NR 507 Week No. 5 Discussion:

 

PART No. 1:

Ms. Blake is an older adult with diabetes and has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. She has a history of Type I diabetes. On admission her laboratory values show:

  

Sodium (Na+) 

156 mEq/L H

Potassium (K+)

4.0 mEq/L N

Chloride (Cl–)

115 mEq/L H

Arterial blood gases (ABGs)

pH- 7.30; Pco2-40; Po2-70; HCO3-20

METABOLIC ACIDOSIS with respiratory compensation, High anion gap

Normal values

Sodium (Na+)

136-146 mEq/L

Potassium (K+)

3.5-5.1 mEq/L

Chloride (Cl–)

98-106 mEq/L

Arterial blood gases (ABGs)

pH- 7.35-7.45

Pco2- 35-45 mmHg

Po2-80-100 mmHg

HCO3–22-28 mEq/L

• List      three (3) reasons on why she may have become bed ridden? 
• Flu?      Pneumonia? 
• Based      on these reasons what tests would you order? 
• Accu      check? CXR? Lactic Acid level, serum and urine ketone levels
• Describe      the molecular mechanism of the development of ketoacidosis. (p. 744) *Pt’s      who develop DKA do so bc bicarbonate buffering does not occur, which      begins the development of metabolic acidosis

pH 7.30 = acid

CO2 40 = Normal

O2 70 = Low

HCO3 20 = acid

PART No. 2:

A three-month-old baby boy comes into your clinic with the main complaint that he frequently vomits after eating. He often has a swollen upper belly after feeding and acts fussy all the time. The vomiting has become more frequent this past week and he is beginning to lose weight.

• Write      three (3) differential diagnoses at this time?
• Is      there any genetic component to the top of your differentials?
• What      tests would you order?

PART No. 3:

Write a one (1) paragraph case study of your own for a patient with Ulcerative Colitis?

PEER:

NR 507 Week No. 5 Quiz:

1. Aldosterone synthesis and secretion are primarily regulated by the (Points : 2)

2. A surgical individual just arrived on the unit from the postanesthesia care unit. This person’s respirations are 4 per minute and shallow. As the nurse calls for assistance, the person suddenly feels jittery and breathing quickens. Which of the following feedback loops is operating for the nurse in this situation? (Points : 2)

3. What effect does aldosterone have on fluid and electrolyte imbalances? (Points : 2)

4. What effect does hyperphosphatemia have on other electrolytes? (Points : 2)

5. Where is oxytocin synthesized? (Points : 2)

6. Which mineral is needed for the synthesis of thyroid hormones? (Points : 2)

7. The portion of the pituitary that secretes oxytocin is the _____ pituitary. (Points : 2)

8. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of a _____ effect by a hormone. (Points : 2)

9. Which of the following hormones acts on its target cell via a second messenger? (Points : 2)

10. Target cells for parathyroid hormone (PTH) are located in the (Points : 2)

11. Which hormone is involved in the regulation of serum calcium levels? (Points : 2)

12. A person who has experienced physiologic stresses will have increased levels of which hormone? (Points : 2)

13. The first lab test that indicates type 1 diabetes is causing the development of diabetic nephropathy is (Points : 2)

14. A deficiency of which of the following may result in hypothyroidism? (Points : 2)

15. Diagnosing a thyroid carcinoma is best done with (Points : 2)

16. The effects of syndrome of inappropriate antidiuretic hormone (SIADH) include solute (Points : 2)

17. Which of the following clinical manifestations is not common to both diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNKS)? (Points : 2)

18. The signs of thyroid crisis resulting from Graves disease include (Points : 2)

19. What causes the microvascular complications of clients with diabetes mellitus? (Points : 2)

20. A man with a closed head injury has a urine output of 6 to 8 L/day. Electrolytes are within normal limits, but his antidiuretic hormone (ADH) level is low. Although he has had no intake for 4 hours, there is no change in his polyuria. These are indications of (Points : 2)

21. Amenorrhea, galactorrhea, hirsutism, and osteopenia are each caused by a (Points : 2)

22. The most common cause of hypoparathyroidism is (Points : 2)

23. The level of thyroid-stimulating hormone (TSH) in Graves disease is usually (Points : 2)

24. The most probable cause of low serum calcium following a thyroidectomy is (Points : 2)

25. Hyperpituitarism is generally caused by (Points : 2) 

 

Assignment Description: This assignment will be at least 1500 words or more

This week you will reflect upon patient safety and satisfaction to answer the following questions:

• How can patient safety measures lead to cost savings?  
• Briefly define the Joint Commission’s role in healthcare.
• Reflect on your future role in healthcare, and how you will contribute to patient safety.
• How do you see the role of the chief nursing officer regarding patient safety?

1-I like these questions!  Our hospital does have drills but we have not had an “active shooter” drill yet.  We talk about it within our department but not as an entire hospital yet.  They have set up emergency response communication via  text messaging and they have used that a few times but not for anything catastrophic.  The topic makes me sick and sad as this is becoming our reality and that this is becoming a part of life.  

I did perform CPR on a Grandfather who was attending “”Disney on Ice” at our huge arena.  It was a snowy night and I got there early.  I was on the level above when I saw him go down and heard the screams from family.  Not many people there yet.  By the time I had gotten down to the level where he was seemed like an eternity.  He was pulse less and blue.  I did do CPR and continued until EMS arrived.  He did die at the hospital and I later found out if was from a pulmonary embolism.  The family was very thankful and obviously devastated.  

I have been called several times from the stands at my girls sporting events to help with injuries or emergnecies as most of us as nurses have been.  

RKim 5 Re:Re:T

2-enjoyed reading your post and also feel like the tertiary prevention phase is very important in the recovery phase. This is the phase that will help individuals long term . The aftermath of the 2010 Haitian earthquake was devastating it is at this phase focus can be put on prevention measures such s counseling, chronic disease rehabilitation, services for housing and any type long term maintenance.

MKim 5 Re:Comp

3-I can definitely identify with compassion fatigue. I am a mental health nurse and each night I clock in I have the privilege of being a listening ear for someone who feels that life is hopeless. Sometimes I am able to lift spirits sometime not. What I try to do is take my time away so regardless of how much they call me stating staffing is low I don’t come in. During that time off I go  do to the gym, spend time with my family and most importantly worship,  pray and praise my Lord.

 Neurodevelopmental disorders begin in the developmental period of childhood and may continue through adulthood. They may range from the very specific to a general or global impairment, and often co-occur (APA, 2013). They include specific learning and language disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and intellectual disabilities. Neurocognitive disorders, on the other hand, represent a decline in one or more areas of prior mental function that is significant enough to impact independent functioning. They may occur at any time in life and be caused by factors such brain injury; diseases such as Alzheimer’s, Parkinson’s, or Huntington’s; infection; or stroke, among others.