Linda Shaw is a 56-year-old female who was brought to the hospital by EMS on December 23, 2019. She presented to the emergency department with complaints of shortness of breath. She has had a productive cough for 3 days with a fever. She is admitted to the hospital with pneumonia and septicemia. She has a history of cellulitis, iron deficiency, high cholesterol and hypertension. She has an allergy to penicillin and vancomycin. She is taking ramipril 10mg daily, atorvastatin 20 mg daily and iron replacement daily. Since her arrival to hospital she has been on IV ceftriaxone 1gm q24 hours. She has been admitted for 2 days on the medicine unit that you are working on. Upon your assessment of the patient you notice she is short of breath during the interview. She can get no more than two words out before having to stop talking and rest. She is on wall oxygen at 2L via nasal prongs. You use your stethoscope to auscultate her chest and note decreased breath sounds to the LLL. You are aware that she has a left-sided pneumonia. You ask her to sit up in the bed and notice that she becomes increasingly short of breath with bed mobilization. Her respiratory rate is 24/min with evidence of accessory muscle use (abdominal breathing). You assess her oxygen saturation to be 92% on 2L of oxygen via nasal prongs. When asked if she has any pain the patient states “I have a heavy feeling in my chest”. You ask her what makes this pain worse, Linda states “The pain is worse when I am coughing”. You ask Linda when she first noticed the pain, “I first noticed the pain at 5am today”. Linda mentions that the pain in her chest seems to move into her throat. You ask Linda to describe the pain in her throat, “it is a scratchy pain”. Linda states that since changing her position on the bed she feels less pain. Linda states “before you asked me to move up in the bed my pain was 7/10 but since moving it is now 2/10 and mostly gone from my throat”. You assess Linda’s heart rate to be elevated (99 beats/min). You auscultate her apical pulse to match that finding. You note that her pulse is regular. You assess her blood pressure to be 111/80. You compare that to the blood pressure that the previous nurse had obtained overnight. Her pressure overnight was 118/79. You recognize that her blood pressure is lower than normal and ask her if she is dizzy or lightheaded, she tells you that she is not. Linda is alert and oriented and answering questions appropriately with no evidence of confusion. Upon assessment you note her pupils are equal and reactive bilaterally. Linda explains to you that she is feeling “unwell and tired”. She expresses frustration with her inability to sleep due to noise in the hallway at night. She tells you that she overheard the nurses talking all night long about baking Christmas cookies and it made her sad because she may not be home for Christmas. While Linda is talking to you about her inability to sleep, you notice that her oxygen saturation remains 92% despite her obvious shortness of breath when talking. Also, while she is talking to you, you take a look at her skin tone and note a normal skin colour and normal skin temperature. She does have dried blood at the site of her IV and the dressing is not intact. You assess her temperature to be elevated at 39 degrees Celsius. Linda also expresses frustration to you about being constipated, “I think I need some bran flakes. I haven’t had a bowel movement in 2 days”. Her abdomen does appear distended. You palpate all four of her abdominal quadrants and note they are soft and appear to be non-tender. You auscultate for bowel sounds and note that they are active in all quadrants. You ask Linda if she is passing gas, “you betcha” she replies. She tells you that before coming to the hospital she was 135lbs and that she believes she has lost weight. You ask her why she thinks this, “I haven’t eaten well since arriving to this hospital. I have no appetite and it seems to take a lot of effort to eat”. She seems to be moving her legs in bed frequently while you are interviewing her. You ask Linda, “Do you have pain in your legs?”. Linda explains that she does not have pain but rather wants to keep moving them so that she doesn’t “stiffen up”. Linda goes on to explain that she has had soreness and morning stiffness every morning for the last several years and her family doctor is investigating for arthritis. She denies requiring any mobility aids currently and denies any history of falls. You notice that Linda has a foley catheter insitu. There is 400cc of straw colour urine in the foley collection bag. You ask her why she has a catheter in. Linda states “the nurses put this catheter in while I was in the emergency department, they needed a urine specimen. Truthfully, I would like it out so that I can try to pee on my own”. Before terminating the interview, you hand Linda her cosmetic bag that she requested. She tears up and states, “I am not feeling much like putting make-up on. I fear that I will never get better. I seem to be wasting away in this bed. I am on my own with two kids in university so all that I can think about is who is going to work to pay for what they need. I need to get out of here!”. LAB VALUES AND DIAGNOSTIC TESTS FOR CASE STUDY #2 You can use the values below to add to the case study provided. If you have already developed the case study using your own lab values that is also acceptable. The idea is to explore the data and learn how to collect it in a comprehensive format along with identifying the priority nursing problem. WBC-16.2 Hgb-123 Plt-361 Na+-134 k-3.3 Cr-69 Glucose-6.2 CXR shows consolidation to left lower lung

Q- please answer : Nursing assessments needed (physical, psychological, social, spiritual, economic):  

Discuss in a 150-200 word essay about what you believe to be the greatest issues dealing with DIABETES

Q: Write Two PES statement for the following short case study.

JJ is a 50 y.o. woman who works as an accountant. She presents to her family physician with elevated blood pressure and obesity. JJ has struggled with her weight since childhood and indicates that her weight problems worsened 5 years ago when she returned to work as an accountant.

Nutrition Assessment

Client History:

Age- 50 years old

Gender- Female

Married with three children-ages 20, 15, and 10

Medical/Health History- elevated blood pressure (145/90 mm Hg)

Family History: Mother history of hypertension and T2DM at age of 60

Medical Diagnosis: Metabolic Syndrome

Food/Nutrition-Related History:

Total energy intake- Diet history indicated estimated energy intake of 2800-3000 kcal/day from a usual meal pattern of three meals and two snacks

Physical Activity History- sedentary lifestyle

Biochemical Data, Medical Tests, and Procedures:

Glucose, fasting- 122 mg/dL

Cholesterol, serum- 236 mg/dL

Triglycerides, serum- 179 mg/dL

Cholesterol, HDL- 39 mg/dL

Cholesterol, LDL- 153 mg/dL

Anthropometric Measurements:

Height- 5' 5"

Weight- 220#

Body Mass Index- 36.6

Waist Circumference- 40

Weight History- Lowest weight of 150 pounds (age of 25). Highest weight is current weight of 220 pounds. Gained approximately 50 pounds since returning to work as an accountant.

Comparative Standards

MyPlate recommendations of 1800-2200 kcal/day

BMI 36.6- Obese Class II

Case Study: Max

Client Profile: “Max is a 12-year old boy whose father died about 5 years ago. His father experienced periodic episodes of depression during his lifetime. After his father’s death, Max displayed tantrums and became more aggressive toward his toys and people. He took on a serious, almost sad expression. He seemed empty and alone, even when in a room full of people. Max saw a therapist; after a period of play therapy, he stopped being more aggressive than boys his age, began to smile and played with peers.”

            “Max’s mother went to work after his father’s death; she now works two jobs. When she is home, she is authoritarian in her parenting style. Recently, Max’s mother snooped around Max’s room and found some morbid pictures that he had drawn (i.e., pictures of funerals, cemeteries, and people being shot or knifed to death). She also found cigarettes; as a consequence, he cannot have any friends visit and he may not leave the house except to go to school.”

            Max is not turning in schoolwork and is picking fights at school. In the evening, he plays video games and makes excuses for procrastinating with his homework. He lies awake at night worrying about his homework and things such as failing school, disappointing his mother, not having friends, and wondering if everyone hates him. When his mother tells him he is going to fail school, he responds, ‘I don’t care.’”

            The school nurse notices Max’s behavior and becomes concerned, especially since two other students recently attempted suicide. She shares this information with Max’s mother and suggests that a health care provider see Max. His mother takes him to a sliding-fee-scale clinic where a family practice health care provider who volunteers at the clinic sees Max. The health care provider identifies depression as a problem, considers putting Max on medication, but decides instead to have him admitted to a residential treatment center for evaluation and treatment. A clinic social worker finds funding from various sources to cover the cost of treatment at the facility for children and adolescents. The facility has child and adolescent psychiatrists and psychiatric nurses on staff.” [Richardson, B.K. (2007). Case Study Series: Psychiatric Nursing, Clifton Park, NY: Thomson Delmar Learning.]

Case Study: The nurse on the children’s unit of the residential treatment center receives word Max will be admitted for treatment of depression. When Max and his mother arrive, the nurse does an intake interview with Max alone and then with both Max and his mother. Then the nurse interviews his mother and gives her a copy of the parent handbook while someone orients Max to the unit and its rules. Both Max and his mother are asked to sign a form indicating they have read the unit rules and will abide by them. Max’s belongings are inventoried; some are locked up, while he is permitted to keep others. The child psychiatrist prescribes fluoxetine (Prozac) as well as individual and group therapy.

            One night, Max gets irritable with the nurse for not letting him stay up past unit bedtime to watch his favorite television show. Max says, “It doesn’t matter because I am just going to kill myself tonight anyway.” The psychiatrist is notified and writes orders for Max to be placed on 1 to 1 observation within eyesight of an assigned staff member at all times. The following day Max learns he cannot go to the recreation building because a unit rule states, “Anyone who threatens to kill himself or herself cannot leave the unit until he or she no longer wishes to kill himself or herself and 24 hours have passed.” Max tells the nurse, “I was just kidding. I really wasn’t going to kill myself.”

Questions

1. Max’s mother tells you (the nurse) about the 2 other students at Max’s school who attempted suicide recently. How should you respond?

2.What data would you gather on Max and his family prior to writing a nursing care plan?

Nursing Care of a Cancer Patient

1. What risk factors does Anna have that could predispose her to the development of cancer?
2. What signs and symptoms could indicate that Anna has developed cancer?
3. Based on Anna’s risk factors and presenting problems, identify three care strategies that you would use to provide quality care to Anna. Provide rationale to explain why you chose these strategies.

list and explain some promotions, outreach, and awareness of childhood obesity children from 5-18 years?

Please discuss your idea about Inflammation and Pain.