Temperament and now would it influence Victoria’s behaviour? 2. Tenzin and Dechen have brought in their 24-month-old son, Kim, for his wellness examination and immunizations. Kim is the first child for Tenzin and Dechen, but Dechen is 6 months pregnant with their second child.

Tenzin and Dechen are Tibetan refugees who have moved to the United States from India. Kim was born in the United States.

Tenzin and Dechen are very focused on Kim’s physical abilities (i.e., motor skills, communication, and sensory skills). They express their desire for Kim to do well in school and be successful in business. (Learning Objectives 3, 4, 7, 11, and 13) a.

What could the nurse share with Kim’s parents regarding the normal motor, communication, and sensory development of a 24-month-old? b. What can the nurse teach Tenzin and Dechen regarding promoting healthy growth and development in Kim? c. Kim’s parents are curious about toilet training.

How can the nurse teach Kim’s parents about toilet training with a toddler?

Allison is a 35-year-old G2P1 F who is currently 6 weeks postpartum. She was induced for intrauterine growth restriction (IUGR delivered vaginally without complications. This morning, her husband found her difficult to rouse and confused so he called EMS.

The husband states she has been anxious since the birth of her child but believes this is expected because the baby was small at birth and paediatricians are concerned about his growth.

Allison had nausea, vomiting and diarrhoea for two days prior. Her milk supply has diminished and she has now switched to formula feeding.

The husband states they have not travelled recently and have no sick contacts.

Allison is still on maternity leave so she has been home caring for the infant. The husband has returned to work.

What additional history questions should we ask the husband at this time? Let’s come up with ten.

What initial nursing assessments should be performed?

Upon further questioning you learn:

PMH vitilaigo, hyperlipidemia, asthma

PSH none

SH: Allison works as a CRNA at a local hospital where she has been employed for 9 years. She walks for exercise but has been exercising less since the birth of the baby. She does not smoke or drink alcohol. She follows a vegan diet. She has been married to her husband Chad for 4 years. The couple recently purchased a new home right next to Allison’s mother which has been both a source of support but also stress at times.

ALL None

Meds simvastatin 10 mg daily, albuterol inhaler PRN

At this time, Allison is only minimally responsive to painful stimuli. She is unable to answer orientation questions and just keeps repeating her husband’s name. The nurse notes redness to her eyes and swelling around her eyelids. She has thyromegaly with +bruit and +thrill. There are no palpable nodules. Heart rate is rapid and irregular. Lungs have diffuse crackles bilaterally. Vital signs are as follows:

HR 145 bpm

BP 120/76 mmHg

RR 32 bpm

Temp 101°F

SpO2 89% on 4L nasal cannula

What should the nurse’s first action be?

What diagnostic tests do you anticipate will be ordered?

Her HR goes up to 155. AN EKG demonstrates atrial fibrilation. The patient becomes even less responsive and she is intubated for airway protection. She is transferred to the ICU. Her lab results are below:

Na 144 pH 7.33 TSH <0.005 (0.2-4.2 is normal)

K 5.0 pCO2 48 WBC 14K

Mg 1.0 HCO3- 24 Hgb 12.5

BUN 11 pO2 190 Hct 38%

Cr 0.7 Lactate 3.2 Plt 450K

What is going on with Allison?

She is treated with IV fluids, a beta blocker, and methimazole 20 mg PO BID. She starts doing much better clinically, she is in normal sinus rhythm and she is able to be extubated. She is transferred to the floor on hospital day 4 and now has the following test results: TSH <0.005, T4 9.0 (normal)

Thyrotrophin receptor antibody (TRAb) 30 (high)

ALT 150 U/L (normal is up to 42)

AST 102 u/L (normal is up to 37)

Alk phos 306 U/l (60-306)

Nuc med thyroid scan demonstrates diffuse increased uptake equal throughout the thyroid gland with no areas suggestive of a hot or cold nodule.

Thyroid sono demonstrates enlarged, hypervascular thyroid with no discrete nodules

What is concerning about her laboratory results and what could be causing it?

What do you think is the etiology of her thyroid condition?

What are her treatment options?

Allison opts to proceed with a total thyroidectomy. Post operatively, she complains of pins and needles in her hands and on exam, you note a positive Chvostek’s sign and positive Trousseau’s sign.

What surgical complication might Allison be experiencing?

What treatment should be ordered?

What patient counseling should be provided to a patient who has just undergone a total thyroidectomy? Any other meds we need to discuss?

Allison’s surgical pathology returns as follows:

Chapter 28: Growth and Development of the School-Age Child 1, Gina has come into the primary care centre with her mother Kris for an 11-year-old wellness examination. As the nurse prepares Gina for her examination, Kris asks to speak to the nurse outside the examination room.

Kris shares with the nurse her concerns about recent changes she has noticed in Gina. She explains that Gina’s body is beginning to change and she has made a number of comments about her body image. Kris is concerned about Gina’s self-esteem and emotional development.

(Learning Objectives 1, 2, and 3) a. What are some of the prepubescent changes school-age children experience that the nurse can share with Kris? b. What are some of the issues regarding body image that the nurse can teach Kris about?

c. What can the nurse teach Kris regarding self-esteem in school-age children to address her

Make a list of the vascular access devices available for delivery of solutions and medications into a vein. Include a brief description of the device, the length of time the infusion therapy is needed, the type of medication or product that will be delivered intravenously, the patient’s individualized needs that determine which option is used, and the nursing care involved.

1. Use the Internet to research how the organs function to maintain fluid homeostasis.

A 67-year-old client had an epidural catheter inserted for pain management following a total knee replacement. After successful treatment of an episode of hypotension in the postanesthesia care unit (PACU), he was transferred to the medical-surgical unit. The registered nurses assessed the client and delegated direct care to an LPN, although the LPN denied this.

Three hours later, the client experienced nausea and vomiting. The client was found cyanotic and unresponsive 10 minutes later and subsequently died of anoxic encephalopathy. Many facts were disputed among the numerous codefendants and there was poor documentation (Nurses Service Organization, 2012).

1. What priority assessments were missed, and how could this have been avoided?
2. What steps of the nursing process were done inappropriately or missed completely, and why?
3. What steps of the delegation were inappropriate, and why?
4. What could have been done to prevent this outcome?

Citation: NSO. (n.d.) Nurse case study: Failure to assess and monitor the patient post-operatively. (2017). https://www.nso.com/Learning/Artifacts/Legal-Cases/Nurse-Case-Study-Failure-to-adequately-assess-and-monitor-the-patient-post-operatively-resulting-in