Sherald is having trouble finding a procedural code in the Alphabetic Index for removal of a cataract. What are some options and/or alternative ways she can perform an Alphabetic Index search?

an example of a situation in which a health care provider does NOT have a Duty to Warn, despite there being some risk posed by a patient's confidential information to a third party.

A nurse is working in a group home for young adults with a history of substance abuse.

1. What are some signs and symptoms that the nurse should look for to ascertain whether a client has returned to “using”?
2. What therapeutic interventions may be most helpful for this group of clients?

Jason is a 22-year-old college student. He has missed several classes and did not turn in a major paper. When contacted by his professor, Jason admits to feeling so depressed that he has not been able to concentrate on his course work and has not left his apartment for several days. His professor expresses concern and suggests Jason go to the campus health center, which takes walk-ins. Jason agrees to go to the campus health center as a condition of getting an extension on the paper. Once there, he tells the nurse he has no appetite and complains of difficulty falling asleep. Jason says he feels guilty for not getting his assignments done and is not doing well in any of his classes. He states he doesn’t know what is wrong with him, he just can’t seem to get motivated and he doesn’t know why. He looked forward to going to college and was excited to be accepted and move away from home for the first time. Jason did very well last semester, and in the beginning of this semester. He was active in several clubs and was thinking of running for the student senate and joining the track team, but recently things just seemed to fall apart. Although Jason has many acquaintances through his classes and activities, he has no close friends in the area. During the intake interview, the nurse observes that Jason sits hunched forward in his chair with his eyes downcast. He becomes tearful at times and never smiles. Questions: 1. What is the most important issue the nurse should assess? 2. How would you describe Jason’s affect? 3. What are the physical health priorities for Jason at this time? 4. What additional information would the healthcare providers need to determine the most likely cause of Jason’s depressed mood? 5. What are the considerations in contacting Jason’s family regarding his situation? 6. What sociocultural factors or stressors might be contributing to Jason’s distress?

Marita sustained the following injuries in the fall:

-Two deep lacerations to her right leg

-Grazes to the right side of her face, shoulder, arm, leg, and torso

-Severe injury to her right wrist and upper right arm

-She had no altered conscious at the time of the accident

-Marita denied any neck pain and denied any altered sensation in her limbs.

Marita was taken to hospital via air ambulance. Where she had multiple Xrays that showed:

• Fractured Right humerus,

• Fractured Right radius

• Fractured Right 3rd & 4th ribs.

• There were no other injuries

• Head CT showed no signs of bleeding or trauma to her brain.

Surgery Marita required surgery under general anaesthesia to clean and suture her multiple wound lacerations and reduce her fractures. A plaster cast was applied to her right arm. She has sutures in her right thigh wound and a Jackson Pratt drain to her thigh, and sutures to her calf laceration. The operation was mostly uneventful apart from approximately 300ml of blood loss from her lacerations. She was given 1 unit of packed red cells, and 1 litre of Hartmann’s solution intra-op. Marita was transferred to the orthopaedic ward from theatre last night at 10:30pm. It is now the following morning and you are assigned to care for Marita. You assess Marita at 08:00 hours and your assessment findings are:

- Marita is awake and alert. She is orientated to time, place & person.

- Her right eye is bruised and almost shut due to an extensive haematoma. She is quite teary & asks if she is going to be ugly due to the facial grazes and her other scars. She’s extremely worried she’ll never get full use of her right arm back. She is also very concerned that she won’t be able pay for this as she’s not covered by Medicare.

- There is blood staining the dressings on her leg. The right leg drain has about 70ml of frank blood in it. Her right arm is swollen and bruised. The fingers on her right hand are also swollen. She has good movement and normal sensation in the fingers of her right hand. The skin is the same colour as her left hand apart from some bruising. The fingers to her right hand are cool to touch, and the capillary refill time is 3 seconds. Marita is complaining that the cast feels tight.

-  Her vital signs are: Temperature: 37.6C, Pulse: 115 & regular, Blood Pressure 92/58 mmHg, Respirations: 20 & shallow, Oxygen Saturation: 95% on 3LNP. She says it hurts to breath. • Marita is complaining of a dry mouth and being thirsty. There is no record of her passing urine since her return from surgery. Marita can’t remember when she last used the toilet

- She did not eat much of her breakfast but drank some of the orange juice and half a cup of coffee. She said it hurt her face to eat and the coffee was cold and not real coffee.

- She has a PCA in place and says her pain is bearable at the moment if she doesn’t move too much or try to breathe deeply or cough. Her PCA and IVT are connected to the cannula in her left arm. She has a litre of Normal Saline running at 40mlshr.

1. Using the case study information above, identify and justify three (3) important health issues that you need to address for Marita during your shift. Identify and explain the significance of the clinical cues you have used to prioritise your selection.
2. Provide an explanation of the action you will take to manage each health issue. Please ensure that your nursing interventions are supported by current evidence-based literature.

1) “Educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended” – What is the mechanism behind this?

2) If you have a patient on insulin who binge drinks on the weekend, and unwilling to change this lifestyle, how will you counsel the patient as a pharmacist?

3) If you tell someone who drinks a 6 pack beer and 6 shots of hard liquor every other Saturday to cut it to just 2 drinks, they are unlikely to make that change. How will you counsel him as a pharmacist? What therapy change will you make?

What are 8 key items you will monitor for Mr. Hayato for while he is on a ventilator and in your care? Explain the rationale behind each one.   

Pt:  Kyle Hayato

DOB: 10/23/60

Age: 60

Sex: M

Education BA degree

Occupation: marketing analyst

Living situation: wife, no children

Ethnic Background: Asian American

Dx:  Exacerbated COPD, peripheral vascular disease

CC:                  “ …I’ve had emphysema for 11 years. After trimming the hedges today, I had trouble catching my breath”

Mr. Hayato has smoked 2 PPD for 27 years. His exercise potential is poor today due to dyspnea on exertion.  Swelling in the lower extremities is visible. Chest x-ray reveals a pneumothroax forming in his right lung. Cyanosis.

Hx:  Dx with emphysema 11 yrs ago. MI in 2008.  Knee surgery in 91’

Meds:  Inhaler delivered albuterol

Family Hx:  CA: father with colon CA;   uncle with lung CA                                

Diet Hx:          Pt feels full after eating only a few bites and has difficulty preparing meals.  “ I am too tired to eat after I prepare my dinner.  When I am coughing a lot it makes it hard to eat too.  I don’t know how much weight I have lost, but I have had to buy smaller clothes. I wear dentures, but they fit kind of loosely.  I normally weigh about 170#.”  NKA.  No supplements.  Our niece prepares a lot of our meals, or else my wife does now.

Height:  5’8”

Weight: 149# (actual)

Hospital Events:

            Chest tube inserted in right thorax to drain fluid using suction.   Client was ventilated with oxygen and intubated using a laryngoscope and placed on a ventilator. Enteral feedings were initiated on day 2 following admittance. ProcAlamine was administered as peripheral parenteral nutrition due to high gastric residuals and enteral feeding was stopped and not resumed for 4 more days.  By day 5, respiratory status had worsened (same time ProcalAmine was discontinued).  The patient was fed enterally until day 8 when he was weaned from the ventilator and discharged from the hospital on day 12.

Typical Food Intake:  

                        Morning:  hot cereal, egg, toast, hot tea (with milk and lemon)

                        Lunch:  sandwich, soup, hot tea (with milk and lemon)

                        Dinner:  Meat, rice, lots of vegetables, water

Labs:                                       Normal                                    on day of admit

            WBC                                       4.3—10 x10³/mm³                  5.6 x10³/mm³

            RBC                                        4.3-5.9 x 10⁶/mm³                       4.7 x 10⁶/mm³

            Hgb                                         14-18 g/dL                              13.2 g/dL

            Hct                                          37-47%                                   39%

            pH                                           7.35-7.45                                 7.22

            pCO2                                      35-45 mmHg                           50 mmHg

            pO2                                         > 80 mmHg                             72 mmHg

            HCO3-                                    24-28 mEq/L                           21 mEq/L            

            alb                                           3.5-5.0 g/dL                            3.9 g/dL

            sodium                                    135-155 mEq/L                       137 mEq/L   

            potassium                                3.5-5.5 mEq/L                        3.5  mEq/L

            osmolality                               275-295 mmol/L                     285 mmol/L

            chloride                                   98-108 mEq/L                         104 mEq/L

if you are designing a new nursing care delivery system, what system/systems would you use? Provide rationale for your decision.

Use the ATI active learning template system disorder to demonstrate the following disorders 1. Hypovolemia 2.Hypervolemia 3.Hyperkalemia 4.Hypokalemia

5.Hypercalcemia 6.Hypocalcemia.

objective physical Assessment

Individually interact with a person that you would NEVER normally associate with, and describe what the experience was like. Include your perceptions of that person or group, how you thought you were perceived by them, what you talked about, what verbal and nonverbal behaviors you observed, and how your own self-concept, beliefs, attitudes, and values may have influenced or affected the interaction.

Suggestions: volunteer at a homeless shelter, hang out at a gay/straight/transgender bay, visit a home for the elderly, attend a religious/cult/activist meeting, chat with an eccentric, intriguing, or peculiar person.

what is the summary of the article Registered nurse staffing, workload and nursing care left undone, and their relationships to patient Safety in hemodialysis units