D.R. is a 74-year-old obese Hispanic woman who is in the third postoperative day after an open reduction internal fixation (ORIF), for repair of a left femoral neck fracture after a fall at home.
States pain in her left hip is a 4 to 5 on a 1-to-10 scale
States pain in her left calf area is a 3 on a 1-to-10 scale
Vital signs: blood pressure 140/68, pulse 64, temperature 98.7° F, respirations 20
Oxygen saturation 93% on room air
Lungs clear all lobes
Bowel sounds are present in all four quadrants
Apical pulse: 64, irregular
Alert and oriented to person, place, and time
Skin warm to touch bilateral lower extremities, slight erythema left lower extremity
No edema right lower extremity, 2+ left lower extremity
Pedal pulses 3+ right lower extremity, 1+ left lower extremity
Calf circumference: right, 8 cm; left, 10 cm
Left hip wound has staples; no signs or symptoms of infection
Last bowel movement was four days ago
Medication Administration Record
Morphine sulfate 2 mg IVP every two hours as needed for pain scale 6-10
Lisinopril 20 mg PO daily
Bisacodyl 10 mg PO daily
What do you suspect is occurring with D.R.? What data were used to make this determination?
What risk factors for development of a DVT does D. R. have?
What measures can be taken to prevent a DVT in an at-risk patient?
Susan is an 8-year-old girl who has been brought to her pediatrician by her mother for a weight loss of 5 pounds over the past 2 months, despite an increased food intake.
Susan complains of thirst, hunger, and frequent voiding.
Today’s weight: 25 kg
Weight from a physical examination 6 months ago: 27.3 kg
Finger stick glucose: 325
Hemoglobin A1c: 9.1
Father was diagnosed with type 1 diabetes at age 8 years.
Will Susan require hospitalization?
Susan plays after-school sports; will she have to stop these activities?
What actions should the nurse take in this situation? Prioritize the actions.
Adam is a 6-year-old boy who dove head first in the shallow end of a swimming pool. Unable to move, he sank to the bottom of the pool and was rescued by his mother. His father called the emergency medical services (EMS) while the mother provided mouth-to-mouth resuscitation. The EMS arrived and continued the resuscitation and placed him in a cervical collar. Adam was placed on a backboard and began to breathe on his own while en route to a trauma center. Neurologic assessment revealed paralysis of the upper and lower extremities, and cervical spine x-ray images and a magnetic resonance image (MRI) confirmed a C6-C7 complete transection injury. The patient was intubated before going into surgery for decompression of the injury.
Into what types of shock could the patient go? What symptoms did the patient exhibit?
For which complications of a spinal cord injury will the nurse assess?
What procedures would you anticipate for long-term rehabilitative management?
L.S. is a 59-year-old female who goes to see her primary care provider because of increasing fatigue and shortness of breath with activity. She has a history of hypertension, hypothyroidism, rheumatoid arthritis, and rheumatic fever as a child. She is taking the following medications:
Triamterene/hydrochlorothiazide 37.5/25 mg PO daily
Levothyroxine 150 mcg PO daily
Methotrexate 15 mg PO every Sunday
Does not exercise, but was always able to do daily activities such as go up and down the stairs of her home and go grocery shopping
The last few weeks has noticed that she gets short of breath with her normal daily activities
Has been waking up at night short of breath
Denies any pain in her chest
Does not have any pain in her joints as long as she takes her “arthritis medicine”
Temperature 98.5° F, pulse 88 and irregular, respirations 24, blood pressure 134/82, O2 saturation 92%
Irregular heart rate with a grade III diastolic murmur
Crackles in bilateral bases of lungs
No peripheral edema noted
ECG shows atrial fibrillation with heart rate of 90
Echocardiogram reveals mitral valve stenosis with mild left-sided heart failure
Hemoglobin 12 g/dL
T4 (total) 5.1 mcg/dL
What is mitral stenosis? What could be the possible cause of L.S.’s mitral stenosis
How did the mitral valve stenosis contribute to the development of left-sided heart failure?
E.W., a 76-year-old white man, comes to the emergency department after a syncopal episode at a local restaurant. He is accompanied by two friends.
Has been feeling weak for a few days
Became dizzy and fainted while awaiting his dinner
Takes one medication, a “water pill” for high blood pressure
Blood pressure 92/50, pulse 125 and irregular, respirations 24, temperature 97° F
Alert and oriented
Lung sounds clear in all fields
ECG monitor shows atrial fibrillation
What is atrial fibrillation?
W. is placed on diltiazem, warfarin, and dronedarone. What is the purpose of each of these medications in treating E.W.’s atrial fibrillation?
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