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- A visiting nurse is performing a family assessment of ayoung couple caring for their newborn who was diagnosedwith cerebral palsy. The nurse notes that the mother’s hairand clothing are unkempt, the house is untidy, and themother states that she is “so busy with the baby that I don’thave time to do anything else.” What would be the priorityintervention for this family?a. Arrange to have the infant removed from the home.b. Inform other members of the family of the situation. c. Increase the number of visits by the visiting nurse.d. Notify the care provider and recommend respite care forthe mother.You are providing the immediate preoperative care for a womanscheduled for surgery to remove a brain tumor. She tells you shedoes not want the surgery because she knows she is dying andjust wants to go home to be with her husband and children. Shealso knows that her husband cannot accept the fact that she is dying and wants her to have the surgery. What do you do?31 TRUE or FALSE: Compared to antemortem pathology, perimortem pathology is less likely to have contributed to death. O True O False
- A 48-year old female presents to her physician with concern of worsening fatigue over thepast months.She reports feeling tired out all the time and unable to concentrate. Nothing seems tomake it better, not even rest. She has not seen a physician in a number of years otherthan for routine OB/gyn care and reports having gradually put on 40-50 lbs. over thepast 10 years. (Current weight 253; height 65.5 inches)She undergoes an oral glucose tolerance test and based on that data (and otherlaboratory values) she is diagnosed with type 2 diabetes. Further testing shows she is alsohypertensive and has hyperlipidemia.What isthe metabolic connection between type 2 diabetes and hyperlipidemia? Be specific inyour discussion and include relevant enzymesrelated to lipid metabolism. Circulating levels of which lipoproteins would be consistent with a diagnosis of hyperlipidemia?Be specific and include rationalesfor why some lipoproteins may be elevated and others not. This individual is prescribed…L.H. is a 26-year-old woman is in the clinic today for evaluation of weight gain and fatigue. She is 5 feet 6 inches and weighs 175 pounds. Prior to her pregnancy, she weighed 130 pounds and her maximum weight during pregnancy was 155 pounds. She is now 18 months postpartum and continuing to gain weight despite no change in diet or activity. She reports that the fatigue is getting worse even though her daughter is sleeping reliably through the night and the patient feels she is getting plenty of rest. She takes no other medications and has no significant medical history. Her vital signs today are HR 68, BP 108/60, RR 10, temperature 97° F Select a potential diagnosis for L.H. and describe the pathophysiology of that diagnosis. How does the pathophysiology explain L.H.’s symptoms?1. Knowing his history and seeing his condition this morning, what further questions are you going to ask JM and his daughter?
- Matthew is a 59-year-old diagnosed with Type II diabetes in the fall of last year. He presents today for follow up. His BS are better—he tells you that they are all still running a bit high—from 170-200 mg/dL—regardless of the time of day taken. He says his fasting BS is about 170 mg/dL. He is trying to follow his diet—and he feels like he has really come a long way in managing his diabetes. He states that when his NP diagnosed him, he was drinking about 4 liters of regular coke every day and eating junk food—his A1C at the time of diagnosis was 14 % Currently, his A1C is 8.0%. Other PMH is CAD, Dyslipidemia and Diabetic neuropathy. His current regimen of medications is: Metformin ER 1000 mg BID; ASA 325 mg daily; Lisinopril 10 mg daily Coreg 6.25 mg BID; Crestor 20 mg daily; Multivitamin [1] daily Vitamin D3 10,000 IU daily; Lyrica 50 mg at HS His CBC and electrolytes are normal; creatinine 1 mg/dL; [calculated GFR 115 cc/minute] thyroid function tests are normal. TC = 200…Physical Concerns Reason for the physical concern IS 1. Nausea and A. Increased prolactin levels for milk production vomiting B. relaxation of GI muscle tone due to elevated ERS 2. Heartburn progesterone level C. Increased appetite 4. physiologic anemia D. relaxation of cardiac sphincter or anxiety 5. Enhanced Appetite E. Secretion of nutrient into breastmilk 3. Increase BMR 6. Calcium F. This is due to increase in oxygen consumption Homeostasis related to increase cardiac output and due to 7. Constipation 8. Postpartum weight G. Circulating volume increase by 30-50%, Total increase oxygen needs of the placenta retention body water increases 9. Inadequate weight H. vomiting gain I. Energy intake more than the required 10. Excessive weight (there are only 9 choices) gainWhat are Bruces options at this point? Bruce and his parents moved to a semi-tropical region of the United States when he was about 3 years old. He loved to be outside year-round and swim, surf, snorkel, and play baseball. Bruce was fair-skinned, and in his childhood years, was sunburned quite often. In his teen years, he began using sunscreens, and although he never tanned very much, he did not have the painful sunburns of his younger years. After graduation from the local community college, Bruce wanted an outdoor job and was hired at a dive shop. He took people out to one of the local reefs to snorkel and scuba dive. He didnt give a second thought to sun exposure because he used sunscreen. His employer did not provide health insurance, so Bruce did not go for annual checkups, and tried to stay in good health. In his late 20s, Bruce was injured trying to keep a tourist from getting caught between the dive boat and the dock. He went to an internist, who treated his injury and told Bruce he was going to give him a complete physical exam. During the exam, the internist noticed a discolored patch of skin on Bruces back. She told him that she suspected Bruce had skin cancer and referred him to a dermatologist, who biopsied the patch. At a follow-up visit, Bruce was told that he had melanoma, a deadly form of skin cancer. Further testing revealed that the melanoma had spread to his liver and his lungs. The dermatologist explained that treatment options at this stage are limited. The drugs available for chemotherapy have only temporary effects, and surgery is not effective for melanoma at this stage. The dermatologist recommended that Bruce consider entering a clinical trial that was testing a DNA vaccine for melanoma treatment. These vaccines deliver DNA encoding a gene expressed by the cancer cells to the immune system. This primes the immune system to respond by producing large quantities of antibodies that destroy melanoma cells wherever they occur in the body. A clinical trial using one such DNA vaccine was being conducted at a nearby medical center, and Bruce decided to participate. At the study clinic, Bruce learned that he would be in a Phase Ill trial, comparing the DNA vaccine against the standard treatment, which is chemotherapy, and that he would be randomly assigned to receive either the DNA vaccine or the chemotherapy. He was disappointed to learn this. He thought he would be receiving the DNA vaccine.