Calvin Umbyuma - Concepts of Nursing III PDF

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Concepts of Nursing III...

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Calvin Umbyuma Room 302 Calvin Umbyuma Mr. Umbyuma is a 42 y/o male who has been admitted for complaints of shortness of breath with pleuritic chest pain. He was diagnosed with HIV positive antibodies over a year ago. He has recently been traveling back to his home country of Kenya to visit his sick mother. He received traditional medical treatment at his village. His temp is 100.9 F, 38.3 C, R 22, P92, BP 152/89 PaO2 91%. Inflammatory markers – Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are elevated at 78.9 mm/h and 67.2 mg/L. He has been placed in a room at the end of the hall.

You responded correctly to 3 out of 6 evaluations:

Category Educational Needs Fall risk Health change Pain level Psychological Needs Neurological

Your response Explanation Normal Patient needs HIV spread prevention education, and current treatments available Normal No indication at this time Normal Presence of shortness of breath, and pleuritic chest pain Normal Patient complains of pleuritic chest pain Normal No indication at this time Normal

No indication at this time

Calvin Umbyuma Calvin Umbyuma Mr. Umbyuma is a 42 y/o male who has been admitted for complaints of shortness of breath with pleuritic chest pain. He was diagnosed with HIV positive antibodies over a year ago. He has recently been traveling back to his home country of Kenya to visit his sick mother. He received traditional medical treatment at his village. His temp is 100.9 F, 38.3 C, R 22, P92, BP 152/89 PaO2 91%. Inflammatory markers – Erythrocyte Sedimentation Rate

(ESR) and C-Reactive Protein (CRP) are elevated at 78.9 mm/h and 67.2 mg/L. He has been placed in a room at the end of the hall.

You correctly diagnosed 5 out of 7 options: Physiological

Description Acute pain Bleeding, risk for Impaired mobility, risk for Nausea Safety

Description Deficient knowledge

Grieving Peripheral Neurovascular dysfunction Scenario 1

Your Response False False False

Explanation Patient complains of pleuritic chest pain No indication at this time No indication at this time

False

No indication at this time

Your Response Explanation False Patient needs HIV spread prevention education, and current treatments available False No indication at this time False No indication at this time

The nurse is doing the admission and has trouble pronouncing the patient's name. He tells the nurse to call him U. Mr. U starts coughing, his sputum is greenish-yellow with blood tinge. He tells the nurse that it is very painful to cough. The nurse asks him if he has night sweats, and he says yes, for the past 4 weeks. Mr. U has traveled back to Kenya twice this year as his mother has been very ill. He tried to convince her to seek medical attention, but his family is very traditional and believes in other methods of treatment. Mr. U admitted he also has been using traditional methods to treat his HIV. The nurse has an order for an IV with antibotics q6hr., blood cultures x2, and Tylenol for pain and fever.

You correctly ordered 2 out of 5 actions: Is this order correct Your Correct order order Step 2 1 Place on respiratory isolation 3 2 Ask Mr. U about the traditional methods he is currently receiving 1 3 Obtain blood cultures x2

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Scenario 2

Explanation To prevent possible spread of TB

To determine if traditional medication(s) could affect his current treatment plan Per HCP order, to determine presence of infection/sepsis. Must be done prior to antibotics being introduces to prevent masking of culture Start IV and antibotics Per HCP order Collect sputum culture and To determine if patient has TB, remind the provider that a acid-fast bacilli is the standard sputum culture order is for diagnosis needed. This will allow check sputum for acid-fast bacilli

Mr. U calls the nurse to his room complaining of severe pain when he coughs, and his shortness of breath has become worse. A visitor is in the room without a mask and has delivered Mr. U’s medication from home to include his traditional herbal remedies. Mr. U admits that he was trying to take his medicine when he experienced an episode of uncontrollable cough. Upon review of Mr. U’s previous chest X-ray, you have identified an abnormal chest X-ray showing a patchy shadowing in the right upper lobe.

You correctly ordered 1 out of 5 actions: Is this order correct Your Correct order order Step 5 1 Wash hands, don PPE

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Scenario 3

Explanation Per CDC guidelines, to prevent possible spread of infection Explain to the visitor that a mask Per CDC guidelines, to must be worn, and they need to prevent possible spread of wash their hands infection Respiratory assessment and assess Patient complains of vital signs worsening symptoms, assess for worsening condition Ask Mr. U for his medication and Per hospital policy, to explain to Mr. U why he can't take ensure medical treatments are not compromised his other medication while admitted to the hospital Place signage on door and above As a reminder for all bed reminder to wear a mask and visitors that may enter the wash hands room

Mr. U does not want to give up his traditional herbal medications. He tells the nurse that his father died in the best hospital in Kenya receiving the newest treatment. The nurse inquires as to the father's illness and Mr. U tells the nurse that he believes it was Tuberculosis. He does not know what his mother is suffering from as she refuses to seek modern treatment. Mr. U is also concerned about his wife as she has been having difficulty with her Visa and is still trying to come back to the US

You correctly ordered 0 out of 5 actions: Is this order correct Your Correct order order Step Explanation 4 1 Ask patient what he knows Understand patients’ knowledge about Tuberculosis of Tuberculosis and potential spread to others 5 2 Ask patient what his To determine if mother's symptoms are consistant with mother’s symptoms are Tuberculosis disease 1 3 Educate patient to the Patients are more empowered about making important decisions signs/symptoms of concerning treatment when they Tuberculosis understand diagnosis 2 4 Evaluate effectiveness of Ensure patient understands patient education Tuberculosis 3 5 Report findings to the To initiate immediate treatment, HCP, notify infection and containment of disease control and social services Scenario 4 Mr. U test positive for TB and new medications are ordered (kanamycin and moxifloxacin). His T-cell count is 160 with CD4 cell at 16%. A consult has been ordered for an infectious disease provider to manage his TB and HIV. The nurse is very concerned that this his TB is a resistant

strain as this can be carried with HIV infected patients. The nurse is also concerned about the social contacts that Mr. U has had in the recent past including his visitor that was not wearing a mask. The nurse has received multiple diagnostic orders that need to be done ASAP. Current vital signs are: 100.6 F, 38.1 C, R:22, P:86, PaO2: 91% Prioritize the following: Blood Gases, Bronchoscopy, Western blot and Elisa test, Chest x-ray, provide patient teaching about diagnostic testing,

You correctly ordered 1 out of 5 actions: Is this order correct Your Correct order order Step Explanation 2 1 Patient teaching about Bronchoscopy is a procedure that diagnostic testing requires sedation; to encourage (Bronchoscopy) compliance and to reduce patient anxiety 1 2 Contact Respiratory Results can quickly form baseline of pulmonary status therapy to obtain ABG’s 5 3 Chest x-ray Results willl need to be read by radiologist (taking up to 3-4hrs) to r/o presence of lesions/nodules in the lung 4 4 Western blot and Elisa Test will take 24 hours to result. The test test is a determinant for the patient's immune status regarding TB and the presence of possible HIV diagnosis 3 5 Bronchoscopy This should be done last because of sedation. It will provide differential diagnosis, obtain cell samples if the sputum culture was questionable or negative Scenario 5

Mr. U’s condition continues to deteriorate, and his tests come back positive for TB. The nurse is informed by the CNA that his pulse-oximetry is 89 on room air and he looks very dusky. The CNA also tells the nurse that while they were taking his VS, he coughed up bloody sputum.

You correctly ordered 0 out of 5 actions: Is this order correct Your Correct order order Step 3 1 Elevate head of bed 4

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Explanation To prevent aspiration and facilitate respiration Initiate O2 at 4L nasal Decreasing O2 saturation requires canula O2 supplementation Reassess vital Signs CNA reports that his pulse-oximetry is 89 on room air and he looks very dusky Reevaluate amount of Blood loss could be a serious blood lost by complication of Bronchoscopy coughing Contact HCP and Change in patient status, and nursing supervisor potential need for transfer to ICU...