Mr George McFarlane. Male, aged 53 years. Married for 5 years with 3 children. Needed help with raising child and so she invited her Chinese mother to come to Australia to help out. Needed help with raising child and invited Chinese mother to Australia to help out

Mr McFarlane’s background includes:

• Second marriage – first wife died of cancer 8 years previously
• Occupation – Long haul truck driver
• Earns good money
• Away from home a lot – not there to support family
• Overweight – 135kg
• Hypertension
• Uses watching television and beer to cope with stress
• Smoker
• Diet preferences are Australian. Often has a poor diet when on the road for work including ‘fatty food from truck stops’
• Has a 26-year old son from first marriage who has severe depression and uses illicit drugs, visits on occasion (very disruptive when he does visit)
• Unknown social support and external interests
• Has osteoarthritis in (L) knee
• Reliant on wife, Yu Yang, to complete all domestic duties as he is not self-sufficient.

Mrs Yu Yang McFarlane is Mr McFarlane’s wife. She is 38 years old.

Mrs McFarlane’s background includes:

• Came to Australian as a university student
• Fell pregnant at the age of 19 – did not marry
• Married George 5 years ago
• Has 3-year old twins at home
• One twin has developmental disorder
• English language is good
• Was/Is isolated with no extended family
• Her issues will be those of isolated immigrant
• Prefers to cook Asian food
• Needed help with raising child and so she invited her Chinese mother to come to Australia to help out
• Needed help with raising child and invited Chinese mother to Australia to help out

Question 1

Outline the information you will need to provide to Mr McFarlane and his wife regarding the ongoing management of his diabetes.   Include in your answer: What specialist services and support organisations are available What information you would provide to Mr McFarlane and his wife relating to his condition, risk factors, medications and self-management to avoid potential complications Education on lifestyle changes that may need to occur to ensure Mr McFarlane’s diabetes remains stable and decrease the chances of potential complications. Education on the assessment and monitoring Mr McFarlane will need to continue to ensure stabilisation of his diabetes What Mr McFarlane and/ or his wife should do if they suspect there is a complication associated with his diabetes.

Question 2		Mr McFarlane has been recently diagnosed with Type 2 Diabetes, with the risk factors of obesity, poor diet and lifestyle factors and a history of smoking.  He has now been commenced on Metformin 1 gm BD and Gliclazide MR 120 mgs daily.   Using the template below, plan your care, within your Enrolled Nurse scope of practice, for Mr McFarlane. Include in your response: Specify four (4) nursing diagnoses or risk factors associated with the client’s current health presentations. Record at least two (2) nursing interventions that could be applied for each diagnosis. Specify at least one (1) member of the multidisciplinary team who may be able to support your suggested interventions. Clarify how your planned intervention reflect the client’s interests and physical, emotional and psychosocial needs Note at least one (1) expected outcomes that you would hope for as a result of each intervention.
Response:
Nursing diagnosis	Planning – (Nursing intervention)		Multidisciplinary member to provide support	Expected Outcome

Intravenous medications are immediately circulated throughout the body, just like fluids. Understanding the potential risks and how to respond to those potential adverse reactions are important to encourage positive patient outcomes.

Proper delegation and use of the interprofessional team can help prevent any adverse reactions, as collaborating with the healthcare team promotes communication. Alone, skills are not high-level learning activities, but reflection can be used to strengthen the application process and enhance the critical thinking associated with skill performance.

Now that you have completed your initial submission for administering intravenous push medication, let’s engage in a conversation on the importance of collaboration with the interprofessional team.

Please respond to the following prompts utilizing the textbooks to include evidence-based information in your post. Please cite and reference using APA 7th edition.

1. What action would you have taken if the medication ordered was the wrong medication/dose? Who would have been notified? Provide your rationale.

2. The patient was given the wrong medication and you must communicate this error to the provider. What framework of communication would you use to relay this information to the provider? Provide your rationale.

3. You are the RN and are unable to gain venous access on a patient who is really dehydrated. Who would you collaborate with to gain access and what methods could you use to help assist in gaining access?

Mrs. Bradley is a 78-year-old female well known to your practice.  She comes to see you requesting pre-op clearance for an upcoming elective left knee arthroplasty.  She has never been hospitalized for her heart failure and maintains and low sodium diet and wears her compression hose when she intermittently develops lower extremity edema.

Her blood pressure has been well controlled with rare home monitoring recordings over 150/70.

Her last total cholesterol under 100, with LDL 60 and HDL  40.  She has been working on weight loss for several months because her orthopedic surgeon told her, her BMI had to be under 30 before they would consider surgery, her current BMI is 29.2.

 

Medications: atorvastatin 20 mg, vitamin D3 2000IU daily, apixaban 5 mg bid, lisinopril 20 mg daily for blood pressure, metoprolol succinate 50 mg qd, acetaminophen 1000 mg tid.

PMH: heart failure with preserved EF (55%)-last echocardiogram was 2 months ago, she has been well controlled as an outpatient and has never required hospitalization, HTN, HLD, obesity, vitamin D deficiency, and afib, osteoarthritis L knee.

 

CBC and CMP are WNL with Cr 1.2 and GFR 50

 

Social:

Married: 2 adult children live in the area

Former smoker: less than one half pack daily for 10 years, quit in 1990

EtoH: rare glass of wine on holidays

Illicit drugs: none

Exercise bike 30 minutes daily , she is unable to walk long distances due to knee pain.  She does all of her own housework without shortness of breath

Has been eating a heart healthy diet for the past 9 months.

 

Surgical History:

TAH 1992

 

Allergies: PCN-causes pruritis

 

Advance Care Planning: Has OOHDNR in place, Directive to Physicians, Medical Power of Attorney and MOST form are complete.

 

1) Mrs. Bradley asks you about how long she should fast before her surgery.  You want to be very thorough and explain to her how long she should be NPO for how many hours with;

 

a) clear liquids=

b) light meals =

c) fatty foods or meats =

 

2) Mrs. Bradley states she has spoken to friends that said they had to take an antibiotic before surgery, her surgeon did not mention this to her.  She asks you why.  How do you reply to this question?

 

 

 

3) Some of Mrs. Bradley’s medications should be held pre-operatively.  Which medications and when do you instruct her to hold them?

 

 

4) Mrs. Bradley says that the surgeon recommended she have regional anesthesia for her procedure. She trusts you and asks your opinion. You explain to her the top two reasons for considering regional versus general anesthesia are:

 

 

5) The primary disadvantage of regional anesthesia is:

 

 

6) She tells you she was instructed on the use of a cryotherapy device to be applied to her knee after surgery.  You understand this is an example of regional anesthesia and explain to her two benefits of this approach to pain control, include;

 

 

7) According to the ACC/AHA guidelines for perioperative cardiovascular assessment should Mrs. Bradley have a cardiac stress test prior to surgery?

a) yes

b) no

c) maybe (please explain and cite your rationale using the references for this module)

 

8) Should Mrs. Bradley have an ECG?

a) yes

b) no

c) maybe (please explain and cite your rationale using the references for this module)

 

9) Should Mrs. Bradley have a repeat echo

a) yes

b) no

c) maybe (please explain and cite your rationale using the references for this module)

 

 

10) According to the 2007 ACP guideline, should Mrs. Bradley have a CXR done

a) yes

b) no

c) maybe (please explain and cite your rationale using the references for this module)

 

11) You choose to use the Revised Cardiac Risk Index.  What is Mrs. Bradley’s risk score based on the information you have?

a) 0

b) 1

c) 2

 

12) Post-operatively, Mrs. Bradley becomes acutely confused.  She is inattentive, has disorganized thinking, and varies between being alert and lethargic.  Her CAM (short form) score is 4.  You know based on this information it is likely that Mrs. Bradley is experiencing:

 

 

 

13) The inpatient team works Mrs. Bradley up for organic causes of her confusion and finds that she is likely having an exacerbation of Heart Failure with preserved ejection fraction (HFpEF) secondary to the extra fluid she received during surgery.  The Adult-Gerontologic Primary Care Nurse Practitioner understands the best treatment for acute confusion is to;

 

 

 

14) Mrs. Bradley’s heart failure is successfully treated her confusion resolves and she is prepared to discharge to a post-acute care center for rehabilitation.  According to Jencks, Williams, & Coleman (2009) up to what percentage of patient’s with heart failure re-hospitalize during this transitional care time period?

a) 5%

b) 10%

c) 15%

d) 20%