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Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment.

Mrs. Thomas is a 54 year old African American widow

Appendix C – Mrs. Thomas

Scenario:
Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment. She is an active member of her church community and friends, comments that she have so much energy that she exhaust ed all of them just being around her. At age 51, she was diagnosed with non-Hodgkin’s lymphoma.

Busy with raising her grandchildren, a little more than 3 years went by before she sought attention for her symptoms and was diagnosed. Despite aggressive treatments with chemotherapy and radiation, her diseased progressed and she was considering undergoing a bone marrow transplant.

Climbing the stairs to the apartment one afternoon she became very short of breath and collapsed. Her twelve, year old granddaughter called 911. At the hospital she was minimally responsive and in severe respiratory distress. She was intubated and transferred to the ICU.

A family meeting with the oncology and ICU team was call ed to discuss Mrs. Thomas’s advanced condition, the fact that she would probably not survive further treatment of the lymphoma and to decide on goals of care.

Fifteen family members arrived, including her daughter, pre-teen granddaughters and grandson, three nieces, four nephews, several friends from her church and the minister. On being asked that only the immediate family participate in the meeting, the family and friends became angry and insisted that all of them be involved in this discussion.

Discussion questions:

1. What is your impression regarding this scenario? What are some concerns you have with this case and what do you anticipate would happen? Support your answer.

2. Have you thought about what kind of care you would want if you could no longer speak for yourself at the End of Life? Give examples.

3.How would you handle all the family members and friends wanting to be included in the discussion?

This is a paper that is focusing on discuss the pathophysiology management and health promotion for Afua. The paper also provides additional questions to use in writing this assignment paper clearly.

Discuss the pathophysiology management and health promotion for Afua

Afua, a 9-year-old partially immunised girl from Narrogin, was admitted on account of one-week history of abdominal pain and fever. At the emergency department, her ultrasound confirmed perforated appendix. Afua was rush to the theatre for emergency surgery. She was brought to your ward post-operatively. She had two intravenous cannulas—one on each hand. Nasogastric tube and indwelling catheter were insitu and connect to a drainage bag. Afua has phobia for medications served in syringes. The surgical notes report the presence of three steri-strips at the incisional sites.

Afua and her mother are now in the ward and they have been allocate to you. Prior to their arrival to your ward, your shift coordinator had given you a brief hand over and advised that they will be arriving in the next 15 minutes. On arrival, you notice Afua has been charted regular analgesia and intravenous antibiotics with prn analgesia for her pain management. On arrival, Afua was alert and her observations were: Temperature 38.6-degree, HR= 130 beats per minute, Oxygen saturation 90% on room air, RR= 28 breaths per minute with mild distress, BP = 100/70mmHg. It is estimate that Afua and her family will be on admission for at least 5 days.

Based on the above scenario, discuss the pathophysiology, management and health promotion for Afua and her family.

Discuss the pathophysiology management and health promotion for Afua

Assignment guidelines Word count = 2000 (+/-10% word count) Your assignment should include the following:

1. Firstly, an introduction summarizing the case study.

2. Secondly, discuss the pathophysiology of the presenting condition.

3. Thirdly, discuss the assessments (Paediatric Assessment Tool and/or Primary Assessment Framework) you will undertake to prioritize and manage care for Afua.

4. Fourthly, describe the nursing management of Afua’s condition

5. Using the child and family centred care model, also how will you care for Afua and her family?

6. What discharge education and health promotion will you emphasize?

7. How will you teach Afua to manage her condition after discharge? What community support resources will you refer Afua to?

This is a paper that is focusing on what evidence does Nurse Deb have that could help her win the case. The paper also provides additional information to use in writing the assignment paper.

What evidence does Nurse Deb have that could help her win the case

Employment Law Scenario Analysis
Write a 750-1,000 word paper in which you review public policy and how it affects employment. Address the following scenarios:

Scenario 1: Nurse Deb was due for her annual flu vaccination as mandated by her hospital’s policy. Nurse Deb is a big supporter of the antivaccination movement and refused to obtain her annual flu vaccination. Upon notice that nurse Deb did not obtain the vaccination, the nurse manager fired Nurse Deb. Nurse Deb has decide to file a wrongful termination suit. As the director of nursing, how would you handle this situation?

Firstly, what evidence does Nurse Deb have that could help her win the case?
Secondly, what law protects the hospital’s mandated vaccination procedures?
Thirdly, how concerned should the hospital be if the lawsuit is a success?
Fourthly, if the lawsuit is a success, how does this impact workplace safety and the obligation of the health care facility to provide protection?

Scenario 2: Joe Gomez worked as a plant operations specialist at Premier Hospital. While Joe’s manager was working on the HVAC system that protects patients from harmful viruses and bacteria, he noticed that he was not using OSHA-approved filters. Joe felt that it was important to report this to the compliance officer. The day following his report, Joe was fired by his manager. As the CEO of Premier Hospital, how would you handle the situation?

How concerned should you be about the termination of Joe?
What legal principles are involvement and how do they reinforce workplace safety?
If Joe was a member of the local employee services union, does this make the termination different?

What evidence does Nurse Deb have that could help her win the case

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity,

Mrs. J. is a 63-year-old married woman who has a history of hypertension

Case study: Critical Thinking
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is exhaust ed and cannot eat or drink by herself.
Objective Data

Height 175 cm; Weight 95.5kg.

Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.

Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.

Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention

The following medications administered through drug therapy control her symptoms:

Firstly, IV furosemide (Lasix)

Secondly, Enalapril (Vasotec)

Thirdly, Metoprolol (Lopressor)

Fourthly, IV morphine sulphate (Morphine)

Further, Inhaled short-acting bronchodilator (ProAir HFA)

Also, Inhaled corticosteroid (Flovent HFA)

Additionally, Oxygen delivered at 2L/ NC

Finally, Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Firstly, describe the clinical manifestations present in Mrs. J.

Secondly, discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

Further, describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.

Additionally, provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

Moreover, describe a method for providing education for Mrs. J. regarding medications that need to be maintain to prevent future hospital admission. Provide rationale.

Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

Also, you are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Finally, submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Maria is a 27-year-old woman with a three-year-old son, Ben. Maria is a stay-at-home parent and her husband, Charlie, works full time. The family resides in Bloomington, Illinois.

Maria is a 27-year-old woman with a three-year-old son

CASE INFORMATION:

Maria is a 27-year-old woman with a three-year-old son, Ben. Maria is a stay-at-home parent and her husband, Charlie, works full time. The family resides in Bloomington, Illinois.

Maria is now 11 weeks pregnant with her second child. She currently weighs 160 lbs and her height is 4 foot 11 inches. Maria gained 40 pounds with her first pregnancy and retained 20 pounds of that weight. With her first pregnancy, Maria states her physician told her they would watch her “blood sugar” as she has had a history of hyperglycemia in the past. She has also had a history of iron-deficiency anemia.

Maria drinks 3 cups of regular coffee per day and 3 cans of diet cola because she states she often feels fatigued and spends most of her time indoors with her son. Based on a food frequency questionnaire, Maria drinks fruit punch with her son with their meals as she has heard that juices are healthy to consume. Due to her morning sickness, she avoids eating meats and does not always eat three meals per day and does not snack during the day.  Has not been taking her prenatal vitamins and prescribed iron supplements because she indicates that they upset her stomach and cause her to be constipated.

She and her son often eat at fast-food restaurants or consume packaged food, including boxed macaroni and cheese or frozen chicken nuggets because these are what her son likes to eat and are the types of foods they can afford.

She also indicates it is more convenient to shop at the grocery store down the street, even though the foods tend to be pricy. Also, she eats very few fruits and vegetables and drinks no milk, although she eats some American cheese.

Because her family lives across the country, she does not have immediate family around her and often feels depressed being alone with her child every day. With her last pregnancy, she did notice that soon after the birth of her child, she felt overwhelmed and more depressed.

Maria would like to eat better but doesn’t know what she should do. She also wants to know more about exercising as she has heard this is healthy during pregnancy. A neighbor told Maria she should sign up for a gym membership in the area, but Maria cannot afford the fees.

Please be specific and provide rationale where appropriate. Provide references in APA format for your sources (including your textbook).

1.       What recommendations would you make in terms of lifestyle management for Maria? These would be social/psychological/economic issues. Be specific. (5 different issues and address X 2 = 10 pts total)

2.       How would you modify her diet? Be specific in the changes you would recommend. (5 each X 2 -10 pts)

3.       Based on the IOM guidelines, how much weight should Maria gain during her current pregnancy? How much weight gain is recommended for each of the trimesters? What recommendations can you give her to manage her weight gain? (10 pts)

4.       Assuming that Maria and her family meet the income guidelines for aide, what nutrition programs might they be eligible for? These can include federal, state, and local programs.  List and describe the services & benefits of each program and how Maria would qualify.  Assume she lives in the Bloomington-Normal, Illinois area. (Provide 2 programs with detailed information, 5 points each =10 pts)

5.       Maria’s doctor recommends that she is screen ed for gestational diabetes. Maria wants to know what type of test she will take. Research what the test is called and explain how the test is performed. When does the test typically occur in pregnancy? What type of diet will she need to follow if she is diagnoses with gestational diabetes? (10 pts)