Chamberlain College of Nursing Week 4 Bone Health and Hyperlipidemia.docx

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Chamberlain College of Nursing Week 4 Bone Health and Hyperlipidemia
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Question DescriptionMrs. Law, a 77-year-old female, is at home recovering from a surgery
that she had after falling and breaking her hip 5 days ago. She lives with her husband, Dean,
who helps to care for her. Mrs. Law is a former smoker and has a past medical history of
hypertension and hyperlipidemia.You are the visiting nurse, assigned to check on her
postoperative progress. You ask the client how she is feeling, do an assessment, and inquire
as to what she has eaten over the past 24 hours. Mrs. Law states that she has “no pep,” no
appetite, has been taking her pain medication as prescribed (every 4 hours—but not real
helpful!), cannot sleep well, doesn’t feel much like walking except to the bathroom, and has
been unable to move her bowels for several days.Breakfast: Two glazed doughnuts, coffee
(black)Lunch: Tossed salad with oil and vinegar, diet sodaDinner: Tomato soup, 1 cup; four
soda crackers; and red homemade wineSnack: Pretzels, diet sodaWhat nutrients that
contribute to bone health are missing in Mrs. Law’s diet?What other dietary concerns do
you have?Is Mrs. Law getting the appropriate amount of vitamins and minerals for her age
and current condition? Why or why not? Devise a plan to address the concerns you
identified previously, taking into consideration that Mrs. Law is a postoperative patient.You
must include SCHOLARLY resources. Remember, blogs, websites ending in .com, wikipedia,
etc., are NOT professional resources. Your resources should end in .edu, .gov, .org…etc. If
you use your text as a resource, you must also include another scholarly reference.

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Case Study: Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home. She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. PMH: Primary Hypertension, Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies : Penicillin Vaccination History: Up-to-date Social history: High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago. Family history: Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS : + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART : Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : + Heberden's nodes at the DIP joints, hands. + Crepi.

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1. Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are pleased with the care she receive in the hospital. (Learning Objectives 3 and 6) a. Describe the quality performance tools that may be used to demonstrate that the care and treatment rendered are both cost-efficient and of high quality. b. Describe the quality performance tools that may be used to demonstrate that the nursing care utilized is evidence-based care and high quality, resulting in patient satisfaction and good patient outcomes. 2. The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3) a. Describe how clinical pathways are used to coordinate care of caseloads of patients. b. What is the role of the case manager in evaluating a patient’s progress? c. What are examples of evidence-based practice tools used for planning patient care? . Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking with crutches (nonweight-bearing postdischarge day 1, and may begin weight-bearing postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg every 4 hours PRN, and Colace (docusate sodium) 100 mg every day. The patient is to follow up with the orthopedic surgeon in 3 weeks. His daughter plans to stay with him for several weeks to assist him with meals and household chores, and take him to physical therapy and the orthopedic surgeon for follow-up. Mr. Jones has three other children who live in other states. He is a widower and attends a local church. (Learning Objective 4) a. What preparations should the nurse make in advance before attaining necessary community resources and referrals before the patient is discharged? 1. What necessary community resources and referrals will the patient need? 2. Mrs. Johnson, a 67-year-old ...

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Case Study Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light-headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home. She started taking her medications but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. PMH: Primary Hypertension, Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies : Penicillin Vaccination History: Up-to-date Social history: High school graduates married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago. Family history: Both parents are alive. Father has a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS : + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART : Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : + Heberden's nodes at the DIP joints, hands. + Crep.

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Chief complaint: “I’m here for a medication refill because I ran out of my medicines”. HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home. She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway. PMH: Primary Hypertension, Previous history of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies : Penicillin Vaccination History: Up-to-date Social history: High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago. Family history: Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS : + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART : Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .

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