Caring for Clients with common Digestive/ Gastrointestinal Health Challenges.

Select any three (3) questions from Case Study # 1 or from Case Study # 2, and discuss the rationale by posting/ responding in the online learning activity/ discussion forum. Please identify the case study selected and copy the three questions chosen directly into the post. Include and properly reference information taken from the course readings to support your ideas.

CASE STUDY #2

(must be 3 pages with at least 5 references no older than 5 years)

Joshua Phelps, 37, arrives at the ED complaining of right lower quadrant abdominal pain. You obtain his vital signs and find out that he has no known allergies and takes no medications. His BP is 156/ 94; pulse, 100 and regular; respirations, 20; and temperature, 99.6 F (37.6 C).

What is the next step in investigating his problem?
Mr. Phelps’ pain began last evening and is associated with nausea, but he hasn’t vomited. Eating doesn’t seem to affect the pain, and he hasn’t had any bowel or bladder changes.

In assessing Mr. Phelps’s pain, what information should you obtain?
Mr. Phelps describes his pain as constant, deep and achy, and worse with movement. On a pain scale of 0- to 10, with 10 being the worst pain he has ever experienced, he rates the pain at a 7. He doesn’t want to lie supine and is guarding his right lower quadrant.

When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?
Abdominal assessment shows a normal inspection, normoactive bowel sounds, and no masses, enlargement, or tenderness of the liver or spleen. However, Mr. Phelps did display rebound tenderness and positive obturator and iliopsoas signs. Based on his history and physical assessment, the healthcare provider orders a complete blood cell count and urinalysis. The results indicate a total white blood cell (WBC) count elevation with 96% neutrophils. The urinalysis is normal.

Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.
Abdominal aortic dissection.
Acute appendicitis.
Renal calculi.
Acute Cholecystitis.

ONE PAGE OF SELF REFLECTION on
What is my knowledge concerning providing care for and with clients experiencing digestive and gastrointestinal challenges? (i am a community rpn)

ONE PAGE OF REFLECTION ON MY PEER WORK ( TWO REFERENCES)
Case Study #2
1) In assessing Mr. Phelps’s pain, what information should you obtain?The information that should be obtained about Mr. Phelps’s pain include:
Character of the pain: deep and achy
Duration: States it’s constant
Frequency
What makes the pain worse or better: movement makes it worse, lying supine
Location: right lower quadrant
Distribution of referred pain
Time pain started: last evening

2) When assessing Mr. Phelps’ abdomen, describe the order and specifics associated with the assessment?

Start with inspecting the abdomen noting colour, contour, symmetry, the umbilicus is midline etc.
Next we would auscultate because “percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds” (Jarvis, 2014). During auscultation we listen for bowel sounds(character and frequency) and vascular sounds.
Percussion comes next “to assess the relative density of abdominal contents, to locate organs, and to screen for abdominal fluid or masses”(Jarvis, 2014).
Palpation is last. You note whether their is tenderness, masses, involuntary rigidity, guarding etc.

3) Mr. Phelps’ signs and symptoms, history, physical assessment, and lab findings suggest which diagnosis? Explain your rationale.

Mr. Phelps’s assessments suggest acute appendicitis based on the following findings:positive obturator and iliopsoas sign, pain in RLQ. “when the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix) pain is felt in the RLQ” (Jarvis, 2014)
Rebound tenderness 
Pain aggravated by movement
Nausea
Fever
Total white blood cell count elevation with 96% neutrophils 

References

Jarvis, C. (2014). The Abdomen, Physical Examination and Health Assessment (2nd CanadIan ed., pp 557-569). Toronto, ON: Elsevier Canada.

1. List and discuss the different types of burn injuries 
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   3.
   1. Discuss the following:
      1. Determine the depth (degree) of burn.
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2. Determine the extent of the burn.
3. Determine which parts of the body are burned.
4. Determine the respiratory involvement.
5. Determine whether other injuries or preexisting medical problems exist or if the victim is elderly (older than 55 years) or very young( younger than 5 years).
6. Determine the burn’s severity
7. Discuss the Following:
8. Minor Burns 
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9. Moderate Burns 
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10. Critical Burns 
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11. Discuss Care for Thermal Burns
12. Discuss Care and Caution (Thermal Burns) for the following : 
     First Degree Burns
13.  Caution
    1. 
        Second Degree Burns
    2. 
        Third Degree Burns
14. CautionList the Do Not for Burns
15. Discuss Sunburn
16. List and Explain the various skin types
17. Discuss care and Prevention for sunburns?
18. Discuss Care for Chemical Burns
19. Discuss Electrical Burns
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    3.
20. Care for electrical Burns
21. 2.
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    7.