Mr. M. is a 70-year-old male living in an assisted living facility who has been experiencing a rapid decline over the past 2 months. He has trouble recalling names and details, becomes easily agitated and aggressive, and frequently wanders and gets lost at night. He has also become dependent with activities of daily living. Objective data shows elevated white blood cell count and leukocytes in urine. A CT scan of the head shows no changes. The assisted living facility is concerned with his rapid decline and ordered further testing to evaluate his condition.
FIRST PAPERCase Study Mr. M.It is necessary for a.docxclydes2
FIRST PAPER
Case Study: Mr. M.
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 Mr. M., 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
Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.
Case Scenario
Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data
Temperature: 37.1 degrees C
BP 123/78 HR 93 RR 22 Pox 99%
Denies pain
Height: 69.5 inches; Weight 87 kg
Laboratory Results
WBC: 19.2 (1,000/uL)
Lymphocytes 6700 (cells/uL)
CT Head shows no changes since previous scan
Urinalysis positive for moderate amount of leukocytes and cloudy
Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. M.'s situation. Include the following:
Describe the clinical manifestations present in Mr. M.
Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
Describe the physical, psychological, and emotional effects Mr. M.'s current health status may have on him. Discuss the impact it can have on his family.
Discuss what interventions can be put into place to support Mr. M. and his family.
Given Mr. M.'s current .
FIRST PAPERCase Study Mr. M.It is necessary for a.docxclydes2
FIRST PAPER
Case Study: Mr. M.
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 Mr. M., 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
Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.
Case Scenario
Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data
Temperature: 37.1 degrees C
BP 123/78 HR 93 RR 22 Pox 99%
Denies pain
Height: 69.5 inches; Weight 87 kg
Laboratory Results
WBC: 19.2 (1,000/uL)
Lymphocytes 6700 (cells/uL)
CT Head shows no changes since previous scan
Urinalysis positive for moderate amount of leukocytes and cloudy
Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mr. M.'s situation. Include the following:
Describe the clinical manifestations present in Mr. M.
Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
Describe the physical, psychological, and emotional effects Mr. M.'s current health status may have on him. Discuss the impact it can have on his family.
Discuss what interventions can be put into place to support Mr. M. and his family.
Given Mr. M.'s current .
Mr. Smith presented to the ED for a complaint of shortness of breath.docxadelaidefarmer322
Mr. Smith presented to the ED for a complaint of shortness of breath. The history and physical is below.
CC:
Shortness of breath for the last 2 weeks.
HPI:
Mr. Smith is a 52y/o Caucasian male who presented to the ED with a complaint of chest pain and shortness of breath for 2 weeks. He has had some degree of shortness of breath for the last 2-3 months and it has progressively gotten worse over the last 2 weeks. Home nebulizer treatments have not relieved his shortness of breath. He endorses a history of orthopnea, paroxysmal nocturnal dyspnea and lower extremity edema all of which have become worse over the last two weeks. His chest pain has been constantly present for the last two weeks, is substernal, sharp in nature, and does not radiate. He denies any previous history of heart failure, does not follow a special diet. He is on a number of medications and brought the bottles with him. His medications were reviewed and the list is below. He reports medication compliance.
Review of Systems:
Constitutional:
Positive for fatigue
. Negative for fever, chills, weight loss and diaphoresis.
Skin: Negative for rash or itching.
HENT: Negative for headaches, hearing loss, tinnitus.
Eyes: Negative for blurred vision, double vision, and photophobia.
Cardiovascular:
Positive for chest pain, orthopnea, PND, and leg swelling
. Denies palpitations.
Pulmonary:
Positive for cough and shortness of breath
. Negative for sputum production.
Gastrointestinal: Negative for heart burn, nausea, vomiting, abdominal pain, diarrhea, constipation, and blood in stool.
Genitourinary: Negative for dysuria, urgency, frequency and hematuria.
Musculoskeletal: Negative for myalgias and neck pain.
Positive for chronic pain and joint pain.
Endo/Heme/Allergies: Negative for environmental allergies. Does not bruise/bleed easily.
Neurological: Negative for dizziness, tingling, tremors, sensory change and speech changes.
Psychiatric: Negative for depression, suicidal and homicidal ideations.
Past Medical History:
COPD
Asthma
HIV Infection
Coronary artery disease S/P 4 drug eluting stents 7 months ago
Myocardial Infarction
Hyperlipidemia
Peptic Ulcer Disease
Hypertension
Surgical History:
CABG x2 7 years ago
Appendectomy
Social History:
Mr. Smith quit smoking 2 weeks ago and has a 10 pack year history of smoking cigarettes. He denies any current or past use of alcohol or recreational drug use. He works full time as a computer programmer.
Family History:
Father- hypertension, COPD, alive, current age 75
Mother- stroke, myocardial infarction and heart failure, alive, current age 76
Brother- hypertension
Home Medications:
Diltiazem 120mg PO daily
Lisinopril 25mg PO daily
Amlodipine 5mg PO daily
Plavix 75mg PO daily
Nexium 40mg PO daily
Atorvastatin 40mg PO daily
Aspirin 81mg PO daily
Metoprolol 50mg PO daily
Etodolac 400mg PO BID
Atripla 1 PO daily
Isosorbide Dinitrate 20mg PO TID
Allergies:
Contrast Dye- rash, itching
Physical Exam:
Vitals: 36.0-87-18-150/83
Co.
Evaluate the Health History and Medical Information for Mrs. J.,.docxhumphrieskalyn
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
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is "running away."
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
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.
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.
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.
Provide a health promotion .
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docxcockekeshia
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Case Study Mrs. J.It is necessary for an RN-BSN-prepared nurs.docxdrennanmicah
Case Study: Mrs. J.
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
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is "running away."
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
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.
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.
Taking into consideration the fact that most mature adults take at least six prescription medicat.
Week 1 Cardiovascular Clinical CasePatient Setting52 year ol.docxcelenarouzie
Week 1: Cardiovascular Clinical Case
Patient Setting:
52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days.
HPI
Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today.
PMH
History of hypertension for 10 years, hyperlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years.
Past Surgical History
Stent placement 2 weeks ago.
Family/Social History
Family: Noncontributary
Social: Smoked 15 pack/year X 20 years. Quit 5 years ago.
Medication History
Lisinopril 20 mg PO QD
Furosemide 20 mg PO QD
Gemfibrozil 600 mg PO BID
Allergies
NKDA
ROS
Otherwise negative.
Physical exam
BP 160/90 (clinic visit 2 months ago 155/85) HR 146, RR 22, T 98.6 F, Wt 254, Ht 5’ 7”
Gen: Well developed male in moderate distress. HEENT: PERRLA, (-) JVDm mild AV nicking. Cardio: Rate irregularly irregular, no murmurs or gallops. Chest: Clear to auscultation. Abd: soft, non-tender, active bowel sounds. GU: Deferred. Rectal: Normal. EXT: No edema, normal pulses throughout. NEURO: A&O X3.
Laboratory and Diagnostic Testing
Na - 136
K - 4.5
Cl - 97
BUN - 20
Cr - 1.2
Total Chol - 240
Trig – 180
INR – 1.1
Chest Xray - Clear
ECG – Atrial Fibrillation, no P waves, variable R-R interval normal QRS
Week 1:
Cardiovascular
Clinical Case
Patient Setting:
52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to
your clinic today for follow up as he has not felt well. He sates he has been lightheaded and
felt
palpitations of his heart. He has also had shortness of breath the last 2 days.
HPI
Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations
associated with exercise that usually went away with rest; 2 d
ays ago while washing dishes he began to
feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away
but they have continued and that is why he is here today.
PMH
History of hypertension for 10 years, hy
perlipidemia for 5 year, status post stent placement 2 weeks
ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low
fat diet for the last 2 years.
Past Surgical History
Stent placement 2 weeks ago.
Famil
y/Social History
Family: Noncontributary
Social: Smoked 15 pack
/year X 20 years. Quit 5 years ago.
Mr. Smith presented to the ED for a complaint of shortness of breath.docxadelaidefarmer322
Mr. Smith presented to the ED for a complaint of shortness of breath. The history and physical is below.
CC:
Shortness of breath for the last 2 weeks.
HPI:
Mr. Smith is a 52y/o Caucasian male who presented to the ED with a complaint of chest pain and shortness of breath for 2 weeks. He has had some degree of shortness of breath for the last 2-3 months and it has progressively gotten worse over the last 2 weeks. Home nebulizer treatments have not relieved his shortness of breath. He endorses a history of orthopnea, paroxysmal nocturnal dyspnea and lower extremity edema all of which have become worse over the last two weeks. His chest pain has been constantly present for the last two weeks, is substernal, sharp in nature, and does not radiate. He denies any previous history of heart failure, does not follow a special diet. He is on a number of medications and brought the bottles with him. His medications were reviewed and the list is below. He reports medication compliance.
Review of Systems:
Constitutional:
Positive for fatigue
. Negative for fever, chills, weight loss and diaphoresis.
Skin: Negative for rash or itching.
HENT: Negative for headaches, hearing loss, tinnitus.
Eyes: Negative for blurred vision, double vision, and photophobia.
Cardiovascular:
Positive for chest pain, orthopnea, PND, and leg swelling
. Denies palpitations.
Pulmonary:
Positive for cough and shortness of breath
. Negative for sputum production.
Gastrointestinal: Negative for heart burn, nausea, vomiting, abdominal pain, diarrhea, constipation, and blood in stool.
Genitourinary: Negative for dysuria, urgency, frequency and hematuria.
Musculoskeletal: Negative for myalgias and neck pain.
Positive for chronic pain and joint pain.
Endo/Heme/Allergies: Negative for environmental allergies. Does not bruise/bleed easily.
Neurological: Negative for dizziness, tingling, tremors, sensory change and speech changes.
Psychiatric: Negative for depression, suicidal and homicidal ideations.
Past Medical History:
COPD
Asthma
HIV Infection
Coronary artery disease S/P 4 drug eluting stents 7 months ago
Myocardial Infarction
Hyperlipidemia
Peptic Ulcer Disease
Hypertension
Surgical History:
CABG x2 7 years ago
Appendectomy
Social History:
Mr. Smith quit smoking 2 weeks ago and has a 10 pack year history of smoking cigarettes. He denies any current or past use of alcohol or recreational drug use. He works full time as a computer programmer.
Family History:
Father- hypertension, COPD, alive, current age 75
Mother- stroke, myocardial infarction and heart failure, alive, current age 76
Brother- hypertension
Home Medications:
Diltiazem 120mg PO daily
Lisinopril 25mg PO daily
Amlodipine 5mg PO daily
Plavix 75mg PO daily
Nexium 40mg PO daily
Atorvastatin 40mg PO daily
Aspirin 81mg PO daily
Metoprolol 50mg PO daily
Etodolac 400mg PO BID
Atripla 1 PO daily
Isosorbide Dinitrate 20mg PO TID
Allergies:
Contrast Dye- rash, itching
Physical Exam:
Vitals: 36.0-87-18-150/83
Co.
Evaluate the Health History and Medical Information for Mrs. J.,.docxhumphrieskalyn
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
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is "running away."
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
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.
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.
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.
Provide a health promotion .
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docxcockekeshia
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Case Study Mrs. J.It is necessary for an RN-BSN-prepared nurs.docxdrennanmicah
Case Study: Mrs. J.
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
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is "running away."
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
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.
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.
Taking into consideration the fact that most mature adults take at least six prescription medicat.
Week 1 Cardiovascular Clinical CasePatient Setting52 year ol.docxcelenarouzie
Week 1: Cardiovascular Clinical Case
Patient Setting:
52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days.
HPI
Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today.
PMH
History of hypertension for 10 years, hyperlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years.
Past Surgical History
Stent placement 2 weeks ago.
Family/Social History
Family: Noncontributary
Social: Smoked 15 pack/year X 20 years. Quit 5 years ago.
Medication History
Lisinopril 20 mg PO QD
Furosemide 20 mg PO QD
Gemfibrozil 600 mg PO BID
Allergies
NKDA
ROS
Otherwise negative.
Physical exam
BP 160/90 (clinic visit 2 months ago 155/85) HR 146, RR 22, T 98.6 F, Wt 254, Ht 5’ 7”
Gen: Well developed male in moderate distress. HEENT: PERRLA, (-) JVDm mild AV nicking. Cardio: Rate irregularly irregular, no murmurs or gallops. Chest: Clear to auscultation. Abd: soft, non-tender, active bowel sounds. GU: Deferred. Rectal: Normal. EXT: No edema, normal pulses throughout. NEURO: A&O X3.
Laboratory and Diagnostic Testing
Na - 136
K - 4.5
Cl - 97
BUN - 20
Cr - 1.2
Total Chol - 240
Trig – 180
INR – 1.1
Chest Xray - Clear
ECG – Atrial Fibrillation, no P waves, variable R-R interval normal QRS
Week 1:
Cardiovascular
Clinical Case
Patient Setting:
52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to
your clinic today for follow up as he has not felt well. He sates he has been lightheaded and
felt
palpitations of his heart. He has also had shortness of breath the last 2 days.
HPI
Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations
associated with exercise that usually went away with rest; 2 d
ays ago while washing dishes he began to
feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away
but they have continued and that is why he is here today.
PMH
History of hypertension for 10 years, hy
perlipidemia for 5 year, status post stent placement 2 weeks
ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low
fat diet for the last 2 years.
Past Surgical History
Stent placement 2 weeks ago.
Famil
y/Social History
Family: Noncontributary
Social: Smoked 15 pack
/year X 20 years. Quit 5 years ago.
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
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Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
1. Health History Mr. M., a 70-year-old male, has been living
Health History Mr. M., a 70-year-old male, has been living at the assisted living facility
where you work. He has no known allergies. He is a nonsmoker and does not use alcohol.
Limited physical activity to difficulty ambulating and unsteady gait. Medical history
includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post
appendectomy, and tibial fracture status postsurgical repair with no obvious signs of
complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily,
Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN. Case Scenario Over the
past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the
names of his family members, remembering his room number, and even repeating what he
has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and
fearful when he gets aggressive. He has been found wandering at night and will frequently
become lost, needing help to get back to his room. Mr. M has become dependent with many
ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The
assisted living facility is concerned with his rapid decline and has decided to order testing.
Objective Data Temperature: 37.1 degrees C BP 123/78 HR 93 RR 22 Pox 99% Denies pain
Height: 69.5 inches; Weight 87 kg Laboratory Results WBC: 19.2 (1,000/uL) Lymphocytes
6700 (cells/uL) CT Head shows no changes since previous scan Urinalysis positive for
moderate amount of leukocytes and cloudy Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L
Critical Thinking Essay In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the
following: Describe the subjective and objective clinical manifestations present in Mr. M.
Based on the information presented in the case scenario, state what primary and secondary
medical diagnoses should be considered for Mr. M. Formulate a nursing diagnosis from the
medical diagnosis and explain why these should be considered and what data is provided
for support. What abnormalities would you expect to find and why when performing your
nursing assessment using the identified primary and secondary medical diagnoses. Describe
the physical, psychological, and emotional effects Mr. M.’s current health status may have on
him. Discuss the impact it can have on his family. Discuss what interventions can be put into
place to support Mr. M. and his family. Given Mr. M.’s current condition, discuss at least four
actual or potential problems he faces. Provide a rationale for each. You are required to cite a
minimum of three 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.
