Using the topic Resources, consider R language definitions. Define the term data structures or objects in R and discuss several examples (e.g., vectors, lists, language objects, symbol objects, expression objects, function objects, NULL). All R objects have attributes. What is the purpose of attributes?
Describing an unethical use of electronic health information of which you are aware. It may or may not be an event that took place at your employer. Describe what led up to the event, how it happened, and how it was (or was not) properly addressed by the person(s) in charge of protecting personal health information.
Suggest strategies for avoiding such events in the future. Consider risk mitigation, security procedures, ethical and legal issues, data protection, and possible policies and regulations
Explain this question. Local anesthesia. Lidocaine is the prototype
Why and when would epinephrine be added to the use of lidocaine?
Topical lidocaine—patient teaching. Just a general reminder—topical is meant to stay “topical” (versus transdermal, which is applied to the skin to intentionally enter the body)
Local anesthetics are what are used in spinal and epidural anesthesia. Review concerns for patients receiving the medications via this route.
General Anesthesia
What is balanced anesthesia?
Inhaled anesthesia is the main focus of the chapter, but again, it is rarely the only substance used because there is no “ideal” agent, so some of the above listed drugs are added to improve the experience
How do they work?
What are the major adverse effects? You need to know what to be concerned about when the post-op patient returns to their room after receiving an inhaled anesthetic.
Neuromuscular blocking agents
Many students believe this is also an anesthetic-it is NOT
Acetylcholine has to attach to the nicotinic m receptor on skeletal muscle to cause muscle contraction. If it does not, then the muscle becomes flaccid (paralyzed)
These drugs do NOT cross into the brain and have no effect on the level of consciousness—if this is the only drug on board, the patient can hear everything, but cannot move, speak, blink, because the person is paralyzed.
Review both depolarizing and non-depolarizing neuromuscular blocking agents to understand the differences. End result is flaccid paralysis.
Your patient has received a neuromuscular blocking agent during surgery and is now post-operative. What are the nurse’s priority concerns?
What is malignant hyperthermia?
What are the risk factors for developing it?
What are the symptoms?
What is the treatment?
What are the concerns with the use of ketamine?
What is nitrous oxide used for?
What makes propofol so dangerous?
CNS Stimulants
Amphetamines in general are used therapeutically for?
What are the effects of caffeine?
All CNS stimulants in excess amounts can cause?
Endocrine System
Growth Hormone (Somatropin)
Somatostatin can be used to treat acromegaly—how does it work?
What is Diabetes Insipidus?
ADH is produced in the hypothalamus and stored in the posterior pituitary gland
Its release is affected by serum osmolarity (you should know what that is—it is the amount of solute in relation to the fluid in the blood stream)
When serum osmolarity is high (there is a lot of solute in relation to the water—imagine ingesting a very salty meal), ADH is released and causes the kidneys to reabsorb water (to dilute that excess solute) and restore the serum osmolarity to normal. This results in decreased urine output (because more water is being retained) and the urine is more concentrated and has a higher specific gravity/urine osmolarity
Some people do not make ADH or it does not work.
This causes DI/Diabetes insipidus, which means excessive urine output.
Thyroid gland
Review how and when the following drugs are used in thyroid disorders? (Hyperthyroidism, hypothyroidism, thyroid storm, myxedema)
Review the major side effects and nursing interventions
Adrenal Gland
Glucocorticosteroids (Cortisol)
Hydrocortisone is the prototype and has BOTH glucocorticoid and mineralocorticoid functions
Mineralocorticosteroids (Aldosterone)
Fluticasone is the prototype for this drug
What drug would be used if there was excess mineralocorticoids?
Something you would have covered in pharm 1 is the difference between physiologic and pharmacologic dosing of these substances.
Glucocorticosteroids are frequently used to treat inflammatory conditions because they block the production of a number of the inflammatory mediators. The dose will be bigger than a replacement dose and is called a pharmacologic dose. When given this way, they produce more adverse effects because of the size of the dose—what are those adverse effects and what teaching should be done to deal with them? (Think “Cushing’s)
On the other hand, if the adrenal gland does make the hormones, the replacement dose will be small (similar to what the body would make on its own). But, because the body would increase it if the person was experiencing stress, the patient will need to be taught to do that too.
Female Reproductive drugs
What are estrogen and progesterone?
What are the reasons for giving a woman hormone replacement? What increases the risk of adverse effects? What are the most concerning adverse effects?
How do oral contraceptives work to prevent pregnancy? (As I write “oral” I imagine that descriptor will change as these drugs can be delivered in a great many different ways, including via rings, transdermal patches, BUT, the mechanism of action is the same.
Clomiphene is the prototype for fertility drugs
Drugs used in Pregnancy—focus here is on how they work, major adverse effects and not on how to fine tune dosing (that is for maternity)
Tocolytics?
I will remind you here that, glucocorticoids are used in preterm labor—why????
What is the purpose of the prostaglandin dinoprostone?
Oxytocics?
Male Reproductive Drugs
What is testosterone?
Sildenafil is the prototype for ED drugs
BPH
What is BPH?
Review the 2 types of drugs to treat it and adverse effects and precautions with each
ROOM ASSESSMENT SIM: Discuss your assessment of the patient’s arm in a What do you few words. What are safety precautions to consider see here? for this patient? What are your concerns and why? MD ORDERS DURING SIM. Additional Orders State 1: . Diphenhydramine hydrochloride 25 mg IV x1 for allergic reaction > What are the primary areas of focus as you continue to . Dexamethasone 10 mg IV x1 for allergic reaction manage this patient?
Epinephrine 1:1000 (1 mg/ml) concentration. Administer 0.5 mg IM x1 for allergic reaction . > After self-reflecting and debriefing, how would you manage this patient in the future? Physician Signature: Dr. Ellen Englebert. Which one would you give first to the patient? What is the most fast-acting? . >
What immediate independent actions could you do to manage the situation? . > Given the history presented and your assessment findings, what did you feel was wrong with the patient > Did this situation require immediate attention or could it wait for routine assessment and reporting? (main problems)? >What needs would you anticipate in this situation? >
How did you decide what to report and to whom? >What could you do or how would you prepare for those needs? > What was the urgency level? >
How would you access resources? > Was there an organized manner in which you reported it? > What was the rationale/reasoning behind your actions? am trying to answer all these question for a simulation, thank you
Assuming you have no limitations on money or resources and that you have full authority to make changes, propose your innovative solution to alleviate that stressor. In detail discuss a nursing experience that you have encountered in your practice that frustrates you when dealing with it. The more detail the deeper we can dig into the discussion.
Applying a Person-Centered Approach. Consider the following scenarios and detail how we can support people living with a disability engage and be involved in the local community. Provide suggestions to assist that person to participate in the wider community.
Scenario One David is a HUGE Collingwood fan but he sits alone in his room and watches the games on TV.
Jimmy Lewis is brought to the hospital emergency department by some friends. He had been vomiting for several days and was complaining of heart palpitations. Mr. Lewis is a 58-year-old white man who is homeless. He has not had any health care for at least 10 years. He is an alcoholic and drinks 1 quart of gin or vodka every day.
He does not have a job, and his family is all out of state. The emergency physician does an initial assessment and transfers him to a hospitalist, who admits him to a medical-surgical unit for further evaluation and treatment.
Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium, 138 mEq/L; potassium, 3.1 mEq/L (low); chloride, 104 mEq/L; and magnesium, 1.5 mEq/L (low). His arterial blood gas measurements are as follows: pH, 7.48 (high); PaCO2, 40 mm Hg; and HCO3, 29 (high). Jamie Taylor, a 22-year-old nursing student, is assigned to Mr. Lewis. She reviews Mr. Lewis’ medical record before going in to assess him.
Question 1 After reviewing his chart and lab work, what fluid and electrolyte imbalances would Jamie determine? Question 2 What type of acid-base imbalance is Mr. Lewis experiencing?
Question 3 The hospitalist orders an IV of D5NS to run at 125 mL/hr. What type of fluid is this? Question 4 Two hours after the IV is started, Mr. Lewis complains of pain at the insertion site. Jamie assesses the site and notes that it is cool to the touch around the site and is edematous. She tries to obtain a blood return and does not get any return.
This indicates what type of problem, and what action should she take?
Label the following structures: Aorta, Brachiocephalic artery (if seen), Left atrium, Left ventricle
Are these properly labeled?
Please complete the Reflection Journal for the concept of Development linked to your clients for the day. Submit a Reflection Journal answering these 4 questions: Which other concepts relate to the main concept in this scenario; explain why these concepts are important and how they are relevant to the scenario?
2. What abnormal signs and symptoms did you recognize and how did you prioritize your care of this patient?
3. How would you change your actions or interventions if you had a second chance to care for this patient?
4. How would you apply what you have learned from this scenario to future patients?
Please answer these questions on the patient below named Daanis Lafontain, you can easily google this but I need help with this so much. Thank you
Focused Exam: Uncomplicated Delivery
Daanis LaFontaine
Two state troopers have just burst into your healthcare facility demanding immediate help in tracking down a prisoner on the run. They believe the man may be responsible for an area carjacking, and they have a written request for a description of any distinguishing physical characteristics, such as scars and tattoos.
The electronic health record reveals that the man has a large heart on his upper arm with the name “Pookie” written inside it.
However, the officers do not have a warrant for the information. Can you give it to them? Does it matter whether the fugitive has committed a violent or a nonviolent offense?
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