She was treated with combination chemotherapy consisting of bleomycin, Velban, and cisplatin without positive response. A one-month course of interferon was given, but discontinued because of low granulocyte count. Tamoxifen therapy was initiated in January of 2002 after metastatic melanoma was found in the membranes of the spinal cord and surgically resected. Shortly thereafter, she had another brain lesion resected, followed by radiotherapy. She resumed tamoxifen treatment with consequent gradual resolution of several metastatic lesions.
TREATMENT: Patient tested negative for Lyme disease and CT and MRI scans show no neurological issues. Mr. McDonnell’s tested positive for Bell’s Palsy. He has partial facial paralysis as shown by EMG and NCV tests. Contraction of Herpes Simplex virus positive and treatment with Acyclovir to clear infected areas. Eye drops administered to eyes TID to prevent dryness.
MEDICATION LIST Zonisamide (Zonegran) 100mg give 1 Capsule by mouth once daily Dx: Epilepsy Amiodarine HCL 200mg tablet give tablet by month once daily DX: Cardiac Arrest Dorzolamide- Timolol Eye Drops Instill 1 drop in both eyes twice daily DX: Glaucoma Furosemide (Lasix) 40 mg tablet give tablet by mouth 3 times per week (Mon, Wed, Fri,) DX: Pneumonia Furosemide (Lasix) 20 mg tablet give tablet by mouth 4 times per week (Tues, Thurs, Sat, Sun) DX: Pneumonia Galantamine (Razadyne) HBR 12mg tablet give 2 tablets by mouth once daily DX: Dementia Lacutulose 10gm/15 ml solution give 30ml by mouth twice daily DX: Constipation Levofloxacin 500mg tablet give 1 tablet by mouth once daily DX: Cellulitis Losartan Potassium 25mg tab give 1 tablet by mouth once daily DX: HTH Simvastatin 40mg tablet (Zocur) give 1 tablet by mouth daily DX: Dyslipidemia Xarelto (Rivaroxaban) 10mg tablet give 1 by mouth once daily DX: Thromboembolism Prostat101 give 30ml by mouth twice daily DX: Supplement Levothyriod 50mg PO daily DX: Hypothyroidism Insulin glargine (Lantus) give 62u SQ Accu check AC + HS with Humalog sliding scale coverage Humalog 100units/ ml viral 140-160= 0 units 176-200=1 units 201-250=2
Correct Answer(s): DEthical-Legal ConsiderationsSince Kat's respiratory status has stabilized, she undergoes an open reduction and internal fixation of the pelvis. Following surgery, Kat receives patient-controlled analgesia for 24 hours. When this prescription is discontinued, a new prescription is written for Morphine 2 mg every 4 hours PRN.The nurse caring for Kat is concerned about the amount of opioid analgesics that Kat has received since her fracture occurred. The nurse administers a dose of normal saline IV the next time Kat requests pain medication and reports to the charge nurse that the client indicates that she is pain free.22. What action should the charge nurse implement?
The nurse from the dialysis unit informs the unit nurse assigned to the patient that 1 L of fluid was removed. She reports that prior to dialysis the patient’s weight was 80kg, and after dialysis it is 79 kg. At the end of the dialysis treatment the patient’s vital signs are: temp 36.7 (98.0) degrees; heart rate 87 bpm; respirations 20/min. ; blood pressure 90/61 mmHg. A 2x2 gauze dressing covers the accessed site of the AV fistula and it is clean, dry, and intact.
A patient who has coronary heart disease and an LDL level of 140 mg/dL | | | c. A patient who has two risk factors and a low-density lipoprotein (LDL) level of 100 mg/dL, without coronary heart disease | | | d. A patient who has one risk factor, an LDL level of 170 mg/dL, and no history of coronary heart disease | | Question 2 Marks: 1 A patient has received too much warfarin. The nurse will prepare to give which antidote for warfarin toxicity? Choose one answer. | a. vitamin K | | | b. vitamin E | | | c. potassium phosphate | | | d. protamine sulfate | | Question 3 Marks: 1 A patient has been taking digoxin (Lanoxin) 0.25 mg, and furosemide (Lasix) 40 mg, daily. Upon routine assessment by the nurse, the patient states, “I see yellow halos around the lights.” The nurse should perform which of the following actions based on this assessment?
Theory in Professional Practice Critically ill patients are at high risk for becoming deconditioned and delirious. When I started working in intensive care, keeping your patient sedated and comfortable on the ventilator was the norm. However few years ago early mobility became the new norm. Intubated patients that were mobilized within twenty-four hours from admission were weaned off the ventilator sooner; and they never became delirious or deconditioned. Using fewer sedatives that promoted a normal circadian cycle prevented delirium.
Therefore, once medically cleared, we have to rely on inpatient psychiatric facilities or group homes like the one Dr. Primrose runs to ensure that these patients remain safe while, in this case, initiating prescriptions to manage medical and psychiatric issues and gathering resources that will be necessary for this patient to regain her independence. This teleconference was efficient and cost effective for the following reasons; an unnecessary one hour trip was avoided to the facility where no beds were available. This patient was able to receive appropriate, necessary medical treatment while psychiatry was reviewing the patient’s chart and then, in this case, finding appropriate placement. The two Psychiatrists involved were able to teleconference with the patient and gather necessary information and details of the patient’s present state of mind and ability to act with sound judgment. The patient’s accessible EMR avoided time spent faxing and/or having to orally present patient’s case several times over.
Case Study #2: A 20 year old woman was brought to the ED in a comatose state. Her roommate stated that the patient had been nauseated earlier in the day. Upon physical examination, it was noted that the patient was breathing deeply and rapidly, her breath had a fruity odor and her skin and mucus membranes were dry. The family was contacted and the mother stated that the woman brother had Type I diabetes. The following laboratory results were obtained: CHEMISTRY PANEL REFERENCE RANGE Na 128 mmol/L (136-146 mmol/L) K 5.7 mmol/L (3.5-5.0 mmol/L) Cl 88 mmol/L (98-109 mmol/L) HCO3 9mmol/L (22-28 mmol/L) BUN 50 mg/dl (5-20 mg/dl) Osmolality 310 mOsm/kg (285-295 mOsm/kg) pH 7.12 (7.35-7.45) pCO2 28 mmHg (35-46 mm Hg) Glucose 750 mg/dl (70-105 mg/dl) Urine Glucose 4+ Serum Acetone 3+ 1.
The infant was originally discharged home on an apnea monitor and continuous home oxygen per nasal cannula. After being admitted to the hospital, the nursing staff must develop an individualized plan of care that will optimize patient outcomes while maintaining the safety of both patients and the nursing staff. The NANDA-I diagnosis that would be appropriate for an infant with bronchiolitis is ineffective airway clearance, which is a state in which the patient is unable to clear respiratory obstructions or secretions in order to maintain a patent airway (Elsevier, 2012). Once the diagnosis has been identified, the nurse is able to recognize the common symptoms associated with patients who suffer from a compromised airway, which include: fatigue, non-productive cough, increase secretions, cyanosis, increased respiratory rate, labored breathing, and abnormal breath sounds, such as wheezing or crackles. Based on the common symptoms of a patient with bronchiolitis, the nurse can then identify appropriate patients goals and outcomes.