How innate immune reactions stimulate adaptive immune responses

1. What are examples of PAMPs and DAMPs recognized by the innate immune system? What is the outcome of recognition?

1. The physician writes an order for ibuprofen 5mg/kg by mouth q6h PRN for pain. The child weighs 77 lbs. The pharmacy dispenses ibuprofen 50mg/2ml. How many mL will you administer per dose?

2. The doctor orders dicyclomine 20 mg p.o. q.6h upon discharge for the patient. Dicyclomine 10mg/5ml. How many teaspoons will the nurse instruct the patient to take per dose?

Write down the implementation process of the strategy of implementing school nurse in every schools of blue mountains local health district. How do you implement it within all schools of blue mountains local health district?

Student Activity 6-4

Discussion Questions

The following are suggested discussion questions for chapter 6 Long Term Care Services - BASICS OF THE U.S. HEALTH CARE SYSTEM - Nancy J.Niles. 4th edition

Do you know anyone who uses long-term care services? Why do they need them?

Do you think the Village Movement is a good idea? Provide statistics to support your answer.

Pick two historical events that you think influenced the development of long-term care in the United States.

Discuss the Green House project and its impact on the elderly population.

Discuss the Supreme Court's Olmstead decision. Do you support this decision? Why or why not?

1. Document two (2) normal and two (2) potentially abnormal findings when conducting a physical assessment of the respiratory system and cardiac system.

Active learning template for oxygen delivery, related content, underlying principles and nursing intervention

Gas Exchange

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Patient Profile

F.T. is a 70-year-old African American man who comes to the emergency department (ED) complaining of increased shortness of breath. He states that he started using his albuterol inhaler every 4 hours a few days ago, but it does not seem to be helping. He has been having trouble sleeping or doing any activity because of his shortness of breath.

SUBJECTIVE Data:

PMH: COPD, hypertension, and benign prostatic hyperplasia. No history of allergies.

Medications: metoprolol (Lopressor) 50 mg/day PO, furosemide (Lasix) 20 mg PO daily, finasteride (Proscar) 5 mg/day PO, Advair inhaler (fluticasone and salmeterol) 2 puffs bid, and albuterol inhaler 2 puffs q4hr PRN. Does not use O₂ at home.

Health Perception–Health Management: F.T. states he usually manages his COPD well with the Advair inhaler and occasional use of albuterol inhaler PRN. He thinks he caught a cold from his granddaughter last week. Increasing difficulty breathing, even with albuterol. Has a history of 30 pack-years of smoking, quitting 5 years ago.

Nutritional-Metabolic Pattern: Not eating, drinking very little over past 2 to 3 days.

Activity-Exercise: At present, cannot walk 100 feet without feeling short of breath, nor walk up one flight of stairs without stopping to catch his breath.

Sleep-Rest: Difficulty sleeping at present. Last night he slept upright in his recliner.

Cognitive-Perceptual: Denies any pain associated with shortness of breath. Feels slightly irritable because of lack of sleep.

Coping–Stress Tolerance: Denies any stress or emotional disturbance.

Discussion Questions

1. What type of assessment would be most appropriate for F.T.: comprehensive, focused, or emergency?
2. From the information provided by F.T., what other information would you ask him about his condition (time permitting)?
3. How will you individualize the assessment based on his current physiologic condition?
4. What considerations will you make based on his age? Ethnic/cultural background?
5. Of the information provided, which subjective assessment findings are of most concern to you?
6. F.T. cannot use his inhaler appropriately while he is talking with you. Is this an appropriate time to teach him about the proper use of his inhaler?
7. What should be included in the physical assessment? What do you think will be the priorities in your physical assessment?

1. Conduct research on geriatric problems with bowel elimination, urinary incontinence, and dehydration. Write a one-page report on your findings. Please cite the source of your findings.

1. You are a nurse admitting a patient to the hospital from the emergency department (ED) with shortness of breath and recent weight loss. After receiving a report from the ED nurse, you ready the patient’s room according to unit specifications and collect the necessary equipment and forms. When the patient arrives, she is using oxygen via a nasal cannula and seems to be comfortable. As you begin your admission activities and paperwork, you note that her shortness of breath slightly increases as she answers your questions. Accompanying the patient is her daughter, who comments, “This is the fourth time she’s been admitted to this hospital in the past year.” The patient and her daughter demonstrate a close, loving relationship. The daughter not only encourages her mother but also sets boundaries regarding her mother’s anxiety. (Learning Objectives #1 & #3)
   1. What data in this scenario are pertinent?
   2. Which conditions within the case study could be addressed by nursing diagnoses?
   3. Which conditions within the case study would be addressed by a medical diagnosis?
   4. How are medical diagnoses, collaborative diagnoses, and nursing diagnoses different?
   5. Compare how a medical diagnosis is written versus a nursing diagnosis

• O• Does the current pandemic create any challenges for working on this particular health behavior? (2 points) • Suggest a short-term goal that you could work on for that behavior (e.g., a goal that you can achieve within a month or less) (4 points)

Religion: Roman Catholic
Address: Malabon
Date of Admission: Aug. 2,2020
Time of Admission: 11:30 PM
Chief Complaint: Shortness of breath
Admitting Diagnosis: CHF

History of Present Illness
The patient is a 60-year-old female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea. She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is new onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath. There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies.
Past Medical History
Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy.
Her current medications include Breo Ellipta 100-25 mcg inhaled daily, hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, Duo-Neb inhaled q4 hr PRN, levothyroxine 175 mcg by mouth daily, metformin 500 mg by mouth twice per day, nebivolol 5 mg by mouth daily, aspirin 81 mg by mouth daily, vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide mononitrate 60 mg by mouth daily, and rosuvastatin 40 mg by mouth daily
Family History
(+) HPN
(+) Diabetes
(-) Asthma
(-) Cancer
Physical Examination
Initial physical exam reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP 104/54, BMI 40.2, and O2 saturation 90% on room air.
Constitutional: Extremely obese, acutely ill-appearing female. Well-developed and well-nourished with BiPAP in place. Lying on a hospital stretcher under 3 blankets.
HEENT:
Head: Normocephalic and atraumatic
Mouth: Moist mucous membranes.
Macroglossia
Eyes: Conjunctiva and EOM are normal. Pupils are equal, round, and reactive to light. No scleral icterus. Bilateral periorbital edema present.
Neck: Neck supple. No JVD present. No masses or surgical scarring.
Throat: Patent and moist
Cardiovascular: Normal rate, regular rhythm, and normal heart sound with no murmur. 2+ pitting edema bilateral lower extremities and strong pulses in all four extremities.
Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. Patient barely able to finish a full sentence due to shortness of breath.
Abdominal: Soft. Obese. Bowel sounds are normal. No distension and no tenderness
Skin: Skin is very dry
Neurologic: Alert, awake, able to protect her airway. Moving all extremities. No sensation losses
Admission Order
Initial evaluation to elucidate the source of dyspnea was performed and included CBC to establish if an infectious or anemic source was present, CMP to review electrolyte balance and review renal function, and arterial blood gas to determine the PO2 for hypoxia and any major acid-base derangement, creatinine kinase and troponin I to evaluate presence of myocardial infarct or rhabdomyolysis, brain natriuretic peptide, ECG, and chest x-ray. Considering that it is winter and influenza is endemic in the community, a rapid influenza assay was obtained as well.
CBC
Largely unremarkable and non-contributory to establish a diagnosis.
CMP
Showed creatinine elevation above baseline from 1.08 base to 1.81 indicating possible acute injury. EGFR at 28 is consistent with the chronic renal disease. Calcium was elevated to 10.2. However, when corrected for albumin this corrected to 9.8 mg/dL. Mild transaminitis present as seen in Alkaline Phosphatase, AST, and ALT measurements which could be due to liver congestion from volume overload.
Initial arterial blood gas with pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air indicating respiratory alkalosis with hypoxic respiratory features.
Creatinine kinase was elevated along with serial elevated troponin I studies. In the setting of her known chronic renal failure, and in the setting of acute injury indicated by the above creatinine value, a differential of rhabdomyolysis is set.
Influenza A and B: Negative
ECG
Normal sinus rhythm with non-specific ST changes in inferior leads. Decreased voltage in leads I, III, aVR, aVL, aVF.
Chest X-ray
Findings: Bibasilar airspace disease that may represent alveolar edema. Cardiomegaly noted. Prominent interstitial markings noted. Small bilateral pleural effusionsRadiologist Impression: Radiographic changes of congestive failure with bilateral pleural effusions greater on the left compared to the right
.2nd Day of Admission
The second day of the admission patient’s shortness of breath was not improved, and she was more confused with difficulty arousing on conversation and examination. To further elucidate the etiology of her shortness of breath and confusion further history was obtained via the patient’s husband. He revealed that she is poorly compliant with taking her medications. He reports that she “doesn’t see the need to take so many pills. ”Testing was performed to include TSH, free T4, BNP, repeated arterial blood gas, CT scan of the chest, and echocardiogram. TSH and free T4 evaluate hypothyroidism. BNP evaluates fluid load status and possible congestive heart failure. CT scan of the chest will look for anatomical abnormalities. An echocardiogram is used to evaluate for left ventricular ejection fraction, right ventricular function, pulmonary artery pressure, valvular function, pericardial effusion and any hypokinetic area.
TSH: 112.717 (H)
Free T4: 0.56 (L)
TSH and Free T4 values indicate severe primary hypothyroidism
BNP: 187
BNP can be falsely low in obese patients due to the increased surface area. Additionally, adipose tissue has BNP receptors which augment the true BNP value. Also, African American patients more excretion may have falsely low values secondary to greater excretion of BNP.
This test is not that helpful in renal failure due to the chronic nature of fluid overload. This allows for desensitization of the cardiac tissues with a subsequent decrease in BNP release.
Repeat arterial blood gas on BiPAP ventilation shows pH 7.397, PCO2 35.3, PO2 72.4, HCO3 21.2, and oxygen saturation 90% on 2 L supplemental oxygen. CT chest without contrast was mainly obtained to evaluate left hemithorax especially retrocardiac area.
Radiologist Impression: Tiny bilateral pleural effusions. Pericardial effusion. Coronary artery calcification. Some left lung base atelectasis with minimal airspace disease.
Echocardiogram
The left ventricular systolic function is normal. The left ventricular cavity is borderline dilated.
The pericardial fluid is collected primarily posteriorly, laterally but not apically. There appeared to be a subtle, early hemodynamic effect of the pericardial fluid on the right-sided chambers by way of an early diastolic collapse of the RA/RV and delayed RV expansion until late diastole. Dedicated tamponade study was not performed.
Estimated ejection fraction appears to be in the range of 66% to 70%. The left ventricular cavity is borderline dilated.
The aortic valve is abnormal in structure and exhibits sclerosis. The mitral valve is abnormal in structure. Mild mitral annular calcification is present. There is bilateral thickening present. Trace mitral valve regurgitation is present.

1. Conceptualize the pathophysiological alterations distinct to the case.

1. You are a nurse preparing to receive a new patient, fresh from surgery, to your unit. The patient is a 71-year-old man who underwent a surgical repair of a fractured femur. As you receive a report from the postanesthesia recovery unit, you learn that his medical history includes hypertension, 40 pack-years of smoking, and COPD. His surgical repair was successful but complicated by excessive bleeding, and he is receiving IV fluids to compensate. He is widowed, and his three children are scattered throughout the United States. He lives alone, receives Meals on Wheels, and pays a cleaning service to keep his home clean. (Learning Objective #6)
   1. What data in this scenario are pertinent?
   2. What potential collaborative problem(s) could be applicable in this situation?
   3. Which nursing diagnoses would you expect to be applicable regarding the medical procedures in this situation?
   4. Which nursing diagnoses would you expect to be applicable regarding the nursing/medical history in this situation?
   5. Which nursing diagnoses would you expect to be applicable regarding the discharge planning in this situation?

1. Explain four functions of water in the body.

2. What type of patients are considered more susceptible to fluid overload problems?

3. A patient with inflammation of the cecum is at risk for fluid volume deficit. Explain why this is so.

4. Which two electrolytes play a role in muscle contraction and relaxation?

5. How do the lungs help maintain normal pH?

6. Explain at least two causes of metabolic acidosis and two causes of metabolic alkalosis.

1. Explain four functions of water in the body.

2. What type of patients are considered more susceptible to fluid overload problems?

3. A patient with inflammation of the cecum is at risk for fluid volume deficit. Explain why this is so.

4. Which two electrolytes play a role in muscle contraction and relaxation?

5. How do the lungs help maintain normal pH?

6. Explain at least two causes of metabolic acidosis and two causes of metabolic alkalosis.

1. Describe at least eight factors that contribute to constipation.

2. Explain specifically how opioid analgesics affect bowel elimination.

3. Explain what to do if signs or symptoms of a vagal response are noted during enema administration.

4. What can you do to help prevent CAUTIs when inserting an indwelling catheter?

5. How will you perform a 24-hour urine collection when the patient has an indwelling catheter?

6. Explain how to prevent recurring UTIs in female patients.