Age: 26 day

Gender: female

Diagnosis: PUD in nursing mother

Rx

Omeprazole T one od

Note: urea breath test was +ve , patient is allergic to penicillin.

according to this prescription find the mistakes, the interaction, dose , the toxicity level , antidotes , the counselling and what the suitable medication for this patient ?

A newly diagnosed diabetic patient is being seen in the health clinic. You are to begin teaching his self-injection of insulin. Develop a teaching plan for this patient. Discuss several outcome criteria associated with the insulin education.

a. Explain the pathophysiology of hyperthyroidism

b. Explain the therapeutic regimen of hyperthyroidism

c. Explain the pathophysiology of heartburn

d. Explain the therapeutic regimen of heartburn

PLEASE DO NOT COPY AND PASTE. WRITE ON YOUR OWN WORDS

How do you promote understanding across diverse groups? The following questions are used as a guide to answer:

1. Identify issues that may cause communication misunderstandings or other difficulties.
2. Discuss the impact of social and cultural diversity where difficulties or misunderstanding occur.
3. Discuss how you could make an effort to sensitively resolve differences, taking accounting of diversity consideration.

(Please answer all questions separately 200 words each)

Explain how a person with a disability can access and make use of an advocate/advocacy service to lodge a complaint.

Patient Introduction

Location: Surgical Unit 0800

Report from night shift charge nurse:

Situation: Sara Lin is an 18-year-old female patient who had an emergency appendectomy. It is day 2 postoperative, and Sara is expected to be discharged late this afternoon. We have discontinued her IV antibiotics after her morning dose. She will be getting oral meds today.

Background: Sara presented in the ED 2 days ago with a 2-day history of nausea, vomiting, and increasing pain. She was taken to surgery that day and had an open appendectomy for a ruptured appendix. She has been stable since arriving to the unit. Her parents have been here with her most of the time and are very helpful and supportive.

Assessment: Sara is alert and oriented, appropriate for age. She needs to be reminded to use her incentive spirometer. Abdomen is soft, tender to touch. Bowel sounds active. She has progressed to regular diet, and she's eating small amounts. No nausea reported since postoperative day 1. The abdominal dressing was changed by the surgery team early this a.m. The incision is closed with staples; the edges are well-approximate and only slightly reddened with minimal serosanguinous drainage. Her sequential compression devices were discontinued, and her Jackson-Pratt drain was pulled this morning. A small amount of bleeding was present; no further bleeding is noted. This morning, she had her first small soft brown stool since surgery.

Recommendation: You will have to transition Sara to oral antibiotics and pain medication. She last had pain medication 4 hours ago. You will need to provide discharge patient education on incision care, pain medication and antibiotics, signs of postoperative infection, activity restrictions, and surgical follow-up.

1.Assessment- 2 subjective data, 2 Objective data

2. 1 Nursing diagnosis

3. 2 long term goals, 2 short term goals

4. evaluation of goals, 3 evaluation of intervention

Cystic Fibrosis (CF)

A 2-year old female patient whose parents have brought her to the hospital because she has a persistent cough and wheezing, and also appears to be underweight despite having a good appetite. The doctor ordered a sweat test, and the excessive amount of salt in the patient's sweat revealed that she likely has cystic fibrosis (CF).

1. What gene is mutated in CF and where in the genome is the gene located?
2. Name the protein that is impacted by this gene mutation and what cellular effects result from this alteration?
3. Is CF inherited recessively or dominantly?
4. Why is an excessive amount of salt in the patient’s sweat an indication of CF?

Explain the etiology of chronic and acute pain

44-year-old male

ETOH Abuse

Smokes 1ppd for 30 years

PMH: COPD, DM, HTN, CHF, Cirrhosis, Ascites, BPH

PSH: TURP, Repair of right inguinal hernia, Cholecystectomy

Allergies: PCN

The above patient came to the ED c/o, spitting up blood and altered mental status. VS 103.5 – 189/103 – 114 – 26 – 89% NRB. The patient was intubated and vented, and NGT was placed. When lungs were auscultated, there crackles heard halfway up. Line and labs were done, and IVF 0.45 NS started at 60ml/hr. BC x 2 drawn, and Vancomycin 1gm IV given. Also given was Tylenol 650mg PO, Labetalol 100mg IV, Lasix 40mg IV. FC placed to bedside drainage with hematuria returned. Labs returned. WBC 28.6, H/H 7.3/18.6, PT 28, PTT 66, PLT 126, Ammonia 58, BNP, 158, Bands 10.5, Glucose 621, K+ 6.8, HgbA1C 10.9, CK 7.4 and Trop 1.6. EKG shows a STEMI, and CXR shows RUL pneumonia and pleural effusion. The patient is intubated via rapid sequence intubation and placed on a vent. Sedation is done with fentanyl and propofol. The patient went to cardiac cath for a PCI. 2 stents placed successfully for 95% blockage. The patient is to be transferred to ICU.

EKG in ED.

question. upon transfer to the ICU, what would you the nurse expectant anticipate in the following scenario?

Case Study 1: Food Poisoning

Background

The faculty and staff of Bristol High decided to hold one of their faculty meetings at Central Park one evening after school. The plan was to have a cookout and then proceed with the meeting after everyone had time to eat and relax. Many faculty and staff members brought family members to the picnic. Everything seemed to progress as planned, that is until later that evening. That’s when people began to get sick. Many of the faculty came down with a mysterious illness.

City officials were alarmed at the sicknesses and deaths, which seem to be associated with the event. They have promised a full investigation. Park managers said that most of the symptoms—such as dehydration, stomach cramps, nausea, and vomiting—seem to indicate some type of food poisoning; however, at this point they cannot be certain.

Even the waste-water treatment plant just a few hundred yards up river will have to submit a report on their procedures for water treatment. This is the first time anything like this has happened at the park and officials want to be sure that it does not happen again.

You are now part of a team of epidemiologists that have been called in to get to the bottom of this mystery. You will need to identify the cause of the disease and prevent any further outbreaks. Time is of the essence.

Information

The picnic started at 6:00 p.m. Tuesday evening at Central Park. The park is located by the Bristol River and contains several gazebos and picnic areas. The administration and faculty of Bristol High School organized the picnic as a relaxing event before their faculty meeting to be held after dinner. Many faculty and staff brought members of their family.

Mrs. Smith and Ms. Johnston arrived at 5:30 to set up. Mr. Albert was next to arrive to set up the grill. He brought his grill from home and had to take a few minutes to clean it off because it had not been used since last summer. Mr. Drake arrived next from the supermarket where he had picked up the hamburgers. After the charcoal was lit and aluminum foil was placed over the grills, Mr. Albert began to cook.

At 5:55, Mrs. Smith realized there was only one serving spoon. She left to get some more, returning about 30 minutes later. The other teachers waited for a while, but finally decided to start eating about 6:20.

When all of the food arrived there was a full menu that included baked beans, chicken, ham, green bean casserole, tuna casserole, cherry pie, pudding, potato salad, macaroni salad, corn, and hamburgers. Drinks included soda, water, coffee, and tea.

Mr. Drake was first through the line. He tried:

• green bean casserole
• ham
• hamburger

Ms. Cummings was next. She ate:

• potato salad
• ham
• a hamburger

The third person through the line was Mr. Carlson. He ate:

• green bean casserole
• potato salad
• a hamburger

Mrs. Albert was next in line. She sampled:

• potato salad
• a hamburger
• cherry pie

Mrs. Smith arrived at this time with more serving spoons. Mrs. Bell came at the same time. She was a little late because she had to be sure that her chicken was done.

Mrs. Wolfe went through the line next. She ate:

• green bean casserole
• chicken
• a hamburger
• pudding

Next was Mr. Lewis, who ate:

• baked beans
• green bean casserole
• macaroni salad
• corn

The line became a little unorganized at this point and it is not clear who went through next. Mrs. Smith and Ms. Johnston were two of the last people through since they helped to serve.

Mrs. Smith ate:

• green bean casserole
• potato salad
• a hamburger
• pudding

Others in attendance included Mr. Harvey, Ms. Jackson, Mr. Dooley, Mrs. Jones, and Mrs. Darwin. A lot of the guests said they could not remember exactly what they ate, but Mr. Harvey, Mr. Dooley, Mrs. Jones, and Mrs. Bell all had hamburgers, baked beans, and macaroni salad.

Ms. Jackson and Mrs. Darwin had ham, baked beans, corn, and some pudding for desert.

Mrs. Cain, Mrs. Williams, Dr. Oakton, Mrs. Corning, and Mrs. Reid have not yet been interviewed. Some other staff members arrived just in time for the faculty presentations, which started at 7:45. These included Mrs. Robinson, Mrs. Brown, and Mrs. Wright.

Some of the faculty and staff walked around while they ate but most sat in one of the gazebos. The presentations were held in the main gazebo, which was a relief for some of the faculty because it seemed to be one of the few places free of duck droppings.

Even during the meeting, some of the kids chased ducks with their water guns. These kids never seemed to run out of water because the guns held almost a gallon each, but even if they did run out, they quickly refilled them from the river.

Just about everyone at the picnic except for those that came for the meeting only were soaked. Since it was a hot day, the only time anyone seemed to mind the soaking was when one of the kids missed their intended target and almost put out the grill. After this incident, which happened about 6:10, the kids stayed away from the main gazebo, where the food was located, and turned their attention to the ducks and teachers walking around.

Bristol High Picnic Menu

Baked beans: Simply purchased two large cans of baked beans and heated on stove top to boiling.

Pudding: Mixed four packets of chocolate pudding with four cups of milk. Heated and then refrigerated.

Chicken: Baked chicken legs for 1 hour.

Ham: Baked ham for 2 hours 30 minutes until thermometer read 150 degrees for 20 minutes.

Green Bean Casserole: Cracker crust covered with two cans of cream of mushroom soup and two jars of green beans. Topped with 2 cans of small onions. Baked for 20 to 25 minutes to warm.

Potato salad: One jar of salad dressing, assorted diced vegetables, 2 tablespoons sugar, 1/2 cup mustard, 6 cups diced and cooked potatoes.

Macaroni salad: One box elbow macaroni, 3 T mustard, one jar salad dressing, various diced vegetables.

Tuna casserole: Cracker crust, 3 cans tuna, one can cream of mushroom soup, one can cream of chicken soup. Mixed and topped with parmesan cheese topping.

Hamburgers: Purchased at the supermarket just before the picnic (receipt showed time was 12:25).

Corn: 2 large cans of corn heated to simmering.

Cherry pie: Mountain top cherry pie, baked 40 minutes, pre-made.

Poisoned Picnic Faculty Information

Mrs. Cain

Brought plates and cups to the picnic. Had chicken, potato salad, pudding, green bean casserole. Became sick Tuesday evening. Symptoms included nausea, vomiting, and dizziness.

Mr. Lewis

Organized a game of volleyball set up by the gazebo. The players were a favorite target for the water guns!!! The only foul was when Mrs. Cain stepped on a duck going after the ball. Mr. Lewis became ill Tuesday evening. He was treated and released from the hospital Wednesday morning.

Mrs. Williams

Recovering. Became ill Tuesday night and was rushed to the hospital by her husband. Her son enjoyed his water gun, dowsing teachers with river water. She loved the burgers made by Mr. Albert. She also tried some green bean casserole, chicken, and pudding. Her son did not become ill.

Mrs. Reid

Sampled a little bit of everything. She became ill Tuesday night and finally went to the hospital Wednesday morning. She complained of stomach cramps and nausea. Doctors quickly began an IV to help replenish lost fluids. She briefly went into a coma then slowly recovered.

Dr. Oakton

Recovering. Had a great time except for when she stepped in duck droppings, which seemed to be everywhere. She didn’t even mind being soaked. She tried a little bit of everything to eat.

Mr. Albert

Mr. Albert took control of the grill. Mr. Drake soon showed up with the hamburger meat and started making the burgers. Mr. Albert had some potato salad, green bean casserole, a hamburger, and pudding for desert. Mr. Albert became ill, suffering from numbness, disorientation, nausea, and vomiting. He was treated and released after several days in the hospital.

Mrs. Corning

Arrived late, just in time to grab a burger and some green bean casserole. Most of the utensils and food were already put away. She became ill Wednesday morning and had to leave work around 8:30. She suffered from nausea, dizziness, and was so disoriented that she could not drive home.

Mrs. Smith

She arrived early with her son and helped to set up for the picnic. After many of the staff arrived, she realized that there was only one serving spoon so she went home to get some more. She returned about 30 minutes later with spoons, (after several faculty had gone through the line) to find her son chasing ducks with the water guns. Both Mrs. Smith and her son became ill.

Ms. Johnston

Helped to set up for the picnic. She had a hamburger, baked beans, pudding, and corn. She and several other teachers spent their time sitting in one of the gazebos talking and watching the children dash about after the ducks. Ms. Johnston is lactose intolerant. She became ill just a couple of hours after the picnic suffering from severe stomach pains. She went to bed and recovered overnight.

Mrs. Albert

Complained of stomach cramps early Tuesday night. Her condition continued to worsen until she finally had to be taken to the hospital. She was given massive doses of antibiotics. Her condition became worse as her symptoms began to include vomiting and disorientation. She soon found that she could not remember much about the picnic. After some time her condition improved.

Additional Information

We have since learned that luckily there was only one burger on the grill when it was soaked. Mr. Albert decided to throw it away because he had to lift up the grill and add more charcoal. Many times he would walk away from the grill to talk to someone and return to some very well done burgers. No one seemed to mind, that's the way they wanted them.

We have also learned that the wastewater treatment plant performed several tests on the water coming from their plant. The effluent (water being pumped out) was virtually void of any bacteria. The plant was doing a good job. They also did tests on the water around the park and found no notable bacterial contamination.

Pathology Report

Victim: Mrs. Wolfe

Admitted to hospital suffering from abdominal pain and vomiting. Began diagnostic tests but patient's condition deteriorated. Death due to respiratory and heart failure. Time of death: 3:30 a.m., 9/21/05.

Victim: Mr. Carlson

Paramedic response to home. Pronounced dead on arrival. Attempts to revive failed. Time of death: 11:30 p.m. 9/20/05

Victim: Mr. Drake

Admitted to hospital suffering from abdominal pain, headache, and paralysis of extremities. Lapsed into shock. Pulmonary failure followed. Time of death: 2:30 a.m. 9/21/05.

Victim: Ms. Cummings

Admitted to hospital suffering paralysis. Unable to communicate to hospital staff. Died of heart and respiratory failure. Time of death: 1:20 a.m., 9/21/05.

Include the following in your Report:

1. Create a table listing all food items at the picnic and all of the people who ate. Use this table to help you determine which fooeds the patrons consumed and the commonalities.
2. What organism caused the disease represented in this activity? How did you arrive at this conclusion?
3. What food item was contaminated? How did you arrive at this conclusion?
4. Briefly outline the events of the picnic that lead to the spread of this illness.
5. What different food items and organisms did you consider as the possible source and cause of the illness? What made you eliminate these as possibilities?

Outline a strategy to prevent future occurrences of this and other food borne illnesses.

Which drug is often given with other antibiotics to prevent antibiotic-induced diarrhea?

A person receiving antifungal medication should be monitored for ______damage.

Red Man syndrome is a possible complication _________therapy.

To help prevent intestinal superinfection during antibiotic therapy, the nurse should teach Mr. Bugs to eat which foods?

The most serious allergic reaction is: