CASE STUDY #1

You are working Monday to Friday in Mrs. Farley’s home from 0700 to 1100 and then you go to Mr. Brown’s home from 1230 to 1530.

Over the last couple of weeks, the PSW (Sharon) who is assigned to Mrs. Farley’s home from 1100 to 1500 has been arriving consistently late by half an hour.

It takes you approximately 45 minutes (on a good day) to travel by bus to Mr. Brown’s house. This has caused you to arrive there with little time to get yourself organized and on two occasions, you even arrived late to Mr. Brown’s house!

At first, you said nothing, assuming it was just a bad week but now a definite pattern has developed. You have since made mention of the problem to Sharon on several occasions. The last time she apologized, saying “This will be the last time, it won’t happen again, please don’t report me to the Agency.” Thinking this was the end of it, you did not report it.

Today again, it is now past 1100 and you have Mrs. Farley drinking tea and chatting with you in the kitchen as you are preparing her lunch. Sharon finally arrives 15 minutes late and she says to you “oh good you’ve started lunch. I’ll let you finish up while I make a few phone calls outside on the front porch.”

a) List three effective steps to take to resolve this problem.

b) Looking back and reflecting upon what happened explain how you should have handled this situation initially (the very first time).

Case #2

Mr. Hedgegrove is 79 years old and he has just been discharged from the hospital. You have been assigned to be the PSW visiting him in his home. Your main task is to ensure Mr. Hedgegrove is eating balanced meals, but the task is difficult because of his failing memory. On the first day, he would not eat any food saying, “I don’t like this!” For the next few days despite changing the selection of foods, he repeated the same complaint but with increasing anger, stating, “You keep giving me the same meal! How many times do I have to tell you, I DON’T LIKE THIS!!!”

a) Describe six effective therapeutic communication methods you could use for this situation.

Case #3

You are working within a community agency and a client’s family approaches you with the following complaint: “You have lost my father’s glasses again!” Shouting in a high-pitched voice pointing her index finger at you. “This is the second pair of glasses that we have bought in the last three months. You have to pay for this and arrange to get him a new pair. We simply cannot afford to keep buying glasses because of bad staff.”

a) How would you respond using your Therapeutic Communication Skills to the client’s family as a PSW? List four actions you as a PSW would be able to do as an effective member of the team. These actions should help correct the problem in the future.

Module 7B: Autonomy Case B (Jennifer)

Autonomy essentially means “self-rule,” and it is a patient's most basic right. As such, it is a health care worker's responsibility to respect the autonomy of her patients. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals. The following two cases address patient autonomy. The first involves the rights of an individual to decide her own fate, even against her physicians' judgments. The second case involves the rights of a parent to care for her child in the manner that she sees fit.

You are a nurse and Jennifer, a mother, comes into the room with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood and improve circulation and healing. When you touch the boy's back, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.

Questions for Case B:

1. Should we completely discount this treatment as useless, or could there be something gained from it?

2. When should a health care professional step in to stop a cultural practice? (If you are tempted to answer "when it harms the child" remember there is some pain in many of our medical procedures, for example, having one's tonsils removed.)

3. Should the nurse be concerned about alienating the mother and other people of her ethnicity from modern medicine?

4. Do you think that the nurse should report the mother?

What are the major causes of burns in children? Explain the differences between superficial (first degree), partial thickness (second degree), and full thickness (third degree) burns?

How do I explain/connect the abnormal lab values to the patien's medical problems? The patient is a  77 year - old male who is admitted 2 days ago for Osteomyelitis of the great toe on the right foot and Gangrene of the great toe on the right foot. with a history of Type 2 diabetes mellitus with skin complications and coronary artery disease (CAD)

• WBC: 12.99 (H)
• Sodium: 134 (L)                  
• Potassium: 3.9                                
• Chloride: 104
• Calcium: 8.3(L)
• CO2: 25       
• Glucose: 95
• Hgb 8.4(L)
• Hct 25.6 (L)
• PLT 284

Julia is a 18 year-old student at a local community college. On several occasions in the past 6 months she has experienced sudden, absolute, overwhelming anxiety. During these episodes, her heart pounds, she trembles, her mouth gets dry, and it feels as if the walls are caving in. The feelings only last a few minutes but, when they occur, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won't ride in cars now, unless she is driving, so she is sure that she can stop if necessary. She will only go to class if she can find an aisle seat in the back row so that she can leave quietly should she have another attack.

1. How do these symptoms impair the client’s functioning?

2. What nursing interventions would be helpful?

1. What are causes of strokes in younger women?
2. Describe your neurological assessment of a patient who just experienced a stroke.
3. What education needs to be provided regarding signs and symptoms of stroke, and when to call 911?

Athena Washington

Your patient is a 48-year-old female brought to the emergency department for stroke-like symptoms.

1. What are your primary concerns for this patient and what assessments and interventions would be associated with your concerns, and why?

2. What do you anticipate the patient’s home medications prior to admission might be, and why?

3. What medications do you anticipate the health care provider would prescribe while the patient is in the hospital, and why?

4. What medications do you anticipate the health care provider prescribing for the patient’s discharge, and why?

The topic is Jehovah’s Witness RELATE THE TOPIC TO THE FOLLOWING . If a question is not clear to u dont answer and let someone else who understands answer. •Illness and medications (eg. Depression, Pain)

•Wellness and disease prevention

A minimum of one nursing intervention must be included for each of the above

A minimum of one academic research articles, one peer reviewed, from nursing journals.

A community resource that could assist individuals related to your topic.

A potential nursing intervention for each of the practices listed above.

Case Study: You are a nurse in the Intensive Care Unit at Plessy Hospital in Chicago, IL where several of your patients are mechanically ventilated. You are made aware that many of the units’ patients have developed high fever and their leukocyte count is higher than normal, thus you fear a widespread nosocomial pneumonia infection. You must determine what bacteria your patients are infected with, how they should be treated, and describe what preventive measures should be implemented, if any.

Use these number 1-4 to answer the case study with at least 250 words

1. Introduction: Introduce your particular case study and explain what it is. Please hypothesize which microorganism you believe may be involved, backing your rationale using primary literature.

2. Methods: Please refer to the provided dichotomous key and identify a minimum of five techniques that can be used to identify the unknown microorganism. Briefly indicate the significance of each technique and what it tells us on a biochemical or molecular level (You will go into more detail about the significance of each test in the discussion section). Also be sure to include practical details of how you would perform this test in a laboratory.

3. Results: List the tests in the order that you would perform them. Be sure to indicate the expected result for the bacteria that you hypothesized. For example, if you choose E. coli, you would start by indicating that a Gram stain was performed and that you were able to identify Gram negative rods. Use a photo of Gram stained E. coli obtained online and cite your source. Do this with each of the 5+ tests that you believe will help you identify the unknown.

4. Discussion: You will want to go into detail about the significance of each test performed and how it helped you arrive at your conclusion. For example, if you chose a fermentation test, talk about the significance of a microbe being able to metabolize X compound and what caused the indicator dye to change colors.  You will also want to discuss possible treatments for your scenario. When writing, remember that we want you to demonstrate that your rationale is based on science and not a lucky guess. Remember to add plenty primary sources and include many in-text citations.

How can barriers to process improvement, such as staff reluctance to change, lack of capital, technological barriers, or clinical practice guidelines, be overcome?

Critical thinking 7.1

How do you explain the connection between electronic health record (EHR) adoption by the medical physician and personal health record (PHR) use by the patient? Does EHR use encourage patients to participate in their own healthcare? Or are proactive patients just more likely to patronize cutting-edge practices to begin with?

Critical thinking exercise 7.3

What type of person or patient is most likely to benefit from creating a personal health record? What type of person or patient is most likely to create one? Are they the same?

Critical thinking exercise 7.4

Do you think a personal health record or other health apps have the power to change an individual’s health behavior? Why or why not?

Critical thinking exercise 7.5

Aside from security concerns, wat reasons might there be for an individual not to create a personal health record?

Critical thinking exercise 7.6

How do personal health record systems benefit health insurance carriers?

Critical thinking exercise 7.7

One might argue that any patient who takes the initiative to create a PHR and spends at least several hours populating it probably has a good grasp of what information is important to include and what may safely be excluded. Do you agree with this line of reasoning? Why or why not?

A 50 year-old Hispanic female came into your 24-hr Emergency care clinic complaining of purpuric lesions on her left and right ankles. She stated that she was being treated for rheumatoid arthritis with leflunomide and steroids.

1.What is your initial differential diagnosis? Give at least three.

You begin to take a patient history and review of symptoms. She is originally from Venezuela but moved to the United States before Hugo Chavez and Nicolas Maduro came to power, and she has not returned in over nine years. She has lived in Corpus Christi for eight years with her husband and two children. She is not on blood thinners such as warfarin (Coumadin). She denies use of alcohol, tobacco, or illicit drugs. She lives in Flour Bluff but states she has not gone to the beach or been on the water for over five weeks. She has not eaten raw seafood in the last four weeks. She denies any known drug allergies.

2a. What conditions might you now exclude?

b. Why can you exclude these?

The patient had rhinorrhea and myalgia. She stated she had no sore throat, shortness of breath but a sporadic cough, felt no fever or chills, no nausea, vomiting or diarrhea, no abdominal pain, no leg swelling or pain in the extremities. Examination revealed temperature of 38.1°C, heart rate 106 beats per min, BP 126/68 mm Hg, respiratory rate 16 breaths per min, and oxygen saturation of 98%. Lungs were clear on auscultation. Her White blood cell count was 4600/microliter (normal 4500-11,000) lymphocyte count was 700/microliter (normal 1000-4800). Her electrolytes, kidney and liver function tests were within normal range.

3a. Do these findings allow exclusion of some of the differential diagnosis possibilities, and suggest some other possibilities?

3b. What other tests would you perform?

The patient was given nucleic acid amplification tests for COVID-19, influenza A, and respiratory syncytial virus—all were negative. She was sent home with fluticasone nasal spray, with the diagnosis of sinusitis. She returned two days later, complaining of shortness of breath. Her oxygen saturation had decreased to 94% .

4. What possibilities must now be considered? List at least four.

Radiography of the chest revealed a 5 cm mass in the left lower lobe. A CT scan revealed ground-glass opacity, and some left hilar lymphadenopathy.

5. What conditions from question 4 should be included?

Patient now had a temperature of 39oC, complained of a productive cough with green sputum, weakness, nausea and vomiting. The heart rate now increased to 115 beats per minute, BP was 138/85 mm Hg. Auscultation revealed crackles in the left lower lobe. Oxygen saturation dropped to 92% within the two hour wait in the emergency room.

6.a. What are the most likely conditions the patient could have?

b. What should your next steps be with this patient?

c. What is your diagnosis?