A 45-year-old male client comes to the nurse practitioner (N P). The NP prescribes a regimen with omeprazole (Prilosec) every morning and Maaloz 30 mL qid. How will you instruct the client about gastroesophageal reflux disease and its relationship to symptoms? stating he wakes often at night with coughing and burning he describes as heartburn.

He drinks 1-2 alcoholic beverages per evening, usually with distilled liquor, and then wine with dinner.

He eats heavy dinners with dessert. He prefers mint ice cream and coffee for dessert.

What will you instruct the client about his diet, particularly the evening meal? How will you instruct the client about his medications?

Bobby, age 46, lives with his wife in a 2 storey home. Bobby works at a newspaper company where he is the chief editor. He usually complains that his job is extremely stressful, he plans to find a new job in the near future. Recently, he has been feeling quite exhausted while taking his daily walks. “I cannot even walk for 30 minutes without feeling out of breath.” This morning he shows up in the emergency room after falling down two flights of stairs in his house. An X-ray confirms that he fractured his right ankle. A cast was applied and he is ordered to use crutches and to remain non-weight bearing for two weeks.

Bobby is mad with himself for not being more careful at home. He told his wife, “This is serious because it is not my first fall, in fact it is my second fracture in 2 years.” Tonight, at home, Bobby was not able to go to the bathroom on his own. He has difficulty getting in and out of bed and although he is using the crutches, he still needs some support from his wife. Not being able to use the crutches to move about freely frustrates him. I am very anxious to “go back to normal functioning,” Bobby tells his wife who is very supportive.

What is the data pattern? What does this mean to the patient and what does this mean to the nurse?

Mr Jones is a 55-year-old man who comes to the clinic with complaints of pain in his right great toe. He tells you that the pain woke him up in the middle of the night and had a hard time sleeping. His toe is very swollen, tender to touch, warm and red. Mr Jones just returned from Las Vegas where he states he ate and drank quite a bit. His diet consists of some vegetables, but he states he eats quite a bit of red meat, especially beef and enjoys red wine.

1. What are the risk factors for gout?

2. What are the clinical manifestations of gout?

3. What education and treatment is effective for Mr Jones?

Case Study: Joey is a 14 year who was just diagnosed with diabetes. Consider Joey’s age and brainstorm some innovative ways to educate about diabetes. Joey has never been in the hospital before and is scared. He has lots of questions but is afraid to ask. He is getting a lot of information but is having a hard time remembering everything.

1. Compare patient education information presented in a nursing textbook and that presented on a credible web site for the same condition.
2. Consider your experience and learning with regard to EHRs. If you were to design a learning program centered on the use of EHRs, what would it look like? Consider this from the viewpoint of an educator, a student, a clinician, and a healthcare administrator.