Georgina Graves is a 42-year-old female who presents to the provider’s office with fatigue.

Georgina Graves is a 42-year-old female who presents to the provider’s office with fatigue.

Subjective Data

  • PMH: none, (except gynecological issues)
  • Significant family history of heart disease
  • Fatigue started about 2 months ago, getting worse
  • Relieved with rest, exacerbated with activity
  • Denies chest pain
  • C/O shortness of breath on exertion
  • Smoker 1 PPD

Objective Data

  • Vital signs: T 37 P 100 R 18 BP 110/54
  • Lungs: clear
  • O2 Sat = 94%
  • Skin = cool to touch
  • CV = heart rate regular, positive peripheral pulses, ECG = intermittent complete left bundle branch block (New Finding)
  • Edema

Medications: Premarin 0.3 mg po/day

  1. What other questions should the nurse ask about the fatigue?
  2. What other assessments would be necessary for this patient?
  3. What are some causes of fatigue?
  4. What should be included in the plan of care?
  5. Based on the readings, what is the most likely cause of fatigue for this patient?

DQ 2

 Nelson Carson is a 62-year-old man who presents to his private practitioner’s office with a hacking, raspy cough.

Subjective Data

  • PMH: HTN, CAD
  • Cough is productive, bringing up green, thick phlegm
  • Runny nose, sore throat
  • No history of smoking or seasonal allergies
  • Complains of fatigue

Objective Data

  • Vital signs: T 37 P 72 R 14 BP 134/64
  • Lungs: + Rhonchi bilateral upper lobes, wheezes
  • O2 Sat = 98%

Medications: Metoprolol 25 mg per day, ASA 325 mg/daily

  1. What other questions should the nurse ask about the cough?
  2. What nursing diagnoses can be derived from the data?
  3. What should be included in the plan of care?
  4. What risk factors are associated with this age group?
  5. Based on the readings, what is the most likely cause of cough for this patient?

week 7

DQ 1

 Jonah Kotter is a 5-year-old male preschooler who presents to the pediatrician’s office for complaints that his leg “hurts”.

Subjective Data

  • PMH negative
  • Immunizations: Up to date
  • No medications
  • No allergies
  • Pain: 3/5 on pain scale
  • Attends Kindergarten
  • Does not remember injuring leg

Objective Data

  • Vital signs: T 37 degrees Centigrade, P 94, R 18, BP 100/70
  • Lungs: clear
  • Heart rate and rhythm regular
  • Moving all extremities
  • + Range of motion legs and arms
  • Strength 5/5 in all extremities
  1. What other questions should the nurse ask?
  2. What techniques are helpful to incorporate in assessing a patient in this age group?
  3. What are a few of the major differences in the musculoskeletal assessment of a child?
  4. What should be included in the plan of care?
  5. Based on the readings, what is the most likely cause of leg pain for this patient?

DQ 2

 Read the case study below and respond to two of the questions below. Make sure you respond to a classmate as well, before the week ends.

Katherine Trembly is a 67-year-old woman who presents to the neurologist’s office after referral from her PCP (primary care provider) for a seizure.

Subjective Data

  • PMH: Seizure, hypertension, anxiety
  • Retired book keeper
  • C/o being “tired”
  • Periods of unresponsiveness to verbal stimuli

Objective Data

  • Vital signs: T 37 degrees Centigrade, P 80, R 18, BP 174/84
  • Lungs: clear
  • O2 Sat = 98%
  • Heart rate regular, + peripheral pulses
  1. What other questions should the nurse ask?
  2. What techniques are helpful to incorporate in assessing a patient in this age group?
  3. What are some of the more common conditions that may cause seizure activity in this age group?
  4. What diagnostic tools will the physician use to diagnose this condition?
  5. What should be included in the plan of care?

week 8

Discussion 1

 Give an example of a rapid assessment of a client and provide a SBAR report to a classmate. Remember to include all concepts of patient safety, standard precautions, and professional standards.

OR

Finish the story on our subject, Mr. Red Yoder, who is a patient you met in Week 2 and wrote a teaching plan on. What do you think his status might be today? Remember to include all concepts of patient safety, standard precautions, and professional standards.

week 2

Discharge Teaching Plan Form

Your Name: Date:

Your Instructor’s Name:

Purpose:The focus of this assignment is identifying patient’s needs and analysis and synthesis of details within the written client record and planning an appropriate discharge plan with necessary patient teaching of the disease process.

Points:This assignment is worth a total of 100 points.

Directions: Please refer to the Discharge Teaching Plan Guidelines found in Doc Sharing for details about how to complete this form. Remember there is a 6 page maximum limit on this assignment.

Type your answers on this form. Click “Save as” and save the file with the assignment name and your last name, e.g., “NR305_Discharge_Teaching_ Plan_Form_Smith” When you are finished, submit the form to the Teaching Plan Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.

Look at the EXAMPLE in the first assessment area. This is NOT an all-inclusive response and you will need to add your responses as well. Please be sure to review your guidelines.

 

Assessment area Need(s) identified. Teaching technique or approach to problem identified. 

Describe content.

Rationale for choosing this technique/approach.
Example: 

Special/age related needs

These are some ideas, there may be others that you identify. 

· Age, lives alone, is non-compliant with diet.

· Expected aging changes such as decreased hearing, visual difficulties.

· Red appears to notunderstand his glucose numbers and how that relates to his diet and insulin administration.

· Home health nurse to assist Red and family in proper insulin management and administration

Ideas for teaching methods/approach based on the scenario and problems noted. You may have identified others. 

· Teach importance of diet and insulin management to Red and family and how to better manage his diabetes.

· Use videos, audio and teach back methods. It may even be helpful to assure proper reading of the glucometer and administration of the insulin by Red or his family.

Provide a brief rationale on why you chose these particular technique/approaches. 

For example, Red may have poor eyesight due to the diabetes and needs audio and demonstration with return demonstration. He may not be able to see the lines on the insulin syringe.

Cognitive issues
Physical barriers
Medications
Nutrition
Roles and Relationships
Self-concept
Wound care
Resources/ referrals needed

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