Females have a mean pulse rate of 74 beats per minute (bpm) and a standard deviation of 12.5

    bpm. If fifty females are randomly selected, what is the probability that their mean pulse rate

    is greater than 79 bpm?

SB is a 74 year old man who presents to your family medicine office with his wife complaining of shortness of breath and fever. They just moved to the area and had been planning to come to your office next week to establish care as new patients. He is confused about what to use when, so you are not sure which medications he actually takes. No known allergies

Past Medical/Surgical History

o   Heart failure following myocardial infarction at age 68 years

o   COPD (on 2 L home oxygen)

o   Hypertension

o   Appendectomy

JS Past Record Review  (brought by wife)

–      Echocardiogram with EF of 25%

–      Spirometry with FEV1 35% predicted that does not change significantly after inhaled bronchodilator

Records Review

Unable to determine when last pneumoccal vaccine was given

–      Patient and wife don’t recall “a pneumonia shot”

–      Does know he got his “flu shot” last month at a grocery store

JS current symptoms include the following:

–      Unable to speak in full sentences for the past several hours per wife

–      Cough productive but unknown color of sputum

–      Audible wheezing since last night per wife

–      Mild chest tightness

–      Dyspnea

•       His wife has noted no change in his alertness or mental status

•       When you inquire, the wife states that JS usually has a cough, worse in the morning, productive of gray sputum, gets short of breath if he walks more then 10 feet, and has episodes of wheezing if he gets sick (e.g. with an upper respiratory infection).

•       He usually is able to help around the house with light work and fixing things.  

•       Physical examination

–      Vital Signs: BP 128/74; P 68, reg; RR 32; Ht 5ft 6 in; Wt 122 lbs; T 101.5 °F oral

–      Unable to speak in full sentences, audible wheezing, alert and oriented

–      Pertinent positives:

•       General:  audible wheezing, no accessory muscle use

•       Nails: tar stains, clubbing

•       Chest: increased anteroposterior (AP) diameter; diffuse wheezing to auscultation

•       Heart: regular, no murmurs

•       Study results

–      Pulse oximetry 86%

–      Chest x-ray shows hyperinflation and right lower lobe pneumonia

–      You continue his heart failure medications as per his home regimen

•       No need to discontinue the cardioselective beta-blocker

What is the patients admitting diagnosis and chief complaint?

What are two priority nursing diagnosis for this patient?

What is the patient at risk for/ potential complication? and an intervention to prevent it from happening?

A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, "My other doctor says I should have my eyes looked at by an expert. It's been a while, and my eyes seem to be acting up lately. I can't see so good anymore." The client states that she takes medication for "sugar" and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. "I was a seamstress for many years and quit when I couldn't see to thread the needles anymore-just in time too. These new materials are too hard to work with!" Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel "dry and scratchy," with the left eye being worse than the right. Admits to rubbing eyes but without relief.

Develop a Plan of Care for this patient that includes:

2 Nursing Diagnosis

2 goals for each Nursing Diagnosis

Interventions with rationales

F. E. is a 74-year-old woman who comes to the medical clinic with concerns related to various “spots” on

her face. She says they have been there for a while and she thought they were just “age spots” but got

concerned after her friend was diagnosed with a malignant melanoma

Nursing Care Plan

Provide a nursing care plan for F.E. Provide a two nursing diagnosis.

Nursing Care Plan 1 and 2.

1.Assessment

2.Diagnosis

3.Goals/Plan Nursing

Interventions

4.Rationale for

the Nursing

Intervention

5. Evaluation

Please cite the reference. Thanks

or the link of reference

D. E. is a 74-year-old woman who comes to the medical clinic with concerns related to various “spots” on

her face. She says they have been there for a while and she thought they were just “age spots” but got

concerned after her friend was diagnosed with malignant melanoma.

Please provide 2 nursing care plans related to this case. Thanks

Nursing Care Plan

Problem 2

A person with mass m1 = 74 kg person climbs a distance d from the base of a uniform ladder before the ladder starts to slip. The ladder has a mass m2 = 30 kg and length L = 7.0 m and rests against a smooth vertical wall at an angle θ = 65° with the floor. The coefficient of static friction between the floor and the ladder is 0.40. Use the symbolic notations given before using numerical substitutions.

A) Find the normal force N from the floor and the force of the wall Fw on the ladder when the man is on the ladder.

B) Find the distance d that the person climbs on the ladder before the ladder starts to slip.

74. A particular brand of tires claims that its deluxe tire averages at least 50,000 miles before it needs to be replaced. From past studies of this tire, the standard deviation is known to be 8,000. A survey of owners of that tire design is conducted. From the 28 tires surveyed, the mean lifespan was 46,500 miles with a standard deviation of 9,800 miles.

Using alpha = 0.05, is the data highly inconsistent with the claim?

In other words, is there convincing evidence (at the 5% significance level) that the deluxe tires actually average less than 50,000 miles before needing to be replaced?

Mr. Jones who is 74 years of age, is being discharged home after having a right knee replacement. the discharged orders from the orthopedic surgeon include: continous passive motion at the current setting 0-degree extension worn when wolking with crutches (nonweight bearing postdischarge day 1, and may begin weight bearing postdischarge day 2); and home nurse visits, as needed, physical therapy should begin the day after discharge at an orthopic center. the orders will be faxed to the center. The following medication with prescription attached include: lovenox (enoxaparin) 70 mg subcutanously onces daily for seven days, vicodin (hydrocodone bitartrate) 10mg every 4 hours PRN, and colace (docusate sodium) 100mg every day. The patient is to fellow up with the orthopedic surgeon in 3 weeks. His daughter plan to stay with him for several weeks to assist him with meal and other house hold chores. and take him to physical therapy and the orthopedic surgeon for follow up. Mr Jones has three other children who live in other states. he is a widower and attends a local church. (learning object 4)

what preparation should the nurse make in advance before attainingnecessary communuity resources and referrals before the patient is discharged.

what necessary community resources and referals will the patient need

1. Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plans to stay with him for several weeks to assist him with meals and household chores, and take him to physical therapy and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a local church. (Learning Objective 4)

What preparations should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged?

What necessary community resources and referrals will the patient need

DDA Cardiac Module

CC: Shortness of breath, cough and fatigue

HPI: Mrs. Short is a 74 year old Caucasian female with h/o of HTN and RA. She is very active at the senior center with group activities and exercise class. She presents today because she feels “her energy is drained” and she cannot get over a cough. She has been seen in the clinic 3 times over the past year for the cough. She was treated each time with antibiotics but has not gotten much better.

ROS: denies fever or night sweats, +fatigue, appetite ok, denies HA or vertigo, denies syncope or presyncope, +SOB on exertion, denies orthopnea, +palpitations, denies chest pain, denies any GI/GU complaints, +edema, +joint pain in hands that is chronic due to RA

PMH: HTN, RA – last visit with rheumatologist was “years ago” because she did not want to take DMARDs, GERD, osteopenia, menopause

Diagnostic testing: EKG 2015 that showed LVH with normal rhythm, ECHO 2012 with normal LV function, DEXA 2010 TScore -1.9

Labs: she had “complete workup” for PE 2 years ago but doesn't know the results

SH: married for 45 years with 4 adult children who live in area, never smoked, +ETOH 2-3 glass of wine daily, no illicit drug use, works part time in real estate. Fully independent in all ADLs, IADLs.

FH: Father side of family with T2DM and HTN.

Meds: metoprolol XL 50mg qd, ASA 1mg qd, Calcium 1000mg daily, Pepcid 20mg qd, Tylenol as needed for pain

Allergies: NKDA

Physical Exam:

VS: BP 142/90, P90, R18, SPO2 98% on RA, height 60in, weight 150lbs, BMI 29.3 (up 7lbs in 6 mos)

General: slightly obese female in NAD, appears well groomed and well nourished.

HEENT: normocephalic, PERRL, teeth in good repair, buccal mucosa moist

Neck: No JVD, No bruits, No thyromegaly

CV: S1S2, RRR, II/VI SEM, +S3

Lungs: CTA A/P, no wheezing

Ext: 1+ BLE edema, pedal pulses 2+ bil, no calf tenderness,

Abd: soft, nontender, BS+, no heptamegaly or splenomegaly

Skin: no lesions or rashes

Neuro: nonfocal, CN 2-12 grossly intact

MS: small joint deformities and synovitis present in bil hands. Slight tenderness in joints of fingers, strength 5/5 in bil hands, ROM slightly limited in fingers.

What are her medical diagnoses?

What are her differential diagnoses, with rule outs?

What diagnostics are needed?

What prescriptions does she need?

What education does she need?