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- Mrs. Christianson is 82 yrs old and lives in a long term care facility. Today she seems irritable and does not recall your name. These issues are not normal for her. She says she’s tired and does not want to eat breakfast. When should you report these changes? Why is it important to report for such changes in older adults?Twenty-six-year-old Wei isn’t feeling well. Wei uses he/him/his pronouns. He is more tired than usual, dragging through his workdays despite going to bed earlier and napping on the weekends. He doesn't have much of an appetite and has started losing weight. When he presses on the side of his neck he notices an unusual lump. Wei goes to his doctor, who performs a physical exam and determines that the lump is a swollen lymph node. Lymph nodes are part of the immune system, and they will often become enlarged when the body is fighting off an infection. Dr. Bouazizi thinks that the swollen lymph node and fatigue could be signs of a viral or bacterial infection, or indicate a type of cancer called lymphoma. However, an infection is a more likely cause, particularly in a young person like Wei. Dr. Bouazizi prescribes an antibiotic in case Wei has a bacterial infection and advises him to return in a few weeks if his lymph node does not shrink or if he is not feeling better. Wei returns a few…Sally Conner is a 60-year-old who recently suffered a stroke at home. She has been moved into Real Nice Long Term Care facility for recovery. Her vital signs are normal but complains of intermittent mild headaches. She has left sided weakness in her arm and leg, and currently spends most of her time in bed. She suffered from CVA last month which has left her debilitated and dependent with self-care. She has difficulty with swallowing and requires assistance with feeding. You will assist her with brushing her teeth, provide a partial bed bath, help her change her gown, and change her bed while she is in it. Question: If patient has weakness on the left side, where should you best approach the patient and why?
- Sally Conner is a 60-year-old who recently suffered a stroke at home. She has been moved into Real Nice Long Term Care facility for recovery. Her vital signs are normal but complains of intermittent mild headaches. She has left sided weakness in her arm and leg, and currently spends most of her time in bed. She suffered from CVA last month which has left her debilitated and dependent with self-care. She has difficulty with swallowing and requires assistance with feeding. You will assist her with brushing her teeth, provide a partial bed bath, help her change her gown, and change her bed while she is in it. Discussion Questions: If patient has weakness on left side, where should you best approach the patient and why?what is the most common trigger for abusive head trauma (aht)? baby needs help waking up baby won’t go to sleep baby won’t stop crying baby keeps spitting upJohnny is 7 years old and in the first grade. He has trouble sitting still, often loses things, is very loud, and acts very impulsively. Your evaluation has determined that he meets criteria for ADHD. His parents are coming to your office tomorrow to discuss the results. How do you tell them? What if they feel that they’ve done something wrong? Do you recommend psychotherapy? Do you recommend medication?
- The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” At this moment, Mrs. Jones is also having anxiety in dealing with old age. What factors may be contributing to urinary incontinence? Discuss. How should the nurse respond to Mrs. Jones? What are the interventions to be made?Ella is an attorney who has worked in private practice for 25 years. She estimates she works 70 hours/week between the office and the courtroom. She has attributed her persistent fatigue to her schedule, poor diet (“I usually eat on the run, whatever is available”) and alcohol consumption (“I drink a bottle of wine a couple nights a week, and maybe more at the weekend especially if there are lots of dinners with clients”). Her fatigue has recently worsened and she has been feeling nauseous and light-headed consistently over the last several days. How do you interpret the increases in ALT, AST and LDH and what is the most likely cause of this? Lactate dehydrogenase (LDH) 190 99-191 IU/L Aspartate amino-transferase (AST) 260 12-45 IU/L Alanine aminotransferase (ALT) 76 <34 IU/LElla is an attorney who has worked in private practice for 25 years. She estimates she works 70 hours/week between the office and the courtroom. She has attributed her persistent fatigue to her schedule, poor diet (“I usually eat on the run, whatever is available”) and alcohol consumption (“I drink a bottle of wine a couple nights a week, and maybe more at the weekend especially if there are lots of dinners with clients”). Her fatigue has recently worsened and she has been feeling nauseous and light-headed consistently over the last several days. Parameter Result Normal Glucose 87 70-99 mg/dL BUN 12 7-22 mg/dL Creatinine 0.71 0.5-1.2 mg/dL Na 141 135-145 mmol/L K 4.9 3.5-5.3 mmol/L Cl 103 98-109 mmol/L CO2 24 22-26 mmol/L Calcium 9.2 8.6-10.2 mg/dL Phosphorus 2.7 2.6-4.9 mg/dL Albumin 3.0 3.2-4.6 g/dL Bilirubin 2.2 0.2-1.2 mg/dL Lactate dehydrogenase (LDH) 190 99-191 IU/L…
- While you are working as an RN in an outpatient medication clinic, a client comes to an appointment for renewal of his blood pressure, thyroid, and diabetic medications. He has a history of alcohol and opioid abuse. As the patient enters, you notice that he is unshaven, unkempt, and appears agitated, talking loudly and fast and gesturing widely. His gait is ataxic and staggering. He carries with him a bottle of soda, which he occasionally drinks from. As you approach the client to obtain his vital signs, a strong smell of alcohol engulfs you. When you ask the client if he has been drinking, he admits that he has been; furthermore, he confesses that the soda bottle contains alcohol. As you explain to the client that alcohol is not permitted on the clinic premises and ask the client to leave, he loudly tells you that he cannot possibly go because he is completely out of his medications and needs to obtain his prescription refills today. Repeatedly, you reinforce that alcohol is not…While you are working as an RN in an outpatient medication clinic, a client comes to an appointment for renewal of his blood pressure, thyroid, and diabetic medications. He has a history of alcohol and opioid abuse. As the patient enters, you notice that he is unshaven, unkempt, and appears agitated, talking loudly and fast and gesturing widely. His gait is ataxic and staggering. He carries with him a bottle of soda, which he occasionally drinks from. As you approach the client to obtain his vital signs, a strong smell of alcohol engulfs you. When you ask the client if he has been drinking, he admits that he has been; furthermore, he confesses that the soda bottle contains alcohol. As you explain to the client that alcohol is not permitted on the clinic premises and ask the client to leave, he loudly tells you that he cannot possibly go because he is completely out of his medications and needs to obtain his prescription refills today. Repeatedly, you reinforce that alcohol is not…LEVEL I EMONSTRATED KNOWLEDGE (ORAL OR WRITTEN) The best way to have good communication with your clients is to (Choose the one best answer): (a) Listen carefully and allow them to tell their feelings. (b) Tell them what you think they should do. (c) Let them know everything will be fine. (d) If they begin to talk about death, you begin to talk about something else. Your client asks you to do something for her which goes against what your supervisor told you to do. You should (Choose the one best answer): (a) Do as she asks and make her promise not to tell anyone. (b) Ask her how much she will pay you to do what she wants. (c) Tell her that no one can make changes in the work plan or schedule. (d) Carefully explain what your supervisor told you to do. Tell her you will discuss with your supervisor what she asked you to do. You are afraid of your client's dog which is kept indoors. You should (Choose the onc best answer): (a) Explain your fear of dogs to your client and ask if there is…