Scenario: Alex is a 6 year old boy who arrives to his primary care office with a 3-day temperature of 102-103F axillary and L leg pain.  Today he started with red pinpoint rash and has been unusually sleep.  Alex is up-to-date on his vaccines.   His vitals today are RR 28

HR 120    T102.5F     BP 90/60   O298% on room air.  Weight 21.8 kg    Height 3.5 feet

the NP finds that Alex has not only cervical lymphadenopathy but also enlarged lymph nodes in the axillae and groin. Yet, Alex is not complaining of a sore throat, headache, ear pain, or trouble urinating.  UA, rapid strep, and rapid flu test are all negative.  Alex hasn’t had any recent injury to his leg.  The NP draws blood to run a CBC and comprehensive metabolic panel.  

The CBC shows a WBC 42,000 (very high)  RBC  (normal)  Hbg 10 (low)  Hct 31% (low)  Platelets 90,000 (low)  Neutrophils-bands – (high)  Neutrophils-segmented (low)  Lymphoblasts at 38% (very high).    The NP admits Alex to the local children’s hospital and orders an oncology consult for suspected leukemia.

1. What in the above scenario could lead to a diagnosis of leukemia?

2.  What additional tests would you expect to be done in hospital?

3. What pain scale would you use for Alex?

4.  Who else in the hospital could you ask to help prepare Alex for the various tests and procedures?  

5. List one nursing diagnosis with interventions & goals.

6. Would advance directives be appropriate here?  Why or why not?

To whom should the duty and responsibility fall when a patient is suddenly rendered incapacitated and incapable of making her own medical decisions, yet has no living will? If married, should the decision automatically fall to the spouse? Under what conditions would it not be rational for the spouse to become the decision maker? If the ultimate decision were to fall to either the court or the medical provider, whom should society choose? Please propose, in this your final discussion, possible measures that could be taken to both educate the public about the need for such planning and, also, those concrete measures that could be taken by lawmakers to implement better legal preparation for end of life and incapacity issues.

In two or three paragraphs, answer the following questions:

a. Using the SLU ( Saint Leo University) Library, locate an article on medical errors. In your own words, provide a brief summary of the article.

b. Explain how managers can assist in improving patient safety.

When undertaking a neurological assessment, some of the most common symptoms associated with neurological disease to note include

Cardiac Arrythmia Care Plan

After graduation you plan to sit for the certification exam. How will you prepare for the final test to ensure a positive outcome and earn your CMA/RMA credential?

Q1: Describe the following terms: (7 marks, each one mark)

Activities of Daily Living:

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Palliative Care:

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Respite Care

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Skilled Care

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Subacute Care

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Total Parenteral Nutrition

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Q2: The manual and electronic patient record has many purposes, but one goal: documentation of patient care. Regardless of the type of care provided, a health care facility’s patient records contain similar content (e.g., consent forms) and format features (e.g., all records contain patient identification information). Distinguish among patient record formats. (10 marks, each one 2 marks)

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3. Be explicit in your discussion of ED_{50 ,} LD_50, TD₅₀: what each of these are and explain in detail why it matters. Please give 2 examples of each.

Rachael Tomkins is 55 years old and is a certified practising accountant. She works part time and lives with her husband Paul, aged 64 and daughter Marie, aged 17. Her grandmother Jean aged 90, lives in a small flat at the back of their house and her mother Mary, aged 72 lives in an Over 55s housing unit nearby. In her early 20s Rachael’s father, a Vietnam Veteran, committed suicide. Rachael is described by her family as reliable and caring. She has a small group of friends from her local parish church. Rachael has regular contact with her GP to manage her Diabetes Type 2. She is prescribed metformin and has been trying to lose weight. She also sees a psychiatrist Dr Lianne Yu for management of her symptoms of schizophrenia. She is prescribed Olanzapine and Lithium. She was diagnosed with schizophrenia in her early 20’s when she was studying at university. She was hospitalised with acute psychosis several times before her symptoms were stabilised. She was able to complete her university degree and has worked part time. The last time she experienced acute psychosis was 17 years ago, just after the birth of her daughter. Her symptoms stabilised, and she has been maintained in recovery for almost 15 years. This year has been a particularly challenging year for Rachael. Both her husband’s parents passed away within months of each other, her daughter commenced Year 12 and her grandmother had an infection in her middle toe, which resulted in a series of trips to the doctor, hospitalisation and finally amputation of the affected toe. Rachael has become irritable with her family, and has developed erratic sleeping patterns, a lack of interest in grooming, and avoided social interactions with her friends or family. She complained to them that her neighbours were spying on her. In the 48 hours before she was admitted to hospital two incidents escalated Rachael’s need for professional help. In the first episode she yelled and threatened the neighbour across the fence. She accused him of spying on her with a ‘trackamanometer’. Her husband intervened and took her back into the house. In the second incident later that day, Rachael started screaming at her family to evacuate the house because they would be bombed. Rachael insisted the news reader on the TV was giving her this important information and they must all get out of the house. Rachael ran onto the road. A concerned neighbour called the police, who were able to convince her to accompany them to the hospital. She was met by her psychiatrist Dr Yu who reports the following -Rachael is dishevelled, dressed in pyjama top and tract pants, no shoes, she has an exacerbation of auditory hallucinations, with persecutory delusions and disorganised thinking. Rachael agrees to be admitted because she says ‘I’m frightened’. Rachael is admitted for inpatient psychiatric care.
In hospital, Rachael is argumentative and resistive to staff interactions and interventions, and her family are frightened and bewildered by her dramatic deterioration.

1. Identify, from the case study, the positive, negative and cognitive symptoms of schizophrenia experienced by Rachael at this presentation to the mental health service and discuss her prognosis and recovery;
2. Considering the case study, outline some common challenges and nursing interventionsassociated with the clinical presentation of a person who has been diagnosed with schizophrenia;
3. Identify the two psychotropic medicationsprescribed for the treatment of the symptoms of schizophrenia experienced by Rachael, and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors;
4. Draw an ecomap to make a pictorial display of Rachael’s family relationships and medical history; Summarise key features of the ecogram for Rachael and her family and their environment (identify family and community connections, strength and quality (supportive/not supportive) of connections between individuals and community support networks/institutions( Refer to the required text Chapter 22 for more information about Genograms and Ecograms).;
5. Develop three questionsyou would ask Rachael during an interview to complete an MSE. They could be from any MSE area. Explain the reasonyou would ask these questions.
6. Complete a risk assessment(template in this tutorial outline);
7. Rachael will be admitted to the mental health inpatient unit. Write a nursing care planbased on a nursing diagnosis.