Case Study

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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Practical Use of Theory

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 All the information needed for the paper is attached. Paper is about the 2 questions bellow. please stay on topic and use information given.

Read the 10 Caritas Processes™ on the Watson Caring Science Institute website which further elaborate on the carative factors listed in Box 8-4: Watson’s 10 Carative Factors located on p. 183 of Theoretical Basis for Nursing.

Write a 250-word message in which you:

 

1-Reflect upon the caritas and address how these compare to your practice with patients and families, and relationships with other nurses and health care professionals. 

2-Identify how you would use this theory to change your relationships with patients and others.

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Different learning styles

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Details:

Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

  1. Click “OK” to receive your questionnaire scores.
  2. Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
  3. Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
  4. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  5. Examine how awareness of learning styles has influenced your perceptions of teaching and learning.

In a paper (750-1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

  1. Provide a summary of your learning style according the VARK questionnaire.
  2. Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  3. Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
  4. Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

Cite to at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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advanced health assessment

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Back pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Respond to this

#1

42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Patient Information:

R.E, 42-year-old African American male

Subjective

CC: “Lower back pain”

HPI: A 42-year-old black African American male who came to the clinic today for complaining of lower back pain which he reported started a month ago. The patient stated that the pain sometimes radiates to his left leg.

 

Location: Lower back

Onset: One month ago

Character: Sharp, constant, radiating to left leg

Associated signs and symptoms: None

Timing: Starts when at work

Exacerbating/ relieving factors: Any movement. Ibuprofen helps to relief the pain temporarily.

Severity: 7/10 pain scale

Medications:

Ibuprofen 200mg 3 tablets every 6 hours PRN for lower back pain.

Amlodipine 10mg daily for hypertension x1 years.

Allergies: No known drug allergy, no food allergy, no seasonal allergy and No known allergy to latex/rubber.

PMHx:

Hypertension diagnosed one year ago.

Influenza vaccine November of 2020.

Tdap vaccine 2018.

Pneumonia: Not yet had any pneumococcal vaccine.

Up to date on all childhood immunizations.

Past surgical history: None.

Social History: Mr. R.E is happily married with three children. He has a bachelor’s degree in medical laboratory and works in the hospital setting. Mr. R.E denies ever smoking, but he drinks Corona beer occasionally and during festive period with friends and family. He denies using any illicit drugs and the thought of suicidal ideation. He goes to the gym at least 1-2 times in a week and walk around his neighborhood to keep him physically active and healthy.  He loves dancing as a hobby and going for vacations with his family. The patient reported that he loves to maintain his activities of daily living and dress according to weather, as for his instrumental Activities of Daily Living he said he manages his finances and financial assets by paying his bills early. Mr. R.E loves his traditional African food and occasionally eat out. The patient reported that he keeps to safety measures by putting on his seatbelt and not texting while driving, he also reported having a working smoke detector and a security camera in his house. He has a good family support system for his wife and children. He sleeps 6-8 hours per night.

Family History:

Mr. R.E mother is still alive, age 70, has hypertension and type 2 diabetes mellitus. The Father is still living; he is 72 years old who has asthma.

Maternal grandmother deceased at age 78, had a stroke, she was diabetic.

Maternal grandfather, deceased at age 80, had prostate cancer.

Paternal grandmother deceased at age 70, from chronic obstructive pulmonary disease (COPD)

Paternal grandfather age 95, still alive had asthma.

Brother age 55 has type 2 diabetes mellitus.

Son, age 20, no health issues

Daughter age 16. No health issues.

Daughter 12, no health issues.

General:

The patient is alert and oriented to place, person, time and situation, appropriate judgement, well-nourished black, African American, dressed according to the weather, no distress noted, mild discomfort due to pain in his lower back. Emotional and behavioral needs are appropriate at the present time considering patient clinical condition, no current home stress or abuse.

HEENT: Denies itching eyes or any discharges. The patient said he uses glasses but does not use contact lens, he denies blurred vision. Denies ringing in his ears, hearing loss and discharged. Denies surgery to his ears and any recent infections. Denies epistaxis, discharges, congestion and sneezing, no loss or decreased sense of smell. Denies any sore throat or infection.

Respiratory: Elevated respiratory rate, 30/min.  Denies difficulty breathing, coughing, and wheezing. Denies secondhand smoking.

Cardiovascular/Peripheral Vascular: Denies chest pain, heaviness, or heart palpitation, denies shortness of breath and edema to both lower extremities.

Gastrointestinal: No complains of abdominal upset, no nausea or vomiting, have regular bowel movement. No changes in his appetite, no recent weight loss.

Genitourinary: Denies difficulty voiding, changes in voiding pattern and denies any penile discharge.

Neurological: Denies light headedness, fainting, seizure, vision changes or weakness to any side of his body. Denise changes in his thinking.

Skin: Negative for skin lesion, eczema, mole or rash and no skin changes.

Musculoskeletal: Lower back pain that radiates to his left leg. Denies joint stiffness or joint pain.

Hematologic: Denies any bleeding.

Endocrine: Denies cold or heat intolerance, excessive thirst, or urination, does not have any issue with his thyroid.

Psychiatry: Mr. R.E said he is fine, does not have any mental problems, denies depression, suicidal thought, patient states he loves his wife and his family and can never kill himself.

OBJECTIVE DATA:

Physical Examination:

Vital signs: BP 120/80 and regular, Heart rate: 65 and regular, Temperature: 98.2 F orally, Respiration 30; pulse oximetry 95% on room air, Weight: 160 lbs.; Height: 5’ 9”; BMI: 26

Neurological: Patient is alert and oriented to place, person, time and situation, appropriate judgement. Speech is clear, no facial drooping, no vision changes, follows movement. Understand clear, complex, comprehensive without cues or repetition.

Skin: Not pale, cyanosis or ashen. Dry and warm to touch. No tear and non-tainting.

Chest/Lungs: Tachypnea, the chest expands symmetrically, bilateral breath sounds are clear.

Heart/Peripheral Vascular: The heart rate is regular with a normal rhythm, S1and S2 sound heard. All peripheral pulses are strong and palpable +3, Negative edema to all extremities. Capillary refill is less than/equal to 2 seconds in all extremities and no cyanosis noted.

Abdomen: Soft and nondistended, bowel sound present and active in all four quadrants, no pain or rebound tenderness noted. Last Bowel movement was this morning.

Musculoskeletal: Lower back pain radiating to the left lower extremity. No evidence of trauma to affected area. Pain increases with flexion, extension, and twisting. Decreased mobility due to pain.

Diagnostic Tests:

Complete blood count (CBC) may point to infections or inflammation.

Erythrocyte sedimentation rate.

HLA-B27

Bone scans

X-Ray of the lumbar spine

Computerized tomography (CT) cervical spine/lumbar w/without contrast.

MRI of the lumbar spine

Assessment.

Differential diagnoses:

· Lumbar disc herniation (LDH): The intervertebral disc consists of an inner nucleus pulposus (NP) and an outer annulus fibrosus (AF). The central NP is a site of collagen secretion and contains numerous proteoglycans (PG), which facilitate water retention, creating hydrostatic pressure to resist axial compression of the spine. The NP is primarily composed of type II collagen, which accounts for 20% of its overall dry weight. In contrast, the AF functions to maintain the NP within the center of the disc with low amount of PG; 70% of its dry weight is comprised of primarily concentric type I collagen fibers. In LDH, narrowing of the space available for the thecal sac can be due to protrusion of disc through an intact AF, extrusion of the NP through the AF though still maintaining continuity with the disc space, or complete loss of continuity with the disc space and sequestration of a free fragment. It is estimated that this condition has approximately 75% heredity origin, other predisposing factors includes dehydration and Axial Overloading. The role of inflammatory signaling in producing nerve pain in LDH has been well-established. The primary signs and symptoms of LDH are radicular pain, sensory abnormalities, and weakness in the distribution of one or more lumbosacral nerve roots. CT myelography and MRI are used to detect this condition (Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017).

· Lumbar spinal stenosis: Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of the back. Stenosis, which means narrowing, can cause pressure on the spinal cord or the nerves that go from the spinal cord to the muscles. Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. This condition is most usually categorized as either primary when it is caused by congenital abnormalities or a disorder of the postnatal development, or secondary (acquired stenosis) resulting from degenerative changes or as effects of local infection, trauma, or surgery. Degenerative LSS anatomically can involve the central canal, lateral recess, foramina, or any combination of these locations. Central canal stenosis may result from a decrease in the anteroposterior, transversal, or combined diameter secondary to loss of disc height with or without bulging of the intervertebral disc, and hypertrophy of the facet joints and the ligamentum flavum. Fibrosis is the main cause of ligamentum flavum hypertrophy and is caused by accumulated mechanical stress, especially along the dorsal aspect of the ligamentum flavum. The symptom most ascribed to LSS is neurogenic claudication, also known as pseudoclaudication. Neurogenic claudication refers to leg symptoms containing the buttock, groin, and anterior thigh, as well as radiating down the posterior part of the leg to the feet. In addition to pain, leg symptoms can include fatigue, heaviness, weakness and/or paresthesia.  The symptoms can be unilateral or more commonly bilateral and symmetrical. The patient may suffer from accompanying back pain, but leg pain and discomfort are usually more troublesome. (Genevay, S., & Atlas, S. J. (2016).

· Lumbar strain/sprain: The lumbar spine, depends on soft tissues to help hold the body upright and support weight from the upper body. If put under too much stress, the lower back muscles or soft tissues can become injured and painful. Lumbar sprain occurs when ligaments are overstretched or torn. Ligaments are tough, fibrous tissues that connect bones together. The most common symptoms of a lumbar strain are sudden lower back pain, Spasms in the lower back that result in more severe pain and Lower back feels sore to the touch. In addition to a complete medical history and physical exam, diagnostic procedures for low back pain may include X ray, CT scan and MRI. (AANS, August 2020)

· Sciatica: Low back pain is one of the most frequently faced conditions in clinical practice. Low back pain has high direct and indirect costs and is a common reason for missed work. The sciatica also called radiculopathy, is affected, and caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg. (AHRQ, November 15, 2016),

· Ankylosing spondylitis: Ankylosing spondylitis is a type of arthritis of the spine. It causes inflammation between the vertebrae, which are the bones that make up your spine, and in the joints between the spine and pelvis. In certain individual, it can affect other joints. This condition is common and more severe in men, it often runs in families, the cause is unknown, but it is likely that both genes and factors in the environment play a role. Early symptoms of this condition include back pain and stiffness. (MedlinePlus, December 7, 2020).

Reference

American Association of Neurological Surgeon, August 2020. Low Back Strain and Sprain.

Retrieved from ans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-

Back-Strain-and-Sprain#:

AHRQ, November 15, 2016) Noninvasive Treatments for Low Back Pain: Current State of the

Evidence. Retrieved from https://effectivehealthcare.ahrq.gov/products/back-pain-

treatment/clinician

 

Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation.

Current review in musculoskeletal medicine, 10(4), 507–516.

https://doi.org/10.1007/s12178-017-9441-4

Genevay, S., & Atlas, S. J. (2016). Lumbar spinal stenosis. Best practice & research. Clinical

rheumatology, 24(2), 253–265. https://doi.org/10.1016/j.berh.2009.11.001

MedlinePlus, December 7, 2020. Ankylosing Spondylitis. Retrieved from

https://medlineplus.gov/ankylosingspondylitis.html

Back pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Respond to this

#2

Assessing Musculoskeletal Pain

 

Musculoskeletal pain primarily affects an individual’s quality of life through aspects such as sleep deprivation, fatigue, depression, as well as an activity together with participation restrictions. The set effect is also impacted by contextual facets that are also inclusive of comorbidity, arthritis coping efficiency, as well as access to care (Hawker, 2017). This then implies that musculoskeletal (MSK) pain evaluation necessitates set bio-psychosocial perspectives that encompass pain alongside baseline impacts combined with contextual facets.

 

Nerve roots that may be associated with back pain exhibit a set multifaceted, heterogeneous state whereby both the nociceptive alongside neuropathic pain mechanisms may be entailed. The pain is due to activation of the set nociceptors innervating ligaments, joints, muscles, fascia combined with tendons. This is due to the reaction to tissue injury or even inflammation combined with biomechanical stress. The neuropathic pain originates from injury or even illness that impacts the nerve roots innervating the spine together with the spine as well as the lower limbs, as well as pathological invasive innervation within the damaged lumbar discs (Baron et al., 2016).

 

Physical assessment can be undertaken by centralization (change of pain along the far end of the whole-length body region) of symptoms within physical assessments. (A positive test applied in ruling diagnosis). Physical assessment can also be done on the facet joint per centralization and lack of relief from recumbency. The other test is on the sacroiliac joint through centralization (Peterson et al., 2017). The next test is disc herniation together with root involvement whereby the dermatological distribution that mirrors neurological results, enhances the set specificity of the outcomes. Other tests would include spondylolisthesis, fracture, myofascial pain, peripheral nerve, and central sensitization.

 

Other symptoms that can be explored for the lower back pain include pain exhibiting dullness or is achy in nature within the lower back, stinging combined with burning pain from the lower back to the lower thigh back, muscle spasms combined with tightness within the lower back, prolonged pain while standing, as well as problems when standing straight or even walking (Allegri et al., 2016).

 

A differential diagnosis for acute lower back pain includes tailbone pain as a result of pain alongside the bony structure within the lower spine (Mayo Clinic, 2019). Another differential diagnosis is lumbar compression fracture due to the collapsing of the bony block or even the vertebral structure that causes acute pain, deformity as well as weight loss (Genev et al., 2017). Another differential diagnosis is psoriatic arthritis that depicts a state exhibiting red patches of skin alongside silvery scales that causes pain within joints (Mayo Clinic, 2019).

You are required to include at least two evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.

 

   

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concept map patient scenario

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Patient Case #4

 

Patient: Vernon Russell

Diagnosis: Right-sided stroke (mild left hemiplegia)

Brief Summary :

Vernon Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday. The patient is nothing by mouth except medications. Chest-x-ray confirmed possible aspiration pneumonia on the right side.

Medications:

· Losartan 50 mg PO BID

· Aspirin 81 mg PO daily

· Metformin 500 mg PO BID

· Chlorthalidone 25 mg PO daily

Orders:

· Vital signs and neuro checks every 4 hours

· Activity: Up to chair, up to the bathroom with assistance

· Nothing by mouth except medications until swallow study completed tomorrow

· Speech therapist swallow study

· Fall risk assessment

· Labs: CBC, chemistry panel, and prothrombin time

· Bedside blood glucose twice a day

SBAR Report :

S: Mr. Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday afternoon. He had a head CT and received thrombolytic therapy in the ED. He is nothing by mouth except for medications until the speech therapist has completed a video swallow study, which is scheduled for later this morning. He is scheduled for physical therapy later today.

B: Mr. Russell has a history of hypertension, coronary artery disease, and diabetes mellitus type 2. He has smoked over a pack of cigarettes per day for the past 35 years and does not exercise.

A: We have already checked his blood glucose level this morning. His vital signs have been stable and he slept well last night. He was able to get up to go to the bathroom with the use of a walker. His neurological checks are stable and he continues to have mild left hemiplegia. His hand grasps are almost equal but a little weaker on the left side. His pupils are equal and react to light. Swallow reflex is intact but impaired. He is oriented x2. Patient is slow to respond and noted to have some periods of slurred or delayed speech. I have already done a Morse Fall Risk assessment with a total high risk score of 60. Fall precautions implemented. Upon bedside RN swallow evaluation, the patient was noted to have frequent coughing when given a small sip of water. Chest x-ray done in the ED reveals that the patient has right-sided pneumonia, possibly due to aspiration.

R: You should do a vital signs assessment, perform a neurological assessment, and talk about safety with Mr. Russell. His morning medications are up and should be administered with caution. Maintain NPO status until video swallow performed. Patient was able to stand on side of bed with physical therapist, but weakness noted. Patient unable to take steps. Continue fall and aspiration precautions.

 

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case study discussion

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Case study 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.

· Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 Pulse 68

· HEENT (head, ears, eyes, nose, throat):  wnl (within normal limit)

· Neck: supple without adenopathy

· Lungs/CV (cardiovascular): wnl

· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

· Abd (abdomen): soft, +BS (positive bowel sound), no tenderness

· VVBSU (Vulvar vaginal bartholin skene’s uretha): wnl, except 1st degree cystocele

· Cervix: firm, smooth, parous, without CMT (cervical motion tenderness)

· Uterus: RV (retroverted), mobile, non-tender, approximately 10 cm,

· Adnexa: without masses or tenderness

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests (include explanation of the tests you might recommend).

Include your differential diagnosis. Be specific and provide examples. Use your Learning Resources and/or evidence from literature to support your explanations.

Some questions to answer in your post:

1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?

3. What are her current cycles like?

4. When was her last gyn exam and what were the results of the tests?

5. Are her migraines with or without auras?

6. What method has she considered.

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine?

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Emergency Response Planning

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Activity 6

Emergency Response Planning

Emergency response planning is the organization, coordination, and direction of available resources to respond to an event or bring and emergency under control.

Select one of the scenarios below and complete the activity.

Earthquake Emergency Response

The healthcare team has just been notified that there was an earthquake in the Sentinel Mountains that has destroyed buildings in Industrial Heights and Casper Park residential area of Sentinel City®.

  • Visit the Industrial Heights and Casper Park residential areas of Sentinel City® and consider the impact zone of an earthquake.  Observe the services, routes and populations that may be involved with the city as a result of the earthquake.
  • Create a report that describes the potential public health effects, infrastructure damage and environmental hazards related to the earthquake.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Tornado Emergency Response

The healthcare team has just been notified that there was a tornado that ripped through Casper Park and Acer Tech Center in Sentinel City®.

  • Visit the Casper Park and Acer Tech Center areas of Sentinel City® and consider the impact zone of the tornado.  Observe the services, routes and populations that may be involved with the city as a result of the tornado.
  • Create a report that describes the potential public health effects, infrastructure damage and environmental hazards related to the tornado.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Civic Disturbance Emergency Response

The healthcare team has just been notified that there is a civic disturbance at City Hall with injuries in Sentinel City®.

  • Visit the area City Hall.  Observe the services, routes and populations that may be involved with the city as a result of the civic disturbance.
  • Create a report that describes the potential public health effects and environmental hazards related to the civic disturbance.  Describe the members and roles of the emergency management team and organizations (public and private) that would be activated in Sentinel City®.
  • Who are the members of the emergency response team that will be deployed? What private and public resources will assist with the response in the short and long term?
  • What are the risks and benefits of the quick public responses that will be shared on social media?

Reading and Resources

Additional Instructions:

  1. All submissions should have a title page and reference page.
  2. Utilize a minimum of two scholarly resources.
  3. Adhere to grammar, spelling and punctuation criteria.
  4. Adhere to APA compliance guidelines.
  5. Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Option

  • 2 to 3-page paper. Include title and reference pages.

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NR 511 Week 4 Midterm Exam Version 5

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NR 511 Week 4 Midterm Exam Version 5

Question 1: How often should the clinician examine the feet of a person with diabetes?

a. Once a year
b. Every 6 months
c. Every 3 months
d. Every visit

Question 2: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors
b. Anxiolytics
c. Antidepressants
d. Atypical antipsychotics

Question 3: Most adult poisonings are:

a. intentional and self-inflicted.
b. accidental.
c. caused by someone wishing to do harm to the person.
d. not attributed to any reason.

Question 4: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

a. “It is probably just a cyst, because that is the most common breast mass.”
b. “We will order a mammogram and ultrasound to help establish a diagnosis.”
c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”
d. “Because your lump is painful, it is most likely not cancer.”

Question 5: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)
b. Computed tomography (CT) scan
c. A lumbar puncture
d. There is no specific test.

Question 6: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation
b. Refer to a podiatrist for a foot care treatment plan
c. Send her for acupuncture treatments
d. All of the above

Question 7: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset
b. Impaired attention
c. Affective changes
d. Delusions

Question 8: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?

a. Decrease in level of consciousness (LOC)
b. Headache
c. Nausea
d. Widening pulse pressure

Question 9: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. Posterior dislocations are more common than anterior dislocations.
b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.
c. Recurrent dislocations are uncommon and would require a greater force to result in injury.
d. Surgery is most commonly the treatment of choice.

Question 10: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

a. Decreased C-reactive protein
b. Hyperalbuminemia
c. Morning stiffness
d. Weight gain

Question 11: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

a. Overweight

b. Mild obesity

c. Moderate obesity
d. Morbid obesity

Question 12: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice
b. Carrots
c. Spinach
d. Potatoes

Question 13: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV)
b. Endometrial hyperplasia
c. Vagismus
d. Polycystic ovarian syndrome

Question 14: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

a. Benzodiazepines
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants

Question 15: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy

b. Lumpectomy

c. Radiation implants
d. All of the above

Question 16: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?

a. Gonorrhea
b. Human papillomavirus (HPV)
c. Chlamydia
d. Trichomonas

Question 17: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

a. Conjugated estrogen 0.625 mg/day oral
b. Estradiol 7.5 mcg/24 hr vaginal ring
c. Medroxyprogesterone 10 mg/day oral
d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 18: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Spores

b. Leukocytes

c. Pseudohyphae
d. Epithelial cells

Question 19: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%
d. 50%

Question 20: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test
b. McMurray circumduction test
c. Lachman test
d. Varus stress test

Question 21: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland
d. A boggy gland

Question 22: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness
b. A reduced or absent ankle reflex
c. Numbness in the lateral foot
d. Paresthesia of the perineum and buttocks

Question 23: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.
b. 3 months.
c. 6 months.
d. 12 months.

Question 24: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia
d. U waves

Question 25: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns
b. Superficial partial-thickness burns
c. Deep partial-thickness burns
d. Full-thickness burns

Question 26: Immunizations are an example of which type of prevention?

a. Primary
b. Secondary
c. Tertiary

Question 27: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.
b. The area will be super sensitive.
c. The area is prone to a repeat frostbite.
d. The area is as susceptible as any other area.

Question 28: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test

b. Pelvic ultrasound

c. Endometrial biopsy
d. Platelet count

Question 29: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

c. Ergotamine
b. Timolol

d. Topiramate

Question 30: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin

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Case Study

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

PLEASE FOLLOW RUBRICS

Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived  Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided. signs and symptoms.

Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

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Advance Practice

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Apply information from the Aquifer Case Study to answer the following discussion questions:

•Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

•Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

•What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

Do Two pages.

Provide References.

See attached Aquifer Case Study.

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