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- Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough,hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago.Blood work values on room air:Blood Gas Blood Gas Arterial Venous pH 7.51 7.40 PaCO2 30 mmHg 45 mmHg PaO2 60 mmHg 30 mmHg HCO3 24 mEq/l 21 mEq/l BE - 1 - 4 SaO2 90% 60% Hb 15 g/dl 15 g/dl Part 1: Interpret the ABGPart 2: What is the arterial- venous oxygen content (Ca-vO2) difference for this patient?Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Part 1: What is his arterial-venous oxygen content (Ca-vO2) difference? Part 2: Calculate his extraction ratio please.Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Mr. H suggests hypoxemia and respiratory alkalosis which might be an indication of serious illness such as pulmonary embolism. Part 1: His arterial-venous oxygen content (Ca-vO2) difference is 5.73 mL/dL Part 2: His extraction ratio (ER) 0.276 or 27.6% What is clinically happening to the patient? Please explain.
- CASE: H.I, a 60-year-old male office worker was admitted to the emergency room due to complaints of severe chest pain whileat work. The pain was relieved by taking nitroglycerin and thrombolytics. The patient also complained of easy fatigabilityand inability to perform heavy tasks at home and work. 3 weeks ago, the patient experienced chest pain after doingmoderate heavy chores while at home. This occurred 3 times and was relieved by rest. The patient also experience shortnessof breath when climbing stairs or walking long distances. The patient has been taking maintenance medication forhypertension. The patient was diagnosed with myocardial ischemia secondary to coronary artery disease 1. What are the risk factors/ causes of the medical condition?2. What are the ways to prevent these risk factors/ causes?3. What is the effect of aging on the body system involved?Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. What preoperative testing is appropriate for Mr.Doe? (Give at least 4 priority examples) Note to Tutor: Thank you so much, Ma'am/SirCase Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Mr. Doe was very restless the evening before. He verbalizes to his wife that he is “scared to death” and worried about losing his foot. She asks the nurse what can be done to help him. How will the nurse address the psychological comfort of Mr. Doe? (Discuss in 2-3 sentences only)
- Case Scenario John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Dr. Ramos is Mr. Doe’s surgeon and Dr. Reyes is Mr. Doe’s anesthesiologist. Both come to see him and discuss the surgery the evening before. How does the nurse ensure informed consent? What must the patient consent to for the procedure to be done? (Discuss in 5-6 sentences)Case 1: Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. When checking the medications for Mr. Doe the evening before surgery, which orders increase the nurse’s concern? Insulin 6 units Regular with 15 units NPH subcutaneous q am. Aspirin 325mg PO q d. Pletaal 100mg PO BID Ativan 0.5mg IVP on call to OR in AM.A 2 1/2 - year old child is brought to the health facility with a history of high fever. Temperature 102.9 F (39.4 C), runny nose, cough, red and watery eyes, and small white spots inside the cheeks, all of 4 days duration. Discuss the nursing management of this child under the following topic: 1. Establishing of an effective relationship with patient/family
- Case Scenario John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Summary: Given case: 53 years old, male History of Type-1 diabetes mellitus, CAD ( Coronary Artery Disease) PAD ( peripheral artery disease) Cigarette smoking 40 packs per year COMPLAINTS: 6 weeks ago, he developed a wound in his left heel. Despite antibiotics, patient developed a gangrene infection. ADVISE: To undergo BKA ( Below knee amputation) of left lower extremities MEDICATION: Daily insulin, aspirin 325 mg /day, pletaal 100 mg BD Post-operative Data: Post-operatively, Mr. Doe goes to the Post Anesthesia Care Unit…Case Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Please make 1 intraoperative NCP with 1 diagnosisCase Scenario: John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: During the admission assessment, the nurse questions Mr. Doe to determine if there is a latex allergy or sensitivity. Why is this essential to the patient’s safety? What symptoms would the nurse question Mr. Doe about in order to determine this? (Discuss in 3-5 sentences only)