Case Study #1

Gastrointestinal Disorders. 

T.H., a 57-year-old stockbroker, has come to the gastroenterologist for treatment of recurrent mild to severe cramping in his abdomen and blood-streaked stool. You are the registered nurse doing his initial workup. Your findings include a mildly obese man who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4° F (38° C); he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. Past medical history reveals that T.H. has a “sedentary job with lots of emotional moments,” he has smoked a pack of cigarettes a day for 30 years, and he had “two or three mixed drinks in the evening” until 2 months ago. He states, “I haven’t had anything to drink in 2 months.” He denies having regular exercise: “just no time.” His diet consists mostly of “white bread, meat, potatoes, and ice cream with fruit and nuts over it.” He denies having a history of cardiac or pulmonary problems and has no personal history of cancer, although his father and older brother died of colon cancer. He takes no medications and denies the use of any other drugs or herbal products.

 

. 1. Identify four general health risk problems that T.H. exhibits.

 2. Identify a key factor in his family history that might have profound implications for his health and present state of mind.

 

3.The physician ordered a KUB (x-ray study of the kidneys, ureters, and bladder), complete blood count (CBC), and complete metabolic profile. Based on x-ray and laboratory findings, physical examination findings, and history, the physician diagnoses T.H. as having acute diverticulitis and discusses an outpatient treatment plan with him.What is diverticulitis? What are the consequences of untreated diverticulitis?

 

4.While the patient is experiencing the severe crampy pain of acute diverticulitis, what interventions would you perform to help him feel more comfortable?

 

5. What is the rationale for ordering bed rest?

 

T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500mg PO q6h, ciprofloxacin (Cipro) 500mg PO q12h, and dicyclomine (Bentyl) 20mg  4 tomes per day for 5 days.

6.For each medication, state the drug class and the purpose for T.H.

 7.Given his history, what questions must you ask T.H. before he takes the initial dose of metronidazole? State your rationale

 

8.What is a disulfiram reaction?

 

9. What are the signs and symptoms of an allergic reaction

Answer All questions in APA format with a separate reference page.

 

Ionic and Molecular Compounds

1. Name each of the following molecular compounds

a. CO2

b. N2O

c. P2O5

d. N2S3

e. CF4

2. Write the formula of the following molecular compound

a. Carbon tetrachloride

b. Sulfur dioxide

c. Phosphorus pentafluoride

d. Dinitrogen tetroxide

e. Chlorine dioxide

3. Classify each of the following as ionic or molecular and give its name

a. Na2SO4

b. Fe(OH)3

c. CCl4

d. OF2

e. CaS

4. Identify the group in the periodic table of the element X in each of the following ionic compounds

a. XSO4

b. XF3

c. XCl

d. XO

e. X2CO3

5. Classify the bonds in each of the following compounds as ionic bond, polar covalent bond, or non polar covalent bond

a. MgS

b. H-Cl

c. Br-Br

d. H-O-H

e. NaCl

This paper has to be in apa style and every question well explained.

1-which of the following behaviors may be (1) ethical but illegal, (2) legal but unethical, (3) illegal and unethical, and (4) legal and ethical.

A. Working in a clinic that performs abortions

b. Respecting the wishes of a client suffering from ALS that he be permitted to die with dignity and not placed on “breathing machines”

c. Respecting the health surrogate’s wishes regarding termination of life support of her friend

d. Observing a coworker take out two tablets of oxycodone as ordered for pain management for his patient but keeping one for himself, administering only one tablet to the patient.

2-differentiate among the following: deontological theories, utilitarianism, and principlism.

3-what do you think about health-care professionals disclosing information to clients about a poor prognosis, even though the information may cause severe distress.

4-What do they think about health-care professionals disclosing information to clients against family wishes?

5. You see a colleague use another nurse’s password to access the medication administration system and take out a narcotic. What would you do?

6.Your colleague’s child fell and was brought to the emergency department. She comes back up to the unit and tells you that they cleaned and debrided the wound, and she needs to change the dressings twice a day using a wet to dry method. You see her go into the supply system and remove the dressings and saline using a patient’s identification number. What would you do?

7. You are caring for a patient who has a terminal disease. He asks you if he is dying. Would you tell him? If yes, how? If no, what might you say? .

8-You are administering hydromorphone to a patient. The patient asks you what you are administering. Would you tell the patient about the medication?

This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community. Answer the questions posted below. 1 page. 

When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses. Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college. They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family. After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him. As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule. Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s. Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself. Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor. Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Critical thinking activities

1. Examine this case study through the dependency cycle model. The outer arrows show a progression through varying stages of dependency. The inner circle represents who can be involved in the dependency cycle. Where are Jane and Dan in this cycle?

2. Using the basic dependent-care system model, assess Dan and Jane. Identify the basic conditioning factors (BCFs) for each. What is the effect of Dan’s BCFs on his self-care agency? Is he able to meet his therapeutic self-care demands? Continue on to diagnose Dan’s self-care deficit and resulting dependent-care deficit. Now assess Jane’s self-care system.

3. Design a nursing system that addresses Jane’s self-care system as she increases her role as dependent-care agent for Dan.

respond

 

I read through all the posts and you mentioned some points that stood out to me. One statement in particular is when you mentioned that program has since supported the organization’s popular model, which combines health plans, physicians, and hospitals. Someone who is curious and has a tendency to question many things, I just wonder is the organizations plan, you mentioned, popular for its investors, share holders,  or its other stakeholders such as the patients? Many people may like something but that does not mean the majority of people will find it beneficial to them based on actual value of care and not just value of dollars lining CEO’s pockets? I raise these questions, not to be confrontational, but to elicit thought regarding our definition of value as a culture aiming to lead healthcare in this country. 

I was actually born at a Kaiser Permanent in Oakland, CA. It is amazing how they have grown as a medical institution. Out of all the hospitals and medical establishments Ive been too Kaiser is definitely one of better care and quality, but there is a huge price tag on  the cost of their care even with Insurance. You mentioned patients having to pay high deductibles. I am really looking forward to the day where this whole idea of high deductibles and premiums will be something of the past. I realize this will take a paradigm shift but ideally, people having access to care without hemorrhaging money  to just barely survive this world, would be ideal. How do you think big hospitals like Kaiser permanente would survive if such a paradigm shift were to occur?