Read the case scenario and apply the FIVE STEPS OF THE NURSING PROCESS.

Identify:

-Three appropriate nursing diagnoses

-For each nursing diagnosis provide one goal/expected outcome (goal should be SMART)

-Three nursing interventions for each diagnosis (independent, dependent, collaborative) and with scientific rationale

-One evaluative statement for each nursing diagnosis (indicate if goal met, goal partially met, or goal not met)

Follow the standard format of a nursing care plan. Thank you.

Levi Yosh is a 36-y/o police officer assigned to a high crime police precinct. One week ago he received a surface bullet wound to his arm. Today he arrives at the outpatient clinic to have the wound redressed. While speaking with the nurse, Mr. Yosh mentions that he has been promoted to the rank of detective and has assumed new responsibilities. He states that since his promotion, he has experienced increasing difficulty falling asleep and sometimes staying asleep. He expresses concern over the danger of his occupation and his desire to do well in his new position. He complains of waking up feeling tired and irritable. During the interview the nurse notes that he is pale, drawn with dark circles under his eyes. Temp: 37.0 C Pulse: 80 bpm, Resp: 18cpm, BP: 140/90mmHg

You are called to the ER to  evaluate b Mr. Collins who has a long standing history of COPD. He was brought to the ER by ambulance and is complaining of increasing shortness of breath and productive high laugh with thick, green sputum. During an examination the his chest you notice hyperesonant percussion with decreased fremitus over the lung except the lower right lope that has a dull percussion note and increased fremitus.

What are the reasons for the differences in the findings?

Based on the findings what would you hear on auscultation over RLL.

A patient with stage four (terminal) brain cancer is estimated to have 3 months to live. This patient, before the confused state of mind, had asked to 'die with dignity', by taking a lethal dose of a cocktail of drugs. (His physicians have conceded to his request and will not be breaking any laws in the state they are in).

1. Do you agree or disagree with physician-assisted suicide? Explain why or why not.

What are common Nursing Plans (SOAP) for a pt with sepsis and afib? Labs and vitals below:

Vital signs:

B/P: 146/92

HR: 112

RR 24

Temp: 101.3 F

Spo2 95%

Pain: 3/10

Labs:

Na+ 135; K+ 4.2; Cl- 95; CO2 29; BUN 18; creat 0.37; glucose 250

Hgb 9.0; Hct 28.7; WBC 15; Plat 371

ABG: 7.46; PaCO2 32; PaO2 97; HCO3 22; O2 sat 95%

An infant is brought to the emergency department by parents who report that the baby’s fontanels seem to be bulging outward. What action by the healthcare provider is most appropriate?

When are childhood cancers most often … ?

The student wants to know how the clinical manifestations and onset of juvenile idiopathic arthritis (JIA) differ from those of rheumatoid arthritis (RA) in adults. What answer by the healthcare professional is best?

An infant has been … with intussusception and the student asks the healthcare professional to explain the condition. What explanation by the professional is most accurate?

A patient is in status epilepticus. In addition to giving medication to stop the seizures, what would the healthcare professional place highest priority on?

A child has osteosarcoma and the healthcare team is assessing for metastases. What diagnostic study would be the priority?

PLEASE Complete the blanks in the following “story” of lipoprotein metabolism

Once upon a time there was a little girl named Alice who ate a double bacon cheeseburger for lunch. After digesting the __________________ in the burger using pancreatic __________, they used a ___________ to cross the unstirred water layer of the small intestine and enter the enterocyte. Once inside the enterocyte, the ___________________ were re-assembled and packaged into a _____________________ with the protein apoB_____ and released first into the _________ and then the __________. During circulation, the chylomicron bumped into it’s friend the happy little HDL particle, which gave the chylomicron two important apoprotein “gifts” named apo_____ and apo_____. The chylomicron was now ready to do its job of delivering _____________ triglycerides to the cells. The chylomicron floated along in the capillary until it docked with __________________________(activated by apo_____), which hydrolyzed the triglyceride to 1 _________ and 3 ___________________ which were taken up by the cell. After releasing its triglycerides, the chylomicron gave back the apo_____ to HDL and became a chylomicron _________________, which was taken up by the liver (whose receptors recognized the apo____ and apo____) and cleared it from circulation.

After eating the double bacon cheeseburger, Alice was very thirsty so she decided that she would drink a 2-liter bottle of soda sweetened with high fructose corn syrup. Because Alice had exceeded her calorie needs for the day, much of the fructose in the soda was converted to ____________ in the liver and used as the backbone for endogenous _____________________ synthesis. The liver took these ________________ triglycerides and packaged them into a ___________________________ with the protein apoB_____. After this nascent _________ was released into circulation, it bumped into it’s friend the happy little HDL particle, which gave the nascent _______ two important apoprotein “gifts” named apo_____ and apo_____, making a mature ________ particle. The mature ________ was now ready to do its job of delivering _____________ triglycerides to the cells. The VLDL floated along in the capillary until it docked with __________________________(activated by apo_____), which hydrolyzed the triglyceride to 1 _________ and 3 ___________________ which were taken up by the cell. As LPL pulled much of the __________________ out of VLDL, the VLDL particle became smaller and more enriched in _______________.

The VLDL particle liked getting smaller and was therefore jealous of its friend the happy little HDL particle, who was the smallest of all the lipoproteins. Therefore, the next time the VLDL particle bumped into the HDL, it made sure that it found a _____________________ to help steal cholesterol esters from the HDL particle and in exchange gave some of its _________________ and phospholipids to HDL. This made the VLDL particle even smaller with less triglyceride and more cholesterol esters, transforming the VLDL into an ________ and then (once the amount of cholesterol was greater than the amount of triglyceride) a ________. Since the VLDL had given back the apo_____ and apo _____ to HDL after the VLDL had released its triglycerides, the only apoprotein remaining on the LDL was apo______.

So now our friend the little LDL particle was ready to do its job of delivering ______________ to the cells. The LDL floated along until it docked with the ____________________ (which recognized the apo______) on the outside of the cell membrane and then the cell engulfed the entire _______ particle, removing it from circulation.

Because Alice had a very high saturated fat diet, she had an excess of cholesterol in her blood. Fortunately, Alice’s liver made the happy little nascent________ particle, who had a flat disc shape and contained apo______, apo______, and apo______. As this happy little particle circulated in the blood, it donated the apo_____ and apo______ to VLDL (and CMs) and became more spherical in shape as it picked up free _______________ from tissues and trapped it inside by esterifying it to make a ______________ ester. The enzyme that helped “trap” the cholesterol inside the _______ particle was named _____________________________, and this enzyme was activated by apo______. Although some of the cholesterol esters inside the ______ particle were transferred to VLDL in exchange for triglycerides and phospholipids by the __________________________________, the HDL was still able to keep much of the cholesterol inside and go back to the liver, which recognized the apo_____ and engulfed the HDL particle. And this is how our friend the happy little HDL takes cholesterol back to the liver, a process called “reverse _________________.”

What are some of the health and illness beliefs and practices, especially around birth, illness, and death? Include a formal health care system as well as folkways of most Muslims, and Christian?

Chief Complaint: Severe productive cough
Admitting Diagnosis: COPD

History of Present Illness
A 56-year-old man with a history of smoking rush to ER with shortness of breath and cough for several days. His symptoms began 3 days ago with runny nose. He reportsachronicmorning cough productive of white sputum, which has increased over the past 2 daysPast Medical History
He has had similar episodes each time of raining season for the past 4 years. He always experiences fatigue, worsening cough, increased breathlessness and waking up in the morning with headache.
Family History
(+) Tuberculosis
(+) Hypertension
(-) Cancer

Personal and Social History
He has smoked 1 to 2 packs of cigarettes per day for 40 years and continues tosmoke. He denies hemoptysis, chills, or weight loss and has not received any relief fromover-the-countercough preparations.

Admission Order:
NPO temporarily. Start IVF, PNSS 1L x KVO. Hook to O2 therapy via nasal cannulaat 2-3LPM.Nebulization of Salbutamol + Ipratropium now, then every 6 hours. Acetylcysteine(Fluimucil)400mg 1 sachet dissolved 1/2 of H2O every 6 hours, can be started tomorrowmorning. Tazobac(Piperacillin sodium) 4.5 g thru soluset dissolved in PNSS 90 cc x 1hr ODANST( ).

For Chestx-ray,CBC, FBS, ECG, Urinalysis and ABG. Please do spirometry and monitor for disease progress. Chest x-ray shows hyperinflation and right lobe pneumonia. ABGresults wasPh7.24,PO2-35 mmHg, PCO2 60mmHg, HCO3 30, O2 sat - 85%. Spirometry with FEVI 35%predictedthat does not change significantly after inhaled bronchodilators. ECG was ordered.

Physical Examination:
Took vital signs which are: BP: 130/80, T: 37.5 Celsius, PR:89, RR:30.

Examination displayed tachypnea, respiratory distress, use of accessory muscles, and intercostal retraction. Barrel
chest is a common observation

1.Conceptualize the pathophysiological alterations distinct to the case. (flow chart}l
- Establish the pathophysiological triad of Non modifiable risk factors– Patient –Modifiable Risk Factors specific to the case.
- Trace the pathophysiological changes and highlight problems that are experienced by the client.
- Connect the pertinent nursing care and medical – surgical management to the various signs and symptoms presented by the client.

Insights and reflection about Weidenbach's model of nursing.

identify 5 Administrative professionals who work within healthcare facilities. Briefly describe their job and explain how they are important to a healthcare organization

Why should health care providers provide information about the cost of treatment/ procedure to the patient in the process of informed consent?

Mr. Abdullah attended the genito-urinary clinic of the local hospital. He is seen by the doctor who informed him that he is HIV positive. He started a course of treatment. During patient history taking, Mr. Abdullah shares to the nurse that he married two years ago and they are expecting they are first born in two months’ time. Prior to his marriage, Mr. Abdullah had a series of sexual partners. The nurse counsels him to contact his sexual partners to inform them of his status.

On his subsequent visit, the nurse learns that Mr. Abdullah has not told his wife about his condition. The nurse explains to him that steps should be taken to assess whether his wife is HIV positive and whether the baby is at risk so that necessary treatments may be started. However, despite the nurse’s counsel and explanation, Mr. Abdullah refuses to tell his wife. He threatens the nurse that if she will attempt to communicate with his wife in any way or tell her of his diagnosis without his consent, he will stop his treatment regimen and will sue her for breach of confidentiality because this is a privileged communication.

What is the legal and ethical dilemma surrounding this scenario?

What is the “right” thing to do for the nurse in the case of Mr. Abdullah? Defend your answer focusing on the legal and ethical aspects of your decision.

What would you recommend to prevent this situation from occurring in

What other assessments should be included for this patient?

What questions are appropriate for a patient presenting with earache?

What risk factors are associated with earaches for this age group?

From the readings, what is the difference between otitis media and otitis externa?

From the readings, what is the most probable cause of the earache in this patient?

What are three nursing diagnoses?

What interventions should be included in the nursing care plan?