Case 1

A 7-year-old boy has a 2-day history of severe headache, nausea, fever, and photophobia. He appears lethargic and ill. His temperature is 40^oC, and he has some nuchal rigidity. The most likely diagnosis in this case is bacterial meningitis.

In order to find the causative agent, a lumbar puncture is requested by the physician. Laboratory analysis confirms bacterial growth in the cerebrospinal fluid (CSF). Appropriate antibiotic therapy is administered and the patient recovers without any complications.

1. Where along the vertebral column is the needle typically inserted in order to perform a lumbar puncture? Provide an anatomical explanation for your answer.  

2. Explain why the needle is inserted in the median plane.

3. Following the procedure, the patient complains of a severe headache. Explain the possible causes for this complication.

4. Identify the most common causative organisms of meningitis.

5. Explain the various anatomical pathways of the bacteria from the external environment to the CSF inside the brain ventricles.  

6. Outline two reasons for the boy’s nausea, and photophobia.

7. Explain the structures, site of production and pattern of circulation of CSF throughout the brain.

Reference APA style

Acute Arm Pain

Jose is a 10-year-old boy who fell off his skateboard. He has an obvious deformity to his right wrist that has been splinted. He is pale, refuses to move his arm, and is sitting in a rigid position, but he states that his pain is 0 on a scale of 1 to 10.

Subjective Data

Fell from his skateboard 1 hour ago.

Displays no loss of consciousness.

Denies pain.

Objective Data

Weight: 34 kg

Vital signs: temp, 37.0º C; pulse, 116 bpm; resp, 40 breaths/min; blood pressure, 138/74 mm Hg; oxygen (O2) saturation: 100%

Radial pulse: strong

Capillary refill time: brisk to right upper extremity

Questions:

What nonverbal cues might lead Jose’s nurse to believe that he is in pain?
Why would a child of Jose’s age deny pain that he is having?
What are the preferred routes for administration of pain medications?
What are appropriate pain scales to use for Jose?

Case Study: Max

Client Profile: “Max is a 12-year old boy whose father died about 5 years ago. His father experienced periodic episodes of depression during his lifetime. After his father’s death, Max displayed tantrums and became more aggressive toward his toys and people. He took on a serious, almost sad expression. He seemed empty and alone, even when in a room full of people. Max saw a therapist; after a period of play therapy, he stopped being more aggressive than boys his age, began to smile and played with peers.”

            “Max’s mother went to work after his father’s death; she now works two jobs. When she is home, she is authoritarian in her parenting style. Recently, Max’s mother snooped around Max’s room and found some morbid pictures that he had drawn (i.e., pictures of funerals, cemeteries, and people being shot or knifed to death). She also found cigarettes; as a consequence, he cannot have any friends visit and he may not leave the house except to go to school.”

            Max is not turning in schoolwork and is picking fights at school. In the evening, he plays video games and makes excuses for procrastinating with his homework. He lies awake at night worrying about his homework and things such as failing school, disappointing his mother, not having friends, and wondering if everyone hates him. When his mother tells him he is going to fail school, he responds, ‘I don’t care.’”

            The school nurse notices Max’s behavior and becomes concerned, especially since two other students recently attempted suicide. She shares this information with Max’s mother and suggests that a health care provider see Max. His mother takes him to a sliding-fee-scale clinic where a family practice health care provider who volunteers at the clinic sees Max. The health care provider identifies depression as a problem, considers putting Max on medication, but decides instead to have him admitted to a residential treatment center for evaluation and treatment. A clinic social worker finds funding from various sources to cover the cost of treatment at the facility for children and adolescents. The facility has child and adolescent psychiatrists and psychiatric nurses on staff.” [Richardson, B.K. (2007). Case Study Series: Psychiatric Nursing, Clifton Park, NY: Thomson Delmar Learning.]

Case Study: The nurse on the children’s unit of the residential treatment center receives word Max will be admitted for treatment of depression. When Max and his mother arrive, the nurse does an intake interview with Max alone and then with both Max and his mother. Then the nurse interviews his mother and gives her a copy of the parent handbook while someone orients Max to the unit and its rules. Both Max and his mother are asked to sign a form indicating they have read the unit rules and will abide by them. Max’s belongings are inventoried; some are locked up, while he is permitted to keep others. The child psychiatrist prescribes fluoxetine (Prozac) as well as individual and group therapy.

            One night, Max gets irritable with the nurse for not letting him stay up past unit bedtime to watch his favorite television show. Max says, “It doesn’t matter because I am just going to kill myself tonight anyway.” The psychiatrist is notified and writes orders for Max to be placed on 1 to 1 observation within eyesight of an assigned staff member at all times. The following day Max learns he cannot go to the recreation building because a unit rule states, “Anyone who threatens to kill himself or herself cannot leave the unit until he or she no longer wishes to kill himself or herself and 24 hours have passed.” Max tells the nurse, “I was just kidding. I really wasn’t going to kill myself.”

Questions

1. Max’s mother tells you (the nurse) about the 2 other students at Max’s school who attempted suicide recently. How should you respond?

2.What data would you gather on Max and his family prior to writing a nursing care plan?

BJ. is a 5-year-old boy who has suffered from repeated upper respiratory infections since he was 16 months old. At 4 years of age, he was diagnosed with allergic asthma. The following winter, at age 5, he was admitted to the hospital twice for acute asthma with a secondary bacterial pulmonary infection.

At the second admission, a complete blood count, sputum culture, and immune status work-up were ordered.

Laboratory Data

Assay                                        Patient Results          Reference Range

Hemoglobin                                13.5 g/dL              11.5-14.5 g/dL

Hematocrit                                    40% 33-43%

Total WBC count 16.2 x 10⁹/L          4-12 x 10⁹/L

Lymphocyte Count 4.3 x 10⁹/L             2.7-5.4

T lymphocytes                             2.4 x 10⁹/L             2.7-5.3

B lymphocytes                              1.0 x 10⁹/L            0.6-1.4

1. What is the etiology of this patient’s recurring infections? Explain your answer.

Listed below is the net sales in $ million for Home Depot Inc. and its subsidiaries from 1993 to 2015. Remember to code the years starting at 1 for year 1993.

Determine the least squares equation. On the basis of this information, what are the estimated sales for 2016 and 2017? (Round your final answers to 2 decimal places.)

There is an evolutionary psychology hypothesis that being beautiful has a bigger evolutionary advantage for women than for men, and some researchers have concluded that this should mean that beautiful parents will have more daughters than sons.

Gelman and Weakliem (2009) tested this hypothesis by compiling a list of everyone named as one of People Magazine’s “50 most beautiful people” between 1995 and 2000. They then recorded how many sons and how many daughters each of these “beautiful people” had as of 2007.

For each celebrity, let’s calculate the difference between the number of sons they had and the number of daughters they had. Then let’s calculate the mean and standard deviation of these difference scores. (I have rounded slightly, but the results are the same as they found in the experiment.)

We get:

• N = 256
• Mean difference = 0.08
• Standard deviation of difference scores: 1.16

What is the numerator of t_obtained?

What is the denominator of t_obtained?

What is t_obtained?

part a

calculate the sample autocorrelation function and provide an interpretation

part b

construct an individual control chart with the standard deviation estimated using the moving range method. how would ypu interpret the chart? are ypu comfortable with this interpretation?

data

2048, 2025, 2017, 1995, 1983, 1943, 1940, 1947, 1972, 1983, 1935, 1948, 1966, 1954, 1970, 2039, 2015, 2021, 2010, 2012, 2003, 1979, 2006, 2042, 2000, 2002, 2010, 1975, 1983, 2021, 2051, 2056, 2018, 2030, 2023, 2036, 2019, 2000, 1986, 1952, 1988, 2016, 2002, 2004, 2018, 2002, 1967, 1994, 2001, 2013, 2016, 2019, 2036, 2015, 2032, 2016, 2000, 1988, 2010, 2015, 2029, 2016, 2010, 2000, 2009, 1990, 1986, 1947, 1958, 1983, 2010, 2000, 2015, 2032

1.) Listed below are the number of deaths in the United States resulting from motor vehicle crashes.

a.) Create a scatterplot in StatCrunch and draw a sketch of it. Make sure to label the x and y axis.

b.) Find the correlation coefficient, rounded to four decimal places.

c.) Find the equation of the line of best fit.

d.) Is the correlation significant? Explain why or why not.

e.) Predict the number of deaths from motor vehicle crashes in 2015.

f.) In 2015 there were actually 32,999 deaths from motor vehicle crashes. Is your above estimate close to the actual result?

g.) Predict the number of deaths from motor vehicle crashes in 2140. Is this result reasonable?

Year 1975 1980 1985 1990 1995 2000 2005 2010

Deaths 44,525 51,091 43,825 44,599 41,817 41,945 43,443 32,708