BACKGROUND LS is a 70yearold with advanced chronic obstr.pdf

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BACKGROUND L.S. is a 70-year-old with advanced chronic obstructive pulmonary disease. He is intubated and unconscious in the intensive care unit with pneumonia complicated further by acute renal failure. His advance directive, completed seven years ago when he was highly functional, indicates that he wants life-sustaining treatments. He has not updated his advance directive since that time. Members of the medical team are concerned that he has little chance of surviving this hospital stay, and if he were to survive, he is at high risk of significant cognitive deficits that would require long-term skilled nursing care. The patient's wife is listed as his healthcare agent in his advance directive. She asks how she should proceed with decision-making as she struggles to balance what she thinks would be in her husband's best interest and what he has indicated in his advance directive. She consults her two adult children regarding their ideas. QUESTION What should Ms. S. do if she disagrees with both her children's ideas related to her husband's advanced directives? What should she do to prepare for the time when she will no longer be able to make her own healthcare decisions? Have you had past experiences with a family member or friend or heard of another situation where a decision had to be made about death and dying? In your peer response provide an alternative course of action for Ms. S and discuss why this might be an appropriate action..

Education

NSG6001 Advanced Practice Nursing I Page 1 of 5 © 2007 South University Week 1: Cardiology Clinical Case HPI A 52-year-old Irish American male is discharged from the hospital. He was hospitalized for four days after a stent placement, following admission from the emergency room with angina symptoms. This patient presented to the emergency room with four hours of crushing chest pain. He was short of breath with exertion and diaphoretic. The patient thought he was having a heart attack and was afraid to come to the hospital. The symptoms lasted for four days before the patient sought help. The patient had been suffering from similar symptoms for the past six months but thought that he just out of shape. It was worse upon admission to the hospital. Prior to this, the symptoms disappeared with rest. His symptoms were relieved in the emergency department with medication and he was transferred to the cardiac floor for catheterization. The patient’s symptoms were highly debilitating upon his admission to the emergency department. Prior to his admission to the hospital for this event, the patient was not very active because of his angina symptoms. The pain that he had was substernal and crushing and radiated to his neck and jaw. His symptoms resolve with rest only. He has not sought any therapeutic maneuvers. He is currently asymptomatic and is here for a follow-up visit from his hospitalization to discuss his risk factors. The patient is still concerned that he may have other episodes of angina, even after the stent placement. PMH The patient has not sought care for his problems in the past. He had been treated for hypertension and high cholesterol in the past but stopped medication on his own. Besides that, he has had no other significant illnesses. He was hospitalized for a cholecysectomy ten years ago. NSG6001 Advanced Practice Nursing I Page 2 of 5 © 2007 South University This patient had a baseline EKG at his doctor’s office when he was first prescribed his blood pressure medication. Otherwise he’s had no other investigations for heart disease besides his cholesterol levels checks. Results of Laboratory Investigations Following Hospitalization Total cholesterol - 210 LDL- 200 HDL- 25 Triglycerides – 250 Fasting blood sugar – 140 HgbA1c – 7.5 CXR – hyperinflation of the lungs – no infiltrate EKG – no change from baseline. Risk Factors: • High blood pressure • Hypercholesterolemia • Type 2 diabetes • Android obesity • Cigarette smoker • Positive family history Past surgical history of Cholecysectomy, almost 10 years age without any complications. ROS Review of systems is otherwise negative DISCHARGE MEDICATIONS Tenormin XL 50 mg QD Lipitor 10 mg QD Glucophage – 500mg BID Baby ASA QD Patient is now compliant with the prescribed regimen, but wasn’t in the past. The medicines were prescribed by the physician who disc.

Nursing Theories in the context of ASSESSMENT (2)

May Vallerie Sarmiento

The document discusses several prominent nursing theories: - Henderson's 14 components of basic human needs that form the basis of nursing care. - Orem's self-care deficit theory which identifies patient needs through assessment and focuses on developing self-care abilities. - Roy's adaptation model which views individuals as systems striving for balance between stimuli. The model is used to assess a patient with a non-healing wound. - Pender's health promotion model which aims to predict health behaviors and was applied to a case of smoking cessation counseling. - Johnson's behavioral systems model which advocates fostering efficient behavioral functioning through assessment of seven behavioral subsystems.

A family divided.docx

write31

A family divided.docx

write5

Non adherence diabetes

BrandcareNet

Acute care scholarly paper

Dave Manriquez

The document provides background information on a 60-year-old patient named D.P. who was admitted to the hospital with acute kidney injury. Key details include that he has a history of chronic kidney disease, type 2 diabetes, and hypertension. He lacks formal education and has a history of unhealthy behaviors like poor diet, smoking, and substance abuse. He is currently undergoing further evaluation and treatment in preparation for fistula placement and management of his acute medical issues.

Cardiology Clinical Case Study.docx

stirlingvwriters

Palliative care motivational style ámsterdam

manu campiñez

This document discusses communication strategies in palliative care, including dealing with ambivalence, resistance, and breaking bad news. It presents case studies and evaluates how motivational interviewing techniques can help address common challenges in palliative care consultations, such as discussing prognosis, treatment goals, and end-of-life decisions with patients who may have conflicting values or perceptions. While motivational interviewing is generally well-suited to palliative care discussions, not all its techniques directly apply, as palliative care aims to help patients make values-consistent choices rather than guide them to particular decisions. Ambivalence is common in palliative care, and communication is important for ethical practice.

This medical history document provides information on a 56-year-old male patient who was admitted to the hospital for inability to move his lower extremities. It details his present illness beginning with low back pain after lifting a heavy object that progressed to weakness, numbness, and paralysis in his lower legs and inability to urinate. It also includes his past medical history of benign prostatic hypertrophy, current medications, allergies, and review of systems. The document comprehensively outlines the patient's chief complaint and history of present illness to inform his diagnosis and treatment.

Page 20 winter issue of empowerment magazine

sacpros

Dr. Stenson recommends assessing urgent issues like suicide or homicide risk first when helping someone with a substance abuse disorder or mental illness. It is also important to understand their insight, motivation, and previous treatment experience. Many who achieve long-term recovery had multiple relapses first, so one should not lose hope. Perseverance and redirecting rebellious energy into recovery efforts can support maintaining sobriety while living a happy life despite challenges. Changes in recovery may cause others to resist the new, healthier person as well, so preparing for loneliness or being treated as a "black sheep" can help cope.

Page 20 winter issue of empowerment magazine

sacpros

Dr. Stenson recommends assessing urgent issues like suicide or homicide risk first when helping someone with a substance abuse disorder or mental illness. It is also important to understand their insight, motivation, and previous treatment experience. For those without insurance, attending free support groups like AA, NA, or NAMI can help with recovery. Maintaining perseverance and redirecting rebellious energy into recovery goals can support long-term recovery and happiness. Relapse does not determine ability to recover - some with the most meaningful recoveries had many relapses before success. Preparing for changes in relationships and finding new support systems can help handle challenges when making positive changes in recovery.

Diabetes Denial

arpanbhattacharya

This document discusses the challenges of managing chronic diseases like diabetes and outlines different types of patient segments based on their attitudes and approaches to treatment. It identifies those who are knowledgeable and disciplined in managing their condition positively, as well as those who are scared, have negative attitudes, low awareness, a short-sighted approach, or overconfidence in their knowledge. Managing chronic illnesses requires patients to balance treatment with daily life while preventing problems through ongoing vigilance and self-management.

005_pm_may15

Julie Bissett

This document discusses end-of-life planning and "do not resuscitate" (DNR) orders. It notes that DNR orders, while intended to save lives, can sometimes result in medical complications that reduce quality of life. The document advocates discussing end-of-life plans earlier, even for healthy individuals, to ensure dignity and meet expectations. It also addresses the debate around the appropriate timing for such discussions, whether during routine checkups or medical crises.

Cardiology Clinical Case.pdf

bkbk37

The patient is a 52-year-old male who presented with chest pain and was found to have coronary artery disease requiring stent placement. He has multiple cardiac risk factors including hypertension, diabetes, obesity, smoking and a family history of heart disease. The care plan should include interventions to modify risk factors, ensure medication adherence, provide education on lifestyle changes, and coordinate follow-up care to prevent further cardiac events.

Ethical and Moral in policy DQ.docx

write22

Mrs. R. is an 87-year-old patient with advanced Alzheimer's disease who has been on a ventilator for 10 days due to pneumonia. Her family does not want continued aggressive treatment and feels she would not have wanted it. However, her doctor wants to transfer her to another facility for more treatment including rehabilitation in hopes she could eventually return to long-term care. The nurses are concerned about this scenario and how to respond to prevent moral distress given the family's wishes and Mrs. R.'s condition.

Running Head 9Assessing and Planning Care for My El.docx

toddr4

Running Head: 9 Assessing and Planning Care for My Elderly Mom NSG4067: Gerontological Nursing My subject I chose my …… as my subject. She is a 68-year-old woman, who is still working full-time as the Vice President of a bank in the small community that she lives in. She is still married to my Dad, with whom she just celebrated her 47th wedding anniversary and, in my opinion, is quite healthy. She has a solid group of friends that regularly eat lunch together as well as take trips together a couple of times a year. She does not take any medications, nor has been diagnosed with any chronic health issues. Although, exercise has never been something she has indulged in, she is still leisurely active around the house and likes to take walks with her dog. Mom loves wine, but has never smoked cigarettes. She agreed to be the subject of my gerontological assessment. Since my subject is not frail but rather very robust for her age, I focused my assessments by using tools that were meant to help gain a better understanding of my subject’s health status and where improvements can be made for optimal health management and disease prevention. In combination with a comprehensive questionnaire, I utilized the Tinetti Balance Assessment Tool to assess gait, and the Katz Index to assess how well subject does with ADLs. Subject questionnaire It seems that my subject is very healthy in contrast to other people her age. She feels strong mentally and physically, and has a great attitude towards the way one should live life. She should concentrate on weight management, exercising more regularly, and preventing osteoporosis by including enough calcium in her diet. She should also be sure to have regular, annual checkups such as vision and hearing checks, in addition to her normal blood work. Subject is not happy with the way she thinks the older generation is treated by younger people or doctors even. It would seem that the subject’s family has been predisposed to living longer lives, with the exception of her father, who was a heavy, lifelong smoker that died of cancer. So far, subject’s genetics are working in her favor. See Appendix A. Tinetti Balance Assessment Tool The Tinetti Gait and Balance Instrument is designed to determine an elders risk for falls within the next year. The higher the score, the better the performance. In performing the balance and gait assessment for my subject, it was found that subject scored as high in points as possible and therefore, has no issues with either balance or gait and is a low risk for falls. Katz Index The Katz Index is a tool that assesses functional status as a measure of the patient’s ability to perform activities of daily living (ADLs) on a daily basis. “One of the best ways to evaluate the health status of older adults is through functional assessment which provides objective data that may indicate future decline or improvement in health status, allowing the nurse to intervene appropriately” (K.

Schizophrenia case presentation.

arunithar

The patient is a 45-year-old married female who has been experiencing psychiatric symptoms for 12 years. She initially presented with fear, talking to herself, and suspicious behavior. Medications provided minimal relief and her condition has worsened over time. She now experiences auditory hallucinations, delusions that she is being harassed, and shows unpredictable and aggressive behavior. A mental status examination revealed impaired thought processes and insight.

Nursing Health History.pdf

TomCuenca3

Patient F is a 39-year-old African American man with sickle cell disease who was admitted to the emergency department due to shortness of breath and dyspnea. He has a history of frequent painful sickle cell crises managed with blood transfusions and is showing signs of chronic renal failure. Upon assessment, it was found that Patient F understands his condition and adheres to his medication regimen, eats a balanced diet, and finds social support from his family which helps him cope with his illness.

Drjunewilliamscolsma : Doctor-patient relationship and patient interview

Dr. june williams colman

This document discusses key aspects of the doctor-patient relationship and clinical interviews. It covers the placebo effect, transference, countertransference, models of the doctor-patient relationship, empathy, and conducting a clinical interview. The placebo effect is a psychological and chemical response that can transform an anticipated effect into a real effect. Transference and countertransference refer to emotional responses patients and doctors have towards each other based on past relationships. Effective doctor-patient relationships balance the roles of each party. Empathy is the ability to understand another's feelings by sharing them. Clinical interviews should make the patient comfortable and invite them to discuss their chief complaint in their own words.

Formulating a Family Care Plan Mr. R., an 80-year-old retired pipe f

SusanaFurman449

Formulating a Family Care Plan Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he has had diabetes for 15 years. Although his diabetes has been moderately controlled with diet and daily insulin, some complications have occurred. He experiences arteriosclerotic cardiovascular disease and peripheral neuropathy, and he recently spent 2 months in the hospital due to circulatory problems in his left leg. The progressive deterioration of circulation resulted in an amputation below the knee. Although fitting him with a prosthesis would be possible, he has refused this and is wheelchair bound. Mr. R. currently depends on someone else to help with transfers. He is cranky, irritable, and demanding to almost everyone. He recently has stopped following his diabetes regimen because he claims, “It just doesn't matter anymore.” Mr. R.'s wife, Doris, is a 74-year-old woman who has been a homemaker most of her life. She has always been the “watchdog” for Mr. R.'s health. Mostly through her changes in food preparation and her lifestyle adjustments, Mr. R.'s diabetes has been managed. She schedules his physician appointments, buys his medical supplies, and administers his insulin. He is now refusing to accept her help, and she is anxious and angry about his behavior. They frequently have arguments, after which Mrs. R. retreats to her room. Mr. and Mrs. R. have three children and four grandchildren who live in the same city. The eldest daughter, Patricia, calls or stops by about once a week. The other children, Tom and Ellen, are busy with their families and see their parents mostly on holidays; they have very little communication with Patricia or their parents. When the children do come to visit, Doris tries to put on a happy expression and pretend that everything is going well to avoid worrying them. She is also embarrassed about Mr. R.'s behavior and does not want anyone from outside the family to see what is happening. On her initial home visit to this family, the community health nurse notes that Mr. R. appears somewhat drowsy and unkempt. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. When the nurse asks them what they hope to get out of the nursing visits, Mrs. R. says, “Actually, you don't need to keep visiting. In a few weeks we'll be back to normal and doing fine.” Based on a thorough assessment of the family, the community health nurse may begin to develop a mutually acceptable plan of care with the family. Assessment In the initial interview, the community health nurse completes a genogram and an eco-map with the family (see Figures 13-3 and 13-4). After the second family interview, the nurse also completes a family map that describes the members’ interactions with each other (see Figure 13-2). A family guide to help structure a family assessment is presented in Box 13-7. Completing the genogram helps break the ice to get the family to talk about their situation. The genogram pr ...

Formulating a Family Care PlanMr. R., an 80-year-old retired pip

SusanaFurman449

Formulating a Family Care Plan Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he has had diabetes for 15 years. Although his diabetes has been moderately controlled with diet and daily insulin, some complications have occurred. He experiences arteriosclerotic cardiovascular disease and peripheral neuropathy, and he recently spent 2 months in the hospital due to circulatory problems in his left leg. The progressive deterioration of circulation resulted in an amputation below the knee. Although fitting him with a prosthesis would be possible, he has refused this and is wheelchair bound. Mr. R. currently depends on someone else to help with transfers. He is cranky, irritable, and demanding to almost everyone. He recently has stopped following his diabetes regimen because he claims, “It just doesn't matter anymore.”Mr. R.'s wife, Doris, is a 74-year-old woman who has been a homemaker most of her life. She has always been the “watchdog” for Mr. R.'s health. Mostly through her changes in food preparation and her lifestyle adjustments, Mr. R.'s diabetes has been managed. She schedules his physician appointments, buys his medical supplies, and administers his insulin. He is now refusing to accept her help, and she is anxious and angry about his behavior. They frequently have arguments, after which Mrs. R. retreats to her room.Mr. and Mrs. R. have three children and four grandchildren who live in the same city. The eldest daughter, Patricia, calls or stops by about once a week. The other children, Tom and Ellen, are busy with their families and see their parents mostly on holidays; they have very little communication with Patricia or their parents. When the children do come to visit, Doris tries to put on a happy expression and pretend that everything is going well to avoid worrying them. She is also embarrassed about Mr. R.'s behavior and does not want anyone from outside the family to see what is happening.On her initial home visit to this family, the community health nurse notes that Mr. R. appears somewhat drowsy and unkempt. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. When the nurse asks them what they hope to get out of the nursing visits, Mrs. R. says, “Actually, you don't need to keep visiting. In a few weeks we'll be back to normal and doing fine.”Based on a thorough assessment of the family, the community health nurse may begin to develop a mutually acceptable plan of care with the family. Assessment In the initial interview, the community health nurse completes a genogram and an eco-map with the family (see Figures 13-3 and 13-4 ). After the second family interview, the nurse also completes a family map that describes the members’ interactions with each other (see Figure 13-2 ). A family guide to help structure a family assessment is presented in Box 13-7 .Completing the genogram helps break the ice to get the family to talk about their situation. The genog ...

Application of betty neuman

Eko Priyanto

The document summarizes an assessment of a 66-year-old male patient using Betty Neuman's System Model. Key details include: - The patient underwent surgery for periampullary carcinoma and is experiencing pain, nausea, vomiting and weight loss. - Stressors include his disease, anticipated lifestyle changes, and concerns about being a burden to his family. - A full physical assessment was conducted, noting edema and difficulties with appetite and urination. Psychosocially, he is anxious and depressed but has strong family support. - The assessment found no discrepancies between the patient's and caregiver's perceptions of his stressors.

Cholelithiasis - Choledocholithiasis

Anu Bajracharya

Psda.Hcda.611. 1

kswisher

The document discusses various laws and issues related to end-of-life medical decisions and patient autonomy. It outlines the Patient Self-Determination Act, which aims to ensure patients' advance medical directives are followed. It also describes the Virginia Health Care Decisions Act and key concepts like terminal conditions and persistent vegetative states. It notes issues courts have addressed around patient and surrogate refusal of treatments, as well as state interests that can limit patient autonomy.

2134 white paper

Jaime Hadley

An effective home care provider can help seniors with congestive heart failure through improved health literacy and self-management. By advocating for seniors and ensuring their understanding of their condition and treatment plan, home care providers can help prevent health complications and hospitalizations. They do this by communicating clearly, taking notes during doctor's appointments, reviewing materials, and teaching seniors self-management techniques like daily weight and symptom tracking. With a home care provider's assistance, seniors with congestive heart failure can better manage their condition and health at home.

Consent & mental capacity

Hosam Hassan

This document discusses consent, mental capacity, and best interests decision-making regarding medical treatment for incompetent patients. It provides information on: - The essential elements of consent including competence, voluntariness, and being informed - Factors considered under the Mental Capacity Act when assessing a person's ability to make a decision - Determining best interests by considering the patient's wishes, clinical opinion, input from those close to the patient, and respecting the patient's autonomy - Options like lasting power of attorney and independent advocates when a person lacks capacity

For this assignment, consider the following case and then using th.docx

budbarber38650

For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow. In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression. The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community. The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977). 1. What, if anything, did the nurse do wrong? 2. Had she moved beyond her scope of practice? 3. Could the nurse's conduct be justified under the patient advocate portion of her role? 4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse? Support your responses with evidence and cite your sources. Length 4 pages not counting the case. At least 4 references; scholarly sources COURSE MATERIAL INFORMATION : Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity Health care .

IntroductionPatients usually go through a lot and in most inst.docx

doylymaura

Introduction Patients usually go through a lot and in most instances; other people influence their decisions in all aspects. They are forced to follow certain aspects even though they themselves are against them. This is because they are sick and as thus depend on the help of others in order to regain their healthy. The scenario Ella has been sick and as thus has been requiring medical help. She wishes to stick to the alternative and complementary medical practices but is coerced to follow the mainstream medical advice. Her husband, who insists to make decision on her behalf, as he is the head of the family, opts for traditional practices. There are alternatives for her care as she may be discharged home to receive treatment and care from there.However; the family members at home also have individual problems. The son is an alcoholic while the daughter has diabetis.The grandson has drugs problems while the grand daughter is bipolar and also has drug problems. The daughter in law is also stressed because of the medical issues in the family which include nephew with leukemia, brother who has HIV and her father’s view that they are all crazy. Ella is expected by the doctor to go home and receive care from there. The family members are thus expected to provide her with all the care needed in order to enhance her recovery. The question is, keeping in mind the current situation with family members; will she be able to recover adequately? Cultural Aspects and alternative treatments Ella’s husband wants the family traditions to be followed in her medications. Assessment of therapy process and its outcome usually vary across cultures. A cure in a system may be regarded as a failure in another system. This makes assessment of success or failure a daunting task. The biomedical perspective of traditional systems is that they usually lack models necessary for chronic disorders. In a scenario, a medicine man may say that their therapy works as their patients never come back. A physician may say that their therapy works as their patients do come back. Physicians view this as success to an ongoing process while the medicine mans` cure does not appear to need any further therapy. These thoughts reflect the different expectations of people on illnesses and therapy. These methods are based on various expectations of patients and their families. (Jennifer Christine Mills Niemeyer, 2010) The current scenario is complicated further as the husband opts for traditional mechanisms. He wants a therapy that will adequately provide a permanent cure and relief. The husband challenging the use of biomedical to traditional poses a great task to physicians and healers of any tradition. This makes the patients to struggle and reject with the chronic illness. The physician should thus recognize the psychosocial problems and try to analyze the complexities of the cross-cultural settings of caring for the patient. This is to ensure positive progress of the patient’s .

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BACKGROUND LS is a 70yearold with advanced chronic obstr.pdf

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