Patient Profile

J.K. is a 57-yr-old white woman who was is referred to the neurosurgery service for management of her temporal-parietal glioblastoma. She was diagnosed after presenting with persistent headaches, a seizure in her HCP's office, and left side upper visual field loss and neglect. Her MRI/MRA demonstrated a temporal-parietal glioblastoma that extends into the occipital lobes. She is scheduled for surgery to debulk the tumor. J.K. lives alone and holds a management position. She is concerned about her ability to return to work after her surgery.

J.K. returns from surgery to the neurosurgery unit drowsy but following commands. During the night J.K. is noted to have a pronator drift of the left arm, her pupils are equal and respond to light, but she has also developed left-sided weakness of both arm and leg and difficulty with answering questions.

Medications: dexamethasone 4 mg q6hr, famotidine, metoclopramide, ondansetron (Zofran), codeine, and levetiracetam (Keppra) since her admitting seizure.

Subjective Data

• Left arm and leg are weak and feel numb
• She is trying to answer questions but looks confused and cannot follow commands.

Objective Data

• BP 150/90 mm Hg
• right gaze preference
• Left homonymous hemianopsia
• Left arm weakness (3/5) greater than leg weakness (4/5)
• Decreased sensation on both left arm and leg
• Has speech but not clear. Difficulty with word finding and following commands
• A diagnostic CT scan demonstrates a hemorrhagic stroke into the site of the tumor bed, and temporal-parietal and anterior occipital areas extending into the thalamus.

Questions:

#1. What are the priority nursing interventions and decisions that have to be made regarding safety and self-care related to the left neglect and visual field cut?

#2. Based on the assessment data provided, what are the priority nursing diagnoses?

#3. How can you work together with the interprofessional team to develop and implement strategies to improve communication for J.K.?

1-

The structures that together make up the external female genitalia are called:

1. Create a concept map of infection or diseases that are quite similar to each other but have stark differences in certain aspects such as BUT NOT LIMITED TO: mode of transmission, age group at risk, etiologic agent, method of detection pathognomic signs and symptoms, screening test, confirmatory tests, diagnostic feature and etc.

2. The concept map should provide a logical flow of explanation.

CHOOSE 5

List of Infectious Disease by viruses

1. HIV

2. Hepatitis

3. Infectious Mononucleosis

4. Rubella

5. Rubeola

6. Mumps

7. Herpes

List of infectious disease caused by Spirochetes

8.Syphilis

9. Lyme Disease

10. Relapsing fever

List of infectious diseased caused by bacteria:

11. Acute rheumatic fever

12. Gastric and duodenal ulcer

13. Ricketssia-related diseased

15. Rocky mountain Spotted fever

1-

A solution used to cause hemostasis during a loop electrical excision of the cervix is:

How does the assessment cycle validate effective teaching? Does this format make it possible for early childhood educators to provide best practices with learning? Explain please?

values,beleifs,assumptions related to nursing ?

Apply your values, beliefs and assumptions to define all four aspects of nursing metaparadigm ?

Upon entering the room a nurse observes a older patient pulling on the IV line, oxygen tubing and foley catheter. The patient also has a diagnosis of tuberculosis. 1. Describe environmental hazards that pose a risk to the patient's safety. 2. Identify methods to reduce physical hazards and the transmission of pathogen. 3. What type of room assignment should the nurse place the patient in? 4. The patient has an order for abdominal and chest x-ray. How should the patient be transported to the diagnostic department with a diagnosis of TB?

Explain the relationship between your personal nursing philosophy and practice

Provide a specific example of practice and elaborate how your nursing philosophy relates

This is Lisa Luther. Lisa has been a resident in Lotus Compassionate Care for two years. Lisa moved to the centre after being diagnosed with early-stage Alzheimer. She loves staying in the centre as all the staff and care workers are very supportive in helping her cope with the difficulties brought about by the disease.
Lisa is also suffering from hearing and vision loss;
Her left hear is completely deaf, while her right ear has moderate hearing loss. Lisa wears a hearing aid on her right ear.
Both her eyes have cataracts that render her eyes with moderate visual impairment.
Lisa is a vegan and has been a vegan for the most of her life.

7 June 20xx
11:45:00 AM
While assisting another client eat lunch in the centre’s common dining area, you noticed that the care worker attending to Lisa is serving her meat. Having cared for Lisa in the past, you know that Lisa is vegan and does not eat or use meat products.
You informed the care worker that Lisa follows a vegan diet. The care worker told you that Lisa is not lucid and will not even know what she had lunch.

⦁   How can you ensure that Lisa’s cultural needs are met?
Guidance: in your explanation, provide an example of such cultural needs and what you can do to ensure it is accepted and upheld.

"Marc and Dan are twins who like the same activities and foods. At a recent doctor’s appointment, Dan was told that he has type 2 diabetes. He has been feeling good and has not noticed any changes in his health. He does not understand why he has diabetes but his brother does not and why he has not had any noticeable symptoms." Make sure that you address the following topics as they relate to Dan's concerns over his recent diagnosis:

1. Carbohydrate Metabolism, 2. Blood Glucose Regulation, 3. Glycemic Index, 4. Glycemic Load, 5. Treatment Options, 6. Complications

"Martin wants to cut back on the saturated and trans fat in his diet. He mentions to you that he is still going to eat hamburgers and fries, but now he will order the burger without cheese and dip his fries in ketchup instead of Ranch dressing."

1. Identify the sources of saturated and trans fats in Martin's diet.

2. Explain whether or not Martin has reduced his dietary intake of saturated and trans fast? \

3. What are several substitutions that Martin could make that would significantly lower his intake of saturated and trans fats?

Assign the correct CPT codes for each case study.

Case Study # 1:

Preoperative Diagnosis: Angina

Postoperative Diagnosis: Patent coronary arteries and grafts, ASHD present

Procedure: Right and left heart cath with coronary angiography

The patient was brought to the cath lab in a fasting state. The right going was prepped and draped in the usual sterile fashion. After local anesthesia was administered, sheaths were placed percutaneously into the right femoral artery and vein. IV heparin 3,000 units were given. Using a thermodilution catheter, right heart pressures were measured, and thermodilution cardiac outputs and AV oxygen differences were obtained. A pigtail catheter was inserted into the left ventricular cavity, and simultaneous left ventricular pressures were measured. A pullback was obtained across the aortic valve.

Using a 7R4 catheter, angiography was performed of the right coronary artery and both vein graft. A 7L4 was used for angiography of the left coronary artery. Additional attempts were made to image the vein graft to the right coronary artery with a right coronary artery bypass catheter. The pigtail catheter was reinserted, and left ventricular angiography and aortic root angiography were performed. The patient tolerated the procedure well and returned to the recovery room.

DX Codes: I25.10, I20.9, Z95.1

CPT Codes:

Case Study # 2

History and Indications: The patient is a 70 year old female who previously underwent a cholecystectomy but presents again with similar pain in the right upper quadrant in the presence of disturbed live function studies.

Procedure: ERCP sphinctereomty and stone extraction. The Olympus Vedeo side-viewing duodenoscoped was atraumatically introduced into the esophagus and advanced with slide-by technique into the stomach. The gastric mucosa was normal. The pyloric channel was normal and easily intubated. The first and second part of duodenum were visualized. The ampulla appeared normal. Initial cannulation was precurved catheter revealed a normal pancreatic duct. A single injection was made into the pancreas. Repositioning was accomplished with the assistance of a straight 0.035 guidewire, and free cannulation and injection of the papilla of Vater was accomplished. Full visualization of the common duct was obtained, revealing a large multifaceted free-floating stone within the proximal duct. The intrahepatic biliary system appeared normal . The extrahepatic biliary system appeared dilated. An exchange was made with the 20-millimiet shpincterotome and sphincterotomy was performed with perfect hemostasis. The duct was then swept with a 15 millimeter stone extraction balloon, and the stone was pulled into the duodenal lumen. The duct was “swept” two more times with negative results. Additional spot and overhead films were obtained to confirm clearance of all stone material. The procedure was terminated with the patient in satisfactory condition, and she was returned to the recovery area.

Assessment: Choledochlithiasis associated with obstruction

DX Codes: K80.51

CPT Codes:

Case Study # 3

The patient is a 77 year old female who has been in generally good health until last month, when she developed a crusty lesion inside the left naris. She initially treated it will Vicks ointment. When it failed to heal, she decided to seek medical attention. Her PCP biopsied this lesion, and the pathologic diagnosis was squamous cell carcinoma of the left internal nasal ala. She is posthysterectomy for endometrial carcinoma 10 years. She has smoked 1 ½ packs of cigarettes each day for the past 40 years.

The patient presented to the outpatient surgery center of the hospital for wide excision of the left internal nasal alar lesion, which is less than .5cm in diameter. This procedure included a full0thickness resection in the middle and posterior thirds of the lateral cartilage, along with vestibular skin and mucous membrane. Nasal reconstruction was required to provide an acceptable cosmetic appearance following excision. A flap graft composite reconstruction was utilized for primary course of the defect that was left following excision, using donor tissue from the right arm and requiring primary closure of a 2-cm graft.

DX Codes:C30.0, Z85.42, F17.210

CPT Codes:

Case Study # 4

Preoperative Diagnosis: Lesion, Right forehead

Postoperative Diagnosis: Basal cell carcinoma, right forehead

Procedure: Excision of 1.0 centimeter lesion involving the right forehead

Technique: The sin and subcutaneous tissue around the forehead lesion were infiltrated with 0.5% Marcaine with 1:100,000 epinephrine. A total of 1.5 cc was used. The patient was then prepped and draped in the usual sterile fashion.

Microscopic excision was carried out. A 2.0 mm margin of resection was planned around the lesion. Long suture was placed on the superior margin and a short suture was placed on the inferior margin. The tissue was excited and sent for frozen section, which returned with a diagnosis of basal cell carcinoma with clear margins. The site was closed with interrupted 5-0 plain gut. The patient was sent to the recovery area in good condition. No complications. Blood loss was 1cc.

DX Codes: C44.319

CPT Codes:

Assignment Details

Bruce Tuckman's stages of team formation outlines four stages, as follows:

1. Forming
2. Storming
3. Norming
4. Performing

Describe a time when you were required to work on a team, either in school or in the workplace. Discuss the strategies the team adopted to manage the teamwork process. Explain the importance of collaboration in solving healthcare problems.