CLINICAL SCENARIO:

NURSING HEALTH HISTORY

Patient’s Profile

Name: Patient X
Age:    18
Date of birth:             April 3, 2000

Sex:    Female:

Height: 5’1 ft.
Weight: 48. 4kg

Date of Admission/ Time of Admission: August 19, 2020 7:00 AM

Allergy: No allergy to food and medication

Initial Diagnosis:

Measles, Pregnancy Uterine 33 5/7 weeks AOG G1P0 with Intestinal Complications (AGE)

Chief complaint:

Fever and productive cough

History of Present Illness:

The client was admitted to the San Lazaro Hospital last August 4, 2020. 2 weeks prior to consultation: (+) undocumented fever, intermittent, no other associated symptoms no consultation done, no medications taken. 1 week PTC: (+) onset of productive cough (yellow mucus), colds, no fever or rashes, no consult done, no meds taken. Interval history revealed persistence of cough and colds until 1 day (+) rashes, non-pruritic on abdomen which spread to the trunk and face. Sought consult and was prescribed vitamins and sent home.

Past Medical/ Personal and Social History:

No previous hospitalizations and surgeries.

Past Medical History:

(-) PTB
(-) Diabetes Mellitus (-) Asthma
(-) Hypertension
(-) Cancer
(-) allergy

Family History:

(-) Hypertension (-) Diabetes
(-) Cancer
(-) PTB

(-) Asthma

Admission Order

The patient was admitted on August 19, 2020 at 7:00 am with a chief complaint of fever and productive cough. Client was admitted to Emergency Room. Consent was secured for admission. Client was the transferred to Adult Female Ward. Patient received with IVF D5LR 1L regulated at 150cc/hr. Client’s vital signs are (BP - 100/70 RR - 25 T - 38.3 HR - 116 O2 saturation - 95%) There is a presence of fever with macula-papular rash on the patient with productive cough (whitish to yellowish mucus secretion). The patient also showed sign of body weakness, poor appetite, abdominal pain and defecates a mushy consistency stool. Physician ordered for CBC, BT, Measles IgG, IgM, CXR-PA view, Serum Creatinine, Na, K, SGPT,

SGOT, and Stool exam. Paracetamol 1 tab PRN for fever >37.8, Hexetidine 10 ml for oral gargle was given. Performed tepid sponge bath. Encouraged to increase fluid intake. Maintained high back rest. Advised the watcher not to leave the client unattended. Kept monitored the safety of the client by maintaining side rails up. Vital signs monitored q4 and recorded. Intake and Output monitored. Watched out for (WOF) any signs of respiratory distress such as dyspnea or increased respiratory rate. The following day, client was seen awake and lying in bed. Client’s vital sign are (BP- 90/60 RR-23 T- 36.7 HR-97 O2 sat- 97%). Client still manifested maculopapular rash with body malaise. Cough still productive with crackles heard on both upper lung area. IVF D5LR 1L regulated at 150cc/hr was started. Noted and referred Physician’s order for Isoxsuprine 10mg/tab, 2tabs PO TID and Dexamethasone 6mg/amp TIV q6 x4 doses. . IVF PNSS 1L at 110cc/hr to follow. Advised not to scratch the skin to prevent skin integrity impairment. Maintained HOB elevation at 30-40 degrees. Provided a quiet and calm environment. Instructed the watcher not to leave the patient alone. Kept monitored the safety of the client by maintaining side rails up. Instructed dietary intake as tolerated. Vital signs monitored q4 and recorded. Intake and Output monitored. WOF vaginal bleeding and refer to the staff nurse immediately. Client was seen awake and lying in bed. Client’s vital sign are (BP 100/60 RR-22 T-36 HR-85 O2 sat95%). Client manifested conjunctivitis and still showed presence of rash in the skin. Cough still productive. Acetylcysteine 600mg 1-tab dissolve in 50cc water ODHS were given. Patient was ordered for discharge. Noted and instructed the patient regarding the following home medications ordered by the Physician, Co-amoxiclav 625 mg 1tab TID for 7 days, Hexetidine gargle 10ml TID, Multivitamins 1tab OD and B-Complex 1tab OD. Encouraged client to increase oral fluid intake. Advised to follow-up to OPD after 1 week. Vital signs monitored and recorded.

1. Complete the Gordon’s Functional Health Pattern of your client based on the history and the chart by answering the box of during hospitalization. What statements will your patient will tell you, can also base your answer in your experience during your duty in the hospital.

2.         Make at least 2 days course in the ward based on the admission order and some activities happened in the ward. (reflect on your experiences in the ward)

1. Explain the behaviours that may facilitate the progression of HIV to the advanced stage.

2. Examine the effects of HIV and AIDS on the living standards of the people of Ghana.

3. (a) State and explain any two (2) Ghanaian values and how they contribute to the prevention of
HIV and AIDS.
(b) Examine the impact of negative peer pressure on the behaviour of an adolescent.

Look back at the top 20 causes of mortality and DALYs for the Philippines. Identify major risk factors of each of the non-communicable diseases

CASE 66 See Me, Hear Me:The Case of the Disempowered Older Adult Kelly Niles-Yokum The administrators and staff of Zen Hospice are preparing a room for a client who is currently receiving in-home services from Zen staff. The client, Mrs. Smith, is a 96-year-old widow who was diagnosed with terminal cancer. She is nearing the end of her illness and is expected to live for another month, at the most. Zen Hospice was contacted by Mrs. Smith’s daughter, Ann, who has been caring for her mother for several months in her mother’s home. Ann and her mother have a very good relationship, in general, but things have become more intense over the last few weeks as it has become clear that Mrs. Smith is at the point in her illness where she requires more help than her daughter can provide. Luckily, Mrs. Smith has her affairs in order. Her grandson, John, who is 46 years old and lives 3,000 miles away, visited a few months ago to assist with the process. Mrs. Smith granted John durable power of attorney and identified Ann as her health care proxy. Mrs. Smith and John enjoy a very close relationship and she confides in him about many things. One thing she is very clear about is her wish to die at home. While Mrs. Smith has nothing in writing about her preference she has been very vocal with everyone in the family. During a recent conversation with her grandson she stated, “Johnny, I trust you. You know how important it is that I am here when I die. I’ve lived my life here, my memories are here.” John assures her that she will be able to die in the home she has lived in for over 40 years. Because Mrs. Smith’s illness has taken a turn for the worse and she now requires constant care, Ann made the decision to bring hospice into the home. Ann assures the family that this is the best decision for everyone involved and explains that hospice is, in fact, holistic care and that the whole family will benefit from the experience, including her mother who will be able to remain in her home. After Ann tells her son, John, about the hospice nurse coming to the house to help and about the relief she feels, John feels better knowing that both his grandmother and his mother are being cared for. As the administrator of Zen Hospice you have familiarized yourself with Mrs. Smith’s case and meet regularly with the staff assigned to her and her family. You are aware of Mrs. Smith’s wishes to die in her own home and have spoken to several members of the family including the grandson, John, about Mrs. Smith’s end-of-life decision about where she would prefer to die. A few weeks later, during the most recent weekly team meetings, one of the nurses mentions that Ann has expressed an interest in temporary residential care for her mother. You ask for more information from the staff assigned to Mrs. Smith’s case. All are in agreement that Ann would like to move her mother to their residential facility for short-term care. You inquire about the end-of-life preference expressed by Mrs. Smith to die at home. After listening to all of the team members you decide that this is the right course of action and give the green light for the move, which will take place the following morning. When you arrive the next day you are briefed by the team and then take some time to visit with Mrs. Smith and her family. You are surprised to find that, while Ann seems to be relieved by the move and expresses her appreciation, you are not able to have a conversation with Mrs. Smith because she is at the point in the dying process where she is not fully aware. She seems confused and her breathing has become apneic. It is clear that death is imminent. While you are assessing the situation, John calls Ann and from her responses it is clear that he is upset by the decision to move his grandmother from her home. Discussion Questions 1. What are the main facts of this case? 2. Describe what is going on and what the main issues are. 3. Do you think the actions taken by the hospice staff were well-intentioned? If yes, why? As evidenced by what? If no, why? What evidence leads you to believe this? 4. What was the role of the administrator in this case and what was her responsibility? 5. Is there anything the administrator should have done differently? If yes, what? If no, why? 6. Throughout this case we hear from Ann, from John, and from the hospice staff. Who should have been the voice of Mrs. Smith? 7. Whose interests were prioritized and why? What were the consequences of not “hearing” Mrs. Smith in her final days? Why did the staff make their decisions based on Ann’s needs and not Mrs. Smith’s wishes? 8. Discuss the ways in which Mrs. Smith’s wishes could have been fulfilled. 9. Mrs. Smith was not exactly given a voice in this narrative and was easy to ignore. Why do you think the case was written this way?

What do you believe are the roles and functions of a professional nurse and how do you envision fulfilling these roles and functions at program completion?

Need good long response page long or more just to understand the idea

You are the manager of a new primary care clinic located about twenty five (25) miles outside of a small city (population of 50,000). With five (5) family physicians, two (2) nurse practitioners, two (2) physicians’ assistants (PAs), and twenty (20) clinical support staff consisting of RNs, LPNs, and CMAs, the clinic provides primary care services to a diverse community of people living and working outside the city limits. Originally a rural area, the community has been growing and now includes promising opportunities in employment, education, and comfortable living spaces for young families. However, there are still many residents who struggle to make ends meet with older farms that have belonged to families for generations. The central city includes two (2) large acute care facilities, and one (1) tertiary care facility that is known for its excellent pulmonary care. Both acute care hospitals provide the usual services such as labor and delivery, outpatient surgery, chronic diseases care, etc. and have fully equipped ancillary departments, such as lab and radiology. Up until this point, the residents have used the facilities’ emergency departments for routine illnesses and conditions when their private physicians were not readily available. Write a five to seven (5-7) page paper in which you: Analyze some of the key social, political, and economic factors that have led to the proliferation of urgent care facilities and primary care practices over the last 20-30 years. Create a comprehensive mission statement for the clinic, and discuss how it will facilitate the provision of quality services. Analyze and discuss one (1) or more directions the clinic might take to grow its business. Determine what factors you would consider when deciding what services to provide in-house and which ones to affiliate with other institutions. Decide how you will determine if the clinic is meeting its goals. Identify three (3) performance measurements you could use to evaluate the success of the clinic’s services. Begin by naming a goal, and then identify a quantifiable measurement you could use for each to determine if you are coming close or falling short of the goal. Determine how you would then address whatever opportunities for improvement seem to exist and what processes you would put in place. Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources. Format your assignment according to the following formatting requirements: Typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length. Include a reference page. Citations and references must follow APA format. The reference page is not included in the required page length.

Examin the following lipid panel and answere the questions.

1. Given the above information, what is Mike’s LDL cholesterol? Based on his LDLC, is he at high risk for coronary heart disease, moderate risk, or within the recommended range?

2. If Mike’s triglycerides were 450 mg/dL, could the LDL be calculated? Why or why not?

2. a) What would be the next step?

3. List eight risk factors associated with CHD as determined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel.

4. How many risk factors does Mike presently have, given the information provided? Is he at high risk for CHD?

5. What are the follow-up testing and treatment recommendations by the NCEP Adult treatment panel?

6. List at least three types of drugs used to treat this condition and their affect (how they work and what they lower or decrease).

How difficult is it to develop and maintain healthcare databases?

Mike L., a 47-year-old man, went to his physician for an annual physical that had been postponed for over 3 years. He had started his own business 4 years ago and had been extremely busy getting it established. Mike’s medical history indicated he was a nonsmoker, and his father and grandfather had histories of myocardial infarctions before age 55. Since she had not seen this patient in a number of years, the physician decided to order routine screening tests.

CHEMISTRY RESULTS:

URINALYSIS:

1. Indicate the abnormal results

2. Which conditions listed for question 2 can the physician rule out with Mike’s medical history, physical examination, and current laboratory results?

3. What is the most probable cause of the abnormal result in this patient.

2. List three HCP-generated roadblocks to threrapeutic communication and explain why they are significant. Describe a clinical situation in which such roadblocks may occur and explain how to resolve them.

Discuss the history of microbiology with an emphasis on the main historical figures and their discoveries. You will describe how these discoveries have shaped our understanding of microbiological organisms.

• Describe the main discoveries that have shaped our ability to visualize, classify and research microbiological organisms.  

Instructions:

Step 1: Respond to the following:

The development of the microscope in the 1600's was the starting point for the study of Microbiology. The science of Microbiology and our understanding of the Germ Theory of Disease has led to significant advances in antimicrobial therapy. Since the discovery of penicillin, we have seen an exponential growth in antibiotic production, which has dramatically increased our ability to treat infectious disease. It has also led to the advent of antibiotic resistance. Answer the following questions.

• Questions:
  • How has the discovery of penicillin and antibiotic therapy shaped society today?
  • What effects has it had on morbidity and mortality rates?
  • Should we continue the broad use antibacterial agents in household hygiene products such has hand soap

Why does the epidemiologist or Public Health professional need to understand these aspects of malaria?

How is the Belmont report which is the  Ethical Principles and Guidelines for the Protection of Human Research relevant in relation to First-in-human clinical trials (as in patient’s company’s and medical authority's perspective) and potential conclusions that can be drawn?