Student Copy Week 3: Interactive Group Activity: IV Therapy x 2 Mr. Davis is a 79 year old male who has been admitted to the General Medical Unit (GMU) with the diagnosis of Gastrointestinal Bleed (GI). He has a single lumen Peripherally Inserted Central Catheter (PICC) placed in his upper left arm basilic vein, and he is currently receiving the first of 2 units of packed red blood cells (PRBC). 1. Compare and contrast a Central Line and a Peripheral IV. 2. Is a PICC considered a central line or a peripheral line?

A seven-year-old previously healthy boy presents with a rash and mouth pain. His mother took him to see his PCP one week prior with a 2-week history of cough, subjective fever, and malaise; he was prescribed amoxicillin for presumed pneumonia. Five days into the antibiotic course, he developed an itchy rash and mouth sores. His mother reports markedly diminished intake of the previous 24 hours, but no emesis or diarrhea. He has no medication or food allergies. This temperature is 102°F (38.9°C), heart rate 122 bpm, blood pressure 119/73 mm Hg, respiratory rate 18 breaths/min, and oxygen saturation 97% on room air. On physical examination, he has bilateral conjunctival injection, alters on his tongue and lower lip, and purpuric macules and bullous lesions on his torso and extremities. Chest x-ray reveals and infiltrate in the right lower lobe.

-What is the most likely diagnosis?
-What is the next step in evaluation?
-What diagnostic studies are needed?
-What additional treatment is needed?
-What consultations are needed?

A mother brings her 12-year-old daughter to the clinic to establish care and to get immunizations for school.  Her mother reports that because of lack of insurance she has not had a regular pediatrician for her children for the previous eight years. She reports the girl to be in general good health other than recurrent bouts of the otitis media. The mother is concerned that she and her other two daughters began their growth spurts and their menstrual cycles by age 11 years, but this child “hasn’t got her period.”  The child reports that she is doing well in school except for mathematics and she requires help with attention in planning in school activities. On physical examination, she is at the 5  th percentile for height and the 90  th percentile for weight.  She is afebrile, heart rate 90 bpm, respiratory rate 16 breaths/min, and BP 117/92 mm Hg. Her chest is broad and her femoral pulses diminished.

-What is the most likely diagnosis?
-What are the most appropriate diagnostic test to order?
-What is the best management for this condition?
-What is the genetic basis of this disorder?

The high incidence of accidental injuries in adolescence is due to:

A 72 year old client is admitted with conversion disorder after the death of a spouse.  The client’s major symptoms is the inability to walk forward.  The client seems to be unconcerned about the problem.  Which nursing interventions are appropriate?  Select all that apply.

A. Adopt a matter of fact, but caring approach to prevent secondary gains

B. Focus on the death of the spouse and the inability to move forward in life

C. Help the client learn ways to express feelings more appropriately

D. Reinforce any positive improvements in the ways the client deals with needs and feelings

E. Encouraging participation in milieu and recreational activities (diversion).