CASE STUDY

After a week the shortness of breath has returned. Her son notices that she seems mildly confused. He takes her to the emergency department. The triage nurse takes her vital signs and performs a focused assessment. (Clinical Hint: When a client is experiencing a new onset of confusion, first, rule out hypoxia as the cause).

BP (MAP) HR RR SpO2 Mar. 10 1039 100/58 (72) 108 26 89% RA

Brought in by son per private vehicle. Oriented to name and place only. Crackles in the right lower lobe, inspiratory/expiratory wheezes. Moist cough. Some use of accessory muscles. States having a hard time breathing.

THIN Thinking Time! Reflect on the events that have occurred since Luanne Yazzie came to the emergency department and apply THIN Thinking.

(T - Top 3 H - Help Quick I - Identify Risk to Safety N - Nursing Process)

T –

H –

I –

N –

SIGNS AND SYMPTOMS OF MALARIA DISEASE/CONDITION

Tiffany, 36-year-old woman who has been experiencing of pain and swelling in her hands and feet. On examination by her General Practitioner (GP) her hands and feet display evidence of inflammation; rubra, heat and swelling and decreased function. On palpation and movement, they cause considerable pain which she rates as 5 - 7 on pain scale of 0 -10. When questioned on when this pain and inflammation first started, she is unable to say, but it has gradually worsened over the past 4 weeks. She states she has been taking Ibuprofen which initially provided relief but is no longer as effective. It is worse in the morning and she is now unable to carry out her many aspects of her normal routine. Her GP suspect’s Rheumatoid Arthritis (RA).

3c.       Disease Modifying Anti Rheumatic Drugs (DMARD) are often the first line of pharmacological therapy despite the significant side effects. Name two non-biological DMARD’s, describe how they work and why they are prescribed despite the significant adverse drug reactions (ADR’s)                                                                                                 3 marks ( 1 mark for drug names, 2 marks for discussion)

Case Study 5 – Neurological disorders – chronic

Tegan Bailey is a 28-year-old woman with a past medical history of generalised Tonic Clonic seizures following a traumatic brain injury 6 years ago. The seizures have been well controlled up until now with Carbamazepine (Tegretol) 500 mg daily. After participating in a fitness class at her local gym she was found in the change rooms lying on the ground unconscious.  

Questions:

5a.       Discuss the difference between a Tonic Clonic seizure and an Absence seizure                                                            3 marks (1.5 Marks for each type of seizure)

5b.       You are doing a set of observations on Tegan when you notice that her body starts to stiffen and she becomes unresponsive, you suspect she is having another seizure. Outline the nursing interventions that you would perform during and post seizure.                                                                                       3 marks

5c.       As a consequence of this latest seizure activity Tegan is to be commenced on Sodium Valproate 200mg three times a day in addition to her Carbamazepine. Discuss and compare how each drug works.                         4 marks ( 2 marks per drug)

1. List five opportunities for developing networks or collaborative partnerships to meet a specific client, personal, or professional need. CHCPRP001

List three aspect of the DNP roles when working with populations, a facility or workforce, or directed a specific clinical problem.

synthesize and integrate nursing practice concepts into their professional nursing practice.

engage in professional nursing practice that is patient-centered and appropriate for diverse individuals, families, and communities.

Provide patient-centered care that is respectful to diverse beliefs, and attitudes.

1. Exemplar of specific behavior that met competency.

As part of 2009s American Recovery and Reinvestment Act, the government allocated $2 billion to accelerate the adoption of health information technology. Why? Consider the advantages and disadvantages between Ethernet and Wi-Fi network technologies shown in Table 8-1. Which type of network is better? Why? What are some examples of how the admission, discharge, and transfer system can be used in a health information system? Why is this all in one system? In what ways can secondary patient data improve a government’s chances of preventing epidemics?

SITUATION: Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away. She has been dieting for several months and skipping meals. Ms. Singh mentions that in addition to her full-time job as a secretary she is attending college classes two evenings a week. She has smoked one package of cigarettes per day since she was 18 years old. Chest x-ray confirms pneumonia.

Physical Examination

Height: 167.6 cm (5960)

Weight: 54.4 kg (120 lb)

Temperature: 39.4°C (103°F)

Pulse: 68 beats/min

Respirations: 24/min

Blood pressure: 118/70 mmHg

Skin pale; cheeks flushed; Chills; use of accessory muscles; inspiratory crackles with diminished breath sounds right base; expectorating thick, yellow sputum

Diagnostic Data

Chest x-ray: right lobar infiltration

WBC: 14,000

pH: 7.49

PaCO2: 33 mmHg

HCO3 -: 20 mEq/L

PaO2: 80 mmHg

O2 SAT: 88%

Applying Critical Thinking and provide a thorough explanation:

1.The care plan appropriately focuses on the acute care of this client. Once she is significantly improved, the nurse will perform discharge teaching. What areas should be included?

THANK YOU!

SITUATION: Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away. She has been dieting for several months and skipping meals. Ms. Singh mentions that in addition to her full-time job as a secretary she is attending college classes two evenings a week. She has smoked one package of cigarettes per day since she was 18 years old. Chest x-ray confirms pneumonia.

Physical Examination

Height: 167.6 cm (5960)

Weight: 54.4 kg (120 lb)

Temperature: 39.4°C (103°F)

Pulse: 68 beats/min

Respirations: 24/min

Blood pressure: 118/70 mmHg

Skin pale; cheeks flushed; Chills; use of accessory muscles; inspiratory crackles with diminished breath sounds right base; expectorating thick, yellow sputum

Diagnostic Data

Chest x-ray: right lobar infiltration

WBC: 14,000

pH: 7.49

PaCO2: 33 mmHg

HCO3 -: 20 mEq/L

PaO2: 80 mmHg

O2 SAT: 88%

Applying Critical Thinking and provide a thorough explanation:

1. The client already has some signs of respiratory distress. What signs might indicate that her condition was deteriorating into a more emergency situation? How would you handle this?

THANK YOU!

what does it mean to ethical accompany someone who is dying? what challenges do you think you would face in accompanying a patient that was dying? what resources might

what is the best argument in favor of increased use of technology in medical organizations, and what is the best argument against increasing the use of technology in medical organizations?

1. What significance does the case of Ethics of Administering Anthrax Vaccine to Children have regarding disease prevention and control? Explain your answer.

What significance does the case of The Prohibition of Smoking in Public Places in Bulgaria have regarding chronic disease prevention and health promotion? Explain your answer

Give at least 5 nursing interventions (with rationale) for pain related to primary breast engorgement.