Bilateral erythema and edema of turbinates

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A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose Subjective Data: States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the springtime, pollen season. However, in the winter, her allergies are not a problem.

Objective Data:

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air

No signs of acute distress. The patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.

Ear canals: normal;
EYES: normal;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages

CTA AP&L

Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no
cobblestoning

Regular rate and rhythm, no murmur, S3, or S4

 

  1. What other subjective data would you obtain?
  2. What other objective findings would you look for?
  3. What diagnostic exams do you want to order?
  4. Name 3 differential diagnoses based on this patient presenting symptoms?
  5. Give rationales for your each differential diagnosis.

Can you include your references please

 

Abdomen and Musculoskeletal Documentation

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Abdomen and Musculoskeletal Documentation Obtain the following information on an adult volunteer. For the history, ask about the items indicated. For the physical exam items; read the assigned chapters, review the course presentations/videos, and gather needed equipment before performing the exam. Use this guide when documenting the findings.

Be sure to address all items in your documentation. Gender, age, birthplace, race/ethnicity Abdomen, musculoskeletal 0

Past medical history – Personal history of acute/chronic disease, surgery, injury, infection, pain a Review of systems 0 Abdomen – Appetite, intolerance to any food, heartburn, nausea, vomiting, constipation, diarrhea, change in stool, incontinence, bleeding, hemorrhoids, laxatives, endoscopic tests and results

0 Musculoskeletal – Pain, stiffness, swelling of joints, limited movement, cramps, weakness, problem with gait, deformities, assistive devices 0 Family history of illnesses in these systems Abdomen Inspect – skin, umbilicus, peristalsis, symmetry, aortic impulse, etc. Auscultate — bowel sounds Percuss – general Palpate — light, aortic pulse, deep, liver, kidneys Costovertebral angle (CVA) tenderness – can do here if not already done with posterior chest Musculoskeletal 0 Inspect— muscularity, symmetry, alignment, deformities, edema, redness, etc. 0 Neck 0 ROM – flexion, hyperextension, rotation, lateral bending 0 Strength

Evaluate the nurse’s role in facilitating safe, quality outcomes for patient-centered care

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The student will evaluate the nurse’s role in facilitating safe, quality outcomes for patient-centered care. The student will select a patient care assignment from the clinical practicum (not the same patient used for the case presentation) to complete the case analysis using the criteria stated below. The student must use at least 2 professional journal articles to supplement content from other recent nursing textbooks to provide evidence for the care provided. Unless classic research, all references must be within 5 years of publication.

 

CriteriaPossible PointsComments/Earned Points
  1. Introduce the background of the patient
  • Health history
  • Economic and social history
  • Spiritual and cultural considerations
  • Family members and relationships
  • Community of residence
10/10

Comments:

  1. Medical diagnoses
  • Discuss pathophysiology of disease or symptoms with focus on current health problem(s)
  • Analyze the risk factors and patient’s assessment findings that relate to the pathophysiology or disease conditions
30/30

Comments:

  1. Patient assessment
  • Discuss physical assessment findings including vital signs and allergies
  • Evaluate the medications including the reasons for patient taking each one.
  • Evaluate laboratory and diagnostic tests relevant to care of the patient
  • Emphasis should be on the analysis of assessment data to care for patient
30/30

Comments:

  1. Analyze the case and progress toward outcomes using the nursing process framework
  • Identify one priority diagnosis and two other nursing diagnoses and provide brief plan of care with rationales and interventions that are realistic and individualized to patient.
  • Evaluate the care provided to the patient and the patient’s achievement of care outcomes
40/40

Comments:

  1. Examine how a systems approach to collaboration with other members of the interdisciplinary team contributed to safe patient care.
10/10

Comments:

  1. Evaluate discharge planning goals or other long term planning goals for the patient.
15/15

Comments:

  1. Discuss how the nurse provided or could have provided for the spiritual and cultural needs of the patient.
10/10

Comments:

  1. Evaluate one or more of the agency specific policies and the impact on the provision of care for this patient.
  • Was policy a barrier or facilitator for care?
  • How does nursing leadership advocate for safe, quality care?
10/10

Comments:

  1. Analyze ethical and legal standards that impacted the care of the patient and family. Possible discussion topics include: ethical standards for professional nursing practice, end-of-life decisions and advanced directives, respect for ethical rights of patients (autonomy, beneficence, etc.)
15/15

Comments:

  1. Analyze ethical and legal standards that impacted the care of the patient and family. Possible discussion topics include: ethical standards for professional nursing practice, end-of-life decisions and advanced directives, respect for ethical rights of patients (autonomy, beneficence, etc.)Reflect on additional learning that you need to enhance your care of a similar patient care situation in the future.
10/10

Comments:

  1. Scholarly presentation of work
  • Uses textbooks and recent journal articles to support discussion points
  • APA format for style, grammar, in-text citations, and references
  • Absence of spelling errors
20/20

Comments:

Total200/200

 

this is one a CHF patient

 

Discuss the role of health care in creating health equity

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Discuss the role of health care in creating health equity. Explain why health care alone isn’t enough to create health equity. Description: David R. Williams, Professor of Public Health at the Harvard T.H. Chan School of Public Health, has been researching health inequities in the United States for two decades. In this video, he sits down with Don Berwick, MD, President Emeritus and Senior Fellow at IHI, to discuss the role of both health care and social determinants of health to create health equity.

 

Discussion Questions:

  1. After hearing Williams say that health care is important to health equity, how do you feel about your role in ensuring high-quality care to people who face barriers to good health as a result of social circumstances?
  2. What role do you think healthcare providers play in addressing the non-clinical determinants of health?
  3. Williams says early childhood development is critical to good health. How do you think health systems can promote early childhood development?

Offering nutritional guidance to patients with type 2 diabetes

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A nurse wishes to implement evidence-based practice in offering nutritional guidance to patients with type 2 diabetes. Which questions represent a valid step in implementing evidence-based practice? Select all that apply.

What is the most relevant evidence for a set of nutritional guidelines?

How old are the findings on nutritional approaches for patients?

Will the patients find these recommendations easy to adopt?

Can I duplicate the findings of these studies in my own study?

Do the nutritional recommendations in this evidence make sense?

The flow velocities

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The flow velocities were recorded as: PSV: 98.7 cm/s and EDV: 21.6 cm/s. What is missing? Discuss the accuracy of the data. These two images were taken at the same level in a patient. Which artery is most likely depicted in these images? Why? Which techniques are used in each image to show flow? What is the advantage of using each technique?

What changes in the patient’s settings you would like to make based on the blood gas

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Please assess the ABG and identify what changes in the patient’s settings you would like to make based on the blood gas. (Note that the patient’s tidal volume range based on the patient’s Ideal Body Weight is 360-480 mL)

 

Time1130
Machine Settings
ModeVC/AC
Tidal Volume450 mL
Pressure Control—
Frequency14 bpm
Inspiratory Time0.9 sec
Flow Rate—
Pressure Support—
PEEP+5 cmH2O
FIO250%
Alarms
High/Low Press Alarm50 cmH2O
Hi/Low Minute VentilationAlarm15L/min/ 3L/min
High Frequency Alarm30 bpm
Hi/Low Tidal Volume Alarm—
Apnea Alarm—
Patient Values
Total Frequency14 bpm
Inspiratory Tidal Volume450 mL
Expiratory Tidal Volume432 mL
Minute Ventilation6.3 L/min
Peak Inspiratory Pressure24 cm2O
Plateau Pressure
Mean Airway Pressure8 cmH2O
Patient Monitoring
SpO293%
ETCO2
Time
ABG1153
Ph7.27
PaCO268 mmHg
PaO263 mmHg
HCO-326 mEq/L
RT Name

Important part of the implementation process

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Evaluation is an important part of the implementation process. At what point should the evaluation begin? At what point should the readjustment process begin? How would you go about determining this? Are these processes the same for every project? Why or why not?

Chronic obstructive pulmonary disease exacerbation

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The patient was admitted for respiratory failure, secondary to a Chronic obstructive pulmonary disease exacerbation. The patient was found down in the downtown public park. You have placed the patient on the setting below and there are orders for Q4 ABGs. As you come back in to get the scheduled ABG you note that the patient’s peak inspiratory pressure is 42 mmHg and it was reading 30 mmHg immediately after intubation.

Educating a middle-aged African-American man with high cholesterol

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The nurse is educating a middle-aged African-American man with high cholesterol. The nurse knows to diagnose the patient as at high risk for a heart attack because based on evidence, the nurse knows that middle-aged African-American men are disproportionately affected by heart disease. What is the most credible source of this evidence?

O An article in a widely distributed magazine on health

O The published opinion of a panel of cardiac surgeons

O A meta-analysis of multiple trials published in an AMA journal

O A series of case studies on middle-aged Americans