Case Study – The Elderly

Scenario:

As a community health nurse, you are working in an outpatient clinic in a community that serves mainly elderly clients.

This year, you noted that 85 percent of the visits resulting in hospitalization resulted from bronchitis, asthma, pneumonia, and influenza as compared to last year. At that time; the visits weredue to colds, sore throats, influenza, bronchitis, and pneumonia, in order of frequency.

Maria Perez, a 73-year-old Cuban American woman has been referred for community health nursing services following her discharge from the hospital. She smokes two packs of cigarettes per day. She was recently hospitalized as a result of a severe shortness of breath due to an asthma attack. The primary care provider prescribed respiratory treatments using Albuterol via jet nebulizer every 4-6 hours as needed. Mrs. Perez lives alone and has three cats to take care of.

Instructions:

1. Read the scenario above and answer the following questions:
   • What are the biophysical, psychological, physical environmental, sociocultural, behavioral, and health system factors influencing Mrs. Perez’s health?
   • Describe at least three primary, secondary, and tertiary prevention strategies that would be appropriate in resolving Mrs. Perez’s health problems. Why would they be appropriate?
   • What activities related to health promotion and disease prevention would you plan for the late fall?
   • How would you evaluate your nursing interventions? What criteria would you use to evaluate care?

 

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Cancer, Genetics, and Genomics

Rachel comes from a family with a history of breast cancer on her mother’s side. Rachel’s mother died of breast cancer when she was very young. Rachel has two sisters, Lisa and Kristin. Rachel has remained close to Lisa, but she no longer has a relationship with Kristin. At a routine checkup, Rachel is told about the availability of genetic testing for identifying a predisposition to breast cancer. Her doctor recommends the test to Rachel given her family history. Rachel has the genetic testing done and finds that she has a mutated breast cancer 1, early onset (BRCA1) gene. Her doctor tells her she is at high risk for developing breast and ovarian cancer. Rachel’s doctor suggests she ask her sisters to be tested also, so they can take the proper preventative measures. Rachel feels comfortable sharing this information with Lisa, but she has not spoken to Kristin in many years. Rachel tells her doctor that she is not in contact with Kristin and will not make an effort to tell her about BRCA1 and genetic testing. Rachel’s doctor feels confident that she can locate Kristin but worries about breaching patient confidentiality if she goes against Rachel’s wishes.

If you were Rachel’s healthcare provider, what would you do? Provide a rationale for your response. Include the pathological processes associated with breast cancer. What role does the BRCA1 gene contribute to managing the patient’s care? Describe and explain the role of the BRCA1 and breast cancer 2, early onset (BRCA2) gene in contribution as a risk factor for breast cancer. Analyze the risk factors for breast cancer and possible interventions to preventive health management for women and men.

-One page

-Provide references.

 

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Based on “Case Study: Fetal Abnormality” and other required   topic study materials, write a 750-1,000-word reflection that answers   the following questions:

1. What is the Christian view of the nature of human     persons, and which theory of moral status is it compatible with? How     is this related to the intrinsic human value and dignity?
2. Which theory or theories are being used by Jessica, Marco,     Maria, and Dr. Wilson to determine the moral status of the fetus?     What from the case study specifically leads you to believe that they     hold the theory you selected?
3. How does the theory determine     or influence each of their recommendations for action?
4. What     theory do you agree with? Why? How would that theory determine or     influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment,   solid academic writing is expected, and documentation of sources   should be presented using APA formatting guidelines, which can be   found in the APA Style Guide, located in the Student Success Center.

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

 

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CASE STUDIES

I- Case Study: Care of the Child in Inpatient and Outpatient Settings

Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.

Subjective Data

• Nausea and vomiting for 24 hours
• Has not voided today
• Unable to tolerate oral fluids

Objective Data

• Vital signs: T 37.8° C, P 120, R24, BP 110/60
• Weight: 34 kg
• Hyperactive bowel sounds to auscultation

1. Question 1

When should the discharge teaching begin for Jordan and his family?

2. Question 2

What is the best way to approach Jordan regarding the IV that has been ordered.

3. Question 3

What would be good distractions for a child of Jordan’s age?

II- Case Study: Pediatric Cancer

Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy.

Subjective Data

• Complains of hurting all over
• States he feels very tired
• States he feels dizzy when he stands up

Objective Data

• Weight 26.1 kg
• Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%
• Purpural rash on extremities
• WBC 0.7
• HGB 3.1
• Hct 8.5
• Plt .08
• ANC 0.1

4. Question 1

Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?

5. Question 2

What testing is required for a definitive diagnosis of meningitis?

6. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

III-  Case Study: Pediatric Respiratory System

Will is a 4-month-old infant born at 34 weeks of gestation. Will’s mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions.

Subjective Data

• Mother complains that infant has had cough for 3 days
• Mother states that infant is having trouble sleeping
• Not voided in past 6 hours

Objective Data

• Birth Weight: 1.9 kg
• Today’s Weight: 5.5 kg
• Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93%
• Thick yellow nasal secretions
• Nasal flaring with moderate intercostal retractions
• Breath sounds decreased with crackles bilaterally to auscultation

7. Question 1

What risk factors does Will have for contracting bronchiolitis?

8. Question 2

What is the first priority for Will’s treatment?

9. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

IV-  Case Study: Pediatric Gastrointestinal System

Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.

Subjective Data

1. Mother states infant has been vomiting undigested formula after feedings
2. Mother states that infant has not had fever or diarrhea
3. Mother states that infant has had 8 wet diapers in the past 24 hours

Objective Data

1. Weight 4.8 kg (birth weight 3.5 kg)
2. Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52
3. Mucous membranes moist, anterior fontanel flat and soft
4. Awake and alert, lusty cry
5. Good muscle tone
6. Olive-sized mass palpated at epigastrium

10. Question 1

What test will be used to diagnose pyloric stenosis?

11. Question 2

What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.

12. Question 3

The second prioritization step the nurse would take is ____.

13. Question 4

The third prioritization step the nurse would take is ____.

14. Question 5

The fourth prioritization step the nurse would take is ____.

15. Question 6

The fifth prioritization step the nurse would take is ____.

16. Question 7

The sixth prioritization step the nurse would take is ____.

17. Question 8

The seventh prioritization step the nurse would take is ____.

18. Question 9

The eighth prioritization step the nurse would take is ____.

V- Case Study: Pediatric Cardiovascular System

Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.

Subjective Data

• Mom states patient has been “fussy” for past 2 days
• Only feeds for a “few” minutes at a time
• Breathing heavily and fast for 2 days

Objective Data

• Weight: 4.8 kg
• Vital Signs: T 36.8° C, P 250, R 65, BP 84/58
• Breath sounds clear to auscultation
• Oxygen Saturation 95%
• Central capillary refill 4 sec

19. Question 1

What is the treatment for an unstable patient with SVT?

20. Question 2

Decreased cardiac output from prolonged SVT will produce what complication?

21. Question 3

In this clinical situation what should the nurse do? Prioritize actions.

VI-  Case Study: Hematologic System

Liam is an 8-year-old male with a history of hemophilia. Liam presents today with a 1-day history of right elbow pain.

Subjective Data

• Right elbow pain for 1 day
• Patient states he hit his right elbow on desk yesterday
• Patient complains that he cannot move his elbow

Objective Data

• Weight 31.6 kg
• Vital sighs: T 37.4° C, P 82, R 20, BP 108/68
• Rates pain 6 on scale of 10

22. Question 1

How should the nurse respond when Liam’s father explains that they watched and waited to see if Liam needed treatment after his injury?

23. Question 2

Why are neuro checks an important part of Liam’s physical exam?

24. Question 3

What should the nurse do in this clinical situation? Prioritize actions.

VII- Case Study: Common Disorders of the Red Blood Cells

Susan is a 26-year-old G1P0 at 6 weeks of gestation with type 2 diabetes. Her BMI is 32. Her hemoglobin A1C is 9. She uses glyburide 10 mg PO daily. The physician has switched her to insulin at this time.

1. Question 1

What is the nursing priority at this time?

2. Question 2

What should Susan be taught about insulin needs during pregnancy?

3. Question 3

What additional risk factor does Susan have?

4. Question 4

How should Susan be counseled regarding weight gain in pregnancy?

5. Question 5

What advice can be given to Susan regarding exercise?

VIII-  Case Study: Pediatric Genitourinary System

Lilly is a 3-year-old female who presents with complaints of abdominal pain and fever since yesterday.

Subjective Data

• Complains of lower abdominal pain
• Fever for 24 hours
• Lilly has ‘wet her pants’ despite being recently potty trained

Objective Data

• Vital signs: T38.5° C, P 114, R 32, BP 104/62
• Urine positive for WBCs, nitrites, blood

6. Question 1

What risk factors does Lilly have for UTI?

7. Question 2

What might prevent Lilly from a recurring UTI?

8. Question 3

What should the nurse do in this situation? Prioritize actions.

IX-  Case Study: Pediatric Neurologic System

Abby is a 1-year-old female who presents after a reported seizure at day care.

Subjective Data

• Fever for 1 hour
• Eating and drinking normally per mother

Objective Data

• Vital signs: T 40° C, HR 160, R 44, BP 104/68
• Awake and alert
• Skin hot to touch, otherwise normal physical examination

9. Question 1

How should the nurse respond to Abby’s mother when she asks if Abby has epilepsy?

10. Question 2

How should the nurse respond to Abby’s mothers question about brain damage?

11. Question 3

In this clinical situation what should the nurse do?

 

 

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