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- Case Study 2Respiratory DrugsBrett is a 12 y/o boy with a history of asthma, diagnosed 2 years ago. He is an outgoing, active boy and participates in a swim club and soccer, but he has a difficult time adjusting to the limitations of his asthma. He has learned to control acute attacks by using albuterol (Proventil) metered-dose inhaler, and because his asthma is often triggered by exercise, he has been using a budesonide (Pulmicort) inhaler and taking montelukast (Singulair). After competing in his swim meet at the local indoor pool, Brett began experiencing respiratory distress. He alerted his coach, who retrieved the albuterol inhaler from Brett’s backpack. After two inhalations, Brett was still in distress and the rescue team was called.On admission to the emergency department, Brett is in obvious distress with pulse oximeter readings of 90% to 91%. He has nasal flaring and bilateral wheezing is heard in is his lung fields, pulse rate is 122 beats/min, and he is orthopneic.…What are 3 interventions with rationale for a patient with impaired gas exchange, acute pain, and imbalanced nutrition due to lung cancer.John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Preventing complications of surgery is an important part of all surgical patient care. What preoperative While Mr. Doe is in the Operating Room, what considerations will be taken to ensure Mr. Doe’s safety and positive outcome? Identify 2 IntraOp nursing diagnoses for Mr. Doe teaching does Mr. Doe require in order to prevent complications? Give 3-4 examples)
- CASE SCENARIOMr. Y is a 59-year-old Head of the Accounting Department in a certain Information and Technology Company. While having his breakfast at home, Mr. Y suddenly experienced slurring of speech, facial droop on the left side with weakness in left side of upper and lower limbs. His wife noted these sudden onset of symptoms and immediately called for help. Past health history revealed asthma which started at age 8. He was on prediabetes state 5 years ago and was diagnosed with Hypertension Stage 1 three years ago. He used to work for 50-60 hours per week as compared to his working hours during the pandemic which is recently reduced to 30 hours per week. Minimal change in lifestyle was done after he was diagnosed with hypertension, but remains a smoker for approximately 39 pack years. A social beer drinker about 10 standard drinks per week at 3-4 sessions. Outside work, he enjoys playing online games. Upon assessment patient was confused, with mild left sided neglect and altered…Case Study #3 than one block. The chest discomfort is diffuse, and he cannot localize it; sometimes it radiates to his lower jaw. The discomfort is more severe when he walks after meals but is relieved within 2-3 minutes when he stops walking. A 74-year-old man presents with a history of anterior chest pressure whenever he walks more Questions: 1. Assuming that a diagnosis of classic angina is correct, what medical treatments should be implemented to reduce the acute pain of an attack, to prevent future attacks, and to reduce the chance of blood clotting?Case Scenario John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Dr. Ramos is Mr. Doe’s surgeon and Dr. Reyes is Mr. Doe’s anesthesiologist. Both come to see him and discuss the surgery the evening before. How does the nurse ensure informed consent? What must the patient consent to for the procedure to be done? (Discuss in 5-6 sentences)
- CASE STUDY - SHOCKYou and your partner are dispatched for a report of an unresponsive 77-year-old male in asenior’s apartment complex. The time of the call is 08:36 am.Upon arrival, a home health aide greets you at the apartment door and informs you thepatient is in the bedroom. As she leads you towards the bedroom, the aide begins to tellyou she arrived for work about an hour ago and found the patient in his bed. “He normallyis awake when I get here, but today I found him still in his bed. I thought he was onlywanting to sleep in so I decided I would give him a little time, but he didn’t respond when Itried to wake him a few minutes ago.”She tells you she routinely visits Mr. Oliveira twice a week to help with cleaning andcooking. She says, “The last time I saw him was 3 days ago and he was sick at the time. Ithought he might have come down with a bad cold because he was coughing a lot and Itried to encourage him to see his physician.”As you approach the patient’s bedside, you observe…2020SP Case Study RHK is a 68 year old man who has been brought to the ER by his son. The two were outside planting spring bulbs when RHK passed out after standing up from a kneeling position. His son managed to break the fall and there is no injury associated with the incident. Afterward, there was a brief period of chest discomfort and shortness of breath. RHK reports feeling lightheaded with some palpitations just before he fainted. He reports feeling pronounced weakness during the prior week. He is two years post CABG. He has no previous episodes of fainting or recent illnesses. He has no other complaints. The patient lives with his wife, uses alcohol occasionally, past tobacco use, no drug use Past medical history includes MI, CAD, 4 vessel CABG, hypercholesterolemia, claudication, and paroxysmal AF. Medications include warfarin 2mg PO QD, Metoprolol 25mg PO QD, Simvastatin 20mg PO QD, Triamterene/HCTZ 25mg PO QD, amiodarone 200mg PO QD Vital Signs BP 116/53 RR 16 HR 52 Oxygen…Case Study 3 – Congestive Heart Failure Dottie is a 78-year old CHF patient. She has been exercising with your facility for several years now. She had a CABGx3 in 2020. She came in today with a 5 lb. weight gain since yesterday when she weighed on her home scale this morning. Her meds include- Lipitor, Procardia, and Lasix. (Cholesterol, Calcium channel blocker Hypertension, and Diuretic, respectively) Her blood pressure is 132/88 and her HR = 102; Her weight is 196, up from 191 when last measured. She is a pleasant, overweight individual who enjoys walking on the treadmill and visiting with other members of your facility. 1. What are specific considerations for someone with CHF and exercise? How is the exercise prescription any different from the apparently healthy adult prescription? 2. What is your biggest concern with Dottie today and how would you handle this concern(s)?
- Case Scenario John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Summary: Given case: 53 years old, male History of Type-1 diabetes mellitus, CAD ( Coronary Artery Disease) PAD ( peripheral artery disease) Cigarette smoking 40 packs per year COMPLAINTS: 6 weeks ago, he developed a wound in his left heel. Despite antibiotics, patient developed a gangrene infection. ADVISE: To undergo BKA ( Below knee amputation) of left lower extremities MEDICATION: Daily insulin, aspirin 325 mg /day, pletaal 100 mg BD Post-operative Data: Post-operatively, Mr. Doe goes to the Post Anesthesia Care Unit…*Case Study* A 2-year-old boy fell from a backyard gym set. His shoulder and upper arm became very swollen shortly after the fall. The boy’s mother took him to the emergency department a few hours after th incident because he was complaining of pain. On physical examination, the physician noted that large hematoma had formed in the upper part of the boy’s right arm. There was no history of surgery (he had not been circumcised), injury, or illness. The boy was receiving no medication. Emergency department treatment consisted of aspirating the hematoma Subsequent to this treatment, the boy began to bleed extensively. He was admitted to the hospital. The following laboratory tests were ordered: a hemoglobin and hematocrit, platelet count, and bleeding time. Because the bleeding continued, a type and crossmatch for two units of fresh blood were ordered on a standby basis. Additional information from the mother revealed that the boy’s cousin had “bleeding problem.” Laboratory Data…b. What is her CrCl? 4. J.C., a 70 year old male (5'8", 100 kg) is to begin Vancomycin (along with Zosyn and Levaquin) for broad-spectrum coverage for pneumonia (moderate infection with goal AUC 500-600). WBC=13.8, SCr=0.9 mg/dL. Using AUC dosing, please come up with a dosing regimen that is appropriate for JC. a. What is the dosing weight? CrCl ? b. What LD & MD & interval would you recommend? c. When should you order a vancomycin trough for J.C? Now, lets adjust his dose Assume his initial dose was 1750mg g 12h scheduled at 0900 & 2100. Assume his doses were given on time. The hospital policy required an infusion time of 2hr. The peak was 45ug/ml drawn after the 4th dose at 1230, 3.5hr after the start of the infusion. The trough level was 21ug/ml drawn at 2030, 11.5hr after the 4th dose. How would you adjust the dose? a. Calculate the patient specific k b. Calculate Cmax & Cmin c. Calculate the AUC d. Calculate patient specific Vd e. Calculate new dosing interval f. Calculate new…