Chamberlain NR 305 All Week
Discussions - Latest November 2016
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NR 305 Week 1 Discussions Latest November 2016
Healthy People Initiative (graded)
The topic this week asks you to apply what you
have learned to the following case study. As the school nurse working in a
college health clinic, you see many opportunities to promote health. Maria is a
40-year-old Hispanic who is in her second year of nursing school. She complains
of a 14-pound weight gain since starting school and is afraid of what this will
do to both her appearance and health if the trend continues. After conducting
her history, you learn that she is an excellent cook and she and her family
love to eat foods that reflect their Hispanic heritage. She is married with two
school-age children. She attends class a total of 15 hours per week, plus she
must be present for 12 hours of labs and clinical. She maintains the household
essentially by herself and does all the shopping, cooking, cleaning, and
chauffeuring of the children. She states that she is lucky to get 6 hours of
sleep per night, but that is okay with her. She lives 1 hour from campus and
commutes each day. Using Healthy People 2020 and your text as a guide, answer
the following questions. What additional information would you like to gather
from Maria? What are Maria's real and potential health risks? Why is Maria's
culture important when obtaining the health assessment? Pick one of Maria's
health risks. What would be one reasonable short-term goal for this risk? What
nursing interventions would you incorporate into Maria's plan of care to assist
her with meeting your chosen goal?
NR 305 Week 2 Discussions Latest November 2016
General Survey/Skin/Nutrition (graded)
Your home health agency has
received an order from a local hospital to evaluate and treat an elderly woman
being discharged from its medical surgical unit. Millie Gardner, an 83-year-old
female patient, is being discharged home today to the care of her husband Fred
(87 years old) following a 9-day hospitalization for pneumonia, dehydration,
and failure to thrive. She has a history of hypertension (HTN), Type II
Diabetes, and cerebral vascular accident (CVA) with left-sided weakness.
Patient is alert and oriented but does have periods of forgetfulness during the
overnight hours. Patient has intermittent incontinence of bowel and bladder and
requires assistance with all activities of daily living (ADLs). Medications: Lopressor
Lisinopril Plavix Metformin Novolin R per sliding scale *NEW* Multivitamin
Colace Zithromax *NEW* Upon arrival you are greeted by Champ, the couple's
rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair
staring blankly out the window, and Fred is busy in the kitchen preparing the
couple's lunch. Based on the scenario above, please use the general survey
process to describe the areas that you would be observing immediately upon
entry to the home. What, if any, concerns related to Millie's skin and
nutritional status do you have? What nursing interventions will you include in
the plan of care to address these concerns? What teaching strategies will you
use to educate Millie and Fred on the new medications? Using the SBAR, please
include the information that you will communicate to the physician's office at
the completion of the visit.
NR 305 Week 3 Discussions Latest November 2016
Assessment of the Neurological System (graded)
Randy Adams is a 38-year-old
male patient of Dr. Joseph Reynolds who was admitted yesterday morning for
24-hour observation for mild concussion following a motor vehicle accident.
Randy lost consciousness during the accident and was very confused when he
arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed
to think after the accident that this all happened in Iraq. Dr. Reynolds is
concerned that Randy has some residual problems from a couple of explosive
incidents that occurred while he was in Iraq. The physician is unsure whether
Randy's current symptoms are from the car accident or from prior injuries so he
has referred him for consultations to both a neurologist and to a behavioral
health specialist. Based on the above please discuss the following.
Pathophysiology of concussive injuries and treatment Neurological assessment
tools used in your current practice setting (if not presently working, please
describe one used during prior employment or schooling) Current best practices
associated with post-traumatic stress disorder (PTSD) Nursing interventions you
would include in this patient's plan of care
NR 305 Week 4 Discussions Latest November 2016
NR 305 Week 4 Discussions Latest November 2016
Assessment of Cardiac Status (graded)
Esther Jackson is a 56-year-old black female
who is 1-day post-op following a left radical mastectomy. During morning
rounds, the off-going nurse shares with you during bedside report that the
patient has been experiencing increased discomfort in her back throughout the
night and has required frequent help with repositioning. She states that the
patient was medicated for pain approximately 2 hours ago but is voicing little
relief and states that you might want to mention that to the doctor when he
rounds later this morning. With the patient appearing to be in no visible
distress, you proceed on to the next patient's room for report. Approximately 1
hour later, you return to Ms. Jackson's room with her morning pills and find
her slumped over the bedside stand in tears. The patient states, "I don't
know what is wrong, I don't feel right. My back hurts and I'm just so tired.
What is wrong with me?" The patient refuses to take her medications at
this time stating that she is starting to feel sick to her stomach. Just then
the nursing assistant comes into the patient's room to record Ms. Jackson's
vital signs, you take this opportunity to quickly research the patient's
medication record to determine if she has a medication ordered for nausea. Upon
return, the nursing assistant hands you the following vital signs: T 37, R 18,
and BP 132/54, but states she couldn't get the patient's pulse because "it
is all over the place." Please address the following questions related to
the scenario. What do you suspect is the cause of the patient's symptoms?
Describe the course of action that you will take to confirm this suspicion and
prevent further decline. What further assessments, lab values, and tests will
likely be ordered for this patient and how often? If testing is to be completed
more than once, please explain the rationale for doing so. While you are caring
for this patient, how will you ensure that the needs of your other patients are
being met?
NR 305 Week 5 Discussions Latest November 2016
Assessment of Respiratory Status (Graded)
Please review the video on the assignments
page under the discussion section as it will provide you with an opportunity to
immerse yourself in the role of a nurse addressing tobacco use during routine
patient care. In doing so, reflect on what you have learned about tobacco use
and the role that nurses and other interdisciplinary team members play in
helping to assist tobacco users with quitting. While viewing, it is also
important to keep in mind that tobacco users move through stages of change in
the process of quitting. They move from pre-contemplation to contemplation,
contemplation to preparation; preparation to abstinence; abstinence to
maintenance. Every stage requires a different strategy by a nurse. After
watching the video, and reflecting on the information presented, address each
of the following questions. What are the common symptoms associated with an
exacerbation of COPD? What assessment techniques will you use to assess Mary?
Identify smoking strategies that would be appropriate for each of the
encounters that Mary had with the nurse throughout the video that could have
been used to assist Mary in quitting smoking. Find a resource in your community
that could assist Mary. Start by searching the Internet for your local health
department's website. What services are available to Mary? Briefly describe the
services that the state quit line provides. Does it meet the 4 As? Is it
accessible, acceptable, affordable, or available for Mary? What will you do to
follow-up on Mary's smoking cessation process?
NR 305 Week 6 Discussions Latest November 2016
NR 305 Week 6 Discussions Latest November 2016
Week 6 Assessment of the Abdomen and Genitourinary System (graded)
Amira is a 27-year-old Syrian refugee who has
been residing in a local homeless shelter since her arrival here in the United
States 4 weeks ago. She was brought into the emergency room this morning via
squad after being found by a shelter employee sitting in a pool of blood on the
bathroom floor crying and holding her abdomen. Due to her limited English
speaking abilities, she is unable to provide specific details as to her
complaints but the shelter employee states that she has recently stopped eating
and has not looked well for the past couple of days. Based on the limited
information provided, please answer the following questions. How will you
prioritize your care of Amira, what assessments will you complete, and in what
order? Please provide rationale for choosing this order. Are there any cultural
beliefs/practices that must be taken into consideration when planning her care?
Considering her symptoms of abdominal pain and bleeding, is it possible that
her status as a homeless refugee is a causative or contributing factor to her
illness? Please provide rationale for your response.
NR 305 Week 7 Discussions Latest November 2016
NR 305 Week 7 Discussions Latest November 2016
Assessment of the Musculoskeletal System and Pain (Graded)
Fred is an 83-year-old male who
is being admitted to the medical-surgical unit status post fall. He is alert
and oriented and reports that while visiting a local casino with his wife
Margaret earlier this evening, he tripped over a curb and fell landing on his
right side. After receiving morphine in the emergency room prior to transfer to
your unit, Fred is rating his pain at 6/10. He has multiple bruises from his
jawbone to his knee as well as a slight rotation of his right leg. Past medical
history includes: myocardial infarction (MI) x 2, peripheral vascular disease
(PVD) with bilateral iliac stents, non-insulin-dependent diabetes mellitus
(NIDDM), sleep apnea, and degenerative joint disease. Medications include:
aspirin, Plavix, Lopressor, Lisinopril, and Metformin. After reviewing the
above scenario please answer the following questions. Based on the information
provided, how will you prioritize your care, what assessments will you include
and in what order? Please provide rationale for your response. Considering this
patient's age, injury, past medical history, and list of current medications,
what, if any, concerns do you have related to his potential need for surgery?
Should surgery to repair his right femur be required; what type of clearance
and pre-op orders would you anticipate receiving related to his diet, meds, lab
work, and so on?
NR 305 Week 8 Discussions Latest November 2016
Rapid Assessment of a Client (Graded)
Please choose one of the patient scenarios
below. Next, complete a rapid assessment, and provide a SBAR report to a
classmate. Remember to include all concepts of patient safety, standard
precautions, and professional standards. You are covering for a coworker who is
off the floor for lunch, when you suddenly hear a loud crash coming from a
nearby patient room. You quickly run in and discover Mr. Johnson who was
admitted yesterday with a diagnosis of cerebral vascular accident (CVA)
unconscious on the floor between the bed and the bathroom. You are called to
the room of 2-year-old Jonah by his mother who states the child has suddenly
started breathing very loudly and does not look right. Upon entering the room
you quickly recognize that the child is in respiratory distress as his lips are
cyanotic and the use of accessory muscles is evident. You are in the process of
admitting Ashley, a 27 year old who is 28 weeks pregnant with her first child,
to the obstetric unit for complaints of headache, dizziness, and swelling of
her lower extremities when she suddenly begins seizing.
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