Question Answered step-by-step How do you foresee a clinical situation in regards to the application of the 5 Rs approach to ethical dilemmas? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Follow established person-centred behaviour supports/CHCDIS002Assessment Task 1: Supporting a Person Using Positive and and Adaptive Responses1.) Describe what you understand by the following terms: a. Behaviour: b. Acceptable Behaviour: c. Behaviour Management:2.) Outline what you understand by effective communication techniques for use with people who have a disability.Assessment Task 2, Adaptive Response Models:1.) Briefly, describe how you might work with a client who has behavioural issues in a positive manner and the benefits of using the following: a. A solution focused behaviour change model? b. Reality therapy and choice theory? c. Negotiation and conflict management techniques?Assessment Task 3: Monitoring Strategies/Effectiveness in Developing and Maintaining Positive and Adaptive Responses1.) State two (2) examples of challenging behaviours that might occur in a disability service organisation.2.) State two (2) examples of unacceptable behaviour in a disability service organisation3.) State how you might immediately respond, without thinking, to these behaviours and how you should respond.4.) State what possible outcomes might occur for a client based on both of your answers outlined above5.) How might you FEEL about these responses / outcomes and who might you seek help from? Health Science Science Nursing NURSING CHC43115 Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Urinary and Bowel Elimination 1- The ureters transport urine from ——————to the bladder and the ———— is the exit canal for urine. 2- The function of the kidneys is to : 3- The kidneys are located on either side of ______________and the ————kidney is positioned slightly higher than the —————-on account of the liver. 4- The kidneys contain the filtering action of glomerulus. A blood test is available to check renal function. What lab in particular gives an indication of how well kidneys are functioning? 5- Glomerulus does not filter protein or blood cells, however you may find some patients’ urine is positive for proteinuria and /or hematuria. What does this indicate? 6- The Renin-Angiotensin system controls —————- 7- Urinary catheterization puts patients at risk for———————–whereas urinary incontinence puts patients at risk for ———————— 8- A bladder scanner would assess the patient for ————————. Percussion over a distended bladder would produce————— 9- Signs and symptoms of a UTI would include: ____________________________________ The WBC count on this patient would most likely be __________________ 10- How would you proceed to obtain a post-void residual? What is a normal post void residual? What is a normal hourly urinary output? A-A patient has an indwelling urinary catheter. What is important to remember about placement of the Urinary collection bag? B-The catheter slips into the vagina during a straight catheterization of a female client. What should you do next? C-Prostate enlargement is a major factor in the development of which of the following: a. UTIb. Mobility deficits c. Overflow incontinenceD- Patient with an indwelling catheter complains of need to urinate. a. Reassure patient that it is not possible for her to urinateb. Catheterize patient again with a larger gauge catheterc. Check catheter for patency Bowel Elimination1- Antibiotics predispose patients to a ————-GI infection. What is the name of the test to detect this infection in the stool? 2- Risk factors to colon Cancer are: 3- Enemas are given with the patient in what position? If you were to give a soap suds enema, how high would you hang the soapsuds bag? 4- For an individual with no family history of colon CA, when is a colonoscopy recommended? And how often thereafter? 5- A patient with an upper GI bleed will most likely have—————–vomitus and lower GI bleed will have ————–stools. 6- What is the difference between a Levin tube and a Salem sump tube? What is the indications for their use? 7- You are about to insert an NG tube. How would you go about measuring the length of tube the patient will need? (approximation) 8- What is the recommended method for nurses to check NG tube placement? 9- What medication and what food can cause stools to be dark red and be mistaken for blood loss? 10- Before feeding a patient who had general anesthesia you would make sure to assess for the presence of ———— Case Study: Peter Griffin is a 75 year old male who is admitted to the hospital for an acute bowel obstruction secondary to a new diagnosis of large bowel carcinoma. Upon exam, his abdomen is distended and he is complaining of intermittent diffuse pain throughout his entire abdomen but mostly localized to the RLQ and LLQ. His VS are BP 127/65, HR 110, Pain 8/10, SpO2 94% RA. His Labs are as follows:WBC 16.9HgB 10.4HCT 30.6Na 132K 2.7BUN 31SCr 2.6Albumin 2.9 Based on the VS, what would you be worried about and what interventions would you want to initiate? Looking at the lab results, what abnormalities do you see and how would you intervene? Over the course of Mr. Griffins stay he requires the placement of an NGT. You have been taking care of him for quite some time and you notice that during his NGT feeds he starts getting SOB with increased WOB. What steps would you take at this point to aid the patient? Health Science Science Nursing NURS MISC Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Assignment: Assessing and Treating Patients With Psychosis and… Assignment: Assessing and Treating Patients With Psychosis and SchizophreniaPsychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat patients presenting with psychosis and schizophrenia.To prepare for this Assignment:Review this week’s Learning Resources, including the Medication Resources indicated for this week.Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with schizophrenia-related psychoses.The Assignment: Examine Case Study: Pakistani Woman With Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.Introduction to the case Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.Decision #1 Which decision did you select?Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #2 Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Decision #3 Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.Conclusion Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.===========================================================================================================Delusional Disorders Pakistani Female With Delusional Thought ProcessesBACKGROUNDThe client is a 34-year-old Pakistani female who moved to the United States in her late teens/early 20s. She is currently in an “arranged” marriage (her husband was selected for her when she was 9 years old). She presents following a 21-day hospitalization for what was diagnosed as “brief psychotic disorder.” She was given this diagnosis as her symptoms have persisted for less than 1 month.Prior to admission, she was reporting visions of Allah, and over the course of a week, she believed that she was the prophet Mohammad. She believed that she would deliver the world from sin. Her husband became concerned about her behavior to the point that he was afraid of leaving their 4 children with her. One evening, she was “out of control,” which resulted in his calling the police and her subsequent admission to an inpatient psych unit.During today’s assessment, she appears quite calm and insists that the entire incident was “blown out of proportion.” She denies that she believed herself to be the prophet Mohammad and states that her husband was just out to get her because he never loved her and wanted an “American wife” instead of her. She says she knows this because the television is telling her so.She currently weighs 140 lbs., and she is 5′ 5.SUBJECTIVEClient reports that her mood is “good.” She denies auditory/visual hallucinations but believes that the television talks to her. She believes that Allah sends her messages through the TV. At times throughout the clinical interview, she becomes hostile towards you but then calms down.A review of her hospital records shows that she received a medical workup from physician, who reported her to be in overall good health. Lab studies were all within normal limits.Client admits that she stopped taking her Risperdal about a week after she got out of the hospital because she thinks her husband is going to poison her so that he can marry an American woman. MENTAL STATUS EXAMThe client is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Her speech is slow and, at times, interrupted by periods of silence. Self-reported mood is euthymic. Affect is constricted. Although the client denies visual or auditory hallucinations, she appears to be “listening” to something. Delusional and paranoid thought processes as described above. Insight and judgment are impaired. She is currently denying suicidal or homicidal ideation.You administer the which reveals the following scores:-40 for the positive symptoms scale-20 for the negative symptom scale-60 for general psychopathology scaleDiagnosis: Schizophrenia, paranoid typeRESOURCESPANSS Scale. Available at: http://egret.psychol.cam.ac.uk/medicine/scales/PANSS§ Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276. doi:10.1093/schbul/13.2.261https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf§ Clozapine REMS Program. (n.d.). Clozapine REMS: A guide for healthcare providers. Retrieved September 7, 2016, from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdfhttp://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdf§ Paz, Z., Nalls, M., and Ziv, E. (2011). The genetics of benign neutropenia. Israel Medical Association Journal, 13(10), 625-629. Retrieved from http://www.ima.org.il/FilesUpload/IMAJ/0/40/20149.pdfDecision Point One Start Zyprexa (olanzapine) 10 mg orally at BEDTIMERESULTS OF DECISION POINT ONE Client returns to clinic in four weeks Her decreases to a partial response (decrease in positive symptoms by 25%) She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the dayDecision Point OneSelect what you should do: Start Zyprexa (olanzapine) 10 mg orally at BEDTIMEStart Invega Sustenna 234 mg IM X1 followed by 156 mg IM on day 4 and monthly thereafterStart Abilify (aripiprazole) 10 mg orally at BEDTIMERESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Result of next decision (what happened): Client worsens (her positive symtpoms scale increased by 25% and her negative symptom scale score decreased by 10% indicating improved negative symptoms), but her weight becomes stabilized and excessive hunger abates Husband explains that she is becoming less manageable at home, and he has to take time off from work because he is fearful of leaving her aloneStart Zyprexa (olanzapine) 10 mg orally at BEDTIMERESULTS OF DECISION POINT ONE· Client returns to clinic in four weeks· Her decreases to a partial response (decrease in positive symptoms by 25%)· She comes in today with a reported weight gain of 5 pounds. When questioned further on this point, she states that she can never seem to get full from her meals, so she is snacking constantly throughout the day· Client seems to be tolerating medication· Her husband has made sure she makes her appointments for injections (one thus far)· She has noted a 2-pound weight gain, but it does not seem to be an important point for her· She does, however, complain of injection-site pain, telling you that she has trouble sitting for a few hours after the injections and doesn’t like having to walk around for such a long period of timeDecision Point TwoSelect what the should do next: Continue same made but instruct administering nurse to begin injections into the deltoid at this visit and moving forwardDC Invega Sustenna and start Haldol Decanoate (haloperidol decanoate ) 50 mg IM q2weeks with oral Haldol 5 mg BID for the next 3 monthsContinue Invega Sustenna. Begin injections into the deltoid and add on Abilify Maintena 300 mg IM qmonthly with oral Abilify 10 mg in the MORNING for 2 weeks Decision Point ThreeSelect what you should do next:Continue with the Invega Sustenna. Counsel client on the fact that weight gain from Invega Sustenna is not as much as what other drugs with similar efficacy can cause. Make appointment with a dietician and an exercise physiologist. Follow up in one monthDC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNINGContinue Invega Sustenna and add on Qsymia (phentermine and topiramate) for weight lossGuidance to StudentWeight gain can occur with Invega Sustenna. It is modest in nature and can be controlled with proper nutrition and exercise. It is always a good idea to try and control a client’s weight through consultation with a dietician and exercise physiologist (life coach) before switching to another agent when a product is showing efficacy for at least 6 months.Abilify Maintena is a good option for someone who has good response to Abilify oral. Remember that Abilify does not bind to the D2 receptor for a great period of time (such as Invega) and can be less effective in certain individuals. Also, remember that akathisia can be a possible side effect. Once an IM long-acting medication is given, the effects of the drug (both efficacious and untoward effects) can be maintained for a long duration (up to a month or longer). Tolerability and efficacy should be established with oral medication before administering the first injection. Also a disadvantage to Abilify Maintena is that a 2-week overlap of oral therapy is required due to effective blood levels lagging behind the induction dose.Qsymia is a weight loss medication that is a combination of phentermine and topiramate. It is only indicated to treat obesity. This client’s BMI (28.9 kg/M2) does not fit the definition of obesity (BMI >30 Kg/M2- Following from CDC website: Class 1: BMI of 30 to < 35, Class 2: BMI of 35 to < 40, Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as "extreme" or "severe" obesity). There are two things wrong with this therapy option. First, there are only a few occasions where add-on therapy to treat a side effect is acceptable, and weight gain is not one of those scenarios. Secondly, phentermine has a lot of cardiovascular toxicities (such as elevated BP, HR, and increased workload on the heart). Health Science Science Nursing NURS 6630 Share QuestionEmailCopy link Comments (0)
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Question conduct a comprehensive history, on someone over the age of 65 thathas a lot of medical problems. Write the results in narrative format and include the family history as a genogram. Use the following guidelines:Health History Current medical conditions/chronic illnesses:Current medications:Medication/food/environmental allergies:Past health history: Childhood illnesses: Hospitalizations/Surgeries: reason for hospitalization, year, and surgical procedures.Accidents/injuries: Include head injuries with loss of consciousness, fractures, motor vehicle accidents, burns, and severe lacerations.Major diseases or illnesses: Include heart problems, cancer, seizures, and any significant adult illnesses. Immunizations (dates if known): Tetanus _______ Diphtheria ________ Pertussis ________ Mumps ________Rubella _______ Polio _____________ Hepatitis B ______ Influenza _______Varicella ______ Other ____________________________________________Recent travel/military services: Include travel within past year and recent and past military service.Date of last examinations: Physical examination _________ Vision ___________ Dental ___________Family History (Genogram) Mother/Father/Siblings/Grandparents: include age (date of birth, if known), any major health issues, and, if indicated, cause and age at death Present as a genogram.Review of Systems. Be sure to ask about symptoms specifically.General health status: Ask about fatigue, pain, unexplained fever, night sweats, weakness, problems sleeping, and unexplained changes in weight.Integumentary : Skin: Ask about change in skin color/texture, excessive bruising, itching, skin lesions, sores that do not heal, change in mole. Do you use sun screen? How much sun exposure do you experience?Hair: Ask about changes in hair texture and recent hair loss.Nails: Ask about changes in nail color and texture, splitting, and cracking.HEENT Head: Ask about headaches, recent head trauma, injury or surgery, history of concussion, dizziness, and loss of consciousness.Neck: Ask about neck stiffness, neck pain, lymph node enlargement, and swelling or mass in the neck.Eyes: Ask about change in vision, eye injury, itching, excessive tearing, discharge, pain, floaters, halos around lights, flashing lights, light sensitivity, and difficulty reading. Do you use corrective lenses (glasses or contact lenses)?Ears: Ask about last hearing test, changes in hearing, ear pain, drainage, vertigo, recurrent ear infections, ringing in ears, excessive wax problems, use of hearing aids.Nose, Nasopharynx, Sinuses: Ask about nasal discharge, frequent nosebleeds, nasal obstruction, snoring, postnasal drip, sneezing, allergies, use of recreational drugs, change in smell, sinus pain, sinus infections.Mouth/Oropharynx: Ask about sore throats, mouth sores, bleeding gums, hoarseness, change voice quality, difficulty chewing or swallowing, change in taste, dentures and bridges.Respiratory Ask about frequent colds, pain with breathing, cough, coughing up blood, shortness of breath, wheezing, night sweats, last chest x-ray, PPD and results, and history of smoking.Cardiovascular Ask about chest pain, palpitations, shortness of breath, edema, coldness of extremities, color changes in hands and feet, hair loss on legs, leg pain with activity, paresthesia, sores that do not heal, and EKG and results. Breasts : (Remember men have breasts too)Ask about breast masses or lumps, pain, nipple discharge, swelling, changes in appearance, cystic breast disease, breast cancer, breast surgery, and reduction/enlargement. Do you perform BSE (when and how)? Date of last clinical breast examination, and mammograms and results.Gastrointestinal Ask about changes in appetite, heartburn, gastroesophageal reflux disease, pain, nausea/vomiting, vomiting blood, jaundice, change in bowel habits, diarrhea, constipation, flatus, last fecal occult blood test and colonoscopy and results. Genitourinary Ask about pain on urination, burning, frequency, urgency, incontinence, hesitancy, changes in urine stream, flank pain, excessive urinary volume, decreased urinary volume, nocturia, and blood in urine.Female/male reproductive : Both: Ask about lesions, discharge, pain or masses, change in sex drive, infertility problems, history of STDs, knowledge of STD prevention, safe sex practices, and painful intercourse. Are you current involved in a sexual relationship? If yes, heterosexual, homosexual,, bisexual? Number of sexual partners in the last 3 months. Do you use birth control? If yes, method(s) used. Female: Ask about menarche, description of cycle, LMP, painful menses, excessive bleeding, irregular menses, bleeding between periods, last Pap test and results, painful intercourse, pregnancies, live births, miscarriages, and abortions. Male: Ask about prostate or scrotal problems, impotence or sterility, satisfaction with sexual performance, frequency and technique for TSE, and last prostate examination and results.Musculoskeletal : Ask about fractures, muscle pain, weakness, joint swelling, joint pain, stiffness, limitations in mobility, back pain, loss of height, and bone density scan and results.Neurological : Ask about pain, fainting, seizures, changes in cognition, changes in memory, sensory deficits such as numbness, tingling and loss of sensation, problems with gait, balance, and coordination, tremor, and spasm.Psychosocial Profile Health practices and beliefs/self-care activities: Ask about type and frequency of exercise, type and frequency of self examination, oral hygiene practice (frequency of brushing/flossing), screening examinations (blood pressure, prostate, breast, glucose, etc.)Nutritional patterns: Ask about daily intake (24 hour recall) and appetite.Functional Ability: Ask if able to perform activities of daily living such as dressing, bathing, eating, toileting and instrumental activities of daily living like shopping, driving, cooking. Sleep/rest patterns: Ask about number of hours of sleep per night, whether sleep is restful, naps, and use of sleep aids.Personal habits (tobacco, alcohol, caffeine, and drugs): Ask about type, amount, and years used.Environmental history: Identify environment as urban/rural, type of home (apartment, own home, condo) Family/social relationships: Ask about significant others, individuals in homeCultural/religious influences: Identify any cultural and religious influences on health.Mental Health: Ask about anxiety, depression, irritability, stressful events, and personal coping strategies.Using the instructions below, identify 1 physical strength, 1 psychosocial/cognitive strength, and 1 weakness in either category. State why you think this to be true.With the information you collected, you can begin developing an idea of a client’s weakness and strengths. What is a strength? This might be that a person’s nutritional status appears to be excellent. It may be that there is no impairment of mobility. They may have lots of friends with them so be socially active. What is a weakness? This might be that a person does have impaired mobility or perhaps imbalanced nutrition – more than or less than body requirements. It might be that they have a communication issue that you note or perhaps seem to have a depressed mood, seem alone/isolated. Health Science Science Nursing NUR 2180 Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Over the past week Henry has become even more concerned as he hasbeen appointed to work with the ICU team to decide how they ration the available beds and how they prioritise care in the unit. Question: Using Utilitarian theory describe how such a theory could assist in prioritising the care to be distributed within this unit. Indicate the principles, rules, and or obligations that would be required. Question: Discuss the bioethical principle of justice in relation to utilitarianism and the rationing of health care.Question: Explain conscientious objection and provide an analysis of such objection to care provision and patient autonomy, in the situations described in this case study. Health Science Science Nursing HLSC 220 Share QuestionEmailCopy link Comments (0)
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Question Follow established person-centred behaviour supports/CHCDIS002Assessment Task 1: Monitoring Strategies / Reduction of Risk to a Person and other – including SelfScenario OneYou are supporting a family who is in distress. The parents are under a great deal of stress. Father has just become unemployed, mother has not found a supportive workplace for the past two years and has just resigned from her job. They heave three children aged between 18 months and 8 years of age. The 18 month old has severe respiratory issues and is terminal. Both parents are lucky to have4-5 hours’ sleep a day. The other children are driven to and from school daily and play sports on the weekends.Scenario TwoYou support a 5 year old child in a conventional primary school who multiple sclerosis. She is wheelchair bound and requires full personal hygiene care daily. She is incontinent and requires full assistance with nutrition intake and transport to and from school. Both parents are in respite in Regional Victoria recovering from a mild mental illness.Questions:1.) Who is involved in each of these cases?2.) List safety issues that require consideration3.) What might you do render assistance to the parents / child to prevent further escalation of their situation/s?4.) What could you do to care for yourself, emotional wellbeing included?5.) What strategies could you use to help maintain each child’s self-esteem and ensure privacy is not breach? Health Science Science Nursing NURSING CHC43115 Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Think of ways that you as an enrolled nurse can protect client informationand ensure that confidentiality is maintained Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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Question Answered step-by-step Treatments and therapies/practical nursing actions or considerations for bipolar Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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