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- Patient C., 32 y/o, complains of excessive weight, shortness of breath, defective memory, performance decrement, feeling cold, emotional retardation. It is known from the case history that the patient is suffering from primary hypothyroidism. Objectively: the skin is dry, waxlike, swollen, periosteal reflexes are lowered, body mass index: 33.5 kg/cubic meter, TSH (thyroid-stimulating hormone) – 25 µU/dL (norm 0.5 -5.0). Obesity is homogenous. Arterial pressure: 150/100 mm column ob mercury. What type of obesity can be suspected?A. Endocrine hypothyroidB. Endocrine accompanying dysfunctions of hypothalamopituitary systemC. Alimentary constitutionalD. HypothalamicE. Androidal with the developed symptoms of metabolic syndromePatient B., 56 y/o, is complaining of weakness, muscle ache, paresthesia in the facial zone, lower extremities, tonic-clonic seizures, breathing difficulty. Anamnesis contains a record of previous subtotal resection of thyroid gland. Objectively: her consciousness is clouded, the skin is dry, cyanotic, “main d’accoucheur”(obstetrician’s hand) convulsions in the upper extremities swallowing function is disturbed, shortness of breath. Heart sounds are dull, rhythmical, arterial pressure – 115/55, pulse – 56 beats/minute. Positive Chvostek’s and Trusso’s symptoms. The level of calcium in the blood – 1.3mmol/l; hyperphosphatemia, hypocalciuria; glycemia –5.6mmol/l. What is your diagnosis?A. Hypocalcemic crisisB. Hypothyroid comaC. Kidney failureD. Hyperthyroid coma E. Brain comaS.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. The nurse is assessing the patient’s pulses. Which locations should the nurse check? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legs
- S.R. is a 65- year-old woman who presents to the emergency department complaining of shortness of breath, productive cough, and swelling in both legs. The patient has a past medical history of congestive heart failure (CHF), hypertension, and diabetes. Vital signs are T 97.5, P 85, R 16, and BP 160/90. Physical exam reveals +2 edema bilateral lower extremities, heart rate and rhythm regular, and lungs with rhonchi in the bases. The patient is started on a nebulizer treatment, and an electrocardiogram has been ordered. What subjective information should the nurse obtain? The nurse is assessing the patient’s pulses. Which locations should the nurse check? What is the most likely cause of this patient’s shortness of breath, productive cough, and swelling in both legsJ.D. is a 64-year-old man who presents to the family practice complaining of increased urination at night. The patient has a past medical history of hypertension, hyperlipidemia, and coronary artery disease (CAD). Vital signs are T 97.5, P 85, R 16, and BP 120/60. What subjective information should the nurse obtain? The nurse is performing the physical examination of the patient’s genitals. What are the major structures of the male genitalia? The nurse needs to assess the patient for a hernia. What is the proper procedure for this assessment?Explain the different glucose monitoring tests and the required preparation (fasting or non-fasting) to the patient using simple language.
- Doctor ordered Tab. Valium (Diazepam) 5mg HS for Ms. S on the night prior to surgery. This is to O reduce pharyngeal secretion minimize the dose of anesthesia prevent nausea and vomiting O relieve anxiety and enhance restOrder:Morphine sulfate 7.5mg, subcutaneous, q4h, prn. childs weight: 84 lb Recommended dose range: 0.1 to 0.2 mg/kg/dose how much will the nurse administerPatient C: An 18 y/o healthy female presents for a routine physical examination. Patient has great difficulty producing a very small volume of urine despite not having urinated since early morning. During discussion with physician it is revealed that she has had only 2 cups of coffee and a donut to eat all day 1) What are the abnormal findings? 2) What is your diagnosis? 3)What suggestions might you have for this patient? 4) Why does the body form concentrated urine? and where in the kidney does urine concentration occur? 5) Why is an extended water fast a bad idea?
- Patient M., 36 y/o, was found in the street unconscious. The patient has a medical history of diabetes. There is a smell of alcohol from the mouth. The skin is moist, warm, arterial pressure -145/90 mm column of mercury, convulsive twitching of muscles. Breathing is shallow, eye ball tone is retained, pupils are dilated, hyperflexion. How would you treat this patients?A. Intravenous introduction of 40-80-100 ml 40% glucose solution B. Injecting 20 units of insulin subcutaneouslyC. Injecting 20 units of insulin intravenouslyD. Injecting 500 ml 5% glucose solution intravenouslyE. Injecting 500 ml 0.9% sodium chloride intravenously(NURSING DIAGNOSIS list) - Risk of fluid volume depreciation as evidenced by nausea, vomiting, anorexia & reduced fluid ingestion. - Imbalanced nutrition less than body requirements as evidenced by difficulty to eat/digest food secondary to dysphagia & evidenced by weight loss & physical examination - Constipation related to immobility secondary to a sedentary lifestyle as evidenced by straining during the passage of stools & absence of bowel movements for 5 days. - Acute pain related to abdominal cramps as evidenced by the patient’s facial grimace. 1. What type of goal should be established? Short term Long term 2. In writing the goal for the top priority problem, what components should be included? Subject Verb Conditions or Modifiers/ Effects of interventions Criterion of desired performance/ Expected outcomes 3. What goal now can you formulate following the above components to resolve the top priority problem mentioned?b. Transcribe the doctor's notes, using abbreviations from the unit where applicable. Patient is a 21-year-old male who presents with an injury to the right upper extremity. No history of diabetes mellitus, eczema, or allergies. First and second-degree burns are noted on the right forearm, running from the elbow to the wrist. Multiple vesicles noted in the 2nd degree area burns located throughout the medial aspect of the forearm. The wound is cleansed with antiseptic, Neosporin applied and bandaged. Prescription written for Tylenol #3, twenty tabs, take one four times a day as needed for pain. Follow up with dermatology in one week.