Healthy People Initiative (graded)
As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic woman who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After doing her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She is in class a total of 15 hours per week, plus 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children.She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1hour from campus and commutes each day.Using .healthypeople.gov/”>Healthy People 2020as a guide:
1. What additional information would you like to gather from Maria?
2. What are Maria’s real and potential health risks?
3. Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?
Cultural Bias (graded)
Understanding cultural phenomena is essential to the completion of an accurate health assessment. Please choose a cultural group from Table 4.1 from your text and describe the cultural differences pertinent to that group. Remember, the table may not include all cultural groups. Let’s try to include all the groups listed in the discussion, so please do not choose a group that has already been done. To expedite this, please use the group name in the title of your post.
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Pain Assessment (graded)
John, a 46-year-old African-American male presents for admission to your hospital for hemi-colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work related injury. History of two (2) previous back surgeries with relief of numbness in RLE but pain has not been relieved. His current medications include Methadone, Neurontin and Norco. John states he takes Benadryl PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.
• What risk factors does John have for risk of opioid withdrawal during this hospitalization?
• Is there a stigma connected to being disabled and or methadone?
• Does the nurse need to be concerned about acetaminophen use?
• What are the differences in acute and chronic pain?
Nutritional Assessment (graded)
Yulang Lei, an 82-year-old Vietnamese man, was admitted to your floor with dehydration and a urinary tract infection following a fall at home. He is alert and oriented, but weak. He appears frail. His admission history includes the following.
• He lives alone; his wife died 6 months ago.
• He states he ran a traditional Vietnamese family, unlike his children, who are married and have now moved away.
• His wife did all the cooking and he hasn’t had much of an appetite since she died. He eats rice and some vegetables, but rarely “bothers to cook meat for just one person.”
• Usual daily activity is reading the Vietnamese community newspaper with his morning tea for breakfast. He says he usually eats lunch, but can’t remember what he usually eats. He has rice and a few vegetables for dinner.
• You notice that his clothes fit very loosely. He states he weighed 140 pounds at his doctor’s office 5 months ago. When you weigh him, he weighs 123 pounds and is 5’8″ tall.
Look at the list of nursing diagnoses in Appendix A of your text. What nursing diagnoses would you choose for Mr. Lei?
• What additional questions would you ask to confirm your diagnosis?
• What physical examination and laboratory findings would you expect Mr. Lei to have?
• What psychosocial and cultural factors should you consider when assessing Mr. Lei?
General Survey and Health History (graded)
Casey is a 17-year-old high school student admitted to the ER with a compound fracture of the left leg obtained falling at the local skateboard park while practicing for a national competition. He has never been hospitalized before. His mother has been notified and is on her way. The EMTs gave him morphine and he reports his pain level as “okay.”
• What part of the interview and examination can be done prior to his mother’s arrival?
• As you enter the room for the first time, what should you observe as part of the general survey?
• As you complete his history, what areas are especially important?
• What are the important developmental considerations for Casey?
The Older Adult (graded)
Jean is a 68-year-old female admitted for a total hip replacement. In her interview you learn that she has a history of obstructive sleep apnea (OSA) with a neck circumference of 16 inches and snores much of the night. She is 5’7” and weighs 265 pounds. She states she is sleepy throughout the day. Her other medical history includes: hypertension treated with angiotensin II receptor blockers (ARB), Diabetic with an Hgb A1c over 8%. Hypercholesteremia treated with a Statin drug. Coronary Artery Disease (CAD) with a history of a drug eluting cardiac stent placed 14 months ago and currently on Plavix and ASA. History of gastroesophageal reflux disease (GERD) and is on Prilosec. Her husband has a history of cerebral vascular accident (CVA) several years ago.
• What medications should she take pre-op and what should she hold?
• Should Jean be allowed to continue ASA pre-operatively?
• Should cardiology be consulted on this matter?
• What are Jean’s risks for diabetes complications? What concerns do you have about her social support system?