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The young couple has come to the clinic concerned something is wrong. At the last visit, ultrasound noted that the fetus was in a complete breech position. The woman has been experiencing contractions every 10 minutes lasting approximately 45 seconds. She feels the baby has not moved into the correct position.
What assessments and concerns should the nurse address?
What nursing diagnoses are appropriate for this couple?
What expected outcomes should the nurse identify?
Fifty-nine–year-old Ray is complaining of a nagging discomfort in his buttocks and hips. It started about 6 weeks ago and is now interfering with his sleep. Ray says that when he lies down, the discomfort gets worse, so he often gets up in the middle of the night to walk around to get relief. He also describes a sciatic-like pain that occurs intermittently but states, “it goes from one side to another” .
How is the inflammatory response associated with this skeletal disorder?
If Ray starts to complain of similar symptoms in other joints, what will you need to consider?
Jose is a 55-year-old Hispanic, male, migrant worker who speaks limited English. He presented to the emergency room with complaints of edema of the scrotum, urinary retention, and hematuria. He does not have any pertinent past medical history. He is married and has five young children. He states he has been having problems for a while but delayed seeing the doctor because of his work schedule and limited money. The doctor performs a digital rectal examination in the office and finds that Jose’s prostate is enlarged.
Initial Post
Male reproductive disorders can make a great impact on the patient’s life. Based on the case study, answer the following questions in your discussion post.
Discuss the potential disease processes and signs and symptoms related to the disease process that Jose may be exhibiting?
How would you provide multidimensional care to include cultural, psychosocial, spiritual, physical, and emotional needs for Jose?
Reply Post
Discuss three potential barriers that you would anticipate when providing care to Jose based on his age and culture.
Provide an example of how you would overcome each of the three barriers through the implementation of multidimensional care strategies.
Topic Sarah is 28 years old and 7 months pregnant with her third child. Her other children are aged 2½ years and 1 ½ years. She had uncomplicated pregnancies and deliveries. Sarah is 5 ft 6 in tall; she weighed 142 pounds at the beginning of this pregnancy, which made her prepregnancy BMI 23. She has gained 24 pounds so far. Prior to her first pregnancy, her BMI was 20 (124 pounds). She is unhappy about her weight gain, but the stress of having two young children and being a stay-at-home mom made losing weight impossible. She went online for her MyPlate plan, which recommends she consume 2400 cal/day. She doesn’t think she eats that much because she seems to have constant heartburn. She takes a prenatal supplement, so she feels pretty confident that even if her intake is not perfect, she is getting all the nutrients she needs through her supplement. A typical day’s intake for her is shown below:Breakfast: Cornflakes with whole milk (because the children drink whole milk), Orange juice Snack: Bran muffin and whole milk Lunch: Either a peanut butter and jelly sandwich or tuna fish sandwich with mayonnaise, Snack crackers, Whole milk, Pudding or cookies Snack: Ice cream Dinner: Macaroni and cheese, Green beans, Roll and butter, Whole milk, Cake or ice cream for dessert Evening: Chips and salsa
Does she have any risk factors for a high-risk pregnancy?
Evaluate her prepregnancy weight and weight gain thus far. How much total weight should she gain?
Based on the 2400-calorie meal pattern in Figure 11.1, what does Sarah need to eat more of? What is she eating in more than the recommended amounts? How would you suggest she modify her intake to minimize heartburn?
What would you tell her about weight gain during pregnancy? What strategies would you suggest to her after her baby is born that would help her regain her healthy weight?
Is her attitude about supplements appropriate? What would you tell her about supplements? Devise a 1-day menu for her that would provide all the food she needs in the recommended amounts and alleviate her heartburn.
After visiting the emergency department for a wrist fracture, a 65-year-old Caucasian female has a follow up appointment with a family orthopedist.
Her past medical history includes mild hypertension which is currently managed with propranolol. She also takes a daily multivitamin. She drinks and smokes occasionally and she has no children or spouse. The orthopedist schedules bone mineral density (BMD) testing and results shows a T-score of 3.0, indicating osteoporosis.
What treatment options may be considered for this patient?
What lifestyle recommendations should be recommended?
Any alternative supplements, integrated medicine or naturopathic treatments or medications?
James is a 24-year-old male who was referred for a Sex Offender Specific Risk Assessment. James was raised in a family with a mother who was addicted to drugs and an absent father. He reported memories of being sexually assaulted as a young boy. He has obvious developmental delays, has always been in special-education classes, and, for the most part, has had difficulty maintaining relationships. He does have a criminal history involving minor criminal offenses, drug possession, and possession of drug paraphernalia.
James listed his name on Craigslist, essentially offering himself as a male escort and a homosexual prostitute. He came under police scrutiny for this behavior and was caught up in a sting operation in which he met an individual who was actually a police officer. He was charged with prostitution, and, as part of the diversion of the criminal justice system, he was ordered to undergo a Sex Offender Risk Assessment.
During the assessment, James spoke about his choices in life and his belief that his activities on Craigslist should not be viewed as criminal because he was caught in a sting operation. James described himself as bisexual. During the interview, he appeared confused and seemed to have very loose terms concerning his sexual boundaries and activities.
Is James’s behavior criminal and/or deviant in nature?
Identify the case scenario you selected.
Explain whether the action represented in the scenario represents deviant or criminal behavior and why.
Explain how the acceptance or rejection of the action by society may have evolved over time.
Provide an analysis of two or three cultural influences that might have an impact on the judgment of sexual behavior from your chosen scenario.
Ms. F. is a 45-year-old female who came into the emergency department with complaints of chest pain and a “racing heart.” She notes that she has lost 15 pounds in the past two months but eats constantly. On initial assessment, she is noted to have a heart rate of 170 beats per minute (QRS duration is 0.06 sec), blood pressure of 179/109 mm Hg, and an audible S3. The physician attempts vagal maneuvers, which are ineffective. She remains tachycardic. Because of her tachycardia, anxious behavior, and obvious bulging of her eyes, hyperthyroidism is suspected. A thyroid panel of laboratory tests is ordered. Ms. F’s cardiac troponin levels are elevated, and a cardiac catheterization is ordered.
Discussion:
Given the potential hyperthyroidism, which drugs might be used to control her cardiac rhythm, and which should be avoided?
What are the top priorities of care for this patient?
Should the nurse be concerned about the cardiac catheterization?
What complications might the nurse anticipate?
Your patient reports a palpable bulge “in my groin.” Upon palpation, this is confirmed as arising above the inguinal ligament and passing into the scrotum.
After considering your assigned case:
What condition(s) might you suspect?
What are the risk factors for this condition?
What further assessment should be performed?
What patient education would you provide if your suspected diagnosis is confirmed?
A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.”
Please answer the following questions in a narrative format:
Discuss the epidemiology of allergies.
What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.
What education will you provide to the patient?