Hepatic encephalopathy secondary to liver cirrhosis

/0 Comments/in /by

Client is in their 60s, male, with hepatic encephalopathy secondary to liver cirrhosis. Data Cluster Actual Problem Data Cluster 1: Client presents history of excessive alcohol intake, diabetes mellitus, decompensated hepatic cirrhosis

Actual Client Problem 1: Impaired for liver function

 

Data Cluster 2: Client presents anasarca, ascites, edema during skin assessment, decrease in hematocrit( 28.3) (decrease in hemoglobin (9.4), alteration in mental status (neuro assessment indicated alert and oriented times 2 but confused with time and situation and hard of hearing), alteration in respiratory pattern (respiratory assessment indicated lung sounds diminished at bilateral bases)

Actual Client Problem 2: Fluid Volume Excess related to retention

 

Of the 2 problems identified above, determine the higher-priority problem. Restate the actual problem with supporting client data and provide evidence for why you determined which diagnosis is higher priority.

 

For the High Priority Client Problem, develop two expected outcomes for the client.  For each outcome, develop 2 related nursing interventions; interventions should be appropriate for and individualized to the client.  For each intervention, include rationale (why the intervention is appropriate) and an in-text citation supporting that it is evidence-based.  Interventions may include assessment/monitoring, education and collaboration with Interprofessional team members.

 

Outcomes should be specific and address only 1 parameter.
Outcomes should be measureable and relate to an observable change.
Outcomes should be achievable and agreed-upon with the client.
Outcomes should be realistic based on the client’s abilities, preferences and resources.
Outcomes should be time-limited (generally within the shift so the nurse can evaluate).

Outcome 1:  The client will …

 
Nursing Intervention 1 for Outcome 1:  The nurse will …

 
Rationale with Reference:

 
Nursing Intervention 2 for Outcome 1:  The nurse will …

 
Rationale with Reference:

 
Outcome 2:  The client will …

 
Nursing Intervention 1 for Outcome 2:  The nurse will …

 
Rationale with Reference:

 
Nursing Intervention 2 for Outcome 2:  The nurse will …

 
Rationale with Reference:

 

Provide narrative documentation of 1 selected nursing intervention (above) in D-A-R format.

Data (client assessment data including subjective & objective; this should be detailed & specific):

 
Action (nursing intervention; this should be specific; example:  if it includes a medication, include route & dose):

 
Response (by the client; assessment data compared to pre-interventional data):

 

 

Re-state above outcome criteria and provide evidence that the outcome was met or not met.

Restate Outcome Met/Not Met Client Data Used to Determine
Outcome 1:

 

 
Outcome 2:

 

 

Health Insurance Portability and Accountability Act

/0 Comments/in /by

You are the Compliance Officer for Rosewood General in Footloose, You have been reviewing the round of Health Insurance Portability and Accountability Act of 1996 violations at your facility.

You wonder how this could happen considering all the training that has been provided to staff.

You are even more disturbed when you read that this is a nation-wide problem.

Your boss has asked for a report on what the issues are and possible solutions. He will forward your report to a state-wide task force that has been put together.

The comments will be sent to state representatives for consideration. You decide to take a look at the act itself.  You find that perhaps the issue isn’t the organization but the provisions of HIPAA.

For the first part of the discussion, provide a brief summary of HIPAA.  What is it?

What was the issue it addressed? Then identify at least 3 provisions that look good on paper but proved to be problematic for organizations and patients when implemented (You may have to do some outside research).

Identify what the issues with implementing the provisions were. Then discuss how it can be amended to be more practical.   Also, how the suggested changes will reduce HIPAA violations?

Non-alcoholic fatty liver disease

/0 Comments/in /by
Natasha is a 45 y/o nurse who works for a local hospital. She goes to her doctor for her annual physical. She reports that she has been feeling more tired and has gained about 15-20 pounds in the last year. She has been under much stress at work, raising her teenagers and assisting her elderly parents. At her visit, her doctor voices much concern over her lab work and weight gain. A 24-hour recall of her diet is also recorded (see food report). She is diagnosed with  Non-Alcoholic Fatty Liver Disease, and is set up with a follow-up with her physician after she sees a Registered Dietitian.
  1. Review the provided data. Create at least 4 or more questions that you would ask the patient about his lifestyle to gather more appropriate information to help you with your nutrition assessment.
  2. Explain what attributes of her anthropometric and lab data support this diagnosis.
  3. Identify two additional relevant tests or procedures that might be performed to help diagnose/evaluate this patient. Please explain what information each of these questions or tests will reveal in relevance to her liver disease. You must explain the purpose of each question or test.
  4. What drug-nutrient interactions should you educate Natasha on?

Sensory receptors stimulate

/0 Comments/in /by

In a reflex arc, sensory receptors stimulate a(n) _ which stimulate a(n) . This neuron stimulates a which stimulates a muscle. A. Interneuron, sensory neuron, motor neuron B. Interneuron, motor neuron, sensory neuron C. Motor neuron, interneuron, sensory neuron D. Sensory neuron, interneuron, motor neuron

31. Which of the following helps keep your body movements coordinated? A. Thalamus B. Hypothalamus C. Cerebellum D. Occipital lobe of the cerebrum

32. A complete spinal cord injury at L1 would likely create which condition? A. Quadriplegic B. Multiple sclerosis C. Peripheral neuropathy D. Paraplegic

33. A cardiovascular condition where a patient could no longer participate in her normal weekly dance class would be considered what? A. A disability B. A functional limitation C. A pathology D. An impairment

34. You are working with a patient who has had a heart attack. During his exercise program, his heart rate has slowly increased, and his blood pressure has increased slightly. His skin suddenly appears very pale. What symptom does the patient demonstrate? A. Pallor B. Cyanosis C. Dangerous blood pressure D. Dangerous heart rate

Brain cancer

/0 Comments/in /by

Discuss the pros and cons that may cause the difference in perspectives about Brittany’s choice: 29-year-old reignites debate about aid in dying. Britany has brain cancer, and her life expectancy is no more than 6 months. Apply a minimum of one Theory and one Principle to analyze the ethical implications of the issue.What is the possible long-term risk to humanity? As a member of the moral community, propose a boundary and/or limitation that may lead to an ethical resolve. (5 paragraphs)

Progressively Worsening knee pain

/0 Comments/in /by

Aleli is a 50-year-old avid marathon runner who is being seen in the local pharmacy quick clinic for progressively worsening knee pain over the last year. She reports that her knee pain is worse in the morning. She has been continuing to run a few days a week but is not running any long distances.

She has been using acetaminophen (Tylenol®), but it is no longer relieving her pain.

Aleli takes no other medications. She drinks red wine at night for dinner or social events, and she does not have any smoking history. Her family has a history of heart disease; her father died of a sudden heart attack when he was 50 years old. She also has a family history of arthritis and colorectal cancer.

She is prescribed ibuprofen 800 mg twice a day to use for knee pain and to follow up with a primary care provider as needed.

Discuss the use of ibuprofen for this Aleli.

Borderline high blood pressure

/0 Comments/in /by

A 47-year-old man presents to your office for a follow-up visit. He vaguely remembers being told that he had Borderline high blood pressure at some point in the past. He was seen 3 weeks ago for an upper respiratory infection and was noted to have a BP of 164/98.

He tells you he feels great, does not smoke and only has a couple of beers on the weekend.  He admits that he does not exercise regularly and his job requires him to sit at a desk all day.

You ask about his family history, and he tells you that his father died of a stroke at the age of 69 years old.  His mother is alive and in good health at the age of 72.  He has two siblings and as far as he knows, they are healthy.

You start by taking his BP.  His BP is 156/96 in his left arm and 152/98 in his right arm.  He is afebrile, AP=78, resp= 14.  A quick listen to his lungs and heart reveal no clinically significant findings. You look in his chart and note he is 70 inches tall and weights 210 lbs.

 

 

1. What are two “red flags” in this case and explain why so.  Support your answer.

 

2. What labs would you order and what would you be looking for in each?

 

3. Name three non-pharmacological interventions you would recommend and why?

Cardiac rehab staff

/0 Comments/in /by

A patient is brought in hospital with chest problems and the Licensed nursing practitioners are looking at him. What procedures will the cardiac rehab staff  going to perform on a patient with chest discomfort?

Fluid replacement based upon the amount of weight lost

/0 Comments/in /by

What is the fluid replacement based upon the amount of weight lost? The child weighs 13 kg and the child weighed 15 kg when she was seen by primary physician yesterday. base on this information.

The parents ask you why the patient’s condition deteriorated in spite of them administering Pulmicort. Elaborate on your evidence-based response and provided citations to support your assertions. Be very specific.

 

 

3.As a future Registered Nurse (RN), after initially entering the first patient’s room (dehydration), how would you proceed with assessing the patient? In performing the review of systems (ROS), what questions would be essential and may assist with expediting the treatment regimen?

 

4.In regards to calculating IV rates and insulin coverage, discuss the legal aspects that would apply if a nurse made a medication error?

 

5.Discuss the legal aspects of a parent refusing medications for a child presenting to the Emergency Department (ED) with respiratory failure and a known history of asthma. The parents are non-compliant, as evidence by refusing for the child to receive medications

 

Patient History Past Medical

/0 Comments/in /by

Patient History Past Medical History: Past medical history is unremarkable Allergies: No known drug allergies Medications: None Code Status: Full code

Social/Family History: Second-year student at a local university for his bachelor of science degree with a pre-medical-school tract

 

Situation:

The patient is a 22-year-old male being transferred to the General Surgery/Trauma Unit from SICU. He was admitted via the emergency department (ED) yesterday after he sustained bilateral compound femur fractures following a MVC in which he rolled his truck.

On admission to the trauma center, his blood alcohol concentration (BAC) was 0.12 mg/dL. His urine and toxicology screen was negative for all other drugs. After immediate treatment in the ED, he was taken to surgery for an open reduction internal fixation (ORIF) of both femurs.

Due to prolonged anesthesia and estimated blood loss (EBL) of 800 mL in surgery, he was transferred to the Surgical Intensive Care Unit (SICU) for overnight observation. He is now stable and ready for transfer.

 

Background:

His diagnosis is ORIF of both femurs secondary to motor vehicle collision (MVC). His medical and surgical history is unremarkable. The patient has no known drug allergies and is awake and alert.

 

Assessment:

Vital signs stable: HR 112, BP 138/75, RR 18 and regular, SpO2 has been 98% on O2 2 LPM via nasal cannula, Temperature 37.7C

Cardiovascular: Sinus tachycardia

Respiratory: Breath sounds clear

GI: Normoactive bowel sounds. Has tolerated ice chips and sips of water without nausea and vomiting

GU: Urinary output by urinary catheter is approximately 30 to 40 mL of concentrated urine per hour

Extremities: Able to wiggle toes. Range of motion in the lower extremities is within normal limits as expected post-operatively. Normal sensation in bilateral lower extremities

Skin: Warm and dry. Clean, dry, and intact dressings to both thighs

Neurological: Awake, alert, and oriented to person, place, and time. Pupils equal and reactive to light. No neurological deficits IVs: 0.9% sodium chloride infusing at 150 mL/hr via triple lumen catheter

Labs: Hemoglobin 11.8 mg/dL, hematocrit 36%, sodium 145 mEq/L, potassium 4.8 mEq/L. All other lab results are within normal limits. Chest x-ray within normal limits

Fall Risk: High-risk

Pain: Effective pain management with narcotic patient-controlled analgesia (PCA), including nurse-administered bolus dose for breakthrough pain

Recommendations: Admit to General Surgery/Trauma Unit and provide general postoperative nursing care

 

Provider’s order

 

Diagnosis: Status post ORIF bilateral femurs
Full code
Admit to med/surg
Bedrest
Vital signs every 4 hours
Notify the healthcare provider for HR greater than 140 or less than 60
Notify the healthcare provider for SBP less than 100 or greater than 180
Notify the healthcare provider for urine output less than 240 mL/8 hours
Notify the healthcare provider for Temp greater than 38C
Notify the healthcare provider for SpO2 less than 92%
Telemetry x 24hrs, then discontinue if no dysrhythmias
Continuous pulse oximetry
O2 2 LPM nasal cannula titrate for sats >92
ABG STAT for SpO2 less than 92%
Admit to med/surg
Incentive spirometry every hour while awake
Clear liquids, advance to regular diet as tolerated
IV of NS at 150 mL/hour
CeFAZolin 500 mg IV piggyback every 6 hours
Hydromorphone 0.5-1mg IV push every three hours as needed for moderate to severe pain
For pruritus: diphenhydrAMINE hydrochloride 25 mg IV push every 6 hours.
For nausea: ondansetron hydrochloride 4 mg every 4 hours IV push.
Enoxaparin 30 mg SUBCUT every 12 hours x 10 days
Bisacodyl suppository one PR on day 3 if no bowel movement, then prn for constipation

 

1. Explain the assessment findings that are outside of normal, provide rationale.

 

2. Which findings are most important and should be addressed first? Provide rationale (Requires more insights than Airway/Breathing first. etc.)

 

3. Based on your priorities listed above, what therapies should be implemented first and why?

 

4. Based on your interventions listed above, what post-intervention assessment findings would you expect to see, indicating that the therapies you selected were effective?