What actions will you take if you notice changes in the client’s vital signs?

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Case Study

Task 1

A 61yr old female patient (Mrs. Chalk) presented at the Emergency Department with dyspnoea. She claims that she has been having difficulty breathing for the past 3 days. It gets worse when walking up stairs and unloading groceries form the car.

Your initial assessment of Mrs. Chalk is her inability to complete sentences, moderately obese and has an unsteady gait.

Physical assessment: BP 145/89 mmHg RR 24/min SaO2 93% with a distended neck veins and productive cough.

From the above information and your knowledge of normal parameters

Identify the likely impact of Mrs. Chalk’s condition

Discuss the likely nursing interventions to manage Mrs. Chalk.

Identify 2 actual and 2 potential problems relating to his condition

Based on Mrs. Chalk’s unsteady gait, what assessment document is required to be         completed and what services will be required to be provided to comply with                 organisational policies and procedures   (500words)

Task 2

Mr. Percy is a 45 yr. old policeman who has presented to your ward with a provisional diagnosis of prostate cancer. He has been referred by his GP. He lives with a flat mate and works up to 60 hrs per week including overtime. He does not smoke but does enjoy a social drink. Mr. Percy also experiences difficulty when emptying his bladder and suffers with retention of urine, this then leads to UTI.

Explain the anatomical position of the prostate.

What are the implications of Mr. Percy’s problem?

Once the specialist has seen Mr. Percy, he is taken to theatre for Trans Urethral Resection of Prostate a (TURP), on return to the ward state the care of the    patient.e.g.Bladder Irrigation. (300 words)

Task 3

Miss Jallopi a 25yr old female presented to A&E having taken 16 Paracetomol and 32 Ibuprofen. This worked out to be 8 g of Paracetomol. She was asymptomatic on presentation, having been brought in about an hour after ingestion after her father realized she had ingested a large amount of tablets. On examination there was evidence of deliberate self-harm. She had a history of overdose with a previous attempt at 17yrs of age, was on Fluoxetine, however her GP was in the process of changing her prescription and she had been without medication for about three days.

State the signs and symptoms of Paracetomol poisoning

How would the A&E department manage an overdose on admission

Within 2 hours of admission, what would be the required treatment for Miss Jallopi.

What other health care service will assist Miss Jolllopi. With her ongoing Care.  (500 words)

Task 4

Using the following Case Study, complete the following questions.

History of Present Condition:

Susan is a 22 year old female University student who has been experiencing episodes of muscle fatigue, numbness and tingling of the extremities and blurred or double vision. For the most part, these symptoms were mild and usually disappeared in a day or two. Susan attributed her fatigue and blurred vision to preparation for exam week and long hour at her part-time job. However, the symptoms persisted after exam week. Susan noted that she felt weak and tired most of the time, so she decided to visit her doctor.

Susan met with her family doctor and explained that she felt tired all the time and that she was having problems seeing, especially with her left eye. The doctor carried out a routine examination and found nothing out of the ordinary so he sent her to see an ophthalmologist. The ophthalmologist noted her symptoms and ordered a full neural examination including an MRI and a spinal puncture for a sample of cerebrospinal fluid (CSF).

The results from her tests indicated that her extremities were slightly hyper-reflexive, she had elevated protein levels in her CSF and her  MRI showed multiple regions of demyelinated axons (plaques) that were located along the optic nerve, cerebellum, brain stem and spinal cord.

The diagnosis was Multiple Sclerosis (MS).

Susan had muscle fatigue and hyper-reflexia because plaques on the corticospinal tract slow nerve transmission along the descending motor pathways from the cortex to the spinal motor neurons. This produces muscle weakness and hyper-reflexia.

In 250 words discuss:-

             Why did Susan have visual problems?

             Why did Susan have numbness or tingling of the extremities?

Susan was treated with high-dose IV steroids over several days for symptoms related to the demyelinating lesions of plaque in her CNS. The RN asked you take Susan’s BP & pulse frequently throughout the treatment.

In 250 words

             Can you explain why this was required?

             What actions will you take if you notice changes in the client’s vital signs?

The causes of MS are thought to be autoimmune in origin. Explain what autoimmune means. What other MS-related symptoms could Susan possibly develop in the future?

Describe how you’re personal, educational, and professional background will help you achieve your goals.

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Pharmacy’s Personal Essay:

1) Talk about myself: I’m Vietnamese and I came to the US 8 years ago. I come from a family where none of my family members graduate from college or university. My sister is a nursing student at Chamberlain College of Nursing. We both work really hard to achieve the same goal which is becoming the first generation of our family to graduate from college
I will only talk about myself. The other areas below, I will let you write for myself. The school committee will read this essay so I want you to write a very strong response that can catch attention to them. You have to state why I would be a strong candidate for admission.
2) Your Personal Essay should address why you selected pharmacy as a career and how the Doctor of Pharmacy degree relates to your immediate and long-term professional goals.
3) Describe how you’re personal, educational, and professional background will help you achieve your goals. The personal essay is an important part of your application for admission and provides you with an opportunity for you to clearly and effectively express your ideas.
4) What is special, unique, distinctive, or impressive about your life story? Do you have notable accomplishments? Have you traveled the world? Do you volunteer to work with patients at a local hospital? Do you currently work in a pharmacy (I volunteer at local Walgreen Pharmacy for the 9 months. I also volunteer at the North Cypress Medical Center of Pharmacy Department)
5) What skills/characteristics do you possess—leadership, perseverance, enthusiasm, integrity, etc. that will allow you to be successful?
6) Why should the admissions committee be interested in you in particular? Again, brainstorm some ideas. Past academic excellence? Job-related experience? Personal experience?

What are the current socioeconomic, political, cultural, and ethical issues surrounding this topic?

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Focus on one dimension of performance of the U.S. health care delivery system. The student is expected to perform a thorough search of the literature, the media, and discussions with stakeholders such as legislators, consumers, and other health care professionals about your chosen focus of the health care delivery system. You will prepare a 8 slide PPT presentation with text notes added that will present the following areas or the selected health issue:

What is the current legislative or regulatory issue, and why is it being debated?

Who is most affected by the legislation?

What are the current socioeconomic, political, cultural, and ethical issues surrounding this topic?

Who are the stakeholders?

respond to the following questions in a comprehensive manner that demonstrates an understanding of the legislative process that focuses on the selected health disparity and the implications of the policy for nursing and/or health care executives..

Provide the rational for the choice of the selected MDT members based on client assessment

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You are a Registered Community Nurse who has been assigned to this new referral (as per the scenario supplied) as part of your caseload.

A part of your responsibilities is to prepare and present a case conference for this new referral to the Multi-Disciplinary Team (MDT) within your Local Health District.

Scenario: Vodka-loops

You pull the car up outside the new client’s house. It is a very small house from the outward appearance and is in disrepair. The yard looks poorly attended and an old car sits rusting and overgrows with weeds and grass in the front yard. Three small children of different ages played on the steps of the house. Three huge gum trees shade the house with some branches resting precariously on one section of the roof. The children looked dishevelled and unkempt. They played with no shoes on and you notice bruising on their legs. As you approach the house the children scatter, each racing off to hide near the massive tree or car body. You note that they are very young; approximately 3-9 years of age.

When you knock at the door and call for a few minutes; a large woman shuffles to the door to let you in. Mrs. Joan Bull had been expecting you as the local General Practitioner (GP) had set this referral up with her. She is an obese woman; dishevelled in appearance, wearing ill-fitting clothes and no shoes. She is very dyspnoea and steadies herself against the doorframe and at times gasping for breath. Joan is a 68year old female although looks much older and you note she has extreme difficulty in mobility. The history from the GP was that Joan has six children of her own and cares for a further 3 of her sister’s children; she lives without a partner. She has been divorced from her husband for two year. His occupation was a shearer and he rarely spent much time in the district due to the shearing sheds he followed being located in interstate.

Joan was recently diagnosed with Type 2 Diabetes 2/12 ago and was commenced on Metformin 500mg BD. She was diagnosed with hypertension 18/12 ago and was prescribed Metoprolol XR 200mg daily. Joan also has a history of alcohol abuse and has been brought to the attention of the local police by the neighbours on several occasions due to disruptive behaviour of the children. She has neither a motor vehicle nor a license.
“Sorry I was sleep. C’min”, she mutters as you enter.
“Were you at work last night?” you ask, thinking she might have been a shift worker.

The woman looks at you as if you have come from another planet. “No one ‘ere works even in the day luv”, the woman mocks. You feel small and foolish as you have not established a good rapport with Joan. You then notice the smell of stale cigarette smoke, and, as your eyes adjust to the dim light you can see a dishevelled state within the lounge area. The house is filthy and there is a significant amount of belongings everywhere. You attempt to navigate the track from the front door to what should be the lounge room and there is just enough room for you to stand and talk with the new client. 
Joan slumps back on to the couch and lights a cigarette.

“What’s all this then?” she asks pointing to your bag of nursing equipment as she coughs up a wad of phlegm, and spits it into a used coffee cup. 
“I am a community nurse, and I have been assigned to assist with your health needs and work with you in getting things organized”.
Joan looks you up and down; “Noth’n’ t’ do ’ere”, she splutters. 
“Have you been taking your medication Joan? I was advised that you had recently been commenced on some medication by tour Doctor”. “I believe you have six children that you care for Joan, is this correct?” Counting only three, you assume the others must be at school. 
“Yep,” Joan grunts, “the little rabbits won’t go to school though and the younger ones are following them, can’t get em to go…..and I‘ve been takin’ my medications if I remember. I haven’t bi’n feeling so bad lately and I don’t want to waste ’em”. 
“But you must take them twice a day”, you insist. “The GP had said that he had spoken to you about this”.

Joan shrugs with contempt and begins a tirade of abuse about the “useless good-for-nothin’ Doctor”. You attempt to regain the thread of the conversation…. “What have your blood sugar levels been like?” you enquire. 
“They’re fine. I b’in takin’ some ‘erbs me sista gi’me. She said they worked when she had sugar last time she was pregnant. I feel good and they’re cheap”. 
“But you seem to be very sleepy, and it is mid-morning”; you remark. “Can I check your blood sugar level now?”

As you take the blood sugar level you notice two of the children poking their heads around the door frame to see what was happening.
“Have the children had all their immunizations?” You ask Joan. 
“No,” Joan said dismissively. “No point is there with this ‘bola thing? Nothin’ll stop that and my sister said the ‘munisations can cause autoimmuneisum or somefink.”
“Autism?” you enquire with puzzlement.
“That’s the one. So there is no point is there”. “My kids, my rules”, Joan said with finality.

You are about to present an argument in favour of immunization, when Joan recommences her story of why she does not take her tablets regularly. She informs you that the children go to the chemist to pick the medication up, however, they open them before they arrive home and mix everything up so she does not bother to take them. 
In your assessment of the home you note that the front veranda has three steps up from the ground and six steps down off a back landing. There are no handrails to assist Joan in her movements from the house and the limited mobility Joan has could explain why she does not go to the chemist herself.

“The BLS is 23”, you inform Joan. “No wonder you are so sleepy Joan – What did you have for breakfast?” 
Joan pointed to a half empty bottle of vodka and a large opened packet of Fruit Loops on the coffee table. “Some of that”’, she said. “Vodka-loops”, she giggled to herself.

Marking criteria

  1. Identify the patient as having complex needs:
  • Provides a detailed summary of the complexity of the client’s requirements.
  • Identified Informed consent of the client. (25 mark)
  1. Participants in case conference

Identifies ALL members of the MDT who should be included in the case conference. (Not limit to follow)

  • Social worker
  • Diabetic educator
  • Occupational therapist
  • Physio- therapist
  • GP
  • Dietitian
  • Immunization nurse
  • Drug and alcohol specialist
  • Psychologist
  • DOC’s Department of social service
  • Community service (transport, meal on wheels…) (20 marks)
  1. Evidence for selection to the case conference

Provide the rational for the choice of the selected MDT members based on client assessment:

o Identifies the Social Determinants of Health.

o Identifies the primary Health Care principles.

o Identifies legal & Ethical issues relevant to this case (30 Marks)