1. What steps are used to evaluate the evidence within clinical practice guidelines?

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1. Amnah’s doctor has commenced her on immediate treatments. Give five types of the medical treatments that could benefit Amnah?

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1. Amnah was diagnosed with health issues other than respiratory. Identify two of these issues and give one diagnostic finding for each?

Case Study

Amnah is a 55-year-old female patient who has been admitted to the medical ward with acute shortness of breath, chesty cough, wheezing and chest discomfort. Amnah’s vital signs were: SpO2 82% on room air, BP 150/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 38.7 °C. Amnah has a history of COPD and hypertension for 15 years. She was also diagnosed with heart failure 2 years ago. While doing the physical examination, the patient seemed to use her accessory muscles and have cyanosis in the lips and nose. She also started to get mixed up during the nursing assessment as she could not figure out that she was in the hospital. Amnah also complaint of weakness and fatigue and her lower limbs were very edematous. After a medical review, ABG was taken, CXR was done and venous blood samples were sent for complete blood count, chemistry and culture and sensitivity. Amnah’s lab results were as follows:

Based on the medical review and the diagnostic tests results, Amnah was mainly diagnosed with impaired respiratory functions. She was also found to have some cardiac and renal abnormalities. The doctor ordered immediate treatment and requested very close monitoring of Amnah.

1-You are the nurse looking after Amnah. Explain five immediate nursing interventions?

1.

2.

3.

4.

5.

Part 1.
Write a Reflection Paper about "Fluid Imbalances".

Part 2.
Make plan of care or interventions to address the following possible nursing diagnoses associated with AKI and ESRD.

a. Fluid volume excess
b. Decreased cardiac output
c. Impaired tissue integrity: renal

Test 1.
Direction: Choose the correct answer and give the rationale.

1. The purpose of research question is to generate new knowledge, while the purpose of EBP questions is to make decision about patient care.
a. True
b. False
c. Maybe
RATIONALE: _________________________________________________

2. Evidence-based practice includes which of the following?
a. Best available evidence
b. Individual clinical experience
c. Patient values
d. All of the above
RATIONALE: _________________________________________________

3. What is the first step in applying EBP concepts to answer a clinical question?
a. Ask the question
b. Acquire the evidence
c. Appraise the evidence
d. Assess the whole process
RATIONALE: _________________________________________________

4. Evidence-based practice can be said to be a quality improvement process because?
a. You have critically analyzed many research articles
b. You have learned how to skim read many research articles
c Trial and error is still important in clinical practice
d. Evidence-based practice is a key factor contributing to accountability and benchmarking

RATIONALE: _________________________________________________

5. Evidence-based nurses ask whether there is a scientific basis for the care they deliver in order to:
a. Make certain they can evaluate findings correctly
b. Convince their colleague to change practice
c Change their practice regularly
d. Provide the most effective care for their patients.

RATIONALE: _________________________________________________

L-Phynelalanine

Case Scenario:

Ruba is a 39 years old, pregnant woman at 8 weeks gestation, and her husband, Ali, is 50 years old, arrives at antenatal clinic for follow-up. The couples have been married for 12 years. Ruba completes the initial paperwork, and the nurse notes the following obstetric history: G6 T0 P0 A5 L0 M0. Ruba and Ali asked the nurse many questions regarding Down syndrome as Ali’s sister, recently, has a boy with Down syndrome.

Q1: As Ruba has many questions regarding her pregnancy, including the physiological and psychological changes, labor process and postpartum period. The nurse advice Ruba and Ali to attend antenatal classes. List six topics should be covered in the childbirth preparation program that may help to answer Ruba’s inquiries.

Q2: After 7 months, Ruba is approximately 37 weeks gestation. She comes for antenatal follow-up visit complaining of backache, leg cramps, heartburn, constipation, and difficulty sleeping at night. Describe three nursing management for each Ruba’s complain (minor discomfort).   

A. Backache :

B. Leg cramps :

C. Heartburn:

D. Constipation:

E. Difficulty sleeping at night      

Which physiologic actions result from normal insulin secretion? Select all that apply.
A. Increased liver storage of glucose as glycogen

B. Increased gluconeogenesis

C. Increased cellular uptake of blood glucose

D. Increased breakdown of lipids (fats) for fuel

E. Increased production and release of epinephrine

F. Decreased storage of free fatty acids in fat cells

G. Decreased blood glucose levels

H. Decreased blood cholesterol levels

A woman from rural area reported to the local hospital with high fever (102^oF), light sensitivity, joint pain, and muscle pain. Her examination showed mild jaundice, and pain in the right upper quadrant of the abdomen. She also had swollen cervical lymph nodes, on both sides of her neck. Her physical revealed temperature of 102.4^oF, pulse of 90 beats/min, respiratory rate of 26/min, and BP of 110/70 mm Hg. Laboratory findings gave erythrocytes a little low, leukocytes normal, platelets low, alkaline phosphatase high, aspartate aminotransferase high, and alanine aminotransferase high. Dermatologic examination showed no rashes, petechiae, or ulcerations. She was not around any rodent manifestations.

What etiologic agent could cause this?

Case Study: Bill is 4 years old, and his mother is worried about his eating habits. He absolutely refuses to eat vegetables, meat, and most meals in general. Some days he eats very little food. He wants to eat snacks most of the time. But, his mother wants him to eat a sit-down lunch and dinner to make sure he gets all the nutrients he needs. Bill likes to eat breakfast cereal, fruit, and cheese and regularly requests these foods for snacks. However, his mother tries to deny his requests, so that he will have an appetite for dinner. Instead, he drinks 5 or 6 glass of whole milk throughout the day because it tastes good and keeps his tummy from growling.

Mealtime is a battle because Bill says he isn’t hungry, but his mother wants him to eat everything served on his plate. When his mother prepares dinner, she makes plenty of vegetables, boiling them until they are soft, hoping this will appeal to Bill. She serves casseroles and stews regularly because they are convenient. Bill’s dad waits to eat his vegetables last, regularly telling the family that he eats them only because he has to. He also regularly complains about how dinner has been prepared.
Bill saves his vegetables until last and usually gags when his mother orders him to eat them. Bill has been known to sit at the dinner table for an hour until the war of wills ends.

At preschool, Bill is often fidgety, and has difficulty remaining in his seat. The teacher finds he will not stay focused on any tasks like his classmates do. Bill’s mother asks you what she should do.

Step 2: Write an Initial Post

Create a new thread and write/submit an initial posting using facts from your book. The original post should be focused on one topic (if there are multiple examples, limit your discussion to 1-2 examples that you explain in more detail with facts from the book). Please do NOT answer every question in one post. The reason I do not want every question answered is because it either becomes too long, or it lacks depth of understanding (listing instead of explaining). It also makes it less conversational and doesn't leave as much for others to talk about. The idea behind this discussion is that collectively as a class you will answer all of the questions thoroughly using the book to back it up. If you talk about everything in one post, what will others have to say in the reply? So, I want you to show depth in your answer, but keep it focused on one idea. Provide details and/or examples in your explanations.

• What mistakes might Bill’s parents be making that contributes to Bill’s poor eating habits. (limit to 1-2 mistakes, explained in depth using facts from the book)
• What nutrient deficiency might Bill be exhibiting and how do you know based on his behavior symptoms and food intakes?
• How might Bill's/his parents’ current behaviors lead to obesity?
• How might eating breakfast be helpful to Bill?
• What strategies might Bill’s parents try to promote good eating habits for Bill? (limit to 1-2 strategies that are explained in depth with examples - foods/solutions to the food related problems)

nothing is missing .