Mary is a 48-year-old woman with severe rheumatoid arthritis. Her pain is no longer controlled by aspirin and her physician ordered 5 mg prednisone three times a day. Over the next 4 weeks, Mary’s symptoms were markedly improved and she became more mobile again. She also noted that for the first time in years she felt “really good.” Her appetite increased, she was no longer fatigued, and her outlook on life was markedly improved. At her follow-up visit, Mary had gained 9 pounds: she had slight edema in both ankles, and her blood pressure was 150/92 mmHg. An inflamed, oozing lesion was found on her right hand, which she stated became infected a few weeks ago after she cut her hand. The physician decided that Mary was past her crisis and that the prednisone should be tapered to 5 mg/day over a 4 week period.

1. What effects did the prednisone have on the process at work in Mary’s joints and what effects did the corticosteroids have on the rest of her body?
2. What teaching points should be included in a plan of care for Mary?

Hyperthyroidism and hypothyroidism produce significant signs and symptoms in clients.

1. Describe the physiologic effects of thyroid hormone.
2. Compare and contrast the two disorders.
3. Both conditions can be treated with medications that help the body to achieve a more normal level of thyroid hormones.
4. Discuss medications used for hyperthyroidism and the therapeutic effects.
5. Discuss medications used for hypothyroidism and the therapeutic effects.
6. As part of the nursing process, assessment of subjective and objective data provides very important information regarding the client.
7. Discuss the possible assessments and treatments for myxedema.
8. Discuss the possible assessments and treatments for a client experiencing thyroid storm.

Brenda Zalewski, a 45-year old woman, had a goiter as a child and a thyroidectomy at age 12. She has been taking a synthetic thyroid preparation since that time. Ms. Zalewski takes a maintenance dose of levothyroxine (Synthroid) 0.1 mg orally daily. She is 5 feet 8 inches tall and weighs 215 pounds.

While Ms. Zalewski is in the hospital, the nurse is administering her medications. Hospital routine is to administer all once-daily medications at 9:00 AM. When reviewing the medication administration orders, the nurse notes that Ms. Zalewski is to receive levothyroxine at 9:00 AM. Patients usually receive their breakfast trays between 8:00 and 8:30 AM.

1. What action should the nurse take with regard to the administration of Levothyroxine?

Ms. Zalewski has been discharged from the hospital and is being seen by the home care nurse. During the visit, the nurse reviews all of Ms. Zalewski’s medications. Ms. Zalewski states she is taking aluminum hydroxide gel (Amphojel) every morning when she arises to prevent gastric distress after breakfast.

1. How will the administration of Amphojel affect her levothyroxine?
2. What patient teaching should the home care nurse provide to Ms. Zalewski?

Rubric

Respiratory Assessment of Mona Hernandez

Discussion Topic

1. Document your focused respiratory assessment of Mona Hernandez. If data not provided put n/a.

2. Document 5 nursing interventions related to Mona Hernandez’s oxygenation after ambulation.

3. Document 5 areas of education to Mona Hernandez

4. Document 5 nursing diagnosis for Mona Hernandez

Patient Introduction

Location: Medical Unit 1600

Report from day shift nurse:

Situation: Mrs. Hernandez is a 72-year-old Hispanic female who was admitted to the medical unit yesterday afternoon with a diagnosis of pneumonia in her right lobe. Chest X-ray shows infiltrates in right lower lobe, indicative of pneumonia. She was started on antibiotics after a sputum specimen for Gram stain culture was obtained. We are monitoring her respiratory status closely.

Background: Mrs. Hernandez was experiencing symptoms of dry cough, fever, and malaise, and was diagnosed with influenza 10 days prior to admission. Her symptoms got progressively worse, and yesterday she had a temperature of 38.4 °C (101.2 °F), shaking, chills, and a productive cough of rust-colored sputum. Her primary care provider saw her yesterday and decided to admit her for treatment of pneumonia.

Assessment: Mrs. Hernandez is alert and oriented ×3, but appears tired. She reports sharp chest pain with coughing and shortness of breath with activity. She rated the pain as a 6 on a scale of 0-10 and was given acetaminophen 650 mg at 1400. Vitals signs were taken at 1200. Her temperature has been elevated since this morning and was 38.1 °C (100.6 °F). Pulse is 104/min, respirations 24/min, and blood pressure 112/72 mm Hg. Her saturation was 95% on nasal cannula with oxygen at 3 L/min. Her respirations were labored when she came back from the bathroom, but improved when she settled back in bed.

Recommendation: You should make sure to maintain saturation levels above 89%. Mrs. Hernandez needs encouragement to cough and deep breathe, and to use incentive spirometry. She only uses her incentive spirometer after much encouragement. You should also start patient education on disease process and management.

Compare and contrast Christiana Care and John Hopkins Hospitals. What service stands out for each facility?

• Compare and Contrast facilities
• What service stands out for each facility?
• What stands out as the SPECIALTY Care of each facility?
• Compare ER’s Status (What level Service offered?)
• NICU (Level of Service?)
• Other services. Orthopedics/ Cardiac/ Neurology/ Pediatrics
• Tertiary Care: Highly Specialized medical care usually over an extended period that involves advanced and complex procedures and treatments.
  • For instance, in Alexandria Virginia, Inova Fairfax Hospital is renowned for high survival rates of heart transplants. (Pre/Post Care)

Application of information researched

• If you were sick with cancer, heart failure, lung transplant, pediatric orthopedic issue, cornea transplant? Where would you go for care?
  • Example: Patient with End Stage Renal Failure
    • Facility: CCHS
    • Specialty: Kidney Transplant
  • Example: Head and Neck Cancer
    • Facility: John Hopkins
    • Specialty: Head and Neck Cancer Department
• Describe a medical condition and select the facility which would meet the needs of the patient to successfully provide medical care.