Questions
C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her neck and chest...

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)

1. Interpret C.O.’s CBC results. What does the presence of blasts in the differential mean?

2. What was the purpose of the bone marrow biopsy?

3. What nursing care is provided immediately post bone marrow biopsy?

4. Considering all the admission data, what potential problem will you be alert for when C.O. returns to the unit after the catheter insertion?

5. What assessments about the central catheter are essential for you to perform?


CASE STUDY PROGRESS
On the ninth day of continuous infusion of chemotherapy, the UAP reports C.O.’s vital signs to you.
Vital Signs
BP 110/54 mm Hg
Heart rate 115 beats/min
Respiratory rate 26 breaths/min
Temperature 101.6° F (38.7° C)

6. What other assessments should you make right now and why?


CASE STUDY PROGRESS
Your assessment findings are unremarkable and you notify the intern on call of C.O.’s vital signs. After evaluating C.O., the orders shown in the chart are written.
Physician’s Orders
Blood cultures now × 2 sites
CBC with differential now
Acetaminophen suppository 650 mg q4-6h prn
Imipenem/cilastatin sodium 500 mg IV piggyback q8h
Notify hematologist for temp over 100.0° F (37.8° C)

7. Do these orders seem appropriate? Explain.

8. What will your next action be?

Laboratory Test Values
WBCs 1200/mm3 (1.2 x 109/L)
Monocytes 25%
Lymphocytes 65%
Neutrophils 5%
Blasts 5%
Bands 0%
Hgb 6.8 g/dL (68 g/L)
Hct 21.3%
Platelets 17,000/mm3 (17 x 109/L)
9. What do these laboratory values indicate about her immune system?

10. Considering the previous data, what blood products will most likely be given to C.O.?

CASE STUDY PROGRESS
With continued blood product support and antibiotic coverage, C.O. is able to complete 14 days of therapy and a bone marrow biopsy shows she is in complete remission. HLA typing has been done on all her siblings. Her oldest brother is a perfect HLA match and has agreed to donate bone marrow. C.O. is being discharged with plans to readmit her to the bone marrow transplant unit within the next few weeks.

11. What does “complete remission” mean for C.O., and what effect did it have on the decision to perform a bone marrow transplant?

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.

In: Nursing

The old saying goes. "its like brain surgery" * Do you think brain surgery is going...

The old saying goes. "its like brain surgery"
* Do you think brain surgery is going to be complicated?
* Do you know what an aneurysm is?
* After looking up aneurysm do you think you will be calm when this is your case?
* How do you think you will react when you first see the human brain?
please answer each question in full detail. 100 words minimum.

In: Nursing

Please describe the difference between regular laparoscopic surgery and the Davinic robot? List pros and cons....

Please describe the difference between regular laparoscopic surgery and the Davinic robot?
List pros and cons.
Minimum of 100 words.

In: Nursing

scenario 1 I. George is a 75 year-old patient with urosepsis being treated in the Intensive...

scenario 1

I. George is a 75 year-old patient with urosepsis being treated in the Intensive care unit (ICU). The
nurse assesses George and finds that he has blood in his urine and stool, and is oozing blood from
his central line site and his gums.
1. What does the nurse suspect maybe occurring with George?
2. What medications should the nurse avoid administering to George?
3. The nurse is monitoring George’s vital signs every 15 minutes. What other monitoring is
essential to include along with the vital signs?
4. What medication does the nurse anticipate infusing?


scenario 2

II. Fred, a 43 year-old construction worker, has a history of hypertension. He smokes two packs of
cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with
stress. His current concern is calf pain during minimal exercise, which decrease with rest.
1. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?
2. The patient is having ankle-brachial index (ABI) determined. The right posterior tibial reading is
75 mm Hg, and the brachial systolic pressure is 150mm Hg. What would the ABI be for this
patient?
3. The nurse is educating Fred about managing his condition. What methids can the nurse suggest
to increase arterial blood supply?
4. What is the best method for the nurse to assess Fred’s peripheral pulses to obtain consistent
results with other health care practitioners?


Scenario 3
III. Georgia, a 30 year-old woman, is diagnosed as having secondary hypertension when serial blood
pressure recordings 170/100 mm Hg. Her hypertension is the result of renal dysfunction.
1. How will Georgia’s kidney help maintain her hypertensive state?
2. The nurse informs Georgia that she should see her ophthalmologist. Why is it important that
Georgia adhere to follow up with an ophthalmologist?
3. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the nurse
understand about the action of Lasix?
4. What health education can the nurse suggest to Georgia to reduce complications and improve
disease outcomes?

In: Nursing

A middle age gentleman arrived at the ER with persistent diarrhea for the previous 3 days....

A middle age gentleman arrived at the ER with persistent diarrhea for the previous 3 days. Upon gathering the patient's history, recent foreign travel was noted. The attending physician noted increased respiration and decided to order an ABG. Results are reported as:

ABG Analyte (reference range at 37oC) Patient's result
pH (7.35-7.45) 7.21
pCO2 (35-45 mmHg) 19 mmHg
pO2 (85-105 mmHg) 96 mmHg
HCO3 (22-29 mmHG) 7 mmHg
SO2 (>95%) 96%

1. What is this patient's acid-base status?

2. Why is the bicarbonate result so low?

3. Why does the patient have rapid respiration?

In: Nursing

One employee is confused by the term “determinants” and asks for clarification. You give a general...

One employee is confused by the term “determinants” and asks for clarification. You give a general definition, differentiating between downstream and upstream determinants, and provide the examples below. You ask them to identify which of the determinants below is the upstream determinant of not wearing sunscreen—the health behavior—for skin cancer prevention. They correctly select

Having a family history of skin cancer

Thinking there is no way you could get skin cancer

Hating how sunscreen makes your skin feel

Sunscreen not being available in local stores

In: Nursing

Since hypertension can often be asymptomatic, (1) what are some effective methods that can be utilized...

Since hypertension can often be asymptomatic,

(1) what are some effective methods that can be utilized to help us identify it early, and

(2) what are the risk factors that we need to look for, and (3) what are some of the main barriers to patient compliance with pharmacological therapy? What can we do to help improve compliance?

In: Nursing

The staff members seem to understand the ecological perspective behind public health program design, so you're...

The staff members seem to understand the ecological perspective behind public health program design, so you're ready to move on. “Many interventions are focused specifically on prevention,” you tell them, and explain that there are various levels of prevention that programs can focus on. “For example, a Health Department Policy requiring all new county employees to get tested for Tuberculosis is a _________ prevention intervention.”

In: Nursing

Velteri vs flolan – how set up and how they work. Amount of drug used. Types...

Velteri vs flolan – how set up and how they work. Amount of drug used. Types of diseases used on.

In: Nursing

What reasons do you think are the largest causes as to why electronic health information standards...

What reasons do you think are the largest causes as to why electronic health information standards are important and difficult to implement? What is being done to facilitate interoperability? Include 1 reference

In: Nursing

TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates...

TS is 67 years old with a long history of knee osteoarthritis for which he self-medicates regularly with over-the-counter (OTC) naproxen. He is in the clinic today complaining of a swallowing difficulty that has progressively worsened over the past several months. He has otherwise been healthy and has not seen a doctor in many years.

TS denies significant past medical history. A review of systems is negative except for arthritic symptoms and swallowing difficulty. He denies noticing blood in his stool and vomiting blood. He denies history of gastroesophageal reflux disease (GERD) and ulcer.

He does not drink alcohol, although he drank heavily many years ago. He does not smoke. TS describes the dysphagia this way: “Food gets stuck in my throat, and I can’t get it down.” The feeling occurs only after he has ingested solid food; liquids are not a problem. There is burning chest pain associated with meals.

He is scheduled for an upper gastrointestinal endoscopy.

  1. What is the likely cause of his dysphagia?
  2. What advice should TS be given regarding his OTC medication at this time?
  3. What are the usual signs and symptoms of GERD? How will it be managed?

In: Nursing

•Discuss the actions, side effects, contraindications and nursing considerations of the following medications: •Ceftriaxone oVancomycin hydrochloride...

•Discuss the actions, side effects, contraindications and nursing considerations of the following medications:

•Ceftriaxone

oVancomycin hydrochloride

oFentanylcitrate

oMidazolam hydrochloride

oDiazepam

oLidocaine/Prilocaine topical cream

In: Nursing

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones,...

The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate. Question: What would be the most important concept of glomerular filtration rate that the APRN should address?

In: Nursing

The patient is a 57-year old woman with a history of hypertension and chronic stable angina....

The patient is a 57-year old woman with a history of hypertension and chronic stable angina. She arrives in the ED complaining of indigestion-type pain that occurs more frequently than her chest pain and takes over 20 minutes to go away. She appears mildly short of breath, with vital signs of BP 155/98, pulse rate 100, respiratory rate 24/min. What should be considered as the most likely cause of this patient’s pain? Why? What is the difference between stable and unstable angina? Why might this new pain most likely be considered unstable angina?

In: Nursing

1. Imagine you have a family member with GAD and they ask you about the pros...

1. Imagine you have a family member with GAD and they ask you about the pros and cons of each of the following treatment options: SSRI, benzo, CBT, "alternative treatments" (exercise, meditation, magnesium, probiotics, etc). What would you tell them?

2. Panic disorder involves a well-established "chemical imbalance" (e.g., disordered acid-sensing receptors in the amygdala). Does this mean it should probably be treated with chemicals (e.g., meds)?

3. Benzos (e.g., Xanax, Ativan, Klonopin) are implicated in over 12,000 drug overdose deaths each year in the US, and yet they remain among the least regulated of all drugs with addiction potential (Schedule 4 classification). How is this even possible?

In: Nursing

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