medical surgical case studies, nursing diagnoses and interventions

Condition Observe, Chapter 34, Conduct of Resigneds With Hematologic Neoplasms
1. John King, 60 years of era, is a beingful resigned who is admitted with the speciality of multiple myeloma. He presents with a spinal disconnection of the fifth lumbar vertebrae. The resigned is listd coercion a vertebroplasty of the spinal disconnection. The resigned is to accrue on bed paright and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The resigned has hypercalcemia. The resigned’s uric shrewd smooth is wealthy. The resigned has beingdate coercion zoledronic shrewd (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin. (Learning Objective 5)
a.  What nursing conduct should the foster arconcatenate the resigned?

Explain the indication and possynod of the diversified medications ordesanguine to discourse the resigned’s symptoms.

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2. Susan Clare, era 38, is admitted to the medical oncology part with intelligent myeloid leukemia (AML). She has frequent areas of ecchymosis and petechiae on her peel, as courteous as generalized pallor. She states she has obsolete 15 pounds in the decisive 2 months, and repeatedly has a low-grade fervor. On tangible impost, you invent her liver and gall to be gentle on palpation. (Learning Objective 3)
a.  What laboratory results would you controlefend imputable to her ecchymosis and petechia?

Why would it be influential to investigate her gums and teeth?

a.  Why is her liver gentle?
Condition Observe, Chapter 37, Conduct of Resigneds With HIV Taint and AIDS
1. The foster is planning to arconcatenate command on HIV taint transmission and obstruction strategies at a national greater interior. (Learning Objectives 1 and 4)
a.  What should the foster understand in the synod respecting the insufficiencys of the older population?
2. Sallie Jefferies, 28-year-old resigned, is at the obstetric clinic coercion a pregnancy scrutinize. The physician informs the resigned that her HIV palliate criterion is actual. The resigned has no indication of AIDS. The foster arranges resigned command respecting what HIV is and what the clinical conduct entails. (Learning Objective 5)
a. What clinical conduct is recommended coercion the resigned during the pregnancy to succor retrench the occasion of transmitting HIV to the unborn slip?

The resigned craves the foster how zidovudine (Retrovir) allure succor her unborn slip from getting HIV. How should the foster answer?
What exaspect encircling Retrovir should the foster arrange?
The resigned craves the foster if it allure be trustworthy to breast-feed her infant succeeding the delivery. The foster should arconcatenate what exposition?

a.  The resigned craves the foster what criterioning list coercion the HIV antiassociation is insufficiencyed succeeding her baby is born. How should the foster answer?
Condition Observe, Chapter 31, Impost and Conduct of Resigneds With Hypertension
1. Joan Smith, 55 years of era, is a femanful resigned who presents to the intensive heed part with the speciality of intracranial hemorrhage. The resigned stopped grant her antihypertensives suddenly owing of the require of the medications and she of-late obsolete her job to extinguishedsourcing. The resigned is particularly drooping and complains of a muddiness and blursanguine expectation. The resigned’s race hurry is 220/130 mm Hg upon grant.
(Learning Objective 6)
a.  According to the definitions determined by the Seventh Report of the Flexure National Committee on Obstruction, Detection, Evaluation and Discoursement of Tall Race Hurry (JNC 7), which symbol of hypertensive opportunity is the resigned popularly experiencing?

Describe the discoursement motives coercion handling the hypertensive opportunity and apportion the motives to the condition observe. Determine the popular moderation arterial hurry (MAP) and the motives coercion discoursement.

The physician beingdate nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS coercion peripheral IV starting at 2.5 mg/hr, and titrebuke by 2.5 mg/hr entire 15 minutes to strain the motive coercion the chief hour, which is to close 25% subaspect of the primal MAP. 

Call the physician if the dosing concatenate of 15 mg/hr has been strained and the MAP is tranquil referable at target motive coercion the chief hour of discoursement, or up to filthy dose increases.
Inferior the BP among 6 hours to 160/100 mm Hg.
Adjust the IV rebuke so that the IV fluids plus the nicardipine IV ooze are correspondent to 100 mL/hr, in completion. Call the physician if the IV fluids must go balancehead 100 mL/hr to arconcatenate the nicardipine.

c. Explain what rebuke to determined primally coercion twain the nicardipine ooze and the NS livelihood fluids.
d. Explain the course of titrating the nicardipine ooze coercion the chief hour to close the ultimate MAP motive of 25% subaspect of the primordial MAP. 
2. The order vigor foster is preparing a program encircling hypertension coercion a national order interior. The nucleus of the program is on the subaspect of occasion factors and docility coercion those who feel been diagnosed with tall race hurry. The target population understands older adults. (Learning Objectives 1 to 4) 
a.  The foster nucleuses on chief hypertension owing it accounts coercion 90% to 95% of hypertension in the Parted States. What occasion factors does the foster understand coercion this population?
b.  The foster prepares to examine the substitutes in how the JNC 7 defines hypertension. What concatenates and descriptions should the foster understand?
c.  Owing this is a gerontologic auditory, the foster insufficiencys to re-examination why race hurry increases with era. Explain how the structural and authoritative substitutes of aging supply to taller race hurry in the older adult.
a.  What counsel does the foster understand encircling lifestyle modifications that may retrench occasion of hypertension (or complications associated with diagnosed hypertension)?
Condition Observe, Chapter 23, Conduct of Resigneds With Chest and Inferior Respiratory Tract Disorders
1. Harry Smith, 70 years of era, is a beingful resigned who is admitted to the medical-surgical part with intelligent order-acquisanguine pneumonia. He was diagnosed with paraseptal emphysema 3 years gone. The resigned smoked cigarettes single pack per day coercion 55 years and release 3 years gone. The resigned has a fact of hypertension, and diabetes inferior with unwritten diabetic erants. The resigned presents with indistinctness as to occasion and locate. The nativity methodic that this is a novel substitute coercion the resigned. The mode inseparable signs are as follows: race hurry 90/50 mm Hg, character rebuke 101 bpm, respiratory rebuke 28 exhalations/min, and sphere 101.5°F. The pulse oximeter on capacity enthusiasm is 85%. The CBC is as follows: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL. ABGs on capacity enthusiasm are pH 7.30, PaO2 55, PaCO250, HCO3 25. Chest x-ray results divulge lawful inferior lobe concord, intercourse of apical bullae, mawkishtened diaphragm, and a diminutive pleural discharge in the lawful inferior lobe. Lung auscultation divulges severely adulterated exhalation sounds in the lawful inferior lobe and scantiness of exhalation sounds at the cheap. The exhalation sounds in the paright of the lungs are particularly retrenchd. The resigned complains of tire and scantiness of exhalation and canreferable terminate a less phrase anteriorly the respiratory rebuke increases balancehead the cheapline and his nail beds and lips hinge a ceruslender dye and the pulse oximetry retrenchs to 82%. The resigned is diaphoretic and is using abettor muscles. The resigned coughs weakly, save he does referable train any sputum. (Learning Objective 3)
a.   What nursing impost inventings acceleration the speciality of pneumonia?

What sign inventings acceleration the speciality of pneumonia?
What NANDA nursing diagnoses should the foster coercionmulate coercion the resigned?
What motives should the foster enunciate coercion the resigned?
What balanceall interventions should the foster arrange?

2. Marie Perez, a 53-year-old resigned, is day 1 succeeding a gastric bypass. She complains of scantiness of exhalation; her respiratory rebuke is 30 exhalations/min, character rebuke is 110 bpm, pulse oximetry 89% on capacity enthusiasm, sphere is 100°F, and her race hurry is 90/50 mm Hg. She complains of sensitiveness restless and having stabbing chest aversion which gets worse with revelation. She complains that she feels love she is going to ignoring extinguished or perchance cease.
(Learning Objective 7)
a.  What could perchance be going on with the resigned and what measures should the foster arconcatenate instantly?

What occasion factors does the resigned feel coercion a pulmonary embolus?
What measures are mismismisapply to beingera a pulmonary embolism?
What measures are mismismisapply to succor the resigned in this condition observe controlefend the reoccurrence of a pulmonary embolism?

Condition Observe, Chapter 29, Conduct of Resigneds With Complications From Character Complaint
1. George Brown, 72 years of era, is a beingful resigned who is admitted with the speciality of intelligent pulmonary edema unimportant to intelligent left ventricular character deficiency. The resigned has a fact of coronary artery complaint that has been discourseed medically. The resigned is restless, dusky, dispassioned, clammy, and dyspneic. The inseparable signs are: race hurry 88/50 mm Hg, character rebuke 110 bpm, respiratory rebuke 32 exhalations/min, and sphere 97°F. There are bubbling crackles and wheezing throughextinguished the lung fields and the resigned is exaltation frothy race-tinged acquitted sputum. The resigned’s mode power is 100 kg. 
a.  What chief possessions should the foster catch and what are the rationales coercion these possessions?
The physician ordesanguine furosemide (Lasix) 40 mg IVP STAT. 

What are the possessions of furosemide that allure succor the resigned? 
What nursing possessions should be implemented when administering a diuretic?

2. Carl Edwards is a 75-year-old being with congestive character deficiency. Having sustained three myocardial infarctions in the decisive 10 years, he has retrenchd left ventricular discharge. Mr. Edwards catchs Digoxin, Capoten, Coreg, and Lasix coercion conduct of this complaint. Today he presents to the embarrassment office with tire, generalized infirmity, and sensitivenesss of “skipping” characterbeats. Upon pretense, he is located on the cardiac instructor, his inseparable signs are assessed, and an IV is inserted. He popularly denies chest aversion, save is experiencing some scantiness of exhalation, and is located on 2 L of oxygen via nasal cannula. 
a.  Which of his medications might be contributing to his symptoms of generalized infirmity and character irregularities?

 Coercion what clinical beingifestations should you assess to correlate to his left-sided character deficiency?
How do his medications discourse his congestive character deficiency?
How does the hypokalemia assume the effects of Digitalis?

Condition Observe, Chapter 39, Impost and Conduct of Resigneds With Rheumatic Disorders
1. Ellie Long, a 55-year-old resigned, presents to the aversion clinic with the speciality of fibromyalgia syndrome. The foster at the clinic obtains a fact and tangible impost of the resigned. (Learning Objective 2)
a.  On what areas should the foster concentrebuke when interviewing the resigned during the fact course?

On what areas should the foster concentrebuke when assessing the resigned?
What sign criterions are rightd with fibromyalgia syndrome?

2. Julie Walker, a 22-year-old resigned, is novelly diagnosed with systemic lupus erythematosus (SLE). She presented with ultimate tire; muscle and flexure aching and swelling; a saveterfly-shaped, mawkish, sanguine thoughtless across the bridge of the nose; patchy alopecia; a low-grade fervor; and detriment of craving. Further performanceup divulgeed a actual antinuacquitted antibodies (ANA) titer, anemia, leucopenia, and tempered thrombocytopenia. She has an monstrous lipid feature, proteinuria, and hypertension. The liver and renal features are among accustomed concatenate. The physician ordesanguine balance-the-counter ibuprofen as insufficiencyed coercion flexure unpleasantness, save referable to achieve 1,200 mg/day; hydroxychloroquine sulfate (Plaquenil) anteriorly meals at the corresponding occasion each day; and prednissingle in tapering doses balance the proximate month. The physician to-boot afloat the resigned on lisinopril, an ACE inhibitor coercion the hypertension and a statin coercion the wealthy lipids. The clinic foster is craveed by the physician to arconcatenate resigned and nativity command. (Learning Objective 5) 
a.  What teaching-plan topics should the foster arconcatenate coercion the resigned?
These are topics coercion you to observe munimenting as applies to your client.
General appearance:

Smooth of hygiene
Association aspect
Resigned mobility
Speech precedent and articulation

This is referable a peculiar march. Evaluating the peel, hair, and nails is an ongoing component of a generous  association impost as you performance through marchs 3-9.
2. Peel, hair, and nails:

Investigate coercion lesions, bruising, and thoughtlesses.
Palpate peel coercion sphere, dampness, and composition.
Investigate coercion hurry areas.
Investigate peel coercion edema.
Investigate scalp coercion lesions and henthusiasm and scalp coercion intercourse of lice and/or nits.
Investigate nails coercion congruity, colour, and capillary fill.

Head and neck:

Investigate eyes coercion drainage.
Investigate eyes coercion pupillary repossynod to whitish.
Investigate bung, language, and teeth coercion dampness, colour, dentures.
Investigate coercion facial interrelation.

4. Chest:


Expansion/retrpossynod of chest wall/performance of exhalationing and/or abettor muscle right
Jugular distension


Coercion exhalation sounds anteriorly and subsequently
Apices and cheaps coercion any unnatural sounds
Apical character rebuke/rhythm


Coercion regular lung expansion




Abdomen coercion distension, asymmetry


Bowel sounds (RLQ)


Filthy quadrants coercion aversion and bladder/bowel distension (whitish palpation merely)

Check urine extinguishedput coercion quantity, colour, odour.
Determine quantity and symbol of bowel movements.

    Check urine extinguishedput coercion quantity, colour, odour.
    Womanly: vaginal discharge
    Beingful: circumcision, discharge

Check if generous or particular power-bearing.
Determine gait/balance.
Determine insufficiency coercion and right of assistive devices.


Arms and legs coercion aversion, hideousness, edema, hurry areas, bruises
Compare bilaterally

Radial pulses
Pedal pulses: dorsalis pedis and subsequent tibial
CWMS and capillary fill (hands and feet)

Assess handgrip ability and correspondentity.
Assess dorsiflex and plantarflex feet despite opaspect (music ability and correspondentity).

Tail area (hinge resigned to aspect or crave to beleaguer up or slender coercionward):

Investigate tail and spine.
Investigate coccyx/buttocks.

Tubes, drains, dressings, and IVs:

Investigate coercion drainage, aspect, and discharge.
Assess wounds coercion strange drainage.

Sample coercionmat coercion munimentation:
General Status
Inseparable signs
Head, Ears, Eyes, Nose, Throat
Understand the condition observe in your muniment.
Do referable transcribe the NCP using a grid coercionmat… right an dissertation coercionmat/ bullet summit using the gum of this rubric.
All NCP allure be graded according to the coercionthcoming rubric.
1) Definition of the medical speciality                        __________10
2) Common signs and symptoms                        ___________5
3) Potential complications                            ___________5
4) Head to toe tangible impost    you are to transcribe single….right the grounds in the condition if there is nsingle you produce it as if this was your resigned.                                                                                                                                                                                   ____________10
5) Sign and lab studies                            ___________5
    accustomed values
    expected monstrousities
6) ALL NANDA Nursing diagnoses                                __________10
7) Enunciate 3 NANDA initiative nursing diagnoses                __________10
8) State a resigned plan/motive coercion each of the                     __________10
 initiative nursing speciality
9) Transcribe interventions coercion each of                         __________10
    initiative nursing speciality
10) Transcribe or-laws rationales coercion you you                     ___________5
11) Transcribe evaluation of your interventions                    __________10
    or effect substitutes
12) List of accustomed medications                        __________10
    accustomed dosage
    aspect effects
    resigned teaching

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