Teri Case Study Nursing

Behavior observations: Ms. Evetta Stowers was a well-dressed 57-year-old African-American female who presented for interview and testing in a timely manner. She reported to be 5 '6" tall weighing 247 pounds. Her speech was clear, logical and goal directed. Mood was bright with congruent affect. Ms. Stowers maintained good eye contact. She was oriented and alert. There was no indication of significant depression, anxiety, hallucinations, delusions or thought disorder. She seem to have good awareness to make positive changes in her life for weight management.

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.

In family therapy, the clinician is able to see the role each member plays within the family structure. The clinician can assist the family to develop a family tree to explore different trends or discover unknown facts. For example, in developing this tree of people the family can include cause of death, possible miscarriages, mental health diagnosis of members, illnesses, or any other trend of interest. This can also promote family connectedness by contacting other members or friends of the family to gather information.

In this view, the healthcare provider may include the family in terms of socioeconomic and functional support, but really focus on the patient as an individual (p.36-37, 2003). Family as Sum of its Members sees each member of the family in the foreground and care is provided to all family members. (p.37, 2003). Family Subsystem looks at the significant relationships in the family; parent-child, marital interactions, caregiving issues, bonding-attachment concerns (p.37, 2003), where Family as Client looks further into family’s internal dynamics, relationships, structure and functions and its relationship with the outer environment (p.37, 2003).

Understanding the hierarchy of the family is imperative in understanding the functions of the family unit. With some familiarity with the different cultures in a given community, a medical professional will be able to ascertain who the head of the household is. The head of the household differs from culture to culture, as such, “misunderstandings which include but are not limited to the involvement of the male in all aspects of health care

Family medicine is a specialty that provides healthcare for both families and individuals. Physicians in family medicine provide medical diagnosis, treatment, and care to people of all ages, both sexes, every organ system, and all diseases. The patient-doctor relationship is generally in the framework of the family. Family medicine practitioners promote good health, stress disease prevention, and coordinate referrals when necessary. Graduates in family medicine have completed a broad range of study, which includes:

Keia is a 31yo, G2 P0100, who is currently 9 weeks 6 days as dated by a 6-week scan that was off from her LMP. She has a history of an IUFD at 29 weeks. She reports that she had decreased fetal movement prior to coming in and there being no fetal heart tones on examination, but other than that there were no other significant precipitating events. She did have an increased risk for Down syndrome at 1:140 but per the old reports all of her analytes were within normal limits. At the time of delivery, the baby did appear to be appropriate weight and there were no obvious causes at the time of delivery. She reports that she had chromosomes performed after and the chromosomes were negative. She also thinks she had a full autopsy that was unremarkable. She did have a work-up for clotting disorders due to the history of loss and according to the chart everything is relatively within normal limits except for MTHFR which was heterozygous for C677T and A1298C. I did not see beta-2 glycoprotein or antithrombin III. Because of the relatively normal work-up she is on a baby aspirin and Metanx. She is here today to discuss her history and plans for this pregnancy.

Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.

WEIGHT MANAGEMENT HISTORY: Ms. Glass related she has been of normal weight until her first child was born at age 32. Beginning early in life, she would feel feelings of nausea or stomach upset, and then eat to feel better. Ms. Glass related she continues to do this when feeling slight physical discomfort. In her childhood home, she was required to eat all on her plate and there was a significant amount of fried foods and sweets offered in the home. In one of her marriages, she had to make corn bread or biscuits at least once to twice per day. She stated the reason for gaining significant weight is her tendency toward snack foods and sweets. Ms. Glasses' triggers to eat are: stress eating, eating when she is sleepy and also tends to eat as an activity. Ms. Glass has attempted counting calories, Weight Watchers, the Atkins diet, low carbohydrate diets and exercise. Most successful for her has been calorie counting and Adkins losing 20 to 50 pounds with a one year maintenance period. Her problem foods are fast foods and sweets.

Joshua is a 31-year old who presents from CRU from UPC. He is ACOT for wanting to leave valley hospital against medical advice. He was admitted to Valley Hospital on voluntary basis for increased depression and anxiety. BHR have a hx of OD and hanging. He is allergic to vicodin. Upon admission, his vital signs were within normal limits. He is partially cooperative, he stated, "I just want to go to bed." He will benefit from meeting with the provider and discussing medication management.

Mr. Brann is a 42-year-old male here today for followup from his left cerebellar stroke and left vertebral artery dissection, status post hospitalization in May of 2015

----- Clinic presents a black male 68 years old. Currently experiencing dyspnea and lethargy. For the past week he has been having a increase of difficulty breathing. Complains of alternating periods of sweating and chills. Other symptoms he has been experiencing is a productive cough with expectoration of thick yellow sputum. Patient is a ex- smoker, he was a 40 pack year history, denies smoking, stopped over 10 years ago. Medical history includes chronic bronchitis, hypertension, MI five years ago, has had a angioplasty, and denies chest pain since having angioplasty. Current medication combined albuterol/ipratropium MDI, nebulized albuterol prn, captopril, and hydrochlorothiazide.

Midway during my first semester of nursing school I found out that my former husband was dying of cancer, specifically CLL- Chronic Lymphatic Leukemia; I was torn between the rigors of nursing school and doing what was best. Despite our shortcomings and however frightful our divorce was many years ago, I decided to care for him during his dying days. I felt that it was the right decision and my moral obligation to “do the right thing”; it was in my heart and for my children.

Moreover, the family understands the specifics about the individual's condition and their daily routines. This can help health care professionals to decide if the person is following the proper steps in their therapy. Once this takes place, is the point that health care professionals can make adjustments to reflect changing realities. Those patients, who have their families involved, will be able to receive better care by ensuring that nothing is overlooked. This is the point that physicians will have a more complete picture surrounding their underlying levels of health. (Saleeba, 2009)