for Transcultural Nursing and Health and in a 2-4 page paper answer the below questions:

1. Apply this theory directly to a scenario you have experienced (or read about) with patient care (direct or indirect).
2. Is this theory applicable to your current work environment? Explain.
3. How does the theory influence transcultural nursing practice?
4. How do transcultural nurses move cultural care to the forefront of nursing practice using the components of the theory?

why is spiritual assessment important for clients in you practice? what kinds of spiritual support can you offer to a person who is not of the same faith as you? which of the spiritual assessment techniques described are you most likely to use in your practice? why?

How does such reduction effect true cultural humility? Do you have a personal example of culturally competent care(or culturally incompetent care) that you would feel comfortable to share with the class?

How is nurse-client therapeutic communication constrained in these pandemic times. What can nurses do to overcome these constraints and How is nurse-client therapeutic communication constrained in these pandemic times what can nurses do to overcome these constraints?

Tobacco companies are required to include warning labels on cigarette packaging. It has been recommended that they illustrate the effects of cigarette smoking. These images are quite graphic; examples include diseased lungs and a man exhaling cigarette smoke through his neck by way of a tracheotomy hole.

Respond to the following questions:

1. How do you feel about these regulations?

2. Will this type of packaging make a difference in the number of people who smoke? If not, can you think of other ways to encourage people to quit or prevent others from starting this habit?

3. Do you think these kinds of labels should be used to deter people from purchasing unhealthy foods? For instance, should soda labels have pictures of rotting teeth?

1. Identify possible nursing diagnoses for Cushing syndrome.
2. Who would benefit from SSKI, PTU, tapazole RAIU? Are there any precautions or patient teaching to be mindful of for each?

A patient on your team is experiencing difficulty breathing. There is no change in the patient's status after you elevate the head of bed, apply oxygen, have the patient use pursed lip breathing, and obtain a breathing treatment for the patient. Auscultation of the lungs demonstrates crackles bilaterally halfway up the lungs. The respiratory rate is 40 breaths/min, with an oxygen saturation level of 90% on 4 liters oxygen per nasal cannula. The patient is restless and having difficulty speaking because of the shortness of breath. After exhausting all nursing interventions, you call the physician by telephone regarding the change in patient's status

1. Describe how you would communicate the following areas using the I-SBAR-R tool.
2. The physician orders Lasix 40 mg IVP and morphine 4 mg IVP and 1 to 2 mg IVP every 1-hour prn. You write down the telephone order and hang up. Your transcription includes the following information:
   • Lasix 40 mp IVP Stat and QD
   • MSO4 4.0 mg IVP Stat and 1.0-2.0 mg IVP q1hr prn

Is this the correct transcription of the order? How would you change it?

3. Did you take the telephone order correctly? What additional steps should be followed?
4. What tips for communicating with physicians on the telephone can you recall from the textbook chapter? Which of these were missing, done incorrectly, or not done during the communication with the physician? Which steps still need to be done?

Pathogenesis at the cellular level of Coronary Artery Disease.

Pathogenesis at the cellular level of Left-sided Heart Failure

Describes how Preload, Afterload, and Contractility are affected by Coronary Artery Disease

Describes how Preload, Afterload, and Contractility are affected by Left-sided Heart Failure

1) An episode of care is:

a) refers only to care provided in ambulatory setting

b) the time frame from initial diagnosis until the condition is resolved

c) one individual identified service given by the provider to the patient

d) the specific instance of condition or illness with defined timeframe with beginning and ending times identified

2) A Key administrative function of EHR systems is to

a) accurately identify the patient

b) integrate information from laboratory systems into the EHR

c) capture clinical information

d) computerized physician order entry process

3) Clinical documentation includes all of the following EXCEPT:

a) Patient Demographics

b) X-ray images

c) Clinical notes

d) Treatment Orders

4) Ambulatory EMRs are used for documenting treatments given in an ambulance.

True

False