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Clinical reasoning Scenario
A morbidly obese 55-year-old man with a history of high blood pressure who takes insulin, antihypertensive medication, aspirin and several herbal supplements daily is scheduled for laparoscopic gastric bypass surgery.
- What resources would you use to identify evidence-based practices for prevention of complications during the perioperative period?
Give at least 4-5 paragraphs
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- Give typed explanation A nurse is assisting the RN with the implementing the plan of care for a client with anorexia nervosa. Identify three (3) cognitive behavioral therapies that can aid with therapy.MAKE SHORT TERM GOAL AND 5 OBJECTIVES FOR THIS DX. Main Dx: Imbalanced nutrition less than body requirements related to Lacto-Ovo vegetarian diet as evidenced by lack of essential minerals & nutrients (Iron, Zinc & Omega Fatty-acids) SHORT TERM GOAL: OBJECTIVES: (ex. after 10 mins, the patient will.. after nursing shift, the patient will.. THE OBJECTIVES ARE ALL ABOUT THE PATIENT.) 1. 2. 3. 4. 5. SCENARIO: Aubrey, 19 years old, an incoming college freshman student went to Ateneo De Manila Health Services for physical examination. The nurse gathered the following information: Height: 5 ft Weight: 48 kg Vital signs: Temp 37.2C, Pulse rate: 95 beats per minute, Respiration rate: 12 breaths per minute, and BP: 100/70mmHg. Family History of illness: Father (+) Hypertension (HPN), and Diabetes Mellitus (DM) Present Health History: Aubrey never experienced to get hospitalized as far as she can remember. Her mother ensures that she takes daily supplemental vitamins such as vitamin…A morbidly obese 55 year old man with a history of high blood pressure who take insulin, antihypertensive medications, aspirin and several herbal supplements daily schedule for laparoscopic gastric bypass surgery. 1. What resources would you use to identify evidence based practices for prevention of complications during the perioperative period. 2. Identify the evidence as well as the criteria used in evaluating the strength of the evidence for the practices identified.
- MAKE A SCIENTIFIC (must include author and year published) AND SITUATIONAL ANALYSIS OF THIS DX. SCIENTIFIC ANALYSIS: SITUATIONAL ANALYSIS: Main Dx: Imbalanced nutrition less than body requirements related to Lacto-Ovo vegetarian diet as evidenced by lack of essential minerals & nutrients (Iron, Zinc & Omega Fatty-acids) SCENARIO: Aubrey, 19 years old, an incoming college freshman student went to Ateneo De Manila Health Services for physical examination. The nurse gathered the following information: Height: 5 ft Weight: 48 kg Vital signs: Temp 37.2C, Pulse rate: 95 beats per minute, Respiration rate: 12 breaths per minute, and BP: 100/70mmHg. Family History of illness: Father (+) Hypertension (HPN), and Diabetes Mellitus (DM) Present Health History: Aubrey never experienced to get hospitalized as far as she can remember. Her mother ensures that she takes daily supplemental vitamins such as vitamin C and B complex, and every year she gets flu vaccine from their family doctor.…TO DO: Make an analysis and interpretation of the Nutritional-Metabolic pattern of the patient below: ANALYSIS: (explanation of the said findings below, analysis) INTERPRETATION: (NORMAL OR DEVIATED FROM NORMAL) Patient details: Conscious about food intake and skipping meals every time (most of the time he only eats dinner in a day) Not well nourished because skipping meals Not immunized with 7 target diseases Conscious about his weight, feel anxious when he gains weight, and he does feel scared when other people tell him fat when he already knows. Allergic to having the stench or taste of fish Low intake of vegetable and fruits (1-2 per week only) Has diet restrictions of 1000-1500 calories per day Not immunized with 7 target diseases Poor diet because of skipping mealsSubjectiveChief Complaint: “Why can’t I just take prednisone every day? It always works when I get admitted to the hospital.” HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month followup appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the second hospital admission in the last 6 months related to TJ’s COPD instability. After TJ’s hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have them reassessed after the change in his COPD regimen. He wants to start taking prednisone every day because he believes this would prevent him from being readmitted to the hospital. The patient states that his respiratory symptoms are better than when he was…
- PLEASE USE YOUR OWN WORD Constipation can be an issue for infants, toddlers and school aged children, and therefore, an issue for the childs parents. What interventions, both pharmacological and non-pharmacological, can the nurse suggest to the parents of a child with constipation not caused by an underlying medical condition?Develop a searchable clinical question for the topic below using an appropriate framework (question formula) " high prevalance of pressure ulcers in elderly patients admitted to acute care hospitals using" In this section you will develop your question using the elements of an appropriate question framework. From your explanation of the issue in the first section, identify the aspects that you will be exploring in this research task. You will choose an appropriate question framework (eg PICO(T), PICo, PEO) and explain why this is the best one to use for your area of interest, supporting this with reference to scholarly literature. Identify the individual elements of the framework, with references, and then identify these elements for your own question. Ensure that each element is as clear and focused as possible; avoid generalisations (such as ‘effective’ outcomes, as these could be anything!). Refine and narrow where necessary, as this will make choosing search terms much easier…Fluoxetine, Sertraline, Escitalopram, Mitrazapine, Trazodone, Memantine, Zolpidem, Flurazepam, Suvorexant, Rivastigmine. Among these drugs, Please mention Dose, Side effects, Indications, Dose adjustment in hepatic and renal impairment, Use in pregnant and geriatric patients . Please answer at your own easy words. Answer should be to the point (specific ).
- MAKE SHORT TERM GOAL AND 5 OBJECTIVES FOR THIS DX. Main Dx: Imbalanced nutrition less than body requirements related to Lacto-Ovo vegetarian diet as evidenced by lack of essential minerals & nutrients (Iron, Zinc & Omega Fatty-acids) SHORT TERM GOAL: OBJECTIVES: 1. 2. 3. 4. 5. SCENARIO: Aubrey, 19 years old, an incoming college freshman student went to Ateneo De Manila Health Services for physical examination. The nurse gathered the following information: Height: 5 ft Weight: 48 kg Vital signs: Temp 37.2C, Pulse rate: 95 beats per minute, Respiration rate: 12 breaths per minute, and BP: 100/70mmHg. Family History of illness: Father (+) Hypertension (HPN), and Diabetes Mellitus (DM) Present Health History: Aubrey never experienced to get hospitalized as far as she can remember. Her mother ensures that she takes daily supplemental vitamins such as vitamin C and B complex, and every year she gets flu vaccine from their family doctor. During the interview with the nurse,…What is the nursing care plan of the following case scenario? Ms. Dela Cruz, 25 years of age, presents to the triage nurse at the local emergency department complaining of severe generalized abdominal pain. She describes it as sharp and intermittent. She states, “Over the last four (4) days, I haven’t been able to have a bowel movement.” She states that she is able to drink liquids and urinates without difficulty. Bowel sounds are present in all four (4) quadrants, however, they are hypoactive (decreased or quiet peristalsis). Abdomen is distended and firm to touch. She states, “Two weeks ago I feel that my back hurts. My doctor gave me a prescription of Tylenol #3 and I have been taking it every 6 hours for pain.” She denies pain at the present time. Abdominal x-ray reveals a large amount of stool in her lower colon. All other diagnostic tests are unremarkable. Assessment Diagnosis Goal/Object goal Planning Intervention Rationale Evaluation Objective data: Subjective data:…A 56-year old maintenance worker, with a past medical history of insulin dependent diabetes, CHF, and hypertension, presents to the emergency room with lightheadedness, lethargy, and periods of confusion. Patient family members found him unconscious outside. Wife states, “he’s been at it for over a weeknow” Medications: Insulin, Lasix, Digoxin and Vasotec: were:Temperature Pulse Respirations36.7C 118 18On examination, the patient has slurred speech with decreased upper and lower motor strength bilaterally 4/5. While examining the patient, he experienced loss of consciousness that lasted less than half a minute. The nurse, drew labs, administered oxygen via NC, Established IV line access and placed patient on a monitor. Lab resultsVitals on admission Blood Pressure 103/61 Electrolytes – in emergency room Hematocrit –PotassiumSodiumPhosphorus 2.6 mg/dL BicarbonateCalciumCreatinineSerum Osmolarity Glucose38%3.3 mEQ/L147 mEQ/L21 mEq/L 7.6 mg/dL2.4 mg/dL321 mmol/kg 389 mg/dL…