DUE 12/27  10 P.M EST

MATERIAL ATTACHED AND YOU’RE ONLY COMPLETING SECTION (B,C AND D) Total of 8 questions

 

Understanding health risks and interpreting them correctly is an important function for anyone involved in public health. Often, the results of epidemiological studies are reported in the media as “known facts,” when indeed that is not the case. Such is the situation for the reported association between vaccinations and the risk of autism.

For this Case Study Assignment, you will analyze and interpret the epidemiological evidence for a possible association between vaccination with the measles/mumps/rubella (MMR) vaccine and the occurrence of autism

 

Using the information provided in the case study, complete Sections B, C, and D (pp. 5–10), typing your answers into a separate document.

Be sure that your completed document contains your responses to all questions from Sections B, C, and D of the case study.

 

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1. The assessment tasks requires you to:
   1. Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case.
   2. Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies:
    

One (1) priority of clinical care and; 

Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research. 

 

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 ADMISSION HISTORY AND PHYSICAL

Patient Name: Jonathan Jones                                                                                        MR#: 44579

Attending Physician: Ajay Shah, M.D.                                                                    DOB: 12/24/89

Chief Complaint: 27 yo [year old] male presents with 2 days of worsening right lower quadrant belly pain, nausea, and vomiting.

History of Present Illness (HPI): 2 days prior to admission, the patient began complaining of diffuse belly pain that initially felt like indigestion. Over the course of the day, this pain grew progressively worse, localizing in the right lower quadrant. This pain became constant and dull and radiated to the back. The evening prior to admission the patient was awakened by pain and nausea. He drank some Alka-Seltzer and attempted to return to sleep, shortly after which he began vomiting nonbloody or bilious emesis. Shortly thereafter, the patient decided to come to the ED [Emergency Department].

The patient indicates he did have a fever but did not take his temperature. He denies chills, testicular pain, blood in the stool, or recent weight change. The patient’s last bowel movement was yesterday, with some small amounts of mucus but otherwise normal. He notes a history of irritable bowel syndrome. However, he states that this pain is different than the pain he has had in the past.

Past Medical History (PMH): Irritable bowel syndrome, last exacerbation 6 months ago. The rest of the past medical history is unremarkable.

Past Surgical History (PSH): Tonsillectomy and adenoidectomy in early childhood. Umbilical hernia repair at age 4.

Medications: None.

Allergies: NKDA

Social History: The patient is employed as a computer programmer. He is married and has no children. He has a 10-year pack-history (in this case, 5 years, two packs a day) of smoking. He drinks alcohol rarely.

Family History: Both parents are alive and well. One sister has a history of GERD.

Review of Systems: 12-point review of systems was performed and was negative except for those items noted in the HPI above.

Physical Examination

General: The patient is an alert and oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78. Pulse 68 and regular. Temperature 38.56°C (101.4°F).

HEENT: Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears clear. Throat normal.

Neck: The neck is supple with no carotid bruits.

Lungs: The lungs are clear to auscultation and percussion.

Heart: RRR, no m/g/r.

Abdomen: Nondistended. Bowel sounds are normal. There is rebound tenderness on the left side, with discomfort and guarding upon palpation in the right lower quadrant, and positive psoas sign [pain on extension of right thigh with patient lying on left side].

Extremities: No clubbing, cyanosis, or edema, distal extremities warm and well perfused.

Laboratory Data: Hemoglobin 14.6, hematocrit 43.6, WBC 13,000, sodium 138, potassium 3.8, chloride 105, CO2 24, BUN 10, creatinine 0.9, glucose 102. Urinalysis was negative.

Diagnostic Studies: Flat plate and upright films of the abdomen revealed a diffuse small bowel distension with no evidence of free air in the abdomen. CT of the abdomen indicated a thickened cecal wall and dilated appendix.

Assessment/Impression: 27 yo male with PMH significant for irritable bowel syndrome presents with clinical signs of acute onset appendicitis.

Plan: The patient will be admitted and kept NPO, and a laparoscopic appendectomy will be performed in the morning.

Rogers, M.D.

Admission H and P performed and dictated by Dr. Ajay Shah for Dr. Rogers.

Discussion Questions

1. Why is it important that the admitting doctor record information about the patient’s heart, lungs, and other body systems when the pain is in the patient’s abdomen?
2. How would you find out what the abbreviation HEENT means? What are some of the other abbreviations used in this case study, and what do they mean?
3. Using what you’ve learned about word parts, describe the types of surgeries listed in the patient’s past surgical history.
4. The extremities are described as “No clubbing, cyanosis, or edema.” Edema is explained in this chapter. Look up what the other two terms mean.

Your answers need to be typed as complete sentences and be thorough and detailed for full credit.

 

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FIRST PAPER

  

Case Study: Mr. M.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

1. Temperature:      37.1 degrees C
2. BP      123/78 HR 93 RR 22 Pox 99%
3. Denies      pain
4. Height:      69.5 inches; Weight 87 kg

Laboratory Results

1. WBC:      19.2 (1,000/uL)
2. Lymphocytes      6700 (cells/uL)
3. CT      Head shows no changes since previous scan
4. Urinalysis      positive for moderate amount of leukocytes and cloudy
5. Protein:      7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

1. Describe      the clinical manifestations present in Mr. M.
2. Based      on the information presented in the case scenario, discuss what primary      and secondary medical diagnoses should be considered for Mr. M. Explain      why these should be considered and what data is provided for support.
3. When      performing your nursing assessment, discuss what abnormalities would you      expect to find and why.
4. Describe      the physical, psychological, and emotional effects Mr. M.’s current health      status may have on him. Discuss the impact it can have on his family.
5. Discuss      what interventions can be put into place to support Mr. M. and his family.
6. Given      Mr. M.’s current condition, discuss at least four actual or potential      problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the 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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

SECOND PAPER

  

Case Study: Mr. C.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height:      68 inches; weight 134.5 kg
2. BP:      172/98, HR 88, RR 26
3. 3+      pitting edema bilateral feet and ankles
4. Fasting      blood glucose: 146 mg/dL
5. Total      cholesterol: 250 mg/dL
6. Triglycerides:      312 mg/dL
7. HDL:      30 mg/dL
8. Serum      creatinine 1.8 mg/dL
9. BUN 32      mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe      the clinical manifestations present in Mr. C.
2. Describe      the potential health risks for obesity that are of concern for Mr. C.      Discuss whether bariatric surgery is an appropriate intervention.
3. Assess      each of Mr. C.’s functional health patterns using the information given.      Discuss at least five actual or potential problems can you identify from      the functional health patterns and provide the rationale for each.      (Functional health patterns include health-perception, health-management,      nutritional, metabolic, elimination, activity-exercise, sleep-rest,      cognitive-perceptual, self-perception/self-concept, role-relationship,      sexuality/reproductive, coping-stress tolerance.)
4. Explain      the staging of end-stage renal disease (ESRD) and contributing factors to      consider.
5. Consider      ESRD prevention and health promotion opportunities. Describe what type of      patient education should be provided to Mr. C. for prevention of future      events, health restoration, and avoidance of deterioration of renal      status.
6. Explain      the type of resources available for ESRD patients for nonacute care and      the type of multidisciplinary approach that would be beneficial for these      patients. Consider aspects such as devices, transportation, living      conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the 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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

 

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