Mark is a 45-year-old individual who wants to improve his overall health.He has a family history of heart disease and is concerned about his own risk factors. As a nutrition coach, you are assigned to help Mark achieve his goals and develop a healthier lifestyle. He works a sedentary job and has a busy schedule, often relying on convenient fast food options for meals. Mark is also a smoker and occasionally consumes alcohol.
A patient with cardiac arrhythmia has a pacemaker system with electrodes in the atrium and ventricle. The patient visits his cardiologist for evaluation of the battery, leads, capture and sensing function, heart rhythm and programmed parameters of the system which included connection, recording, and disconnection of the pacemaker. Analysis, review, and a report were performed by the physician and placed in the record. What CPT® code is reported?
Nursing Care Plan A Client with Cancer James Casey, age 72, is of Northern European heritage. He has moved in with him to provide care and sup been receiving medical care for the chronic obstructive pulmonary port during his final months. The daughter has the ac- disease, chronic bronchitis, status postmyocardial infarction, and accepts, saying she is glad to be able to spend this time with her fa- type I diabetes mellitus for over 15 years. He reports that he lost her; she has been informed of the physical and emotional stress of his wife from lung cancer 5 years ago and still" misses her terribly." this will entail. He describes his bad habits as smoking two packs of cigarettes a day for 52 years (104 packs/year), one to two six-packs of beer an ASSESSMENT week, one " bourbon and water" a night, and "a lot of sugar-free Glynis Jackson, RN, the hospice nurse assigned as case manager junk food, like french fries."
He assures the nurse that he quit for James Casey, and completes a health history and physical exam- smoking 2 years ago, when he could no longer walk a block with- nation during her first two visits to his home, 1 day apart. She put considerable shortness of breath, and just quit drinking also- gathers this information over 2 days to conserve his strength hol a few weeks ago at his physician’s insistence. About a year and allow more time for James and his daughter to talk about ago, he had a basal-cell carcinoma removed from his right ear. Six their concerns. months ago, cancerous tumors were discovered in his bladder, During the physical assessment, Glynis notes that James is pale and he underwent two 6-week chemotherapy courses of the bladder with pink mucous membranes, thin with wasted appearance instillations of BCG.
His latest report indicates that the tumors and a strained, worried facial expression. He complains of severe have grown back and no further chemotherapy would be useful. back pain no longer adequately relieved by Percodan and Vicodin The urologist had considered surgery but believed that James’s alternating every 2 to 4 hours. His blood pressure is 90/50, right other medical problems would compromise his chances of sur- arm in the reclining position with no significant orthostatic vival. James decides to let the disease run its course and to be change; his apical pulse is 102, regular and strong; respiratory rate managed at home through hospice care. Because he lives alone 24 and unlabored; breath sounds are clear but diminshed in the in a modest home, he asks his daughter, Mary, and her family to bases; oral temperature is 96.8.F. (continued) Nursing Care Plan A Client with Cancer (continued) A tunnelled Groshong catheter as a VAD PLANNING AND IMPLEMENTATION is present in the right anterior chest. There is no . Ask about favorite foods, and ask Mary to offer a small portion drainage, redness, or swelling at the site. The catheter was placed of one of these foods each day. last week when the client was being evaluated at the anesthesiol- Encourage drinking up to four cans of liquid nutritional supple- ogist’s office for pain management, but no medication is running ment with fiber a day, sipping them throughout the day. via the VAD. Mary reports that his urinary output is adequate. Talk with the physician about prescribing a medication to help Approximately 200 mL of yellow, cloudy, non malodorous urine is stimulate the appetite. present in the urinal at the bedside from his last voiding. Plan to have a home health aide come to the home, give him a James states that he spends most of his time either in bed or shower or bed bath daily, and assist his daughter with some of sitting up in a chair in his room. He reports that he has no energy for the household chores. any more and is unable to walk to the bathroom unassisted, dress Talk with Mary about having her adult son and daughter relieve himself, or take care of his own personal hygiene. Glynis rates her of the housework and stay with James so that she can get James’s functional level at ECOG level 4: capable of only being limited out of the house occasionally. Offer to talk with them if she is self-care, confined to bed or chair 50% or more of waking hours uncomfortable doing so. (Karnofsky 10 to 20). He tells the nurse that his daughter "is work- Request a volunteer to spend up to 4 hours a day, twice a week ing day and night to help me and is looking awfully tired." with James so that Mary can attend to outside activities and Many reports that James is eating very poorly: He usually eats a chores. small bowl of oatmeal with milk for breakfast and vegetable soup Talk with the anesthesiologist, and work out a pain control pro- and crackers for lunch, but he tells her that he is too tired for dinner gram, using the VAD and a CADD-PCA infusion pump with a and wants only fruit juice. James tells the nurse that he has no ap- continuous morphine infusion. petite and eats just to please Mary. He does drink at least three to four Call the infusion therapist to set up the equipment and supply glasses of water a day plus juice. His fingerstick blood sugars remain (including the medication) for the morphine infusion. within normal range. Teach them how to use the pump and about the side effects of the His current weight is 120 pounds at 67 inches tall, down from morphine infusion, including those that require a call to the 180 pounds a year ago. He has lost about 30 pounds over the last nurse for assistance.
Teach which untoward effects should be 2 months. reported. Available laboratory values from his visit with the doctor show a Request a physical therapy consultation to evaluate current the following: level of functioning and determine how to maintain his current Total protein: 4.1 g/dL (normal range: 6.0 to 8.0 g/dL) level. Albumin: 2.2 g/dL (normal range:3.5 to 5.0 g/dL) Instruct Mary to allow ample rest periods for James between Hemoglobin: 10.2 g/dL (normal range: 13.5 to 18.0 g/dL) activities. Hematocrit: 30.5% (normal range: 40.0% to 54.0%) Order a hospital bed with electronic controls to be delivered to BUN: 30 mg/dL (normal range: 5 to 25 mg/dL slightly higher in the house. older people Order a special foam pad for bed and chair and a bedside com- Creatinine: 2.2 mg/dL (normal range: 0.5 to 1.5 mg/dL) mode from the medical supply house. Instruct Mary and the home health aide to inspect the skin daily, DIAGNOSIS give good skin care with emollient lotion after bathing, and Imbalanced nutrition: Less than body requirements related to reporting any beginning lesions immediately to the nurse. anorexia and fatigue Risk for caregiver role strain related to the severity of her father’s ill- EVALUATION ness and lack of help from other family members James Casey did increase his oral intake a little, sometimes eating Chronic pain related to the progression of the disease process the special treats his daughter prepared and drinking one or two.
Impaired physical mobility related to pain, fatigue, and begin- cans of liquid nutritional supplement a day. However, his weight ning neuromuscular impairment did not increase; it stayed at about 120 pounds until his death Risk for impaired skin integrity related to impaired physical mo- 2 weeks later. His daughter was very grateful for the extra help ability and malnourished state from the home health aide and the volunteer, though she could not bring herself to ask her son and daughter for help and did not EXPECT OUTCOMES want the nurse to do so. She did become more rested and re-. Increase oral intake and show improvement in serum protein ported that " Dad and I had some wonderful 3:00 A.M. talks when values. he couldn’t sleep." Daughter will be able to maintain supportive caretaking activities- James was started on 20 mg of morphine per hour with bo- ties as long as James needs them.
uses of 10 mg 4 times a day, for breakthrough pain. This medical- Minimal pain for the rest of his life. tion relieved his pain quite well; after 2 days he was alert enough Able to continue his current activity level. most of the time to carry on a normal conversation and still walk Maintain intact skin. to the bathroom with help up until 2 days before he died.
The hospital bed simplified James’s care and made it much 3. One of the specified interventions was to easier for him to rest comfortably and change position. His skin consult the physician regarding medication remained intact and in good condition. to increase James’s appetite. What medications might fulfill that Mary reported that James died peacefully in his sleep and function? What side effects might they have that would con- 2 weeks after care was started? She said spending the last weeks contraindicating these medications for him. his life together was a healing experience for both of them. 4. If James had developed signs and symptoms of sepsis, what manifestations would you expect to see? As the nurse making Critical Thinking in the Nursing Process the home visits, what would be your nursing actions, and in 1. What other tests could be done to evaluate James Casey’s what order of priority? nutritional status? See Evaluating Your Response in Appendix C. 2. James had severe back pain. What were the possible pathophysiologic reasons for his pain?
Diabetes Care through Government services; At our hospital, the government health facility gives free service to diabetics who are under age 18 and over age 64.
However with diabetes being so prevalent and chronic leading to kidney failure and other illnesses I want to propose that my country’s government give diabetics of all ages access to free diabetes medication and free clinic follow-up with 2 free HBA1c lab tests per year and free glucose test strips for the glucose monitors.
Also, I want to propose the government strengthen the school health program to include monitoring Diabetes children while at school.
Can you see if any of the country’s or country’s government health systems provides free care for diabetes patients?
Do a Literature review of how the government healthcare system of a Caribbean country and another country (you can choose which country) has stepped in to ensure diabetics receive diabetes medication and follow-up care. This is to put together a proposal for the government and health system in my country to make diabetes care and follow-up accessible to all citizens no matter their economic status.
A 48-year-old woman presents with a five-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her grandchildren problematic. She admits to increased fatigue, but she thought it was due to her stressful job.
FH: Grandmothers had “crippling” arthritis.
PE: remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth.
Diagnosis: rheumatoid arthritis.
Question:
The pt. had various symptoms, explain how these factors are associated with RA and what is the difference between RA and OA.
Philosophies of Women and People of various Cultures
Many women have pushed back against these accusations and misogynistic views, sparking an intellectual revolution in the process. For a long time, philosophy was seen as a boy’s club, but with Simone de Beauvoir’s views, Harriet Taylor Mill, Hypatia of Alexandria, and others, that prejudice has been dispelled. A diverse perspective is sometimes required to make progress, and a fabulous idea can originate from anybody, anywhere.
Males have definitely controlled the philosophical discourse, Marjorie, especially in terms of whose voices were taken seriously. Men have long defined women as different. often, less than. Are female philosophers caught within a “Catch 22”? Are they marginalized as long as their gender is highlighted, as long as they continue to be called “female philosophers” instead of just philosophers? Do we ever append male to the philosopher, or do we see that as the default?
Of course, this raises some very big issues about sex and gender, with sex being defined as biological differences between males and females and gender being described as the cultural constructs that the culture attaches to sex. And we often mistake one for the other, mistake cultural constructions for biological differences.
Ursula Le Guin’s classic, award-winning science fiction novel The Left Hand of Darkness imagines a world without gender. That world’s inhabitants are not just genderless, but sexless for most of the time (on a regular cycle they become one gender or the other, not always the same gender each cycle, during which they can have sex and even reproduce). What is particularly interesting is that the story is told from the perspective of a man from Earth. And he repeatedly misreads people on this planet (sometimes to his great detriment) because he cannot get past his own assumptions about gender.
This brings us back to the issue of universality here on Earth. Do we often mistake the male experience for the universal experience?
Non-Opioid Pain Intervention for Veterans; PICO – In injured veterans experiencing chronic pain (P), does the use of non-opioid modalities (Pharmacological and Non-pharmacological) (I), compared to the administration of systemic opioids (C), lead to improved pain management and decreased incidence of opioid overdose (O)?
Hallucinations are a common perceptual disturbance for someone living with a psychotic illness, and they can have a significant impact on how they experience psychosis. Give one culturally safe nursing intervention for a consumer with a psychotic illness. Give one evidence-based psycho-education strategy which can be adopted when working with someone who has a psychotic illness.
