Ms. Van Dorn, a 19-year-old female student from Holland, visits the college health center for “being tired all the time.” The nurse notes that she is pale with cool skin, mucous membranes are pale and moist, and lungs are clear. Ms. Van Dorn states that she does get short of breath climbing the stairs or walking uphill. Laboratory results;

RBC 3.8 million µL

HGB 9.8 g/dL

HCT 37%

MCV 70 fL

MCH 25 pg

MCHC 300 g/L

WBC 6000/mm³

Her blood smear is abnormal

1.    How should the nurse interpret these findings?

2.   What questions should the nurse ask Ms. Van Dorn to help in differentiating the type of anemia?

3.Are there any other lab results you want to know?

The physician ordered furosemide 2.5 mg/kg q8h for a child who weighs 28 lb. The safe dosage range is 3 to 6 mg/kg q8h, How many milligrams of furosemide should the nurse administer for each dose? Round to the nearest whole number.

A 60-year-old homeless man, “Jesse”, is found confused and in distress by a passerby who calls 911. Paramedics bring the man to the hospital. Jesse’s feet and legs are swollen and covered in ulcers and dead tissue—diagnosed as osteomyelitis, or infection of his legs. His past medical history is established to include chronic obstructive pulmonary disease (COPD), chronic foot infections, alcoholism, and tobacco use. In addition to this, clinicians find a mass in Jesse’s lung that could either be TB or cancer. Physicians recommend a biopsy. The infections in this patient’s legs are so severe that a double amputation is recommended, also.

Jesse says “No!” to amputation, but reluctantly agrees to a biopsy of the lung mass. Then a psychiatric consultation leads to an opinion that the patient actually lacks capacity for healthcare decisions. Jesse had been able to identify his location in a hospital but not why, or what could happen as a result of not going along with medical recommendations for treatment. He had stated to the psychiatrist that he just wants to leave the hospital and die. But does he? Maybe. In a previous hospital admission, the chart indicates that Jesse had refused surgery as treatment for recurring infection in his legs, and physicians believed he had done so with decisional capacity.

Jesse’s support system initially seems to consist only of a couple recent acquaintances at the homeless shelter (who don’t have telephones and cannot be reached) and a dog that Jesse says is his very best friend. A hospital social worker searches for any next of kin, someone who knows Jesse and might be willing and able to make decisions as a surrogate. Social work eventually finds an out-of-town brother and an estranged sister. Neither have seen their brother in many years, and anyway are unwilling to make decisions on his behalf. The attending physician wonders aloud what should be done for Jesse now, and who can decide?

An ethics consultation is requested and received. An ethics note placed in the chart later that day offers several recommendations following a summation of the situation. This is a case seen by Ethics as one involving an unrepresented patient without advance directives and a care team with beneficent intent and insufficient information to know exactly what actions would constitute respect for the patient’s autonomy, such as it is, or his best interests otherwise. Ethics recommendations include:

• convene a multidisciplinary patient care meeting to foster communication amongst multiple care teams
• periodic reevaluation of the patient’s capacity given that it could be an acute rather than chronic state
• continue to update Jesse on his situation so as to respect whatever autonomy he retains or regains
• consider whether there might be other sources of infection, such as TB, that are contributing to his recent loss of decisional capacity and impeding recovery
• reiterate with nursing staff the need for infection control for the safety of care providers and other patients

Jesse is stabilized and remains hospitalized for another week. The lung biopsy shows evidence of a lung cancer that is treatable but not curable. Reevaluation of capacity for decision-making indicates that the patient has regained capacity sufficient for decisions for or against treatment of his cancer and infections. Jesse chooses to leave the hospital without further treatment. Upon discharge, he refuses also to be taken either to a homeless shelter or the nursing home placement that Social Work had found as the recommended discharge option. Jesse is discharged to the street, as he wishes.

Questions for Discussion:

• Is Jesse making the right decision to leave the hospital without treatment? How would we know what the right decision is in this case?
• How should the patient’s medical history, including his history of treatment refusal, impact decision-making during the period when he lacked decisional capacity?
• What justification might have been found to do the recommended amputations over Jesse’s incapacitated objections?
• Might that course of action have been justified if the leg infections were determined to be the primary cause of his acute decisional incapacity?
• What other recommendations might have come from ethics consultation?
• Treatment refusals—whether reasonable or unreasonable (and how would Jesse’s be categorized?) can be emotionally difficult for members of the care team. What should be done to support this care team in light of Jesse’s decisions?

Health Rationale: A Program for Sexually Transmitted Infections

1. Title this health rationale and state in broad terms what the problem is.
2. Propose a solution to the problem of sexually transmitted infections (e.g., name and purpose of the proposed health program). Here, you will give a general overview of your proposed program.
3. State why the program will be successful.

A child weighs 95 lbs and has an order for IV tobramycin. The order is for 3mg/kg/day in three divided doses. How many milligrams of medication should be administered per dose?

to nurse that he was not sure if a piece of the Q-tip had gotten stuck in his right ear. Blood came oozing from his right ear and stated it was hard for him to hear. can someone the following questions:

What other information is important to ask the patient.?

What type of nursing interventions will the nurse suggest for the patient.?

What type of medication will he need?

What education will you provide to him regarding cleaning his ears?

linda is a 45 year old female with mild to moderate lumbar pain and knee pain that has persisted for more than six months. she has mild relief with rest and non- steroidal anti-inflammatory drugs. her pain worsens with exercise
what are the advantages/ disadvantages of the option
should she try one therapy or treatment option at a time or consider a combination approach why?
would she benefit from beginning her treatment with less invasive options? Are there downsides to this approach?

Provide a brief summary of at least 5 support networks you could use to promote stress management. For this assignment, you can list the 5 support networks and provide a one sentence description of what services they provide or the purpose of the organization.

Add a reference

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

1. What are the current recommendations from the CDC regarding vaccines needed during pregnancy and/or the immediate post-partum period? Explain.

2. There are a wide variety of lab tests that are ordered throughout pregnancy. Below is a small sample. Complete the table.

Lab Test, Purpose, When is this checked? (if once then when?, if multiple times then when?), Possible results and How does the result alter the plan of care?

Urine

dipstick

Blood type

Rubella titer

Glucose tolerance test

Group B beta strep

1. The client has come to the clinic for her first prenatal visit at 18 weeks gestation. After the nurse explains the prenatal visit schedule. The client states, “I don’t really see any need to come back until I go into labor.” How should the nurse respond?
2. A woman who had twins, then one preterm infant, and is now pregnant again, what is her OB score? (GP TPAL).
3. The client who is 28 weeks gestation complains of fatigue. She reports difficulty sleeping. She says that she slept on her back before becoming pregnant, but now, she feels like she is going to faint in that position. How should the nurse respond?
4. The client, who has come to the clinic for her first prenatal visit, asks why she needs to be tested for HIV when only homosexual men are at risk for contracting the infection. How should you respond to the client?

1. The patient is an ER and complains of a headache

a. What test or labs can be done for severe headaches?

b. Definition and Description of that lab

c. Significance of the Test Being Ordered for this Patient:

d. What medication can be prescribed while waiting for the lab results

2.  A 75-year-old white female patient with a 9-year history of hyperthyroidism presents to the outpatient clinic with complaints of frequent heartburn over the past month.

a. What test or labs can be done?

b. Definition and Description of that lab

c. Significance of the Test Being Ordered for this Patient:

d. What medication can be prescribed while waiting for the lab results

PLEASE PUT IT IN YOUR OWN WORDS

How we can improve  Affordable Care Act?

Compare and contrast cystic fibrosis and pneumonia/influenza