Keia Case Study Nursing

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.

Erin is a 33yo, G3 P1101, who was seen for an ultrasound evaluation and consultation. The patient has a longstanding past history of substance abuse as well as alcohol abuse and she is HIV positive with a positive viral load. She is followed by infectious disease and is on numerous medications including Genvoya and Prezista. She also is reportedly hepatitis C positive. She has a history of alcohol abuse in the past but states that she has not had any alcohol since early June. Her LMP was 08/06/17. She also has a history of cocaine usage but again denies any usage in the past year. She does have a longstanding history of physical abuse and has had issues with anxiety. She has 2 previous deliveries. The 1st of which was in 2004 that occurred

Rachel is a 32yo, G7 P3033, who is currently 18 weeks 1 day. She is dated by LMP. She was seen previously for a dating scan and declined aneuploidy screening. She has 3 prior full-term deliveries. She had preterm labor with her last pregnancy but ultimately delivered at term. While she has miscarriages, she does not have 3 in a row. She is here today for an anatomic survey.

The patient is an 18 year old Spanish female who came to the unit on 11/31/2016 at 23:10 complaining of cramping and she had thought that her water had broken. Her pain was a 4 on a scale of 0-10 in her abdomen described as cramping. Upon examination she was dilated to 3cm, 80% effaced and the position of the baby was -2 and vertex. Her membranes remained intact. Her estimated due date was 10/28/2016. This is her first pregnancy. She has no history of abortion or miscarriage. She has had her flu vaccine and tdap vaccine in October, 2016. She has never smoked or done illegal drugs. She is negative for group b strep, hepatitis, HIV, and syphilis, gonorrhea, and chlamydia. She is rubella immune. There is a language barrier between the patient and the staff. The patient and her family only speak Spanish and only knew very little

Kacie continues to make progress on her Case Plan. She began another job through Jimmy’s Restaurant in the second week of November. Her work schedule is nightly and on weekends, therefore, affording her the flexibility to care appropriately for her children, and ensure that children take the school bus to and from the family residence daily. Her mother babysits her children when she works on weekends. To avoid violation of her Voucher Program, this worker encouraged Kacie to notify her housing case manager about using her mother to babysit her children in her home when she goes to work on weekends.

Patient is a G1P0, 23-year-old Caucasian female patient, LMP is January 10, 2013, EDC is October 17, 2006 and gestation of 384/7 weeks confirmed by an ultrasound per chart. Pre-pregnancy weight was 110 lbs and pregnancy weight is 145 lbs for a total gain of 35 pounds. Patient stated she eats a normal diet, does not drink alcohol and she has never smoked cigarettes nor taken any kind of recreational drugs. Was admitted 0430 hrs on October 5, 2014 with intact membranes with 2cm dilation and 50% effaced. Birthing plan shows she plans on a natural birth, patient states “I plan on following my birthing plan to have no drugs during my labor, but am open to hearing my choices.” Patient plans on breastfeeding her infant for at least 1 year. Supportive husband was at bedside throughout the labor, delivery and postpartum.

Paige is a 25yo, G3 P1011, who is currently 30 weeks 6 days. She is followed in our office after being admitted to the hospital for abruption with a positive KB and decreasing fibrinogen. Her fibrinogen stabilized around 200. She had no more vaginal bleeding and she was discharged home. When she came in she was also contracting and noted to be 2 cm and have a shortened cervical length at 1.9 cm that decreased down to 1.2 cm with pressure. She was ultimately discharged home and has been home for about one week. She is here today for follow-up.

Marisna is a 39yo, G3 P2002, who is currently 21 weeks 0 days as dated by LMP using a due date of 04/25/17. This was consistent with her 1st ultrasound in your office that measured just slightly ahead with a due date of 04/18/17. She is AMA. She had a quad screen in your office that returned screen positive with an increased risk of Down syndrome of 1:100. This is close to what her age based risk would be. Open neural tube defect was screen negative. In reviewing her analytes, AFP was slightly elevated at 2.15 MoM and inhibin was borderline at 1.87 MoM. She was diagnosed with chronic HTN fairly early in her last pregnancy. She did not have preeclampsia with that pregnancy to her knowledge. The baby was quite small, as it weighed just over 4 lb at term. She was not on BP medication chronically, but coming into this pregnancy at 19 weeks her BP was elevated at 162/90 and she was started on labetalol. I cannot tell in the records if she had protein in her urine but she did have 2+ on her dip in our office today. She reports that she has collected a 24-hr urine last week, although we do not have those results. Because she entered care late, she is not on baby aspirin for the prevention of preeclampsia.

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

Jessica is a 28yo, G4 P3003, who was seen for a follow-up ultrasound assessment and fetal anatomy evaluation. The patient herself does have a diagnosis of lupus that occurred in 2012. She was on Plaquenil and has been on Plaquenil with her last pregnancy. She discontinued this as she did in her previous pregnancy. She states that she has never received corticosteroids for a flare but her last flare was in July 2015. Overall in this pregnancy to date she has done well. She also has a history of Hashimoto thyroiditis and now has hypothyroidism and is on Synthroid. We did obtain some labwork and all of her antiphospholipid antibodies and lupus anticoagulant are negative as well as the other thrombophilia panel assessments. Her TSH was somewhat

Fred (W.E. Bowman) gave a brief progress update: Flooring down today and tomorrow, after that, trimming everything out on 1 South. The cabinet installers are ready but having are having a man power issue trying to find people to install the cabinets. They are hoping to be here in the next couple of days. There is a massive labor shortage.

A.M. was a 29-year-old mother who gave birth at 0836 on 11/20/14. Upon beginning the shift, she was being prepared for her cesarean section (c-section) at 0800. She was a G4P1PT2AB2L1 and was 36 weeks and one day at the beginning of the shift. A.M. had no known allergies and no latex allergy. She was O+ and Rubella immune. Her husband was present throughout the day supporting her at her bedside. M.A. had a history of type II diabetes, depression, hypertension, previous right cornual ectopic pregnancy, previous c-section, cholecystectomy, and salpingectomy. She was having a c-section due to the possible risk of tearing and bleeding from the previous ectopic pregnancy*. Mother planned on breastfeeding her baby with minor supplements of

An attending physician statement completed by Dr. Ikeda, dated 04/28/2017, indicated that the claimant presented anemic. She was pregnant with twins and had an elevated blood

“The abdomen is a large, oval cavity extending from the diaphragm down to the brim of the pelvis” (Jarvis, 2016, p. 537). Amira is a 27-year old Syrian female who has been brought in to be seen due to abdominal pain and bleeding. I would first start to assess where the bleeding is coming from to stabilize and stop the bleeding from occurring cause excessive loss of blood could cause her to pass out and die. I want to know whether she might just be having a painful menstrual cycle which could include abdominal pain, upset stomach and appetite changes. I would start an IV to challenge possible fluid depletion, and then the doctor would order blood work which should include CBC, BMP, and of course a pregnancy test. An abdominal sonogram would