A 25 years old woman who is at 34 weeks gestation arrives at the obstetrician’s office for her routine appointment; she is accompanied by her husband. The client informs the nurse that she has some generalized abdominal discomfort and has had firm stools recently that are hard to pass and less frequent than usual. Additionally, the client reports urine leakage that is especially noticeable with coughing, laughing or sneezing.

The client reports managing the symptoms of constipation with increased fluid intake but no other measures. The provider examines the client and determines the client demonstrates an otherwise normal assessment. The provider instructs the nurse to provide the client with directions on constipation management, including an over-the-counter stool softener and urinary incontinence related to pregnancy.

Assessment Questions

1. Identify the relevant subjective and objective assessment information related to the client’s condition and place the findings in the assessment data box below. (Recognizing Cues; Assessment)

2. Based upon assessment information, identify and prioritize the top 3 client problems. Write one client problem in each of the Client Problem boxes below. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)

3. Below each client problem, determine and enter the relevant assessment information that supports the identified client problem. (Analyze Cues; Analysis and Prioritize Hypothesis; Planning)

4. Identify important nursing interventions that should be taken to address each client problem and enter them in the related intervention box for the associated client problem. (Take Action; Implementation)

Discussion Questions

Educators may choose to instruct students to include relevant information identified during the discussion questions into the concept map.

1. Discuss special considerations to be made for clients from diverse backgrounds. (Recognize Cues; Assessment)

A. Teenage female with no support.

B. Clients from diverse backgrounds(i.e. Age, culture, socioeconomic status).

2. Identify potential client problems. (Analyze Cues; Analysis)

A. Instruct students to provide a rationale for their choices.

3. Discuss nursing interventions to address the identified potential client problems. (Generate Solutions; Planning)

A. Instruct students to provide a rationale for their choices.

4. Discuss the desired client outcomes related to the performed interventions identified in the concept map as well as for potential client problems. (Generate Solutions; Planning)

A. Discuss client responses that demonstrate an improvement of the client problem.

B. Identify client responses that indicate worsening of the client condition. (Generate Solutions; Planning)

5. Discuss safety considerations that should be included when planning care for this client (i.e. fall risk). (Generate Solutions; Planning)

6. Identify client education the nurse should provide for this client (i.e. diet, activity, ADLs). (Take Action; implementation) Discuss client outcomes you would anticipate based on the performed nursing interventions (i.e. improved SPO2 with raising head of bed, increasing amount of oxygen being delivered). Identify how achievement of client outcomes would be evaluated. (Evaluate Outcomes; Evaluation)

7. Discuss ways to modify or revise the plan of care when client outcomes are not me.(Evaluate Outcomes; Evaluation)

Concept Map

Admitting Diagnosis

Assessment Information

Client Problem 1:

Assessment information

Intervention

Client Problem 2:

Assessment information

Intervention

Client Problem 3:

Assessment information

Intervention

Client’s Feelings PSW Actions (physical and emotional help) Situation 2 Mrs. Gregg has expressed a desire to read, but she is unable to understand the text in her old books.

Mrs. Gregg continually uses her knife to eat with and is generally unable to choose the correct utensil and unable to cut her meat. She has difficulty getting food to her mouth. She resists heip. One day she threw her plate across the room

She asks you to help her practice words. She says that she has trouble passing the time and that she expects to return to work in several weeks. Client’s Feelings PSW Actions (physical and emotional help)

Points As a medical researcher, you identify a new type of excitable cell with similar cell physiology as neurons. You have identified the following ion concentrations across its cell membrane but misplaced both the location where the concentrations were measured as well as the type of ions that were measured. Match these concentration values with the most likely location and type of the ions across the cell’s membrane. Drop down to select the correct answer

The addiction lab at the Neuroscience Institute of Victoria is working with a small start-up pharmaceutical company to try and formulate a new drug for the market in the treatment of long-term alcohol addiction. In the lab, pharmacological studies in vodka-addicted rats have shown that administration of the drug in quite high doses has been successful in reducing
alcohol intake. In vitro studies suggest that the drug interacts with both the dopamine and GABA receptors in the brain.

1. What are the considerations that need to be made when making a drug that needs to cross the blood-brain barrier?

2. Discuss how you think this drug is reducing alcohol intake? In your answer, you should consider the pharmacology of both neurotransmitters.

3. Compare this potential drug to other drugs involved in treating alcohol addiction.

Cross-bridge cycling 4. CytoplasmicCa2+removal 5. Depolarization of tubules a. 1-2-5-3-4 b. 1-5-2-3-4 – c. 5-4-3-1-2 d. 5-4-1-3-2 e. 4-5-1-3-2 6. Repeated stimulation of a skeletal muscle fiber causes a sustained contraction (tetanus). Accumulation of which solute in intracellular fluid is responsible for tetanus?

a. Adenosine triphosphate (ATP) b.$$\mathrm{K}+$$c.$$\mathrm{Na}+$$d. Troponin e.Ca2+. f. Calmodulin 7. In the contraction of gastrointestinal smooth muscle, which of the following events occurs right after binding to calmodulin? a. increased intracellular concentration b. activation of myosin light chain kinase c. depolarization of the sarcolemmal membrane d. opening of ligand-gated channels e.-induced release 8. Which autonomic receptor mediates the secretion of epinephrine by the adrenal medulla?

a. Cholinergic nicotinic receptor b. Adrenergic alpha 1 receptor c. Adrenergic beta 2 receptor d. Adrenergic beta 1 receptor e. Cholinergic muscarinic receptor 9. Which of the following statement is not true about the autonomic nervous system? a. Sympathetic and parasympathetic nervous systems are two groups of the autonomic nervous system b.

Preganglionic nerve axon synapse with the postganglionic nerve at ganglion c. The preganglionic nerve of sympathetic and parasympathetic release acetylcholine that binds a nicotinic receptor on the ganglion d. The postganglionic nerve of sympathetic and parasympathetic release acetylcholine that binds a muscarinic receptor on a target tissue e. The adrenal medulla is part of the sympathetic nervous system