case study 13 2025

Case Study, Chapter 13, Fluid and Electrolytes: Balance and Disturbance 1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. What are possible causes of a low potassium level? What action should the nurse take in relation to the serum potassium level? What clinical manifestations might the nurse assess in Mrs. Dean? 2. Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. The following results are returned from the laboratory: Sodium (Na+) 150 Potassium (K+) 5.5 Chloride (Cl¯) 110 BUN 42 Creatinine 0.8 Glucose 86 pH 7.32 PaCO2 35 HCO3¯ 20 PaO2 90 O2 Sat 98% What is your interpretation of this arterial blood gas sample? Explain the high potassium in this patient. Calculate the patient’s anion gap: What is the interpretation of this anion gap?

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case study 2025

Assignment: Complete the following: Mexican case study #2 Puerto Rican case study #2 Version:1.0 StartHTML:000000480 EndHTML:000049909 StartFragment:000001223 EndFragment:000049877 StartSelection:000001535 EndSelection:000049877 SourceURL:https://classroom.aspen.edu/d2l/common/assets/pdfjs/1.0.0.30/web/viewer.html?file=%2Fcontent%2Fenforced%2F43768-N512-KK8-08-20-19-Sect2%2FCaseStudies.pdf%3Fd2lSessionVal%3DglW6MPAb8f19FLpB5Bx8XsIpt%26ou%3D43768&lang=en-us&container=d2l-fileviewer-rendered-pdf&fullscreen=d2l-fileviewer-rendered-pdf-dialog&height=1186 PDF.js viewer MEXICAN CASE STUDY #2 Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have tw o children: Roberto, aged 7, and Linda, aged 18 months. Olga’s two younger sisters, Floren cia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, ag ed 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware fo r 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for l earning English, even though free classes are available in the community. Olga ’s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty w ith his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks mi nimal English, drinks beer heavily, and occasionally works picking vegetables. The Ga borra family lives in a trailer on a large vegetable farm. The house has cold runni ng water but no hot water, has an indoor bathroom without a shower or bathtub, a nd is heated with a wood-burning stove. The trailer park has an outside shower, wh ich the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby a nd picking vegetables. When the vegetable- picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their inco me last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines. Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out “chits” to the vegetable picker s so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years a nd sporadically takes medication from a local clinic. When he is not traveling or is t oo busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family s ubscribes to the hot and cold theory of disease and health-prevention maintenance. Study Questions 1. Identify three socioeconomic factors that influence the health of the Gaborra family. 2. Name three health-teaching interven tions the health-care provider might use to encourage Olga to seek treatment for her anemia. 3. Identify strategies to help improve communications in English for the Gaborra family. 4. Identify three health-teaching goals for the Gaborra family. 5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda. 6. Discuss three preventive maintenanc e–teaching activities that respect the Gaborra family’s belief in the hot an d cold theory of disease management. 7. Identify strategies for obtaining h ealth data for the Gaborra family. 8. Identify four major health problems of Mexican Americans that affect the Gaborra family. 9. If Olga were to see a folk practitioner, which one(s) would she seek? 10. Explain the concept of familism as exhibited in this family. 11.  Distinguish  between  the two culture-bound syndromes el ataque and susto . 12. Discuss culturally conscious health-car e advice consistent with the health- belief practices of the pregnant Mexican American woman. 13. Discuss two interventions to encour age Mexican American clients with tuberculosis to keep clinic appointment s and to comply with the prescribed medication regimen. 14. Identify where the majority of Mexican Americans have settled in the United States. NAVAJO CASE STUDY Mr. Begay, aged 78, lives with his wife in a traditional Navajo hogan. He has lived in the same area all his life and worked as a uranium miner until the government closed the mines. His hogan has neither electricity nor running water. Heat is provided by a fire, which is also used for cooking. Lighting is obtained from propane lanterns. Water is hauled from a windmill site 20 miles aw ay and stored in 50-gallon steel drums. Because the windmill freezes and the roads are often too muddy to travel in the winter, sometimes he must travel an additional 10 miles to the trading post to obtain water. Because Mr. Begay does not own a car, he must depend on transportation from extended family members who live in the same vicinity. Mr. Begay has continually experienced shortness of breath, and it is getting worse. He has been hospitalized with pne umonia several times as a result of the uranium poisoning. He had a cholecystectomy at age 62. His diet is traditional and is supplemented by canned foods, which ar e obtained at the trading post. All health care is obtained at the Publ ic Health Service Hospital in Shiprock. Neither Mr. Begay nor his wife obtain routin e preventive-health care. He was admitted from the clinic to the hospital with a diagnosis of pneumonia. Mr. Begay shows clinical improvement after initial intravenous antibiotic therapy. However, his mental status continue s to decline. His family feels that he should see a traditional medicine man a nd discusses this with his physician. The physician agrees and allows Mr. Begay to go to see the medicine man. Several members of the nursing staff disagree with the physician’s decision and have requested a patient-care conference with the physician. The physician agrees to the conference. Study Questions 1. Identify three physical barriers Mr. Be gay must overcome to obtain health care. 2. Discuss the benefits of Mr. Bega y’s seeing the traditional medicine man. 3. Identify some potential negative outcomes of Mr. Begay’s seeing the traditional medicine man. 4. Identify culturally relevant interventions to reduce the potential for the recurrence of pneumonia. 5. Identify at least two majo r health risks that the Begays face, based on their current lifestyle. 6. Discuss potential outcomes fo r negotiation during the conference. 7. Mr. Begay’s diet is described as traditi onal Navajo. What foods are included in this diet? 8. Because of his continued need for oxygen, what services do you anticipate for Mr. Begay when he returns home? 9. What might the nurse do to encourag e preventive-health measures for the Begay family? 10.  Identify at least three types of traditional Navajo healers. 11.  Identify contextual speech patterns of the Navajo Indians. 12.  Distinguish differences in ge nder roles among Navajo Indians. 13.  Identify two culturally congruent teac hing methods for the Navajo client. 14.  Discuss the meaning of the First Laugh Ceremony for the Navajo. 15.  Identify two culturally congruent approach es for discussing a fatal illness with a Navajo client. More InformationLess Information Close Enter the password to open this PDF file. OKCancel File name:- File size:- Title:- Author:- Subject:- Keywords:- Creation Date:- Modification Date:- Creator:- PDF Producer:- PDF Version:- Page Count:- Close @media print {  #printContainer div {  page-break-after: always;  page-break-inside: avoid;  } }  #mozPrintCallback-shim {  position: fixed;  top: 0;  left: 0;  height: 100%;  width: 100%;  z-index: 9999999; display: block;  text-align: center;  background-color: rgba(0, 0, 0, 0.5); } #mozPrintCallback-shim[hidden] {  display: none; } @media print {  #mozPrintCallback-shim {  display: none;  } } #mozPrintCallback-shim .mozPrintCallback-dialog-box {  display: inline-block;  margin: -50px auto 0;  position: relative;  top: 45%;  left: 0;  min-width: 220px;  max-width: 400px; padding: 9px; border: 1px solid hsla(0, 0%, 0%, .5);  border-radius: 2px;  box-shadow: 0 1px 4px rgba(0, 0, 0, 0.3); background-color: #474747; color: hsl(0, 0%, 85%);  font-size: 16px;  line-height: 20px; } #mozPrintCallback-shim .progress-row {  clear: both;  padding: 1em 0; } #mozPrintCallback-shim progress {  width: 100%; } #mozPrintCallback-shim .relative-progress {  clear: both;  float: right; } #mozPrintCallback-shim .progress-actions {  clear: both; } Preparing document for printing…  0% PUERTO RICAN CASE STUDY #2 Carmen Medina, aged 39, lives with he r husband, Raúl, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, José; a 16-yea r-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school afte r completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medina’s job. They live in a three- bedroom apartment in a low-income Illinoi s community. Miguel works in a fast-food store a few hours a week. Because Rosa has re sponsibilities at home, the Medina’s do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Mi guel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telli ng the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosa’s and Miguel’s developmental and behavioral challenges. Although Mrs. Medi na is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is mo re preoccupied with the family’s financial situati on. Mrs. Medina’s parents are en couraging them to return to Puerto Rico. Mr. Medina was diagnosed with hypertensi on 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medina’s last physical examination was after she had José. She is experiencing insomnia, tiredness, headach es, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the family’s finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions 1. Explain Mrs. Medina’s attitude in her relationship with her adolescent daughter. 2. Identify strategies to ensure that Rosa seeks prenatal care. 3. Identify barriers to accessing heal th care for the Medina family. 4. What are the high-risk behaviors exhibited by this family? 5. What communication barriers exist in this family that affect care delivery? 6. Discuss gender and family roles in th e context of traditional Puerto Rican culture. 7. Identify sociodemographic factors af fecting the physical- and mental- health well-being for this family. 8. Identify Puerto Rican folk practices appropriate for this family.

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Topic 5 DQ 2 2025

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

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soap note (Gastritis) 2025

Follow the Soap Note Rubric as a guide: Grading Rubric Student______________________________________ This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up. 1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number. 2) Subjective Data (___30pts. ): This is the historical part of the note. It contains the following: a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts). b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts). c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner. 3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate. a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts). b) Pertinent positives and negatives must be documented for each relevant system. c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts). 4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately. 5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections. 6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified. 7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete? Use APA format and must include minimum of 2 Scholarly Citations. Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program) Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement. Soap Note 2 Chronic Conditions

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