Max Points: 150

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Interview a patient with a chronic pulmonary health condition who is on at least two medications.

In a 1,350-1,600-word paper, discuss the following:

1. Obtain a complete health history.
2. Obtain a complete medication history, including prescription and over-the-counter drugs or supplements.
3. Analyze the client’s current knowledge level of medications and compliance with the prescribed dosing and administration.
4. For each medication, identify the pharmacokinetics, pharmacodynamics, dose, route of administration, side effects, adverse reactions, any drug interactions, potential safety issues, and the impact on the client’s health status.
5. Formulate possible interventions related to lack of drug efficacy, lack of client knowledge, or client compliance issues as identified during the interview.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 

 

Use attachment senerio to assist with assignment.

Write a 700- 1250 word paper in which you identify and recommend technology needs, hours of operation, and services offered for the health care organization. The facility will be an Urgent care facility in Augusta Ga.

Include the following in your paper:

• Recommend which services should be provided at the center and describe why they are appropriate at this site.
• Describe the hours of operation and why you recommend those hours.
• Describe the major equipment and technology needed to provide the recommended service. Include a projected cost for that equipment.
• Discuss the type of corporation you think the center should consider (e.g., a department of the hospital or an LLC) and why.

Cite at least 2 peer-reviewed, scholarly, or similar references.

Format your paper according to APA guidelines.

The wife of C.W., a 70-year-old man, brought him to the emergency department (ED) at 4:30 this morning. She told the ED triage nurse that he had had dysentery for the past 3 days, and, last night, he had a lot of “dark red” diarrhea. When he became very dizzy, disoriented, and weak this morning, she decided to bring him to the hospital. C.W.'s vital signs (VS) were 70/- (systolic blood pressure [BP] 70 mm Hg, diastolic BP inaudible), 110, 20, 99.1° F (37.3° C). A 16-gauge IV catheter was inserted, and a lactated Ringer's (LR) infusion was started. The triage nurse obtained the following history from the patient and his wife. C.W. has had idiopathic dilated cardiomyopathy for several years. The onset was insidious, but the cardiomyopathy is now severe, as evidenced by an ejection fraction (EF) of 13% found during a recent cardiac catheterization. He experiences frequent problems with heart failure (HF) because of the cardiomyopathy. Two years ago, he had a cardiac arrest that was attributed to hypokalemia. He also has a long history of hypertension (HTN) and arthritis. He has also had atrial fibrillation in the past but it has been under control recently. Fifteen years ago he had a peptic ulcer. An endoscopy showed a 25 × 15 mm duodenal ulcer with adherent clot. The ulcer was cauterized, and C.W. was admitted to the medical intensive care unit (MICU) for treatment of his volume deficit. You are his admitting nurse. As you are making him comfortable, Mrs. W. gives you a paper sack filled with the bottles of medications he has been taking: enalapril (Vasotec) 5 mg PO bid, warfarin (Coumadin) 5 mg/day PO, digoxin (Lanoxin) 0.125 mg/day, PO, potassium chloride 20 mEq PO bid, and diclofenac sodium (Voltaren) 50 mg PO tid. As you connect him to the cardiac monitor, you note that he is in sinus tachycardia. Doing a quick assessment, you find a pale man who is sleepy but arousable and oriented. He is still dizzy, hypotensive, and tachycardic. You hear S3 and S4 heart sounds and a grade II/VI systolic murmur. Peripheral pulses are all 2+, and trace pedal edema is present. Lungs are clear. Bowel sounds are present, midepigastric tenderness is noted, and the liver margin is 4 cm below the costal margin. A Swan-Ganz catheter and an arterial line are inserted.

  

1. What may have precipitated C.W.'s gastrointestinal (GI) bleeding?

2. From his history and assessment, identify five signs and symptoms (S/S) of GI

bleeding and loss of blood volume.

3. What is the most serious potential complication of C.W.'s bleeding?

4. What is the effect of C.W.'s blood pressure on his kidneys?

Case study progress:

C.W. receives a total of 4 units of packed red blood cells (PRBCs), 5 units of fresh

frozen plasma (FFP), and several liters of crystalloids to keep his mean BP above 60 mm Hg.

On the second day in the MICU, his total fluid intake is 8.498 L and output is 3.66 L for a

positive fluid balance of 4.838 L. His hemodynamic parameters after fluid resuscitation are

pulmonary capillary wedge pressure (PCWP) 30 mm Hg and cardiac output (CO) 4.5 L/min.

5. Why will you want to monitor his fluid status very carefully?

6. List at least six things you will monitor to assess C.W.'s fluid balance.

7. Explain the purpose of the FFP for C.W.

Case study progress:

As soon as you get a chance, you review C.W.'s admission laboratory results. These

were drawn before he received the PRBCs.

Chart view:

Lab work:

· Sodium – 138 mEq/L

· Potassium – 6.9 mEq/L

· BUN – 90 mg/dL

· Creatinine – 2.1 mg/dL

· WBC – 16,000/mm 3

· Hgb – 8.4 g/dL

· Hct – 25%

· PT – 23.4 seconds

· INR – 4.2

8. After examining the lab results, are there any concerns with C.W.'s electrolyte levels?

Explain your answer.

9. In view of the previous lab results, what diagnostic test will be performed and why?

10. Evaluate this ECG strip, and note the effect of any electrolyte imbalances.

11. Why do you think BUN and creatinine are elevated?

12. What do the low hemoglobin (Hgb) and hematocrit (Hct) levels indicate about the

rapidity of C.W.'s blood loss?

13. What is the explanation for the prolonged prothrombin time/international normalized

ratio (PT/INR)?

14. What will be your response to the prolonged PT/INR? (Select all that apply.)

a. Prepare to administer a STAT dose of protamine sulfate.

b. Hold the warfarin.

c. Monitor C.W. for signs and symptoms of bleeding.

d. Obtain an order for aspirin if needed for pain.

e. Avoid injections as much as possible.

15. What safety precautions should be considered in light of his prolonged PT/INR?

16. How do you account for the elevated white blood cell count?

Case study progress:

Mrs. W. has been with her husband since he arrived at the emergency department

and is worried about his condition and his care.

17. List four things you might do to make her more comfortable while her husband is in

the MICU.

Activity

1. Present the medical management of Peptic Ulcer Disease by highlighting:

a. Nutritional therapy

b. Surgical therapy

 

1. What aspects of brain development underlie the tremendous gains in language, thinking, and motor control of early childhood?

2.  Among children who spend much time playing alone, what factors distinguish those who are likely to have adjustment difficulties from those who are well-adjusted and socially skilled?

3. What experiences help children differentiate moral imperatives, social conventions, and matters of personal choice?

4. Explain how the social environment and young children’s cognitive limitations contribute to rigid gender stereotyping in early childhood.

5. Summarize findings on ethnic variations in child-rearing styles. Is the concept of authoritative parenting useful for understanding effective parenting across cultures? Explain.