...am compassionate, enthusiastic, caring and dedicated nurse who has been working at St. Joseph Hospital for 23 years. I started in 1995 as a license practical nurse and have made my way up to become a Nurse Practitioner. I was able to advanced my education and achieved my goals with the help of SJ’s employee reimbursement program as well as with The Al Greenway Nursing scholarship. I would love the opportunity to continue to work for Baycare to show my appreciation and have more of an impact on my patients care as provider. During my first 12 years at SJ, I worked on cardiac step down caring mostly for post open surgery patients and cardiac patients treating conditions such as CHF, HTN, CP, post MI, arrhythmias. I later felt that I was not...
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...Nurse Driven Education for A Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heather Horsley Wilkes University School of Nursing Abstract Heart failure (HF) is a chronic progressive disease, arising from structural or functional disorders of the heart, in which incidence increases with age. This review attempts to describe the types and causes of HF while focusing on variable aspects of patient education that have a positive effect on patient outcome and quality of life. Specifically, the potential benefits of this education for a 55 year old male patient diagnosed by transthoracic echocardiogram with chronic systolic heart failure, who has refused physician deemed necessary diagnostic testing and treatment. Keywords: heart failure, nurse driven education, heart failure, self-care Nurse Driven Education for Patient Diagnosed With Chronic Systolic Heart Failure Refusing Diagnostic and Interventional Procedures Heart failure (HF) is a major health care concern affecting over 5.7 million people in the United States. It is responsible for 1 in 9 deaths and costs the nation over 32 billion in health care expenses each year (Center for Disease Control, 2013). HF is the most common reason for hospitalization of people older than age 65 (Hinkle and Cheever, 2014). According to Hinkle and Cheever, HF is a “clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles...
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...NURSING CARE PLAN COURSE: Basic Adult Health CLIENT INITIALS: DATE OF ADMISSION: AGE: GENDER: JL June 13, 2011 85 M HT: WT: ALLERGIES: 140 lbs. NKA CODE STATUS: FULL RACE/ETHNICITY: CULTURAL CONSIDERATIONS: Caucasian None RELIGION/SPIRITUAL CONSIDERATIONS: Unknown OCCUPATION/HOBBIES/RECREATIONAL ACTIVITIES: Retired LIVING SITUATION/WITH WHOM: (home, assisted living, LTC, etc) Lives with daughter. SOCIAL HISTORY: (tobacco, ETOH, illicit drugs, family dynamics) Quit smoking many years ago, no history of ETOH or drug use. NURSING CARE PLAN ADMITTING MEDICAL DIAGNOSIS: Client's principal admitting diagnosis was leukocytosis. Definition: (from Taber’s) “An increase in the number of leukocytes (usually above 10,000/mm3) in the blood. It occurs most commonly in disease processes involving infection, inflammation, trauma, or stress, but it also can result from the use of some medications” (Venes, 2009, p. 1327). Etiology/pathophysiology: ( NOT from Taber’s or Wikipedia) Etiology: Causes of leukocytosis are infection, inflammation, tissue damage, immune reaction, bone marrow problems, medications, and stress (Drug Information Online, 2011). Pathophysiology: “Leukocytosis can be a reaction to various infectious, inflammatory, and, in certain instances, physiologic processes (eg, stress, exercise). This reaction is mediated by several molecules, which are released or regulated in response to stimulatory events that include growth or survival factors (eg, granulocyte...
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...severe regurgitation from the tricuspid and mitral valve dysfunction. Physical Findings: The patient had a difficult fundoscopic exam, with a heart rate of 104, with an irregular gallop, crackles in left lower lobe, right side is dull, red sacral area, 3+ pitting edema to knees, and shortness of breath, difficulty sleeping. Lab/X-ray findings: Chest x-ray: left pleural effusion, CHF, Pneumonia. Course of Treatment: Course of treatment includes admission into the hospital, with the administration of diuretics and IV antibiotics; will also collect blood cultures and sputum if possible. Treatment will also include O2 and bedrest. Medications administered during treatment 25 mg Capoten po tid, 40 mg Furosemide po qd, 10 mg Nortriptyline HCL po qd, and 0.125 mg Digoxin po qod. The patient was also put on low sodium, low cholesterol, and lactose free diet. Condition on Discharge: Patient was discharged to a long term care facility closer to her family. Her strength and endurance improved during her treatment at the facility. Also new x-rays show a slight improvement in the left lower lung field infiltrate. Patient was still having problems with shortness breath at discharge, resulting in a dependency upon a wheelchair...
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...medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and tiredness. His vital signs (VS) are 162/84, 124, 36, 102° F, SaO2 88%. Admitting diagnosis is chronic emphysema with acute exacerbation. Admitting orders includes: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain SaO2 of 90%; maintenance IV of D5W at 50 ml/hr.; intake and output (I&O); arterial blood gases (ABGs) in AM; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h x10 days, azithromycin 500 mg IV piggyback (IVPB) q24h x2 days then 500 mg PO x 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q AM. In this case, I will discuss the definition of COPD/emphysema, causes, S/S, risk factors, contributing factors, normal lab values, current lab values, diagnostic tests, prevention...
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...Guided Reflection Questions Opening Questions How did the simulated experience of Josephine Morrow’s case make you feel? The simulated experience of J. M case make me feel confident in my nursing skills. In addition, the simulation reinforced the knowledge obtained in lectures and readings about skin care and documentation in a more productive way. Talk about what went well in the scenario. At the beginning of the simulated experience of J.M case I introduced myself and identified the patient. I proceeded by checking allergies and vital sings. Then, I educated the patients about wound care and irrigated the wound. Also, I elevated the patient’s legs to improve venous return. Reflecting on Josephine Morrow’s case, were there...
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...have to blood and bodily fluids, that’s why it’s so important to use precautions when dealing with these and making sure that any accidental needle stick gets reported immediately in order to take the necessary steps for treatment if needed. Another way Hepatitis B can be transmitted is by mother to child, pregnant women can transmit the infection during childbirth and although these babies get vaccinated for Heptatitis B after birth to avoid getting infected special precautions must be taken from the expecting mother and getting tested for hepatitis B during pregnancy is recommended. Hepatittis B can be acute and chronic, acute infections can last for a short time and can get better, on the other hand chronic hepatitis b infections can cause liver damage or cirrhosis of the liver which in turn additional complication arise from. Usually people that have chronic Hepatitis B don’t even know they have it because they don’t have any symptoms and if they do it’s manifested as flu like symptoms, malaise, headaches, decreased appetite, belly pain,...
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...Nursing learning has an immense contact on a nurse’s capability to practice, so as patient also requires the knowledgeable nursing personnel. I am an associate degree nurse. I have been working in the hospitals for last 8 year. I do have experience but still I am lacking something as a nurse then I have decided to add three more letters after RN. Nurses with Bachelor of Science in Nursing (BSN) degrees are well-educated to meet the workload placed on today’s nurse. BSN nurses are appreciated for their proficiency in critical thinking, problem solving, case management, clinical decision and health promotion. Baccalaureate nurse have additional chances to move up in nursing employment ladder in a variety of health care areas which offers as extensive professional development. Furthermore, nurses with a baccalaureate degree exhibit more nursing competencies as compared to their associate degree or diploma nurses. This discussion will point out the dissimilarity between Associate degree nurse (ADN) and Baccalaureate degree nurse (BSN) and also their ability to make sound clinical decisions. Associate Degree Nursing Versus Baccalaureate Degree Nursing The nation’s demand for nurses increased noticeably after World War II, as 78 million children were born between 1946 and 1964 (eventually known as baby boomers) (Creasia &. Friberg, 2011). Because of the nurses’ shortage after the World War II, associate degree nursing was originated by Mildred Montage in 1951. ADN was introduced...
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...Krystina, Excellent job, in evaluating TC from a physical assessment standpoint, developing both a nonpharmacological and pharmacological therapy plan. Utilizing lab values (renal and hepatic -CBC) to narrow underlying differential diagnoses allows reaching a clinical diagnosis. Woo and Robinson (2016), emphasizes completion of full comprehensive assessment coincide to pain etiology, pathophysiology, related comorbid conditions, activity level, and quality of daily life impact with pain experienced (p. 1352). I have been taught early in nursing, “pain perception from a patient is always whatever the patient says”. Establishing what pain is to a patient, to then developing realistic pain control goals set from patient expectations to achieving patient compliance. Commonly, goals to remove chronic pain entirely is not realistic. Suggestive, patient support involves providing patient education to achieve improvement in quality life...
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...The United States federal Healthy People Initiative is intended to play a crucial, integrative role in guiding national, state, and local approaches to setting quantifiable health objectives and monitoring progress (Fielding, Kumanyika, & Manderscheid, 2014). There are several health care reform initiatives and mandates that have impacted my organization. The hospital I work for has many specialties, primary care center, as well as a children center. The healthcare initiatives, which are related to providing the quality of care, preventive strategies, eliminating duplicated and unnecessary test, as well as addressing chronic cases, have changed in some way the organization functions. For preventive care, most patients will see a primary...
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...hospitalization was not medically necessary. You are a 55 year old woman with past medical history of hypertension, coronary artery disease, systolic congestive heart failure with ejection fraction (test of heart function) 22% in Dec 2014, Atrial fibrillation on Coumadin, severe non-ischemic cardiomyopathy (poor heart function), chronic kidney disease status post (had) right Nephrectomy (kidney removal) in 2005, cervical cancer treated status post (with) bladder reconstruction who presented to the emergency department complaining of shortness of breath and chest tightness that started 4 days ago....
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...in the United Sates of America. Nursing case studies benefits the nursing professional in the process of diagnosis, treatment, planning and nursing interventions of patient that they care. It helps the nurses for critical thinking and also to resolve the health problems of patient’s. In the case study provided Ms. A. presents with symptoms of Iron deficiency anemia. Anemia is a medical condition where quality and quantity of hemoglobin and red blood cells (RBC) are decreased, which in turn decreases the oxygen carrying capacity of the blood to the body parts, tissues and organs. The normal level of hemoglobin in male and female are different. In men hemoglobin level less than 13.5gram/100ml and in women hemoglobin level less than 12.0gram/100ml is considered as anemia. The most common causes for anemia are RBC destruction, bone marrow dysfunction, acute, chronic blood loss, and nutritional deficit (Bryan &et al, 2012). Here the author explains and assesses Ms. A. and her presented signs and symptoms of iron deficiency anemia which is a common type of anemia affects young women of reproductive age. Signs and Symptom of Iron Deficiency Anemia Malnutrition is the main cause of anemia. Iron deficiency anemia causes almost 841,000 deaths every year. Ms. A. has the signs, symptoms and lab values of iron deficiency anemia. Iron is the main component...
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...HEME CLASS QUESTONS 1. Q: A 48 y/o alcoholic male presents to your primary care office c/o diarrhea that began 1 week ago. Patient admits to eating fast food 3 times day. During the exam you note yellow sclera and glossitis, lab findings show MCV>100. What are you suspecting to be the cause of his symptoms? a) folate deficiency b) B12 deficiency c) hereditary spherocytosis d) thalassemia e) lipid deficiency A 2. 67 yo homeless, white male patient was brought to ED by local EMTs. Pts stuporous, HR: 120, regular BP: 160/90 and RR: 10 non-labored. While inspecting the patient, you notice upper extremity peripheral jaundice, rosacea, finger clubbing and rhinophyma. On futher exam, JVD and LE edema is visible with palpable splenomegaly and hepatomegaly. As a part of your work up, you order a CBC with diff, which reveals normocytic, hypochromic red cells and a decreased reticulocyte count. Your CBC work up reveals the patient's likely cause of anemia. ANSWER: alcoholic with anemia of chronic disease. 3. Pregnant 28 year old female brought into the ER by her husband because she was exhibiting neuro symptoms of stupor, bloody diarrhea, and abdominal pain. On further observation patient is in renal failure, has microangiopathic hemolytic anemia, and severe HTN. You ran labs on your patient and discovered she has low thrombocytes, low haptoglobin, high reticulocyte count, high LDH and creatinine, schistocytes on peripheral smear. What would you diagnose the...
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...Critical Pathway: Case Study of Chronic Renal Failure Advanced Pathophysiology NURS 5104 October 4, 2013 Critical Pathway: Case Study of Chronic Renal Failure I. Introduction Mr. P. J., a 38-year-old African American male, presented to the Emergency Department by the rescue squad team, with a six day old complaint of increased swelling of the bilateral lower extremities, unusual weight gain, and a feeling of ‘I can not breathe’ per patient. Patient was sent as a direct admit to the Intensive Care Unit (ICU) and placed on 2 liters NC with hydration and adult special care monitoring. Vital signs were taken by the paramedic enroute revealing the following: Ambulance Vitals: * BP 202/112 * Pulse 101 * Respirations 20 * O2 86% before O2 * Temp. 98.4 * Height 5’10 Patient stating * Weight 222 lbs. Patient stating (weighed the day before) The paramedic started a 20 gauge IV into Mr. J’s right antecubital and started him on 2 liters nasal cannula; due to the “presence of crackles no Procardia was administered” (J. Madden, personal communication, August 14, 2013). The paramedic monitored the vitals and reported to medical control the situation and estimated time of their arrival in five minutes. Mr. P. J. has been married to K for twenty years and they have one child, a twelve-year-old daughter. Mr. P. J. has worked in construction for twenty years; Mr. J stated working on his feet all day he noticed the swelling six days ago...
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...fewer calories however, grilled chicken have a hidden danger. The second research was talked about a cure for cancer because her grandfather (Shree Bose) died due to cancer. The third research discussed by Naomi Shah was on the quality of indoor air and asthmatic patients’ because, her father and brother suffered badly from chronic allergies ("Tedtalks: Award Winning Teenage Science in Action", 2013). The topic that was discussed on grilled chicken the hidden danger was important because, Lauren wanted to find out why the chicken edges were white so as Lauren stated, that was when her idea was born. Furthermore, listening to Shree Bose research was also important because, her grandfather died of cancer. Naomi Shah research was essential also because her father and brother have had chronic allergies all year round ("Tedtalks: Award Winning Teenage Science in Action", 2013). To begin their researchers they have to find someone to was passionate as they were so Lauren Hodge found someone that would allow her to use their lab at Penn State University main Campus, and to begin Lauren had to mostly marinate and grill her chicken at home first then took it to the lab where she would use the equipment to extract the chemicals...
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