NR305
Week 1 Discussion DQ 1 & DQ 2
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DQ 1
As the
school nurse working in a college health clinic, you see many opportunities to
promote health. Maria is a 40-year-old Hispanic woman who is in her second year
of nursing school. She complains of a 14-pound weight gain since starting
school and is afraid of what this will do to both her appearance and health if
the trend continues. After doing her history, you learn that she is an
excellent cook and she and her family love to eat foods that reflect their
Hispanic heritage. She is married with two school-age children. She is in class
a total of 15 hours per week, plus 12 hours of labs and clinical. She maintains
the household essentially by herself and does all the shopping, cooking,
cleaning, and chauffeuring of the children. She states that she is lucky to get
six hours of sleep per night, but that is okay with her. She lives one hour
from campus and commutes each day. UsingHealthy People
2020and your text as
a guide:
What
additional information would you like to gather from Maria?
What are
Maria’s real and potential health risks?
Why is
Maria’s culture important when obtaining the health assessment?
Pick one of
Maria’s health risks. Would you classify Maria’s problem as first-level
priority, second-level priority, third-level priority, or a collaborative
problem? What would be one reasonable short-term goal for this risk?
DQ 2
Understanding
cultural phenomena is essential to the completion of an accurate and holistic
health assessment. Please review a cultural group from Table 2-3 (p. 20) from
your text and describe the cultural differences pertinent to that group (you
may have to do some additional searching). Remember, the table may not include
all cultural groups. Let’s try to include all the countries within the groups
listed in the discussion, so please do not choose a group that has already been
done. To expedite this, please use the group name in the title of your post.
NR305 Week 2 Discussion DQ 1 & DQ 2
DQ 1
John, a
46-year-old African American male presents for admission to your hospital for
hemi colectomy for colon polyps. He is complaining of chronic back pain.
Patient is on disability from work-related injury. History of two previous back
surgeries with relief of numbness in RLE, but pain has not been relieved. His
current medications include Methadone, Neurontin, and Norco. John states he
takes Tylenol PM every night in addition to his prescribed medications. John is
a smoker and smokes 1 PPD. John confides in you that he is considering a spinal
cord stimulator for the chronic pain.
What risk
factors does John have for risk of opioid withdrawal during this
hospitalization?
Is there a
stigma connected to being disabled and/or methadone?
Does the
nurse need to be concerned about acetaminophen use?
What are the
differences in acute and chronic pain?
DQ 2
Red Yoder is
an 80-year-old farmer who lives alone in the farmhouse where he grew up. It is
located 20 miles outside of town. Red has been a widower for 10 years. Red
rarely cooks for himself and mainly eats packaged or processed foods. His son,
Jon, manages the farm now, but Red is still involved in the decision making.
Red’s current medical problems include insulin-dependent diabetes complicated
by an open foot wound. He also has some incontinence and difficulty sleeping.
Red is
awaiting a visit from the home health nurses. He relates that he has an open
wound on his big toe that developed after walking in a new pair of shoes. When
his daughter-in-law, Judy, saw the wound, she called the family doctor, who
suggested a visit by the wound care nurse, who works with the home health
agency. Red agreed as long as his VA benefits cover the costs. Red is aware
that his son and daughter-in-law have concerns about him living alone, but Red
insists that while he needs a little help from Jon and Judy at times, he is
still capable of caring for himself.
What are
Red’s strengths?
What are
your concerns for this patient?
What is the
cause of your concern?
What
information do you need?
What are you
going to do about it?
What is Red
experiencing?
NR305
Week 3 Discussion DQ 1 & DQ 2
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?
NR305
Week 4 Discussion DQ 1 & DQ 2
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?
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