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Handover: Mr Eddie Baker is 31 years old. He was diagnosed with Crohn’s disease in his early 20s. Since then, the disease process has become extensive, affecting most of his terminal ileum and ascending colon. He has experienced some severe exacerbations which have required hospitalisation. He has used most of the pharmacotherapies available, including immunosuppressive medications and corticosteroid therapy for acute exacerbations.
Recently, after a colonoscopy showed progression of the disease to other sections of his large bowel, he made the decision to undergo a total colectomy to better manage his condition.
His initial surgery was booked for yesterday at 1000. He last ate at 1930 the night before his surgery and last drank at a black weak tea at 0600 the morning of surgery. Due to an emergency Eddie’s operation was delayed until the afternoon. The surgical team were happy with the operation and reported minimal blood loss. Eddie returned to the ward at 1900 last night.
It is now 0700 and you have received morning handover from the night shift.
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NURSING DIAGNOSES, GOALS, ACTIONS, RATIONALE and EVALUATION (word count 800) |
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Nursing diagnosis 1: (not included in word count) >>insert text here<< |
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- A 62-year old, recently widowed male Hispanic patient, KB. was brought in to the emergency department (ED) by his daughter for progressively worsening shortness of breath, fatigue, a lingering non-productive cough, and generalized edema. One month prior, he noticed dyspnea upon exertion, loss of appetite, nausea, vomiting and malaise, which he attributed to the flu. In the emergency department, he appeared anxious and pale, and had a dry yellow tint to the skin. He denied any chest pain, and he could not recall the last time he urinated. He has history of benign prostatic hyperplasia, diabetes mellitus type 2, hypertension, dyslipidemia, and renal insufficiency for the past two years. His ED assessment findings included: 1+ pedal edema, basilar crackles in the lungs bilaterally, and a scant amount of urine according to a bladder scan. His lab results indicated a glomerular filtration rate (GFR) of 12. Based on his subjective and objective symptoms, he was admitted with a diagnosis of…case study: C was a six year old boy who passed away at the Lady Cilento Children’s Hospital on14 January 2017. He was a generally healthy and happy child. C’s treating team at the Lady Cilento Children’s Hospital attributed his death to overwhelming sepsis due to melioidosis. His death was not discussed with the coroner at that time. No autopsy was performed. C’s death was first reported to the State Coroner on 3 May 2018 due to the family’s concerns about the care C received from a remote hospital over several days leading up to his admission on 10 January 2017 and subsequent transfer to a regional hospital by which time he was seriously ill. The family also lodged a complaint with the Office of the Health Ombudsman. The Health Ombudsman considered the family’scomplaint potentially identified broader systemic issues and undertook a systemicinvestigation. The family’s concerns related to failure by remote hospital staff to correctly diagnoseand investigate the cause of C’s worsening…The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement should be included in this teaching session? a) “We -ill need to teach a family member ho- to give this drug in your arm.”b )“This drug is given in the folds of your abdomen, but at least 2 inches a-ay from your navel.”c) “This drug needs to be taken at the same time every day -ith a full glass of -ater.”d )“Be sure to massage the injection site thoroughly after giving the drug.”
- Mr. Jones is a 69-year-old man who was admitted to the hospital 10 days earlier with a diagnosis of acute diverticulitis. He was given intravenous fluids and empiric antibiotic coverage with ceftriaxone and metronidazole. His antibiotics were stopped after 7 days, and he continued to do well until today, when he developed abdominal pain, fever, and diarrhea. A diagnosis of Clostridium difficile colitis was made, and antibiotic treatment was initiated. Discuss the following questions: What diagnostic test would confirm the diagnosis? What risk factors did Mr. Jones have to acquire a Clostridium difficile infection? Why is oral but not intravenous vancomycin a potential treatment option for this infection? One person from each group should respond to this discussion with a link to their group’s recording and a summary of the discussion that took place.SCENARIO Identifying Data: This 72-year-old female presents with a biopsy proven adenocarcinoma of the sigmoid colon at 20 cm. History of Present Illness: The patient has been noted to have some bright red bleeding intermittently for approximately 8 months, initially presumable of a hemorrhoidal basis. She recently has had intensification of rectal bleeding but no weight loss, anorexia, or obstructive pain. No significant diarrhea or constipation. Some low back pain, probably unrelated. Recent colonoscopy by Dr. Scoma revealed a large sessile (attached by a broad base) polyp, which was partially excised at 20-cm level, showing infiltrating adenocarcinoma at the base. The patient is to enter the hospital at this time after home antibiotic and mechanical bowel prep, to undergo sigmoid colectomy and possible further resection. 1. Using the scenario above, answer the following questions: A. What chronic symptoms did this patient have? Describe the symptoms using medical…A client fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include a) hyperactive bowel sounds. b) elevated temperature and presence of erythema at incision site. c) ecchymosis and edema at incision site. d) complaints of activity intolerance. asap please.
- A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film? What is the clinical significance of the platelet count?A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film? What is the clinical significance of the platelet count? NOTE: If you could answer all the questions please. Thank you!A 54-year-old man presents with a 12-hour history of headache, confusion and declining consciousness. His wife says that he has recently completed oral chemotherapy for an ‘indolent form of leukemia’. Examination reveals him to be responding to painful stimuli but not to verbal commands. He has bilateral axillary and inguinal lymphadenopathy. He is clinically jaundiced and anemic. His spleen is palpably enlarged. He has neck stiffness, generalized hyper-reflexia and bilateral up going plantar reflexes. Fundal examination is normal, and there are no focal neurological signs. Full blood count shows: Hemoglobin (Hb) 7.5 g/dL White blood cells (WBC) 37 × 109/L (lymphocytes 86%) Platelets 26 × 109/L What blood component is best to harvest to find out the patient’s disease? Why lymphocytes are prevalently seen in the peripheral blood film?
- DOB: 28 Jun 1961 | GENDER: FEMALE SITUATION Mrs Donna Hovey is a 60-year-old female who was admitted to the ward two (2) days ago for pneumonia. She is now complaining of mild pressure in her chest (rated 4/10) that started 10 minutes ago while she was lying on the bed. Mrs Hovey states she also has a slight ache in the underside of her upper left arm.She is diaphoretic and feeling a little nauseated. Mrs Hovey has developed slight shortness of breath. Her peripheries are a little cool to touch BACKGROUND Mrs Hovey has a history of Ischaemic Heart Disease (IHD), hypertension and beginning Peripheral Vascular Disease (PVD). She had Coronary Artery Bypass Graft (CABG) surgery six (6) years ago with Saphenous Vein grafts to her Left Anterior Descending (LAD) coronary artery and diagonal branch. Mrs Hovey also had a Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary Artery (RCA) and Posterior Descending Artery (PDA). ASSESSMENT Her…DOB: 28 Jun 1961 | GENDER: FEMALE SITUATION Mrs Donna Hovey is a 60-year-old female who was admitted to the ward two (2) days ago for pneumonia. She is now complaining of mild pressure in her chest (rated 4/10) that started 10 minutes ago while she was lying on the bed. Mrs Hovey states she also has a slight ache in the underside of her upper left arm.She is diaphoretic and feeling a little nauseated. Mrs Hovey has developed slight shortness of breath. Her peripheries are a little cool to touch BACKGROUND Mrs Hovey has a history of Ischaemic Heart Disease (IHD), hypertension andbeginning Peripheral Vascular Disease (PVD). She had Coronary Artery Bypass Graft (CABG) surgery six (6) years ago with Saphenous Vein grafts to her Left Anterior Descending (LAD) coronary artery and diagonal branch. Mrs Hovey also had a Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary Artery (RCA) and Posterior Descending Artery (PDA). ASSESSMENT Her observations at…DOB: 28 Jun 1961 | GENDER: FEMALE SITUATION Mrs Donna Hovey is a 60-year-old female who was admitted to the ward two (2) days ago for pneumonia. She is now complaining of mild pressure in her chest (rated 4/10) that started 10 minutes ago while she was lying on the bed. Mrs Hovey states she also has a slight ache in the underside of her upper left arm.She is diaphoretic and feeling a little nauseated. Mrs Hovey has developed slight shortness of breath. Her peripheries are a little cool to touch BACKGROUND Mrs Hovey has a history of Ischaemic Heart Disease (IHD), hypertension and beginning Peripheral Vascular Disease (PVD). She had Coronary Artery Bypass Graft (CABG) surgery six (6) years ago with Saphenous Vein grafts to her Left Anterior Descending (LAD) coronary artery and diagonal branch. Mrs Hovey also had a Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary Artery (RCA) and Posterior Descending Artery (PDA). ASSESSMENT Her…