Read the patient case studies below. List 3 differential diagnosis for each and why you believe these to be solid options that should be considered by the provider. Copy and paste the patient scenarios into a word document and use bullet points below each patient for your differential diagnosis, and then upload the assignment. Below is an example.

Patient X: 7-year-old Hispanic male with a cough and temperature of 99.9F.

• Differential Dx:
  • Allergic rhinitis
  • URI
  • Pneumonia

Patients

Patient 1: 28-year-old woman with opioid use disorder; uses IV heroin; has PTSD; no other medical problems or medications. She currently is single, lives with several roommates, and has a history of legal problems (with some jail time). Sexually active with men and women; inconsistent use of protection.

Patient 2: 70-year-old man with a history of CHF, COPD, and HTN; currently smokes one pack of cigarettes daily; takes Lisinopril, Digoxin, and Symbicort daily. Married to wife of 30 years and is retired (previously an accountant), is supported by adult children, and lives with his wife at home.

Patient 3: 40-year-old woman with a history of breast cancer that was successfully treated with Tamoxifen for several months. Otherwise healthy, with no other issues at this time. She is a successful businesswoman in a high-profile career with much stress. Married to wife of four years; relationship is rocky at times. Denies any substance use; travels frequently.

Symptoms are the same for all 3 patients:

• Shortness of breath
• Chest pain
• Flank pain
• Fever

In one paragraph, describe your own perceptions of health. Then have ask a patient (or family member) for his or her perceptions of health. Compare your personal perceptions with the perceptions of those you interviewed.

A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented to an internist complaining of a cough and wheezing. The patient had immigrated to the United States from Ecuador several years earlier, and she spoke mainly Spanish. She lived with her son, who had been in the U.S. longer, spoke English fairly well, and worked as a computer technician. The son had sometimes come to medical visits with the patient in the past, but he did not come to this visit. The internist diagnosed sinusitis and attempted to convey to the patient, without using an interpreter, that she should take acetaminophen, rest, and drink fluids.

This physician had a very strong and often-expressed view that people who come to the U.S. should learn to speak English. His grandparents had emigrated from Italy, and the physician liked to point them out as an example of people who had quickly adopted the language of their new country and successfully assimilated to American culture. He had repeatedly said he did not agree with spending his practice’s money on interpreters. If patients wanted interpreters, they could hire their own or use family members, this internist believed. He had expressed this view to the patient and her son at some past visits.

A week after this visit, the patient was significantly worse, and her son took her to the emergency department of the local hospital. Her examination in the emergency department revealed bilateral wheezing. A chest x-ray showed left lower lobe consolidation. Labs taken in the emergency department included elevated blood glucose, slightly elevated white blood cell count and abnormal CPK and troponin levels. The patient was admitted to a general medical floor with a diagnosis of pneumonia, and a nephrology consult was ordered. The patient’s internist was her attending physician. He did not use a language interpreter while she was in the hospital. For the first two days of the hospitalization, the patient’s status seemed to be improving: her respiratory symptoms and kidney function were better. However, the patient then developed shortness of breath and nausea. The internist ordered furosemide and an antiemetic. Repeat labs still showed an elevated CPK level.

The next day the patient had continuing nausea and shortness of breath, and her internist ordered a 100% NRB (non-rebreather) mask and intravenous theophylline. The patient developed respiratory and metabolic acidosis. That evening, at about 11 p.m., the patient had a cardiac arrest. She was resuscitated but remained minimally responsive in the intensive care unit (where she was transferred). Her son withdrew medical care two days later and the patient subsequently expired.

What are the ethical and legal issues in this case?

What event could have been done differently?

What other questions should the nurse ask about the cough?

Develop a problems list from the objective and subjective data.

What nursing diagnoses can be derived from the problems list?

What should be included in the plan of care?

What risk factors are associated with this age group?

Based on the readings, what is the most likely cause of this patient’s cough?

What other questions should the nurse ask about the fatigue?

What other assessments are necessary for this patient?

What are some causes of fatigue?

Develop a problems list from the objective and subjective data.

What should be included in the plan of care?

Based on the readings, what is the most likely cause of fatigue for this patient?

What subjective information should the nurse obtain?

The nurse is assessing the patient’s pulses. Which locations should the nurse check?

The nurse needs to evaluate the adequacy of the collateral circulation before obtaining an arterial blood gas (ABG) sample. How should the nurse proceed?

What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs?

1. TCRs do not act directly against antigens but trigger a signaling cascade inside the T-cell for further actions.
2. What are the molecules in addition to the TCR that T cells use to initiate their responses to antigens, and what are the functions of these molecules?

. What care should Mrs. M. receive before she is transferred to the recovery room. Why?

Mrs. M. is a 27-y/o gravida 3, para 2, who was admitted at term at 6:30 p.m. She stated that
she had been having contractions at 7 to 10 minutes intervals since 4 p.m. They lasted 30
seconds. She also stated that she had been having "a lot of false labor" and hoped that this
was "the real thing". Her membranes were intact. Mrs. M.'s temperature, pulse and respirations
were normal and her blood pressure was 124/80. The fetal heart tones were 134 and regular.
The nurse examined Mrs. M. and found that the baby's head was at +1 station, and the cervix
was 4 cm. dilated and 80 percent effaced. She reported her findings to the doctor and he
ordered Demerol 50 mg. with Phenergan 25 mg. to be given intravenously when needed.

11. Before planning a response for rescue and recovery all personnel should perform a hazard assessment. True or False.

a) Dmort teams are teams that respond to medical needs of those injured in disasters. True or False.

b) The purpose of triage is to limit the impact that a major disaster will have on hospitals. True or False.

c) Only the SEMO representative can call up the National Guard in New York State. True or False.

d) The only person able to declare a disaster to be a major event is the Governor of the state he must request the presidential declaration. True or False.

e) The American Red Cross has always assisted in major disasters. True or False.

f) The Stafford act assisted all Americans with flood insurance. True or false.

g) The role of public health in a Flu epidemic is to provide surveillance for its county. True or false

h) A NGO’s that always responds to disasters is the World Health Organization. True or False.

i) Emergency Management is most likely to succeed at a disaster because of the effectiveness of its different teams performing their duties as one. True or False

1.Many factors affect drug absorption. Select five (5) of these factors and provide a rationale or mechanism(s) for each one’s effects on drug absorption. Use examples to clarify your answer.

Discuss the role of the liver and kidney in drug metabolism and excretion. Include, at least, an analysis of two (2) relevant cellular and/or biochemical processes per organ (showing how the drug is metabolized and excreted).

How could Maslow's Hierarchy of Needs affect a health care worker's ability to exercise sound judgment and values when faced with an ethical dilemma? (Must be 300 a minimum of words)

a. what are some therapeutic procedures for Alzheimer's disease?

b. What are some laboratory tests for Alzheimer's disease?

What is the role of the Executive Branch in country's healthcare?

1. What complicating factors can affect urinary incontinence?

2. Discuss why it is important to support the patient with a toileting schedule and promote their hydration.

3. Why is it important to give peri-care, provide garment and linen changes frequently to patients who are incontinent of urine/feces?

4. How can the Personal Support Worker possibly prevent this for the patient and help promote fecal and urinary continence?

5. What types of treatments are sometimes used for individuals experiencing constipation?