Real Life Clinical Reasoning Scenario - Type 1 Diabetes Mellitus ISBAR.

The patient is a 92-year old male who was just admitted to your med/surg unit through the ED for dehydration, hypokalemia, and gastroenteritis of unknown etiology. His past medical history indicates that he has had COPD for 26 years. His COPD has been characterized by a mixture of emphysema, chronic bronchitis, and reactive airway symptoms. 8 years ago he developed right-sided HF, and after a knee replacement 5 years ago his HF became bilateral, and he developed atrial fibrillation. He has HTN, chronic renal insufficiency, and Type 2 DM. His meds include: 3 inhalers - tiopropium, salmeterol/fluticasone, and albuterol prn; and the following PO meds - digoxin, furosemide, warfarin, prednisone, theophylline, lisinopril, metoprolol, metformin, and glipizide. Upon admission his VS were P 108, RR 32, BP 98/52, T 99, and O2 sat by pulse oximetry 90% on room air. He is oriented, but states he is too tired to answer questions. Lung sounds diminished bilaterally, extra heart sounds noted, bowel sounds hyperactive and high-pitched. His wife states he has had approximately 12 loose BMs in the last day, and that this is the third day of severe diarrhea, nausea, and vomiting. She does not know when the last time he voided was, and states that he has continued to take all of his medications, except his diabetes pills, which he stopped taking because he hasn’t been eating . He also had the following diagnostic results:

ABGs:

pH: 7.25

CO2: 50

HCO3: 25

PaO2: 84

SaO2: 90%

CXR: changes consistent with COPD, enlarged heart

EKG: atrial fibrillation

2-D Echo: left ventricular hypertrophy with 25% EF

CBC & METABOLIC PANEL:

HGB: 19

HCT: 58

WBC: 8

BUN: 59

CREAT: 2.8

Na: 155

K: 2.8

Cl: 110

Ca: 8

PO4: 5.1

Mg: 1.2

Glucose: 987

Pre-Albumin: 15

Albumin: 2.9

Total protein: 4.8

INR: 3.5

Digoxin level: 1.9

Theophylline level: 24

Analyze and explain the rationales for each of these orders listed below (Hint: keep the same things in mind here as when analyzing assessment data). Are there any additional orders that you think would be appropriate? Why?

Orders include:

O2 2L via NC

IV ½ NS with 30 mEq KCL @ 125 mL/hr X 1 liter, then change to NS with 20 mEq KCL @ 75 mL/hr

Regular insulin IV 10 unit bolus, FSBS q 15 min with IV bolus scale until FSBS under 250, then FSBS ac + hs with sliding scale SQ lispro insulin

Clear liquid diet

Heparin 5000 units SQ q 12 hrs

furosemide 20 mg PO daily

lisinopril 10 mg PO daily

metoprolol 50 mg PO BID

inhalers as at home

prednisone 5 mg PO daily

vitamin K 10 mg IM X 1

ondansetron 4 mg IV q 4 hrs prn/nausea

loperamide 2 mg PO q 4 hrs prn/diarrhea

Repeat CBC, basic metabolic panel, & INR in the AM. 24-hour urine for creatinine clearance, stool for OB, C&S, O&P, C Diff.

Alcohol, Tobacco, and Other Drugs: Assignment

The use of alcohol tobacco and other drugs continue to take a toll on the economy, life expectancy and health care delivery system of the United States.

1. What are the 3 most common reasons individuals start using drugs?
2. Explain how “people, places and things” are related to continued drug use and explain what needs to be done regarding people, places, and things to start changing drug behavior.
3. Explain what happens in the brain when a person takes a drug. Include the terms neurotransmitters, synapse, axon, and dendrite in your answer.
4. Explain the science of how the brain can become addicted to a drug (chemical substance).

The second task

Choose a nutrition related problem and describe it in a flow chart (This should include a small paragraph defining it in 500 words)

After readings chapters 1-5, discuss the presence of race and gender in American history leading up to the American Revolution. Consider the changing role of women, the issues of race and slavery, and the idea of American identity. Discuss the varying perspectives that existed throughout this period. Please write between 300-350 words, or more, and please provide examples from the text.

what do you need to know about supervising UCP's ? Give an example of something you would need to supervise a UCP for and explain what the CNO expects from you as the nurse doing the supervising for that example ?

Citing practical examples from the clinical setting, explain Henri Fayol’s fourteen (14) Principles of Management     

Guidelines for Case Management: Objectives: The main aim of this activity is to provide the student interpersonal and social responsibility by answering the questions in the assignment that is related in some issues concerning nursing leadership and management. Instruction: Read and understand the case situation regarding conflict management in the healthcare setting. Based from the below-mentioned criteria in resolving conflicts, create a conflict management and resolution document using a case study format. Please see attached rubrics for details. Case Situation: Workplace Violence in the Nurses Station Carlo is a newly-hired staff nurse at King Fahd Hospital of the University (KFHU). He is assigned in the Male Medical Ward, which is situated in the 3rd floor. Carlo had been in the area for less than six (6) months. Despite of being the newest addition to the roster of staff nurses in the ward, he was handling the most difficult cases in the area and increase number of patients per shift compared to other staff nurses on duty. Carlo never complained of the situation. Instead, he decided to keep silent and continue what he is doing. One day, Carlo had an argument with Marvin, his senior staff nurse on duty, about Carlo being the favorite of their unit manager and supervisors because he often gets good working schedules and been receiving a lot of excellent feedback from both the nurse managers and patients. After their confrontation, Marvin started creating malicious and negative issues towards Carlo. Since the staff nurses were convinced of Marvin’s wrong accusations and comments, they have started to dislike Carlo and been throwing unnecessary comments and jokes about him up to the point that Carlo had been the subject of their laughing stock verbally and through their social networking account like Facebook and Twitter. Carlo was outcasted every shift. He was alone all the time and started to be demotivated about his work. In 2 weeks’ time, Carlo had been absent five (5) times and been late most of the time, which is very unusual to him because he is known to be the early bird among the staff nurses in the ward. After a month, Carlo submitted a letter to the unit manager asking for a transfer of area or if not he will just resign from the hospital. If you are the unit manager of the Male Medical Ward, how would you respond with this kind of issue of workplace violence particularly with nurse bullying? Questions: 1. Based from the above-case situation, identify and define the main problem and/or main issue? 2. What are the relevant information that needs to be addressed that would help resolve the conflict in the area? 3. In addressing the issue, identify all the contributing factors & connecting relevant information required to solve the issues in the case. 4. In mitigating this case scenario, generate hypotheses & construct sound and coherent arguments related to the solving of the case problem(s). 5. Among all the alternatives you think of resolving the conflict, weight the alternative that will give the most impact and rank the best three (3) accordingly. Justify advantages of each alternatives. 6. If you will be the unit manager, how will you manage and resolve this conflict based from the alternative resolution presented above? What are your possible course of action (COA) and recommendations in this kind of workplace violence?

This piece of legislation makes business associates subject to all of the HIPAA privacy requirements, including governmental sanctions and penalties.

A. Health Insurance Portability and Accountability Act

B. Affordable Care Act

C. 2013 HIPPA Omnibus Rule

D. Health Information Technology for Economic and Clinical Health Act

Focusing on motivational interviewing strategy as a nurse, think of an example from your professional nursing practice and answer the below questions:

1. How might you apply the motivational interviewing approach or strategy to demonstrate culturally competent communication in the creation of caring environments with the interprofessional team?

2. What barriers might you encounter and how might you overcome them?

3. As a professional nurse, give a practical example (scenario) of how you applied the motivational interview strategy on a patient in your nursing practice over the years.

4. Evaluate Culturally competent communication skills and techniques in the creation of caring environments with the interprofessional - motivational interview

5. Explain how the holistic nursing journey affect how you provide care for self

HGB: 16 HCT: 50 WBC: 8 BUN: 55 CREAT: 2.2 Na: 148 K: 3.2 Glucose: 223 Pre-Albumin: 14 Albumin: 2.8 Total protein: 4.7 INR: 3.2 Theo level: 18

The patient continues to have severe watery diarrhea, particularly after eating. The physician makes him NPO, has a PICC line inserted, and starts him on TPN.

How long can most people tolerate being NPO, with IV fluids, before needing TPN?

Why is that length of time not appropriate for this patient?

What nutrients is he in particular need of?

What complications does his deficiency of those nutrients place him at risk for?

Should he continue to receive his regular IV fluids? Why or why not? 16. What fluid imbalance is he at high risk for and why?

Should his FSBS schedule be adjusted in light of the TPN? Why or why not?

Review your state's mandated, reporter statute, Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer's scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state's website related to mandated reporting. Do for state Illinois

1. what two types of bacteria are use for blood culture?

2. Whoat color top is use for blood culture?

3. what are the additives in blood culture tubes ?