You are working on a medical/surgical floor with a client with adrenal dysfunction. The client is a 61-year-old male who presented to the ED in a markedly unwell state. He complains of progressive development of symptoms that include feeling generally not well, weakness, and fatigue. He is dizzy most of the time, and it gets worse upon standing. During your admission assessment he comments on unintentional weight loss and a darkening of his skin, "like a suntan.” His vital signs on admission are: P = 110, RR = 20, BP = 95/55, & T = 97.6 (F). He is diagnosed with primary adrenal insufficiency or Addison’s disease.

Answer the following questions:

1. Explain the pathophysiology of your clients' disease processes.

2. Explain the fluid volume, electrolyte, hemodynamic, and metabolic imbalances your clients are experiencing.

3. What other lab value abnormalities would you anticipate?

4. What symptoms, other than the ones listed, might your clients manifest?

5. What tests would confirm the diagnoses?

6. What medical interventions do you anticipate?

7. What medications do you expect to be ordered, and what are the nursing implications of those meds?

8. What are your priorities in planning care for these clients?

9. What nursing interventions will you implement?

10. What discharge teaching will you provide?

how does atherosclerosis cause vasospasm?

A number of drugs with different properties are shown below. Which of these drugs are most likely to cross the blood-brain barrier? (select all that apply)

- High molecular weight drug

- Low molecular weight drug

- Water-soluble drug

- Fat-soluble drug

- Nonpolar drug

- Small drug

- Polar drug

Lab Assignment

• Create a table and identify ranges of acceptable vital sign values (temperature, pulse rate, respiration rate, blood pressure and oxygen saturation) for an infant, a child, and an adult.

• J.P. is a 15-year-old African American adolescent who was diagnosed with sickle cell disease 3 years ago. J.P. presents to the emergency department with pain related to sickle cell crisis.

Subjective Data
Pain level is an 8/10 location = bilateral legs, described as deep muscle pain
Student in 10th grade, honor roll student
On the track team
Lives with mother and father

Objective Data
Vital signs: T 37 P 80 R 18 BP 140/68
Weight: 140
HT: 5 feet, 6 inches

Questions

1. What other assessments should be included for this patient? Explain your answers.
2. Discuss the various types of pain that a patient can experience. Explain your answers.
3. What type of pain does this patient describe? Explain your answers.
4. What standards of assessing pain will be applied to this patient’s plan of care? Explain your answers.
5. Discuss three (3) patient education/teachings that should the nurse consider from the problems list. Explain your answer.
6. Provide four (4) interventions that should be included in the plan of care for this patient. Explain your answers.

J.P. is a 45-year-old man who presents to the outpatient clinic with two swollen toes on his right foot. He does not recall injuring his foot.

Subjective Data

Pain level is a 6/10 location = right foot, throbbing
Works as a truck driver

Objective Data

Vital signs: T 37 P 80 R 14 BP 120/68
+2 edema great toe and second toe, right foot, warm to touch
+ pulses
+2 capillary refill

Questions

1. What other assessments should be included for this patient?
2. From the readings, what is the most probable cause of the edema?
3. What are two (2) nursing diagnoses related to the patient's situation?
4. What would be included in the nursing care plan? Explain your answer.
5. Discuss three (3) interventions that might be included in the plan of care for this patient. Explain your answer.

C.M. is an 89-year-old female who presents with her daughter to the provider’s office. The daughter is concerned because her mother has not been eating well.

Subjective Data

PMH: HTN, Hypothyroid
24-hour diet recall reveals approximately 1,100-calorie intake
Lives alone, daughter nearby
Does not drive
Daughter shops
Patient cooks light meals

Objective Data

Vital signs: T 37 P 72 R 12 BP 104/64
Weight: 105 lb
Weight last visit, 3 months ago: 115 lb
HT: 5 feet, 1 inch
Medications: Metoprolol 12.5 mg per day, Synthroid 0.75 mg per day
Oral mucosa dry, gums bleeding, dentures loose
Poor skin turgor

Questions

1. Develop a problems list. Differentiate from the objective and subjective data.
2. What two (2) nursing diagnoses can be derived from the problems list?
3. What should be included in the plan of care?
4. Calculate the patient’s body mass index.
5. How many calories a day does this patient need to maintain her current weight? Explain your answer.
6. Discuss three (3) laboratory studies that would help determine the patient’s nutritional status. Explain your answer.

name one pathological condition, giving symptoms, diagnosing, treatment, and prognosis.

Considering what you know regarding the U.S. health care system, stake holders, the health care systems of other countries and cost, in your opinion is the Affordable Care Act a good change?

J.G., a 49-year-old man, was seen in the emergency department 4 days ago, diagnosed with alcohol intoxication, and released after 8 hours to his brother's care. He was brought back to the ED 12 hours ago with an active gastrointestinal (GI) bleed and is being admitted to the intensive care unit (ICU); his diagnosis is upper GI bleed and alcohol intoxication.

You are assigned to admit and care for J.G. for the remainder of your shift. According to the ED notes, his admission vital signs (VS) were 84/56, 110, 26, and he was vomiting bright red blood. He was given IV fluids and transfused 6 units of packed red blood cells (PRBCs) in the ED. On initial assessment, you note that J.G:s VS are blood pressure 154/90, 110, 24; he has a slight tremor in his hands, and he appears anxious. He complains of a headache and appears flushed. You note that he has not had any emesis and has not had any frank red blood in his stool or melena (black tarry stools) over the past 5 hours. In response to your questions, J.G. denies that he has an alcohol problem but later admits to drinking approximately a fifth of vodka daily for the past 2 months. He reports that he was drinking vodka when he got home from the ED the first time. He admits to having had seizures while withdrawing from alcohol in the past. He tells you that he "just can't help it" and has strong urges to drink, but that he never means "to drink very much." He has had trouble keeping a job over the past several months.

Chart View

Admission Lab Work

Hgb 10.9 g/dL

Hct 23%

ALT (formerly SGPT) 69 units/L

AST (formerly SGOT) 111 units/L

GGT 75 units/L

ETOH 291 mg/dL

1. Please do a SBAR for this patient

How do beta blockers affect the sympathetic nervous system?How might a non selective beta blocker affect client with asthma?what should you be aware if client is a diabetic and taking beta blocker?

Case 85: Inappropriate Touching in the Operating Room

You are giving anesthesia for a patient undergoing ankle surgery. The patient adeep and her vital signs are good. You look up and see that the podiatrie foot surgeon is at the wrong end of the table and appears to be fondling the breast of the patient.

You cant believe your eyes and ask, "What are you doing?"

The surgeon stops touching the patient and looks up with a surprised expression. The nurse and the podiatric resident who are present in the OR are widecyed. The surgeon stops the inappropriate behavior. The surgery then proceeds without any further problems.

At the end of the case after the podiatrist has left the room you ask the nune and resident if they also observed the same behavior. The nurse confirms your observation and states she will only report the incident if you report it too. You and the OR nurse meet with the head nurse of the operating room as well as the Chief of Surgery and recount the story. Both administrators request the observa- tions be put in writing as an incident report which you and the OR nurse do.

When the surgeon is confronted with this digression from acceptable profes- sional behaviors he has no reasonable or plausible excuse for his behavior.

USE INFORMATION FROM CASE TO DO A WRITE UP (PLEASE INCLUDE DETAILED EXPLANATION AND COMPLETE ALL 6 STEPS)

1 - Write a background statement

2- What are the major problems and secondary issues?

3- Your Role

4- Organizational Strengths and Weaknesses

5- Alternatives and Recommended Solution

6- Evaluation

THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!!

Case Write-Up

Background Statement

A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.

Major Problems and Secondary Issues

The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.

Your Role

In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.

Organizational Strengths and Weaknesses

As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”

Alternatives and Recommended Solution

As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.

Evaluation

If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.