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

Hilda is being admitted to the hospital for open heart surgery. She reports being diagnosed with hypertension and Type 2 Diabetes, and taking medication for both disorders. Hilda is 65 years old. She reports her usual weight is 320 pounds. Hilda is able to provide a typical day of food intakes prior to admission that you enter into diet analysis software. During your assessment, you obtain a current weight of 290 pounds and height of 5 feet 6 inches. You observe physical signs of edema in her limbs.   She is currently NPO in preparation for surgery.

Answer the following:

1) During your assessment, you ask Hilda what dietary restrictions (if any) she has been following for her hypertension and diabetes. What type of historical information does this provide?

a) Lab history

b) Social history

c) Medical history

d) Diet history

2) Which physical test finding in the case study is the most accurate indicator of fluid imbalance in her body?

a) Presence of edema

b) Low albumin

c) Low water intake reported prior to admission

d) %IBW = 223%

3) Which of the following assessment measures in the case study identifies risk of malnutrition?

a) Hilda’s %UBW of 91% indicates significant weight loss.

b) Hilda’s edema dilutes lab values.

c) Hilda’s %IBW of 223% shows excess weight.

d) Hilda is NPO for one day prior to surgery

4) What other measure could be obtained to strengthen the assessment for malnutrition?

a) Past medical history to identify severity of illness.

b) Physical test of head, hands, and upper body to identifying muscle loss.

c) Prescribed medications to identify interactions.

d) C-reactive protein to identify signs of inflammation.

5) To meet the goal of maintaining Hilda’s weight, what intervention would be appropriate for the nurse?

a) Order labs to assess protein status.

b) Write a diet order for her to receive food.

c) Assess for nutritional adequacy in her diet.

d) Weigh her regularly.

How can Nursing informatics be applied to clinical practice?

EMG (electromyography) functions

1. Describe the physiological function and disease states that the EMG devices are designed to detect.

2. Give three examples of related physiological functions that the EMG device cannot detect.

Could you please put a link to your sources so that I can go back and read them as well?

Thanks

The last 50 years have seen much cleaner air and ____________________ in the United States, due in part to federal legislation.

_______________________ are a vital part of the public health's assessment function, used to identify special risk groups, to detect new health threats, to plan public health programs and evaluate their successes, and to prepare government budgets.

The time when the leading cause of death in the United States switched from infectious to chronic disease was the ______________.

Mrs. Sullivan, an 82-year-old female with a frequent history of Alzheimer Disease, UTI, fall and combativeness brought by her son and presents to the medical-surgical unit came from E.D. She previously worked as a full-time local administrator at a real estate office for over 50 yrs. Her worsening of her condition in the last 10 months. Various progressive cognitive symptoms such as memory deficits and confusion have rendered her unfit to continue to work. Mrs. Sullivan sought for physical therapy in order to delay the physical progression of the disease. Her chief complaints include mild difficulties with following directions, gait, balance, and being fatigued easily and fell yesterday. She noted that she has stumbled and tripped several times in the past 6 months but was fortunately not hurt and break her hips. She has also noticed the increasing difficulty she is having with fine motor skills such as writing and doing up her buttons when dressing. With the diagnosis of Alzheimer’s Disease, the patient is at an increased risk of various secondary conditions such as HTN, osteoporosis and falls. Create a nursing care plan for Mrs. Sullivan by using this template.