She also consumes one to two drinks of brandy per week. She has owned a gas station for the past 12 years. She is single and not sexually active. Data Obtained From Nursing Assessment System review reveals a thin woman with complaints of increasing fatigue and weakness for the past 3 to 4 months, increased frequency of bowel movements—now “watery”—hyperactive bowel sounds, 9-pound weight loss over the past six weeks with a noticeable increase in appetite—“I’ve lost weight without even trying”—and slight hand tremor. Ms. Kissinger complains “my eyes look like they are bulging.” .
– Nurse-led clinics and procedures • Nurse-led endoscopy – MINuET trial 2009: nurses more thorough in their examinations – No significant difference in safety, patient satisfaction or outcomes compared with doctor led service. Benefits – Money, Time, Efficiency • Cost savings – Nurse-led endoscopy: 33% reduction in overall cost (Wallace et al 1999) – Similar reduction in basic cost for physiologist-led TOE – Time savings: • 450: Average number of TOEs per year in a District Hospital = 300 hours of clinical time Census of Consultant Physicians and Medical Registrars 2010: Consultant Cardiologists – 71% reported an increase in professional pressures – 56% reported an increase in total hours worked – 61% reported a decrease in time available to teach trainees – 70% increasingly performing tasks previously the work of junior doctors • 1/3 of the TOE service handled by a
Meet the Client: Bert Graham Sixty-three-year-old Bert Graham visits the health care clinic complaining of increasing fatigue and difficulty breathing. Physical assessment findings include a rapid, irregular heart rate of 138 beats per minute, BP of 140/86, and a respiratory rate of 28. His breath sounds are clear with fine crackles in the bases bilaterally. He has positive jugular vein distention (JDV) bilaterally and 1+ pitting edema of his ankles bilaterally. His initial medical diagnosis is heart failure (HF).
Cystic Fibrosis Meet the Client: Debbie Baker Paula and David Baker bring their 3-year-old adopted Caucasian daughter, Debbie, to the pediatrician reporting that she has recently been having large, greasy-looking stools. The pediatrician notes that Debbie has fallen below the 10th percentile in height and weight. Debbie appears to be unhealthy and is very listless. Clinical Manifestations The pediatrician suspects that Debbie may have cystic fibrosis (CF). 1.
Case Study 1: Patient Admission Concepts related to HLTEN512B Topic 1 Mrs. Gwen Jones is a 70 year old woman who has been admitted to your ward after arriving from her doctor’s surgery. Her GP has included a letter stating that he has assessed Mrs. Jones and requests she is admitted. She is feeling very unwell, with a high temperature, frequency of urination and burning when urinating. She appears slightly confused. She complains of back pain.
Inpatient Meds: * amiodarone (Cordarone) 200 mg 1 T PO Daily * Digoxin 250 mcg 1 T PO Daily * enoxaparin (Lovenox) 90 mg Subcut every 12 hour * pantoprazole (Protonix) 40 mg 1 T PO Daily before breakfast * NaCl flush IV Push every 8 hours * warfarin (Coumadin) 5 mg 1 T PO Daily PRN meds: Active meds * acetaminophen (Tylenol) 325 mg 1 tablet every 4 hours as needed (received 2/6/12 and 2/7/12) * MOA: inhibits COX-2 and release PG by inhibiting pyrogens in the hypothalamus * AE: nausea and pruritis * diphenhydramine (Benadryl) 25 mg 1 capsule PO QID PRN itching (received 2 doses on 2/7/12, 2/6/12) * antagonizes histamine at the H1 receptor * Fentanyl 25mcg/0.5ml IV push PRN pain (Cath lab) (Received 2/6/12, 3 doses on 2/7/12) * acts with the opioid mu-receptor in the CNS * depresses cough, may lead to N/V * hydromorphone (Dilaudid) 0.5mg/0.25ml IV push PRN pain (received 2/7/12) * opioid agonist * constipation, N/V * metoclopramide (Reglan) 10 mg 2ml Injection IV push every 4 hours PRN N/V (received 2/7/12) * promotes motility in the upper GI tract by sensitizing tissues to the action of
Stabalize ABG and eventually wean off mechanical ventilation. Patient Assessment Summary (SOAP) Subjective: N/A Objective: HR 140, SpO2 91%, Vent settings SIMV PC on Rate 30, PS 5, Peep +5, FiO2 21%, temperature 36.9 degrees Celsius, skin is transparent and is tearing. CXR shows moderate RDS and worsening. Assessment: 23 week old premature infant weighed 500 grams and 10 in. long at birth, no known maternal history, pre-mature rupture of membranes.
Case Study #2: A 20 year old woman was brought to the ED in a comatose state. Her roommate stated that the patient had been nauseated earlier in the day. Upon physical examination, it was noted that the patient was breathing deeply and rapidly, her breath had a fruity odor and her skin and mucus membranes were dry. The family was contacted and the mother stated that the woman brother had Type I diabetes. The following laboratory results were obtained: CHEMISTRY PANEL REFERENCE RANGE Na 128 mmol/L (136-146 mmol/L) K 5.7 mmol/L (3.5-5.0 mmol/L) Cl 88 mmol/L (98-109 mmol/L) HCO3 9mmol/L (22-28 mmol/L) BUN 50 mg/dl (5-20 mg/dl) Osmolality 310 mOsm/kg (285-295 mOsm/kg) pH 7.12 (7.35-7.45) pCO2 28 mmHg (35-46 mm Hg) Glucose 750 mg/dl (70-105 mg/dl) Urine Glucose 4+ Serum Acetone 3+ 1.
Ms. A’s presenting symptoms include shortness of breath, low energy level, and light-headedness. Her vital signs show increased heart rate and respiratory rate as well as low blood pressure. According to her history, she has had menorrhagia and dysmenorrhea for 10-12 years and takes 1,000 mg of aspirin every three to four hours for an average of six days. Her laboratory values include: * Hemoglobin: 8 g/dL (Normal 12.0- 15.5 g/dL) * Hematocrit: 32% (Normal 34.9- 44.5 %) * Erythrocyte Count: 3.1x10/mm (Normal 4.2-5.4) * Reticulocyte Count: 1.5% (Normal 0.5- 1.5%) * Microcytic & Hypochromic cells According to her symptoms, history, and laboratory results, it would be safe to assume that Ms. A is suffering from iron deficiency anemia. This condition is common among females that have a history of menorrhagia, or heavy menstrual flow (Mayo Clinic, 2014).
Neurological Disorder Case Study - Meningitis The nurse is caring for a 21-year-old female college student who presents to the emergency department (ED) with complaints of “bad” headache pain, nausea, vomiting and neck tightening. She states, “My sinuses were bothering me last week, but I thought I was getting better until this morning.” No past surgical history noted, has recurrent sinus infections, and denies drug use, but is a social drinker on the weekends. Physical assessment findings are as follows: T – 100.8 F, P – 104, R – 24, B/P – 122/78 Alert and oriented X3 – person, place and time with periods of confusion and agitation over last 4 hours Lung sounds slightly diminished at the bases Mucous membranes dry and capillary refill <3 seconds Assessment of cranial nerve XI elicited severe pain response Pain to neck worsening and unequal pupillary responses are noted 4 hours after admission Lumbar puncture was prescribed and results are: Turbid appearance WBC - 560 cells/µL Glucose - 20 mg/dL Protein - 510 mg/dL Other diagnostic test results CT scan identified no obstruction to flow of CSF Define the key terms below: * Meningitis - see pgs. 1451 – 1455 in Lewis (8th edition) Critical Thinking Questions: 1. Define meningitis?