Respiratory Drugs

Brett is a 12 y/o boy with a history of asthma, diagnosed 2 years ago.  He is an outgoing, active boy and participates in a swim club and soccer, but he has a difficult time adjusting to the limitations of his asthma.  He has learned to control acute attacks by using albuterol (Proventil) metered-dose inhaler, and because his asthma is often triggered by exercise, he has been using a budesonide (Pulmicort) inhaler and taking montelukast (Singulair).  

After competing in his swim meet at the local indoor pool, Brett began experiencing respiratory distress.  He alerted his coach, who retrieved the albuterol inhaler from Brett’s backpack.  After two inhalations, Brett was still in distress and the rescue team was called.

On admission to the emergency department, Brett is in obvious distress with pulse oximeter readings of 90% to 91%.  He has nasal flaring and bilateral wheezing is heard in is his lung fields, pulse rate is 122 beats/min, and he is orthopneic.  While treatment is started, the nurse asks him questions that he can nod or shake to answer.  He shakes his head “no” when asked if he used his budesonide inhaler today and shrugs when asked about his last dose of montelukast. Course hero

1. According to the onset of action, which specific group of drugs would you anticipate will be prescribed to treat Brett’s acute asthmatic attack and why?  (10 points).  Name an inhaler the patient be taught to use to for rescue? (5points)

2. Considering Brett’s history, medications, and the location where Brett’s asthma attack occurred, what might explain his acute attack? (5 points
3. Use keywords and a textbook as a resource to search for an asthma support group or online support group for children or for adults.  Include the URL and information about what the group does or services provided. (15 points)

An 11-year-old boy presents to the emergency department with low back pain and a palpable mass on his right side near his hip. His parent also reports intermittent, low grade fever and weight loss over the past 3 months. After a careful physical examination, laboratory studies, and imaging studies, a diagnosis of Ewing sarcoma is determined.

1. Outline the process that has most likely occurred in his body.

2. What would you expect for clinical manifestations?

3. What diagnostic tests were used and what do these tell you?

4. What treatment measures would you anticipate?

Josiah, a 22-month-old boy, lives with his mother and grandmother. He is at an early childhood center during the weekdays, and due to his mother's work schedule does not get home until after 6 p.m. most days. His mother and grandmother allow him to walk around the house with apple juice in a sippy cup while they are preparing dinner. He also "demands" snacks such as crackers, slices of cheese, and cookies. When they attempt to put Josiah in his booster chair at the table, he fights with them and yells, "NO chair!" Mother and grandmother often eat quickly in front of the television while feeding Josiah from their plates while he also watches TV. Josiah's mother and grandmother are frustrated and are concerned that he is not eating enough for dinner. The early childhood staff also state that they are having a difficult time with him sitting down at lunch time.

1. Describe the issues surrounding Josiah's mealtime behaviors.

2. Describe how Josiah's mother and grandmother could introduce new foods into Josiah's diet.

3. What suggestions can you give for between-meal snacks for Josiah?

4. What concerns do you have about giving Josiah unlimited access to apple juice in the sippy cup?

5. How can healthy eating behaviors be developed in Josiah?

6. Should Josiah be encouraged to eat all the food on his plate before he is allowed to get down from his booster chair and play? Why or why not?

Scenario: Alex is a 6 year old boy who arrives to his primary care office with a 3-day temperature of 102-103F axillary and L leg pain.  Today he started with red pinpoint rash and has been unusually sleep.  Alex is up-to-date on his vaccines.   His vitals today are RR 28

HR 120    T102.5F     BP 90/60   O298% on room air.  Weight 21.8 kg    Height 3.5 feet

the NP finds that Alex has not only cervical lymphadenopathy but also enlarged lymph nodes in the axillae and groin. Yet, Alex is not complaining of a sore throat, headache, ear pain, or trouble urinating.  UA, rapid strep, and rapid flu test are all negative.  Alex hasn’t had any recent injury to his leg.  The NP draws blood to run a CBC and comprehensive metabolic panel.  

The CBC shows a WBC 42,000 (very high)  RBC  (normal)  Hbg 10 (low)  Hct 31% (low)  Platelets 90,000 (low)  Neutrophils-bands – (high)  Neutrophils-segmented (low)  Lymphoblasts at 38% (very high).    The NP admits Alex to the local children’s hospital and orders an oncology consult for suspected leukemia.

1. What in the above scenario could lead to a diagnosis of leukemia?

2.  What additional tests would you expect to be done in hospital?

3. What pain scale would you use for Alex?

4.  Who else in the hospital could you ask to help prepare Alex for the various tests and procedures?  

5. List one nursing diagnosis with interventions & goals.

6. Would advance directives be appropriate here?  Why or why not?

10- Please provide examples

Niles and Marsha adopted an infant boy (a U.S. citizen). They paid $18,750 in 2017 for adoption-related expenses. The adoption was finalized in early 2018. Marsha received $3,850 of employer-provided adoption benefits. For question (a), assume that any adoption credit is not limited by modified AGI or by the amount of tax liability.

1. What amount of adoption credit, if any, can Niles and Marsha take in 2018?
2. Using the information in question (a), assume that their modified AGI was $240,000 in 2018. What amount of adoption credit is allowed in 2018? (Do not round intermediate calculations. Round your final answer to the nearest whole dollar amount.)

When should the discharge teaching begin for Jordan and his family?

What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?

What would be good distractions for a child of Jordan’s age?

When should Susan’s nurse explain the procedure to her?

To give Susan some control over this situation, what choices could be given to her?

What actions should the nurse take in this clinical situation? Prioritize the actions.

Case Study # 1

Jordan is a 9-year-old boy who is a direct admit for observation. He has had a history of vomiting and diarrhea for 48 hours.

Subjective Data

Has a history of nausea and vomiting for 24 hours.

Has not voided today.

Is unable to tolerate oral fluids.

Objective Data

Vital signs: temp, 37.8º C; pulse, 120 bpm; resp, 24 breaths/min; blood pressure, 110/60 mm Hg

Weight: 34 kg

Hyperactive bowel sounds to auscultation

Questions:

1. When should the discharge teaching begin for Jordan and his family?
2. What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?
3. What would be good distractions for a child of Jordan’s age?

Case Study #2

Susan is a 4-year-old girl with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Susan has had fever for 1 week.

Her mother has noticed a decreased activity level.

Susan states she is “afraid” of needles.

Objective Data

Weight: 26.1 kg

Vital signs: temp, 39.3º C; pulse, 110 bpm; resp, 40 breaths/min; blood pressure, 108/54 mm Hg; oxygen saturation (O₂ sat) 100%

No abnormal findings on physical examination

Questions:

1. When should Susan’s nurse explain the procedure to her?
2. To give Susan some control over this situation, what choices could be given to her?
3. What actions should the nurse take in this clinical situation? Prioritize the actions.

pls with the reference. Thanks

What other assessments should be included for this patient?

What questions are appropriate for a patient presenting with earache?

What risk factors are associated with earaches for this age group?

From the readings, what is the difference between otitis media and otitis externa?

From the readings, what is the most probable cause of the earache in this patient?

What are three nursing diagnoses?

What interventions should be included in the nursing care plan?

CASE STUDY 2:

Sammy is a newborn boy at 32 hours of life. His birth weight was 8 pounds. He was born via normal spontaneous vaginal birth at 40 weeks of gestation to a 26-year-old G1. There were no maternal prenatal issues. Labor and delivery were complicated by a prolonged second stage of labor, which eventually progressed to spontaneous birth. The Apgar scores were 6 and 8, and the infant was taken to the nursery for an observation period; he received IV fluids but did well and so was discharged to routine care in the mother’s room at 12 hours of life. Sammy was noted to have facial bruising and a cephalhematoma, which were attributed to the prolonged second stage of labor. All newborn blood work was normal. The group B strep culture was negative. Maternal blood type is A positive. Exclusive breastfeeding was initiated at 12 hours of life. On physical examination, Sammy has some jaundice evident on the chest and torso.

1. What risk factors does Sammy have for hyperbilirubinemia?

2. The pediatrician orders a bilirubin level, and the total serum bilirubin level is 7 mg/dL. A repeat level is ordered in 8 hours. Does this result indicate a dangerous level of hyperbilirubinemia?

3. What are the risks to the newborn with elevated bilirubin levels?

4. Sammy’s repeat total serum bilirubin was 5 mg/dL at 40 hours of life, and the pediatrician has given discharge orders for this evening when Sammy will be 48 hours old. What education is appropriate for Sammy’s parents at this time regarding jaundice?

NO PHOTOS PLEASE