A 46-year-old Caucasian female presents to the PCPs office with a chief complaint of severe intermittent right upper quadrant pain for the last 3 days

/in /by

A 46-year-old Caucasian female presents to the PCPs office with a chief complaint of severe intermittent right upper quadrant pain for the last 3 days

A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanineaminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.

Question 1 of 2:

Describe how gallstones are formed and why they caused the symptoms that the patient presented with. 

Question 2 of 2:

Explain how the patient became jaundiced.

A 65-year-old man with a history of atrial fibrillation presents to his PCPs office 2 months after suffering from a myocardial infarction

/in /by

A 65-year-old man with a history of atrial fibrillation presents to his PCPs office 2 months after suffering from a myocardial infarction

A 65-year-old man with a history of atrial fibrillation presents to his PCP’s office 2 months after suffering from a myocardial infarction.  He declined anticoagulation due to fear he would bleed to death. He has had sudden-onset, moderately severe diffuse abdominal pain that began 18 hours ago. He has been vomiting, and he has had several episodes of diarrhea, the last of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of 15,000/mm3.

Question:

What is the most likely mechanism behind his current symptoms?  

A 45-year-old man with known alcoholic cirrhosis portal hypertension and ascites is brought to the ED by his family due to increasing confusion

/in /by

A 45-year-old man with known alcoholic cirrhosis portal hypertension and ascites is brought to the ED by his family due to increasing confusion

A 45-year-old man with known alcoholic cirrhosis, portal hypertension, and ascites is brought to the ED by his family due to increasing confusion. The family states that he had been stumbling for several days but had not fallen. The family also noted that he had been “flapping his hands” as well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia (NH3) level is 159 μmol/L. The APRN informs the family that the patient has developed hepatic encephalopathy (HE).

Question:

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice

/in /by

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension. The increased abdominal girth has been progressive, and he says it is getting hard to breathe. The APRN reviews his last laboratory data and notes that the total protein is 4.6 gm/dl and the albumin is 2.9 g/dl. Upon exam, he has icteric sclera, jaundice, and abdominal spider angiomas. There is a significant fluid wave when percussed. The APRN tells the patient that he has ascites.

Question:

Discuss how ascites develops as a result of portal hypertension. 

 

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice

/in /by

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice

A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension and tells the APRN that he was told he had chronic, non-curable cirrhosis.

Question:

How does cirrhosis cause portal hypertension? 

A 64-year-old steel worker presents to his Primary Care Provider PCP with a chief complaint of passing bright red blood when he had a bowel movement that morning

/in /by

A 64-year-old steel worker presents to his Primary Care Provider PCP with a chief complaint of passing bright red blood when he had a bowel movement that morning

A 64-year-old steel worker presents to his Primary Care Provider (PCP) with a chief complaint of passing bright red blood when he had a bowel movement that morning. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some left lower quadrant pain for several weeks but described it as “coming and going”. He says he has had a fever and abdominal cramps that have worsened this morning. The likely diagnosis is lower GI bleed secondary to diverticulitis.

Question:

What can cause diverticulitis in the lower GI tract? 

 

A 34-year-old construction worker presents to his Primary Care Provider PCP with a chief complaint of passing foul smelling dark tarry stools

/in /by

A 34-year-old construction worker presents to his Primary Care Provider PCP with a chief complaint of passing foul smelling dark tarry stools

A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.

Question:

What factors can contribute to an upper GI bleed? 

A 36-year-old morbidly obese female comes to the office with a chief complaint of burning in my chest and a funny taste in my mouth

/in /by

A 36-year-old morbidly obese female comes to the office with a chief complaint of burning in my chest and a funny taste in my mouth

A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)

Family history-non contributary

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).

Question:

The client asks the APRN what causes GERD. What is the APRN’s best response? 

 

A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks

/in /by

A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks

A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain

Family Hx-non contributary

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.

Breath test in the office revealed + urease.

The healthcare provider suspects the client has peptic ulcer disease.

  1. What factors may have contributed to the development of PUD? 
  2. How do these factors contribute to the formation of peptic ulcers? 

Lifestyle Modifications and Adherence to Prevent Heart Disease

/in /by

Lifestyle Modifications and Adherence to Prevent Heart Disease

My topic is how people can modify their lifestyles and ways to adhere to the lifestyle so we can prevent heart disease. Heart disease a contributing leader in the deaths we see in Americans.
Guidelines for Analysis of a QSEN Problem in Nursing Paper (Worth 100 points)
Use the nursing process as the format to complete the paper. The following questions can guide your assessment of the patient safety issue:
Assessment/Analysis
Complete a thorough analysis and assessment of a patient safety problem in nursing. Identify the QSEN category that your problem is reflective of and why this problem needs to be solved. If the problem was observed during a clinical rotation, a few questions to address in the paper
might be:

1) Specifically what was the situation? Give a detailed description.

2) Who were the people involved in the situation?

3) What do you believe was the underlying cause of the situation?

4) Was the behavior adaptive or maladaptive? In addition, what did you observe to validate this judgment? If the problem was observed, the use of first person when describing the problem is appropriate. If the problem was not
observed, document a thorough analysis and assessment. Give as many details as possible so the reader is fully informed of the problem, the issues involved with the problem, and the implications to the profession of nursing. Identify the QSEN category that your patient safety issue is related to.
Planning/Literature Review
Conduct a review of the literature that addresses the problem/issue. The paper needs to include no less than 5 current (within the past five years), scholarly (peer reviewed) sources. In the planning/literature review section of the paper, summarize the problem from the point of view from each author and include any suggestions for improvement identified by each source. Provide a synthesis/summary of the combined
sources. Sources must be reflective of nursing and healthcare in the United States. Global sources can be used, but the information should be applicable to your practice.
Intervention
In this section of the paper identify your suggestions for improving the problem/issue. Be very specific in developing your interventions making sure to thoroughly respond to the: who, what, when and where of each intervention. Include rationale for each intervention. Devote at least one paragraph to each intervention.

Evaluation
How do you plan on determining problem/issue resolution? How will you know if your interventions are successful? Consider multiple ways of collecting data to determine success or a need to change the plan. If you expect to use a data collection form or other tool, include that information here and if possible, place a copy of the tool in an appendix. Summarize your findings or what changes you expect to see as a result of your proposed interventions.
Guidelines: The due date for the paper is listed on the course calendar. It must be computer generated, 6-8 pages of content not to include the title or reference pages, double-spaced, and in APA format. Submit 1 copy of the paper electronically in the D2L Assignment Folder for this course. A complete grading rubric has been provided on the next page. The elements that will be evaluated are: statement of the problem, duration or frequency of the problem, literature support for the problem, suggestions for problem resolution original and literature based. Other elements that will be graded are: organization of the paper, neatness, spelling, punctuation, grammar, clarity, smooth flow of thought, adherence to APA format, and quality of references.