Devry NR305 Week 3 Discussion DQ 1 & DQ 2 Latest 2015 November DQ 1 General Survey and Health History (graded) Casey is a 17-year-old high school student admitted to the ER with a compound fracture of the left leg obtained when falling at the local skateboard park while practicing for a national competition. He has never been hospitalized before. His mother has been notified and is on her way. The EMTs gave him morphine and he reports his pain level as “okay.” What part of the interview and examination can be done prior to his mother’s arrival? As you enter the room for the first time, what should you observe as part of the general survey? As you complete his history, what areas are especially important? What are the important developmental considerations for Casey? DQ 2 As you recall, our older patient, Red Yoder, with whom you met in Week 2, is preparing for discharge from the hospital since his wound required intravenous antibiotics and wound care. Jon (Red’s son) thinks that Red should move in with him for now, but Red is sure he is able to care for himself and insists that his confusion was due to the fact that he did not have his glasses or hearing aids for the last week. You have identified discharge teaching needs for him. This morning, however, in report the night nurse has shared “Patient is alert and oriented; vital signs stable. Fasting blood sugar this morning is 118. Red had his usual night of sleep. He was up several times to go to the bathroom. Since his catheter was removed yesterday, he has urgency incontinence. He is able to ambulate to the bathroom, but he is weak.” You administer his AM medications and note that he has some difficulty grasping the water cup and needs assistance holding it. Mr. Yoder states he needs to go to the bathroom and when you assist him up to his feet, he seems a bit unsteady. He takes several steps and tells you he needs to sit down. How much, if any, functional decline has occurred while Red was hospitalized and how will this affect his recovery? What are the risks and benefits of Red living with Jon and Judy? What are the risks or benefits of Red living at home after discharge? If services are in place, would it be considered a safe discharge? Considering all aspects of aging, what are the best and appropriate options for Red at this time? Devry NR305 Week 4 Discussion DQ 1 & DQ 2 Latest 2015 November DQ 1 William Smaile is a 65-year-old man who presents to his general practitioner’s office with complaint of right forearm swelling, redness, and pain. He was recently discharged from the hospital where he had been receiving intravenous antibiotics for a respiratory infection. Subjective Data Pain level is a 5/10 location = right forearm, aching Retired foreman at a local industrial plant Objective Data Vital signs: BP 150/68, T 37 degrees Centigrade, P 80, R 16 Swelling and reddened right forearm, warm to touch + pulses, brachial and radial (R) +2 capillary refill fingers right hand What other assessments should be included for this patient? From your readings, what is the most probable cause of the swelling? What is your nursing diagnosis? What would be included in the nursing care plan? What interventions might be included in the plan of care for this patient? DQ 2 Assessment of the Head, Neck, and Regional Lymphatics (graded) Describe the characteristics of the lymph nodes associated with the disease states listed below: (Choose one.) Acute infection Chronic inflammation Cancer week 5 DQ 1 Kevin Valeri is a 64-year-old man who presents to the gastroenterologist’s office with constipation and abdominal bloating. Subjective Data Pain level is a 4/10 location = right lower abdomen Retired Engineer States he has been going to the bathroom with the help of laxatives, but not having regular movements Appetite is decreased, some nausea PMH: depression, anxiety, chronic constipation Objective Data Vital signs: T 37 degrees Centigrade, P 64, R 16, BP 124/58 Bowel sounds hypoactive in all four quadrants Medications: Lamictal 200mg daily, Lexapro 10 mg daily Weight = 210 lbs, last visit weight = 195 What other assessments should be included for this patient? What questions should the nurse ask with regard to the abdominal pain? From the readings, subjective data, and objective data, what is the most probable cause of the abdominal pain? What should be included in the plan of care? What interventions should be included in the plan of care for this patient? DQ 2 Choose one topic and respond: Discuss three ways of creating an environment that provides psychological comfort for both patient and practitioner when conducting an examination and assessment of the Genitourinary system. Discuss medications that can affect the sexual performance of an aging adult male, possibly resulting in withdrawal from sexual activity. Discuss circumcision and the arguments for and against it. Discuss its associated religious connections. week 6 DQ 1 Georgina Graves is a 42-year-old female who presents to the provider’s office with fatigue. Subjective Data PMH: none, (except gynecological issues) Significant family history of heart disease Fatigue started about 2 months ago, getting worse Relieved with rest, exacerbated with activity Denies chest pain C/O shortness of breath on exertion Smoker 1 PPD Objective Data Vital signs: T 37 P 100 R 18 BP 110/54 Lungs: clear O2 Sat = 94% Skin = cool to touch CV = heart rate regular, positive peripheral pulses, ECG = intermittent complete left bundle branch block (New Finding) Edema Medications: Premarin 0.3 mg po/day What other questions should the nurse ask about the fatigue? What other assessments would be necessary for this patient? What are some causes of fatigue? What should be included in the plan of care? Based on the readings, what is the most likely cause of fatigue for this patient? DQ 2 Nelson Carson is a 62-year-old man who presents to his private practitioner’s office with a hacking, raspy cough. Subjective Data PMH: HTN, CAD Cough is productive, bringing up green, thick phlegm Runny nose, sore throat No history of smoking or seasonal allergies Complains of fatigue Objective Data Vital signs: T 37 P 72 R 14 BP 134/64 Lungs: + Rhonchi bilateral upper lobes, wheezes O2 Sat = 98% Medications: Metoprolol 25 mg per day, ASA 325 mg/daily What other questions should the nurse ask about the cough? What nursing diagnoses can be derived from the data? What should be included in the plan of care? What risk factors are associated with this age group? Based on the readings, what is the most likely cause of cough for this patient? week 7 DQ 1 Jonah Kotter is a 5-year-old male preschooler who presents to the pediatrician’s office for complaints that his leg “hurts”. Subjective Data PMH negative Immunizations: Up to date No medications No allergies Pain: 3/5 on pain scale Attends Kindergarten Does not remember injuring leg Objective Data Vital signs: T 37 degrees Centigrade, P 94, R 18, BP 100/70 Lungs: clear Heart rate and rhythm regular Moving all extremities + Range of motion legs and arms Strength 5/5 in all extremities What other questions should the nurse ask? What techniques are helpful to incorporate in assessing a patient in this age group? What are a few of the major differences in the musculoskeletal assessment of a child? What should be included in the plan of care? Based on the readings, what is the most likely cause of leg pain for this patient? DQ 2 Read the case study below and respond to two of the questions below. Make sure you respond to a classmate as well, before the week ends. Katherine Trembly is a 67-year-old woman who presents to the neurologist’s office after referral from her PCP (primary care provider) for a seizure. Subjective Data PMH: Seizure, hypertension, anxiety Retired book keeper C/o being “tired” Periods of unresponsiveness to verbal stimuli Objective Data Vital signs: T 37 degrees Centigrade, P 80, R 18, BP 174/84 Lungs: clear O2 Sat = 98% Heart rate regular, + peripheral pulses What other questions should the nurse ask? What techniques are helpful to incorporate in assessing a patient in this age group? What are some of the more common conditions that may cause seizure activity in this age group? What diagnostic tools will the physician use to diagnose this condition? What should be included in the plan of care? week 8 ek 8 Discussion 1 Give an example of a rapid assessment of a client and provide a SBAR report to a classmate. Remember to include all concepts of patient safety, standard precautions, and professional standards. OR Finish the story on our subject, Mr. Red Yoder, who is a patient you met in Week 2 and wrote a teaching plan on. What do you think his status might be today? Remember to include all concepts of patient safety, standard precautions, and professional standards
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