A Case Study Scenario That Provides Situations We May Face As Future Nurses

Unhealthy lifestyle behaviors account for 50 percent of preventable death in the US. As the diversity of the US population increases, health care providers are expected to provide services that are reasonable and responsive to the unique cultural and ethnic identity, socio-economic condition, emotional and spiritual needs, and values of patients and the population. In this class, I have learned various diseases and conditions of all ages and ethnicities (American Association of Colleges of Nursing, 2017). Through case studies, I was able to apply broad, organizational, client-centered, and culturally appropriate concepts in the planning, delivery, management, and evaluation of evidence-based clinical prevention and population care and services to individuals, families, and aggregates/identified

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

1. The nurse is asked to implement a new, complex, and invasive procedure and is concerned that this may violate the state’s nurse practice act.

Over the past 30 years nursing has evolved from a task-oriented to a logical and systematic approach to care, using theories and models to guide practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision-making and so reduce conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according to Pearson et al (1999,p ).

1. Monitor the patient's oxygen saturation frequently (once per hour) at rest and after exertion on room air

Clinical reasoning is “the process of applying knowledge and expertise to a clinical situation to develop a solution” (Carr, 2004 cited in Banning, 2008, p.177). Poor clinical reasoning skills can lead to a “failure to recue” (Aitken et al., 2003) the deteriorating patient. Additionally, studies by Hoffman et al. have compared the way in which the expert nurse and the novice nurse accurately collect cues from which they base their decisions. Effective clinical reasoning is therefore linked to “the ability to collect the right cues and take the right action for the right patient at the right time and for the right reason” (Levett-Jones et al., 2010). The ability to apply these “five rights of clinical reasoning” (Levett-Jones et al., 2010) will be discussed in more detail in Nursing Actions and Interventions: A Reflection.

20. Analyzes and interprets initial assessment findings and collaborates with the client in developing approaches to nursing.

The patient is an 84-year-old female who did stop her iron supplement, which she was taking for a history of iron deficiency anemia thought related to a Mallory-Weiss tear, which was seen on an EGD done in February 2015. Her hemoglobin and hematocrit had been stable. Because of her symptoms, I did ask her to stop the iron supplement. She does tell me her abdominal pain, increased stooling did go away, since that time, although, she does state today that several weeks ago she did have one further episode of it, but none since that time.

Mr. B is planning on obtaining an associate degree in nursing. It is possible for him to achieve his ambition. Although schizophrenic, Mr. B has been able to manage his condition relapse-free for the last ten years. For the previous five years, Mr. B has been successfully working as a certified nursing assistant. The above information builds confidence in support of Mr. B because he has been meticulous with his medication regimen and with his psychosocial therapies. Since Mr. B has been able to manage his manifestations successfully, he should consider College for his associate degree. The only pre-condition to Mr. B pursuing his career plans is that he continues with his medication rigorously. Specific issues Mr. B may face while working toward

The patient is 65-year-old gentleman who has recurrent presentations to the ER first 1/22/2017 for a fall. Discharged 1/26/2017, another fall, admitted to having some alcohol to drink, discharged, a repeat visit on 1/27 again because of falls, discharged with instructions to see Dr. Silva the following Monday only for the patient to return to the ER about 5 or 6 hours later. He evidently has no place to live since the death of his wife a year ago. He states he lives in the laundry room of the the building and he was kicked out and again has fallen. His laboratory work shows he has a CO2 of 15, which is unexplained. He does have a left below the knee amputation with pain, swelling and some cellulitis of the lateral aspect. Evidently

Normocephalic. Scull palpated without masses, deviations or lesions noted. Facial features are spaced appropriately and symmetric. No evidence of edema or puffiness. Temporal arteries present bilaterally without bruits. PERRLA noted. Cranial Nerves III, IV, and VI are intact. Bilaterally, sclera is white and conjunctivae is moist and pink without drainage. Pupil size is 3 bilaterally. Visual fields and acuity intact. Optic disk with defined margins and ref reflect noted bilaterally. Patient ears are bilaterally aligned. No tenderness, nodules, or lesions, were noted upon palpation of the external ear. While performing an ear exam with the otoscope, there was a moderate amount of cerumen noted bilaterally. The auditory canal color is pink bilaterally. Tympanic membranes are bulging with fluid noted bilaterally. Hearing loss not detected while performing the whisper test. Patient’s nose is located in the center of the face. Nasal turbinates are slightly erythemic with thin clear discharge. No polyps noted. Palpation of frontal and maxillary sinuses performed without tenderness. Cranial Nerve I is intact. Lips are intact without signs of cracking or dryness. Oral and buccal mucosa is pink and moist. Oropharynx erythema without signs of dehydration. Tonsils are 2+ with generalized petechial lesions and erythema. Bad breath

1. When a nurse performs a physical examination on a newborn, which of the following nursing assessments should be reported to the physician?

This is a house call I made on this 94-year-old individual, multiple medical problems including chronic obstructive pulmonary disease, recurrent exacerbations of COPD with recurrent hospitalizations for pneumonia. Past medical history also includes that of recurrent hyponatremia intermittent atrial fibrillation,coronary disease, heart failure, pulmonary edema, hypertension, chronic constipation. The last time I saw her was in 01/2017. She had a previous hospitalization one year ago at Rex Hospital for respiratory failure from COPD. CPAP was used for rescue and family apparently got a CPAP machine at home for intermittent use. Since the last time I saw her in January, the patient has become non ambulatory. The last time I saw her

Amy is a 29-year-old here today for a followup regarding her anxiety and depression. She would also like to talk about some dysuria she is having and a breast lump she has noticed.

Reginald is an octogenarian with multiple health issues. He is living in a regional NSW town and was recently widowed. He has a son who is not geographically close and his daughter, who does live nearby, has heavily laded family commitments. The community registered nurse visits three times per week to dress an ulcer on Reg’s leg. This report will focus on how to keep Reg living with assisted independence by becoming and staying healthy and promoting safety.