Give at least 5 important nursing considerations you need to focus in the care of client 24-48 hours after normal delivery.

A 9-year-old female with cystic fibrosis presented to the pulmonary clinic with persistent exertional dyspnea and cough with scant sputum production. Physical assessment revealed normal vital signs, but she had an oxygen saturation of 91% while breathing room air. Her weight had fallen from 68.2 kg to 65.5 kg over the last 3 months. Cardiovascular assessment was completely normal. Lungs demonstrated coarse breath sounds bilaterally and were moderately decreased. The abdomen was normal, extremities demonstrated mild clubbing, and there was no peripheral edema. FEV1 had decreased from 70% to 50%. The chest radiograph resembled baseline findings with no obvious infil- trate or pneumothorax. Her standard inhaled treatment regimen was albuterol, 7% hypertonic saline, dornase alfa, and Flovent followed by vest therapy twice daily. She was prescribed a month-long course of azithromycin, aztreonam, and inhaled tobramycin for suspected pulmonary exacerbation with an acute superinfection. One month later she returned to the clinic for a follow-up visit. Physical exam re- vealed moderate improvement in dyspnea as well as her FEV1, which now was back to baseline, and her oxygen saturation improved to 95% on room air.

1. Why do you think multiple antibiotics were prescribed for this child?

A 9-year-old female with cystic fibrosis presented to the pulmonary clinic with persistent exertional dyspnea and cough with scant sputum production. Physical assessment revealed normal vital signs, but she had an oxygen saturation of 91% while breathing room air. Her weight had fallen from 68.2 kg to 65.5 kg over the last 3 months. Cardiovascular assessment was completely normal. Lungs demonstrated coarse breath sounds bilaterally and were moderately decreased. The abdomen was normal, extremities demonstrated mild clubbing, and there was no peripheral edema. FEV1 had decreased from 70% to 50%. The chest radiograph resembled baseline findings with no obvious infil- trate or pneumothorax. Her standard inhaled treatment regimen was albuterol, 7% hypertonic saline, dornase alfa, and Flovent followed by vest therapy twice daily. She was prescribed a month-long course of azithromycin, aztreonam, and inhaled tobramycin for suspected pulmonary exacerbation with an acute superinfection. One month later she returned to the clinic for a follow-up visit. Physical assessment revealed moderate improvement in dyspnea as well as her FEV1, which now was back to baseline, and her oxygen saturation improved to 95% on room air.

1. What is the mechanism of action of dornase alfa?

A comfortable environment will be individual to the particular client that you are providing care and support for. Give details of a specific time that you altered an environment for a client in order to make them feel comfortable.

It is essential to respect clients’ individual differences. Give examples of the different ways that you can do this to maintain their dignity and privacy whilst providing them with support.

Managing Change

Jennifer Kowal, a family nurse practitioner, moves to a small rural community in Michigan. There is no primary health care office within a 50-mile radius. She decides that she will open a community health center and provide primary care services. Nurse Kowal has never managed or owned a business. She has negotiated a collaborative agreement with a family practice physician in a major urban area. Nurse Kowal begins to review the literature on best practices in primary care settings.

1. What activities should Nurse Kowal undertake before opening the health center?
2. Nurse Kowal’s dad is a prominent business owner in the city she grew up in. When she tells him what she is trying to do, he asks what her mission statement and business vision are. When she tells him, he warns her, “That’s all very well, but make sure you build in a way to be flexible, too.” If Nurse Kowal’s core purpose and core values will be unchanging, how can she keep her organization flexible as well? Is it possible her father is wrong because he does not understand how health care must work?

Goes to hemodialysis 3 days a week

Oxygen saturation 86% on 15 LPM via mask

Oriented to name only

Crackles in bilateral lower lobes

2+ edema bilateral lower extremities and hands

Abdomen is distended with hypoactive bowel sounds x4 quadrants

Chemistry Panel: Serum sodium 132 mEq/L, serum potassium 6.0 mEq/L, calcium 9.3 mg/dL, phosphorus 6.0 mg/dL, glucose 197 mg/dL, albumin 2.4 U/L, serum blood urea nitrogen 77 mg/dL, serum creatinine 7.30 mg/dL, eGFR African American 10, BNP 182 pg/mL

Urinalysis: Dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones

Blood cultures pending

What is MODS? After reviewing W.A.’s presentation, what organ systems do you suspect are involved and why?

What do you think is the origin of W.A.’s septicemia?

What additional tests would you anticipate for W.A.?

What are the interprofessional care goals for W.A.?

Describe interprofessional care that would be appropriate for W.A.

A 32 hispanic female has come to the clinic today for a comprehensive assessment

What are your primary concerns for this patient and what assessment would be associated with your concerns and why ?

1. what are your thoughts concerning the use of popular children's television character for advertisement of snack? share your own experience with this is applicable.(100+words)
2. How would you redesign food and snack marketing to reflect a healthier approach for young children? ( 100+words)

are we exploiting our children ( minimum of 400word)

An employee of the nursing home left a facility laptop in a vehicle. The vehicle was stolen. The facility does not know who took the vehicle or where it is. The laptop included files of resident information on the hard drive. It allowed remote access to the facility’s system and health records, but was password protected. The computer itself also required a password to utilize and access anything. Breach analysis? Write up your analysis in 250-500 words.