What would it be like to be a  young single teenage mother in the San Fernando (California) community?

What resources are available for them?

discuss teamwork/collaboration observed in your clinical week. discuss

how your observations will be incorporated into your practice.

Please see an attachment for details

15. Know how to prom 16. Know what parasomnia is and priority nursing interventions for these types of patients 17. Know & understand the stages of pressure ulcers (I, II, III, etc 18. Know how to prevent friction & shear injuries to patients 19. Understand the effect dry skin has on patient health and well-being 20. Know safety measures & assessment techniques that help prevention of skin breakdown/impairment 21. How & where to give injections (IM, SubQ, Intradermal) and which sites are preferred 22. Know what the Z-track method is and how/why we do it 23. Appropriate medication administration for Oral, IV, Ophthalmic, & patients receiving tube feeding, including the 6 rights of med admin 24. Know normal lab values for electrolytes (Na, K, Mag, Ca, BUN, urine specific gravity, Hematocrit & Hemoglobin) 25. Understand the difference between sensible & insensible fluid loss 26. Understand s/s of hyper/hypomagnesemia; hyper/hyponatremia; hyper/hypocalcemia; hyper/hypokalemia including patient education (what foods to avoid or eat) 27. Know how to interpret an ABG (alkalosis vs. acidosis and compensated vs. uncompensated) including lab values (pH, PaCO2, HCO3) 28. Understand risk factors for respiratory acidosis/alkalosis

create a concept map or decision flow chart of a differential diagnosis showing signs and symptoms in assessing and diagnosing of a patient with different types of osteoporosis. Kindly read case study below for the signs and symptoms.

 

Reference: https://www.scribd.com/document/514553698/Bruyere-Case79-001-010

 

Case Study:

PATIENT CASE

Patient’s chief complains

“I’ve had back pain now for more than 5 weeks and I can’t stand it anymore. I’ve tried extra- strength ibuprofen, naproxen, and acetaminophen, and I’ve visited a chiropractor, but I don’t get any long-term relief.”

History of Present Illness

Mrs. I.A. is a very pleasant 63-year-old white woman of slight stature who has been referred to an orthopedic specialist by her PCP. She has been experiencing insidious back pain for 5-6 weeks. OTC analgesics provide temporary relief, but the pain is otherwise constant and aggravated by activity. She denies any obvious acute injury to her back, although she reports that she had a case of the flu with a prolonged and severe cough approximately one month ago. She also reports a vertebral fracture approximately five years ago.

The patient has been an avid gardener for many years. Following the death of her husband 18 months ago, she has continued to live in her house and do all the household chores. Since her back pain began, she has been limited in her ability to do her household chores and gardening.

Past Medical History

The patient entered natural menopause at 52 years and has never used hormone replacement therapy. Currently, she has mild hot flashes and vaginal dryness. At age 58, she suffered a vertebral fracture at T10 by simply carrying a shopping bag. DEXA scans conducted at that time revealed the onset of osteoporosis. Her bone mass density T-scores at that time were: -3.33 lumbar spine, -2.24 right femoral neck, and -2.44 right radius. These scans represented a 6.1%, 6.9%, and 6.2% decrease in bone mass density in the previous 19 months in the lumbar spine, right femoral neck, and right radius, respectively. Her serum calcium concentration was low-normal at 8.5 mg/dL and serum alkaline phosphatase level was moderately increased at 290 IU/L. She was prescribed alendronate and a calcium supplement daily.

The patient was diagnosed with a seizure disorder at age 22 years and is currently well controlled with phenytoin. She has had asthma since childhood. Her current asthma medications include a bronchodilator that she uses when needed, a daily steroid inhaler, and an oral corticosteroid that she uses about four times per year for 3-6 weeks when symptoms worsen. She also takes a daily multivitamin tablet and has 1-2 dairy servings every day. She has noticed a slight reduction in height in recent years, but denies any significant changes in weight. She had an appendectomy at 11 years of age.

 

 

Family History

The patient has a positive family history of osteoporosis. Her older sister has experienced a hip fracture and her paternal aunt was diagnosed with an osteoporosis-related wrist fracture following a fall.

Her mother was diagnosed with breast cancer at age 56, but died from lung cancer at age 69. She also suffered from high blood pressure and “high blood sugar.” Her father died at age 54 from AMI. Her brother (age 65) has HTN and high cholesterol, and her younger sister (age 57) has no known medical problems.

Social History

The patient smokes four cigarettes a day (down from 11⁄2 ppd eight years ago) and drinks one glass of wine daily. Her main sources of dietary calcium are milk with her breakfast cereal and “some” cheese about three times a week. The patient is widowed and was married for 39 years until the death of her husband 11⁄2 years ago. She has one son who is healthy. She had a miscarriage at age 19. She does most of her cooking and “watches what she eats.” She denies non-compliance with her medications. She gets very little weight-bearing exercise. She uses SPF 30 sunscreen to protect herself from sunburn and skin cancer every time that she spends more than 15 minutes in the sun.

Review of Systems

The patient denies any unusual bleeding, weakness, back spasms, shortness of breath, chest pain, fever, chills, heat or cold intolerance, and changes in her hair, skin, and nails. She reports vaginal dryness, occasional hot flashes and night sweats “maybe once every 6 months.”

 

Medications

• Alendronate 10 mg po QD

• Calcium carbonate 1.25 g (500 mg calcium) po BID

• Multivitamin tablet po QD

• Phenytoin 100 mg po TID

•  Albuterol MDI 2 puffs BID PRN

• Triamcinolone MDI 2 puffs QID

• Prednisolone 5 mg po BID PRN

 

Allergies

• Codeine intolerance (nausea, vomiting)

• Sulfa drugs (rash)

• Aspirin (hives, wheezing)

• Cats (wheezing)

 

Physical Examination and Laboratory Test

General

The patient is an alert and oriented, cooperative 63-year-old white female of slight stature who walks with a normal gait and is in no apparent distress. She appears somewhat anxious.

VS

• BP-129/83 sitting, left arm
• RR-20 and unlabored
• HT-5 31⁄2″
• PR-88 and regular
• T-98.6°F oral
• WT-106 lbs

Skin	Fair complexion Color and turgor good No lesions
Head	Normocephalic No areas of tenderness Slight hair thinning
Eyes	Conjunctiva clear PERRLA EOMI Funduscopic exam unremarkable
Ears	TMS pearl without bulging and retraction
Throat	Mucous membranes moist Clear without drainage or erythema
Neck and Lymph Nodes	No obvious nodes Thyroid non-tender without thyromegaly and no masses palpable (-) JVD No bony tenderness Full ROM without pain elicited
Chest	Normal chest excursion Clear to A & P
Breast	WNL Mammography normal (3 months ago)
Cardiac	RRR (-) murmurs Normal S1 and S2  No S3 or S4
Abdomen	Soft, NT/ND (+) BS (-) organomegaly or masses
Genitalia	Deferred
Musculoskeletal/Extremities	Good peripheral pulses bilaterally Point tenderness with palpation of bony prominence at L2 Limited flexion and extension of the back Significant lumbar lordosis Lateral bending unlimited and non-painful (-) kyphosis (-) deformity or swelling of joints
Neurologic	A & O X 3 Recent and remote memory intact Cranial nerves intact No focal motor deficits No gross sensory deficits DTRs 1+ and symmetric throughout Toes downgoing

 

 

Laboratory Blood Test Results

 

Laboratory Blood Test Results
Na	139	meq/L	Glu, fasting	91 mg/dL	25,OH vitamin D        3 ng/mL
K	4.4	meq/L	TSH	1.42 µU/mL	Hb                      12.6 g/dL
Cl	103	meq/L	Ca	8.6 mg/dL	Hct                         39.5%
HCO3	23	meq/L	PO4	4.6 mg/dL	WBC           8.8 X 103/mm3
BUN	15	mg/dL	Mg	1.8 mg/dL	Plt               339 X 103/mm3
Cr	1.0	mg/dL	Alk phos	283 IU/L	PTH                    33 pg/mL

 

 

 

 

DEXA Scan Results

DEXA Scan Results
Site	T Score
Lumbar spine L2-4	-3.79
Right femoral neck	-3.19
Right radius	-2.97

 

 

Spinal Radiographs

• Significant radiographic lucency suggestive of poor bone density

• Recent compression fracture at L2

• Healed compression fracture at T10

• Thoracic vertebrae are wedge shaped, consistent with progressive osteoporosis

• Lumbar vertebrae are biconcave, consistent with progressive osteoporosis

hi, please could help me with; S.B.A.R. for this patient please. don’t be too long just a couple of lines for each. thanks

 

Doorway Information
Lynn Zimmel, 30 years old, is 25 weeks pregnant, comes to the clinic today to follow up on a positive glucose challenge test
(tested after clinic visit last week). Serum glucose level 145 mg/dL after 1 hour. She returns for a three-hour glucose
challenge. Of note, serum glucose at the initial visit 88 mg/dL.
Test results: Results of three-hour glucose challenge 148 mg/dL.
Last prenatal visit – 24 weeks
–
• G1PO.
• Denies headache, vision change, swelling of hands and feet, epigastric pain.
• Denies dysuria/urgency; increase or change in vaginal discharge.
• Denies recent travel, illness, stressors, exposure to infection.
• Fetal movement – positive
Negative depression screen.
Negative domestic violence screen.
Denies smoking and the use of substances.
· BP – 115/68.
Weight – 155 pounds.
• FHT – 145 bpm.
Fundal height – 5 cm above the umbilicus.
• Edema – none noted in hands, face, lower extremities bilaterally.
Urinalysis – trace glucose; negative for protein.