Case Study, Chapter 17, Preoperative Nursing Management

1. Joan Arnold, 67 years of age, is a female patient who underwent a coronary angiogram that diagnosed severe coronary artery disease in three of her coronary arteries, the left anterior descending, the left circumflex, and the right coronary artery. She is scheduled for a coronary artery bypass graft operation tomorrow. The nurse provides patient education for Mrs. Arnold and her husband, which includes watching a hospital video on the operation, the intensive care environment, what to expect after the surgery, the recovery period, and cardiac rehabilitation. The video also covered the importance of coughing and deep breathing, using an incentive spirometer, splinting, early ambulation, pain medication, and how to position oneself safely. The video stressed the importance of not rolling onto the side that the chest tube may be in place postoperatively. The video also discussed the preoperative preparation. The nurse also provided a booklet on the subject material. The nurse had a session with the patient and her husband to assess their understanding and to answer any questions they may have had. 

1. What specific preoperative nursing measures should the nurse review with the patient to help decrease the risk for postoperative complications?
2. Explain the role of the nurse when implementing the immediate preoperative preparation the day before surgery and the morning of the surgery?

2. The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. 

1. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?
2. Why is it important to assess the patient for use of herbal products prior to surgery?

c.The patient asks how surgery could affect her blood glucose; how should the nurse respond?

 

 

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Case Study, Chapter 15, Oncology: Nursing Management in Cancer Care

1. Emanuel Jones, 60 years of age, is male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the left lower lobe of his lung. He is receiving chemotherapy. Two weeks before a round of chemotherapy, a complete blood count with differential, and a renal and metabolic profile are obtained for the patient. The patient presents to the oncology clinic for chemotherapy with a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, and a productive cough expectorating green colored mucus. The patient is short of breath and has a pulse oximetry reading that is SaO2 of 85% on room air. The patient has a history of benign prostate hypertrophy (BPH) and has complaints of urinary frequency and burning upon urination. The patient is admitted to the oncology unit in the hospital. The oncologist orders the following: blood, sputum, and urine cultures; and a chest x-ray. An x-ray of the kidneys, ureters, bladder (KUB) is ordered. An arterial blood gas (ABG) on room air, CBC with differential, and renal and metabolic profile are ordered. Oxygen is ordered to begin with nasal cannula at 2 L/min and titrate to keep SaO2 greater than 90%. A broad-spectrum antibiotic, levofloxacin 500 mg in 100 mL of NS is ordered to be administered IV over 60 minutes once daily. 

1. After examining the physician orders, in what sequence should the nurse provide the care to the patient admitted to the hospital? Give the rationale for the sequence chosen.
2. On what areas should the nurse focus the assessment to detect potential complications for Mr. Jones?
3. What patient education does Mr. Jones need from the nurse to help prevent the reoccurrence of an infection and to get treatment for an infection promptly?

2. The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. 

1. What does the CNS describe as the goals of chemotherapy?
2. How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”
3. In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?
4. What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

 

 

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APA Format.   -Introduction or abstract page   -Summary or Conclusion page   -Four pages minimum, no including Introduction or abstract,  summary or conclusion, and Bibliography pages   -It is completely unacceptable to Copy and Paste from the Internet, or other resources   -Bibliography has to be in APA Format, minimum 3, no more than 3 years old

The following position is advertised on a career Web site: RN I Surgical Job Travel Involved: None. Job Type: Full-Time. Job Level: Minimum Education Required: Associate Degree Skills: Category: Nursing FTE: 0.9. Position Summary: Description/Purpose of Position: Responsible for providing patient care based upon the nursing process; being effectively involved with maintaining the standard of care for assigned patients through assessment, planning, implementation, and evaluation. Oversees and guides employees who are under your supervision. Requirements Description/Purpose of Position: Responsible for providing patient care based upon the nursing process; being effectively involved with maintaining the standard of care for assigned patients through assessment, planning, implementation, and evaluation. Oversees and guides employees that are under your supervision. Minimum Qualifications: Education: Graduate of an accredited school of Nursing. License/Certification: Current RN license in the state of XXX. Current BCLS Certification. Other: Must be able to demonstrate the knowledge and skills necessary to provide care/service appropriate to the age of the patients served on the assigned unit/department. Note: An RN graduate is a nurse who has completed a course of study at a school of nursing and is eligible for the NCLEX. The RN graduate performs directly under the supervision of the charge nurse or RN designee.   

1. List three substantive questions you might expect to be asked in an interview for the job, and summarize your answers.  

2. Describe three to five ways in which you could prepare for the interview to make the most positive impression. 

3. Be sure to describe what you would wear and what material you would bring with you.

 

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The assignment below is a group project. Please the attached pdf of the case studies and the whole project instructions, however, you are to only answer questions 1 through 4 below as these are my assigned questions. I will also attach the some of the questions already answered by my group project members as a guide only. Use it as a chart also to complete the highlighted in yellow section only. Thanks!

Use the attached chart to complete only the highlighted questions. This assignment is due by 9 am America New/York time tomorrow 01/18/18.

In week 9 the case study team assumes full senior leader support on the validation of the two

root causes identified.

1. Review the literature to find at least 4 peer reviewed research studies which evoke

validation of the latest patient safety evidence in support of your root cause finding (Only locate 1 peer-reviewed article). 

2. At this point, the case study team determines recommendations using the latest

evidence from the literature on what is needed within these two hospitals to address

these significant root causes.

3. Assume a three-month implementation timeframe, recognizing that full realization may

take longer.

4. Construct a straw man Gantt chart or project plan to capture all necessary components

to move the recommendations forward.

 

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Case Study 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 750-1000 words, explain your answer and include rationale. 

Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide.  You are required to submit this assignment to Turnitin. 

 

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