The coup-contrecoup mechanism of injury

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Case study:

A 22-year-old male was an unrestrained front seat passenger of a car traveling at 50 miles per hour. The driver swerved to avoid hitting a deer that darted in front of the car and hit a tree. EMS on the scene noted a stellate fracture of the windshield on the passenger side.

The patient was non-responsive at the scene when the paramedics arrived, and his pupils were unequal with the left pupil larger and sluggish to react to light. He was placed in a hard-cervical collar per the protocol and log rolled onto a long backboard.

He was breathing spontaneously at the scene, but pulse oximetry in the EMS unit revealed a SaO2 of 78% on room air. He was intubated at the scene for airway protection and transported to a Level 1 trauma center. Glasgow Coma Scale=3

After a full trauma workup, the patient was diagnosed with an isolated traumatic brain injury with acute subdural hematoma secondary to the coup-contrecoup mechanism of injury.

He was emergently taken to the operating room for craniotomy after which he was taken to the Intensive Care Unit (ICU) for close monitoring. He had an intracranial bolt for measurements of his intracranial pressure (ICP).

Question:

Explain the differences between primary and secondary traumatic brain injuries (TBIs)? 

The APRN is called by the ICU staff because the patient’s ICP has risen to 22 mmHg. The APRN recognizes the urgent need to lower the ICP. The APRN institutes measures to decrease the ICP and increase the cerebral perfusion pressure (CPP). What are the factors that determine CPP?

Transient ischemic attack

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Case study:

A 68-year-old man was brought to the emergency department by his family.

During his routine morning walk, he noticed a sudden onset of left facial numbness associated with a dull headache on the right posterior aspect of his head. He was staggering to the right side and feeling unsteady and nauseated, with no vomiting.

He telephoned his wife, who noticed his speech was slow and slurred, but there was no word-finding difficulty. His family immediately took him to the hospital.

There was a history of hypertension, hypercholesterolemia, ischemic heart disease (MI and PCI with a bare-metal stent in 2007), and probable transient ischemic attack (TIA) at the time of cardiac intervention. His medication included atenolol, ramipril, simvastatin, aspirin, and clopidogrel.

Within one hour, the patient’s symptoms had totally resolved. The diagnosis of transient ischemic attack was made, and the patient was discharged to home with instructions to contact his healthcare provider (HCP) for follow-up.

Question:

Why did the patient’s symptoms totally resolve?

How does atrial fibrillation contribute to the development of a CVA? 

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Case study:

An 83-year-old man presents with a history of atrial fibrillation (AF), hypertension, and diabetes. His daughter, who accompanied the patient, states that yesterday the patient had a period when he could not speak or understand words and that approximately 4 weeks prior he staggered against a wall and was unable to stand unaided because of weakness in his legs. She states that both instances lasted approximately a half-hour. She was unable to persuade her father to go to the emergency room either time.

Today he suffered another episode of right-sided weakness, dysarthria, and difficulty with speech. Past medical history: Hypertension for 15 years, well-controlled; diabetes for the past 10 years, and  Medications: Diltiazem CD 300 mg daily; lisinopril 40 mg daily; metformin 500 mg twice daily; aspirin 81 mg daily and atorvastatin 20 mg po qhs.

Social history: reported former smoker with 40 pack-year histories. Alcohol -drinks one beer a day. Denies any other substance abuse. Review of systems: Denies dyspnea, dizziness, or syncope; complains that he cannot move or feel his right arm or leg. Difficulty with speech.

Physical exam: Vitals: height = 70 inches; weight = 185 pounds; body mass index = 26.5; BP = 134/82 mm Hg; heart rate = 88 bpm at rest, irregularly irregular pattern.

HEENT: remarkable for expressive aphasia, eyes with contralateral homonymous hemianopsia.

No loss of sensation but unable to voluntarily move right arm or leg.

The patient was diagnosed with a right middle cerebral artery vascular accident (CVA) secondary to atrial fibrillation (AF)

Question:

How does atrial fibrillation contribute to the development of a CVA? 

Describe how osteoarthritis develops

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Case STUDY:

A 57-year-old male construction worker comes to the clinic with a chief complaint of pain in his right hip. The pain has progressively gotten worse over the last 2 months and he has been having trouble sleeping. There is little pain in the morning, but he is a bit stiff.

The pain increases as the day wears on.  has taken acetaminophen without any relief but states that the ibuprofen does work a little bit. He is anxious since the hip pain has limited his ability to work and he is afraid that his boss will fire him if he cannot perform his usual duties.

There is no history of past trauma or infection in the joint. Past medical history noncontributory. Social history without history of alcohol, tobacco, or illicit drug use. Physical exam remarkable for decreased range of motion of the right hip.

BMI 34 kg/mRadiographs in the office demonstrated asymmetrical joint space narrowing of the right hip with osteophyte formation. Several areas of the hip showed bone-on-bone contact with loss of the articular cartilage. The APRN tells the patient he has osteoarthritis (OA) and refers the patient to an orthopedist for evaluation of his need for a total hip replacement.

Question:

Describe how osteoarthritis develops and forms and distinguishes primary osteoarthritis from secondary arthritis.   

The Symptom Severity Inventory

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Case Study :

A 34-year-old Caucasian female presents to the clinic with a chief complaint of widespread pain in her joints and muscles. She states that her skin seems sensitive, and sometimes it hurts to be touched.

The Caucasian female has had extreme fatigue for the past 4 months. She admits to being depressed and is unable to sleep well. She has had to drop out of her gardening club due to pain. She says that bright lights and loud noises really bother her.

Past medical history noncontributory. Her social history was significant for her divorce from her husband 14 months ago. She is the mother of 2 small children and works as an administrative assistant at the local insurance company.

Physical exam remarkable for tender points over her posterior supraspinatus muscles, occiput, trapezius, gluteal area, and sacroiliac joints bilaterally. BASED ON HER PHYSICAL EXAM, the APRN tells the patient that she most likely has fibromyalgia.

Question :

What are the underlying causes of fibromyalgia? 

The APRN tells the patient that the tender points are no longer used to diagnose FM. She suggests that the patient takes the Widespread Pain Index (WPI) and the Symptom Severity Inventory (SSI).

The patient asks the APRN what these tests are for. What is the APRN’s best answer?

Explain how the nursing practice has changed over time

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The field of nursing has changed over time. In a 750‐1,000 word paper, discuss nursing practice today by addressing the following:

Explain how the nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how the scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision‐making, differ between the BSN‐prepared nurse and the ADN nurse.
Discuss the significance of applying evidence‐based practice to nursing care and explain how the academic preparation of the RN‐BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Long-term care system base eligibility for services on functional needs

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The “ideal” long-term care system base eligibility for services on functional needs rather than financial needs. Find the criteria for eligibility for Medicaid coverage for a nursing facility in your state (you can get the eligibility standards directly from the state or from a nursing facility).

Do you think they measure functional need vs. financial need? How close do they come to the “ideal” criteria? How would you change them if you could?

Strengths and weaknesses as sites for an EBP QI project

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Instructions
In a paper of 6–8 pages, plus a cover page and the references page, include the following:
• Describe the three healthcare settings that you explored as proposed sites for an EBP QI project. For each healthcare setting, identify the following defining features: patient population, mission, public or private entity, single institution or member of a corporation, and others you identify as significant.
• Compare the settings for strengths and weaknesses as sites for an EBP QI project. Be specific and provide examples.
• Explain the practice problems that you explored based on your interests and identified needs of the health care settings you investigated.
• Explain why each problem is a potential focus for an EBP QI project. Be specific and provide examples.
• For each healthcare setting, describe the stakeholders whose approval would be required to initiate an EBP QI project and implement the results.
• Compare similarities and differences in stakeholder requirements across the settings.
• Identify the one proposed healthcare setting/practice site and one proposed practice problem you have selected as the focus of a hypothetical presentation to stakeholders, and explain your choices.
– The proposed Health Care Setting is Advance Asthma and Allergy Clinic – please see the reference of the last bullet from the completed PPT.

Syndrome of Antidiuretic Hormone

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• In this exercise, you will complete 5-essay-type questions in the Knowledge Check to gauge your understanding of this module’s content.
• Each question will hold one to two parts asked to be addressed and each part will need at least one citation, at least two citations if asked two parts to the question from the textbook and/or current peer-reviewed journals.
• Each question is worth 4 points. I would expect substantive paragraphs per answer (a paragraph would include 6-10 sentences).

KC each essay needs a citation(s) and reference(s), if using textbook apply correct page(s)
Basic book citation format
The APA in-text citation for a book includes the author’s last name, the year, and (if relevant) a page number.
In the reference list, start with the author’s last name and initials, followed by the year. The book title is written in sentence case (only capitalize the first word and any proper nouns). Include any other contributors (e.g. editors and translators) and the edition if specified (e.g. “2nd ed.”).
Format Last name, Initials. (Year). Book title (Editor/translator initials, Last name, Ed. or Trans.) (Edition). Publisher.
Reference entry Anderson, B. (1983). Imagined communities: Reflections on the origins and spread of nationalism. Verso.
In-text citation (Anderson, 1983, p. 23)

•
QUESTION 1
1. Scenario 1: Syndrome of Antidiuretic Hormone (SIADH)
A 77-year-old female was brought to the clinic by her daughter who stated that her mother had become slightly confused over the past several days. She had been stumbling at home and had fallen twice but was able to walk with some difficulty. She had no other obvious problems and had been eating and drinking. The daughter became concerned when she forgot her daughter’s name, so she thought she better bring her to the clinic.
HPI: Type II diabetes mellitus (DM) with peripheral neuropathy x 30 years. Emphysema. Situational depression after death of spouse 6-months ago
SHFH: – non contributary except for 40 pack/year history tobacco use.
Meds: Metformin 1000 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago
Labs-CBC WNL; Chem 7- Glucose-102 mg/dl, BUN 16 mg/dl, Creatinine 1.1 mg/dl, Na 116 mmol/L,
K 4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.
The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH).

Question:
1. Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH

QUESTION 2
1. Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question
1. Explain the pathophysiology of the three P’s for (polyuria, polydipsia, polyphagia)” with the given diagnosis of Type I DM.

QUESTION 3
1. Scenario 2: Type 1 Diabetes
A 14-year-old girl is brought to the pediatrician’s office by his parents who are concerned about their daughter’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with her school activities. She had been seemingly healthy until about 4 months ago when her parents started noticing these symptoms. She admits to sleeping more and gets tired very easily.
PMH: noncontributory.
Allergies-NKDA
FH:- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process
SH: denies alcohol, tobacco or illicit drug use. Not sexually active.
Labs: random glucose 244 mg/dl.
DIAGNOSIS: Diabetes Mellitus type 1 and refers to an endocrinologist for further work up and management plan.

Question
1. Explain the genetics relationship and how this and the environment can contribute to Type I DM.

QUESTION 4
1. Scenario 3: Type II DM
A 55-year-old male presents with complaints of polyuria, polydipsia, polyphagia, and weightloss. He also noted that his feet on the bottom are feeling “strange” “like ants crawling on them” and noted his vision is blurry sometimes. He has increased an increased appetite, but still losing weight. He also complains of “swelling” and enlargement of his abdomen.
PMH: HTN – well controlled with medications. He has mixed hyperlipidemia, and central abdominal obesity. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 333 mg/dl.
Diagnosis: Type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching.

Question:
1. How would you describe the pathophysiology of Type II DM?

QUESTION 5
1. Scenario 4: Hypothyroidism
A patient walked into your clinic today with the following complaints: Weight gain (15 pounds), however has a decreased appetite with extreme fatigue, cold intolerance, dry skin, hair loss, and falls asleep watching television. The patient also tearfulness with depression, and with an unknown cause and has noted she is more forgetful. She does have blurry vision.
PMH: Non-contributory.
Vitals: Temp 96.4˚F, pulse 58 and regular, BP 106/92, 12 respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted.
Diagnosis: hypothyroidism.

Question:
What causes hypothyroidism?

Healthcare technology trends

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Instructions
To Prepare:
Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as the use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.
By Day 3 of Week 6
Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.
By Day 6 of Week 6
Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
*Note: Throughout this program, your fellow students are referred to as colleagues.