Case 1: Mrs. T is a 60-year-old woman had arterial bypass surgery to restore circulation in her legs. After surgery, she has incision lines in her groin and upper leg. A Foley catheter is in place. She states that she had difficulty controlling urination and was frequently incontinent prior to surgery. She states, “Sometimes I am completely soaked.” When I have to go, the sensation is so strong that I have to go RIGHT now and I can’t make it to the bathroom in time. (Look up incontinence and its subtypes in the nursing diagnosis book.

It is the 1st postoperative day and the Foley catheters are supposed to be removed per policy. With incisions in the groin area, the patient is having difficulty getting out of bed and can only do so slowly with great effort and pain. Is there be a valid reason for keeping the Foley in longer than 1 day? SBAR the surgeon.

 

Case 2: Mr. Z is a 56-year-old female patient who had lower abdominal surgery. After surgery, she did NOT void for 6 hours. Then, she voided only 30 mL of urine. She felt like she still had to urinate but was unable to void any additional urine.

SBAR the primary provider about this situation. (The initial interventions were NOT successful and the patient is unable to urinate. Make up appropriate details, as needed)

Health care maintenance items  A 45-year old African American female who was assigned male sex at birth, presents to the clinic as a new patient to establish care. She has no physical complaints, and is requesting medication refill as she has been out for 2 days. She is new to the area and recently had he belongings stolen while staying at a local shelter. she states the following ,medications are working well for her ad reports no intolerable side effects or adverse reactions :

Triumeq 1 tab PO QD

Estradiol 2 mg PO BID

Spironolactone 50 mg PO QD

Escitalopram 10 mg PO QD

Amlodipine 2.5 mf PO QD

 

1: Based on the in formation provided what are the differential diagnosis?

2: What history questions would you ask based on the information given?

PART 2

Ms. Copeland further details her history, She has struggled with her identity since her youth, also disclosing a history of depression she contributes to her years living in foster care. How ever 2 years ago she found comfort and clarity in a transgender support group in Seattle, WA. she states a concern for relapsing depression since she just moved to the ate and does not have a support group.

She started hormone therapy 1 year ago, and she has been happy since, and would like to continue treatment; she eventually would like to undergo gender affirmation surgery once her housing situation is stable.

She denies alcohol and recreational drugs, except for occasional marijuana. she is a tobacco cigarette smoker of 1/4 pps x 20 yrs. she discloses being in an open relationship with a male parter and is working as a prostitute. Her last STI check was aprox 6 months ago with no new abnormal results.

 

3: what screening tools would you use during today’s visit?

4: What focus physical assessment will you complete today?

 

PART 3

Objective

Bp: 12268, Pulse: 84, Temp: 97.2 F, Resp: 16, Ht: 6ft, wt: 164, BMI: 22.2.

PHQ9 total : 8, denies suicidal ideations

 

5: What is the diagnosis after physical exam and vitas?

6: will you fill her medications today?

7: What initial diagnose will you order? Include rational

8: what health care maintenance items should be addresssed.

9: what resources or patient education should you provide?

10: what is your follow up plan? what would Justify sending patient to higher level of care?

 

Thank you