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Christian is a 20-year-old male college student who was involved in an automobile accident 3 days ago, suffering a traumatic amputation of the left lower leg. Christian’s mother has remained with him since the accident and is very supportive. His father is depressed and having difficulty dealing with his son’s condition because Christian was captain of the college basketball team and had aspirations of becoming a professional athlete. Christian’s condition is stable and he is being placed into a rehabilitation program immediately. Soon he will be fitted for a leg prosthesis. Usually an outgoing individual, Christian is somber and non-talkative. He does not look at his leg when dressings are being changed and he refuses to discuss his rehabilitation program.
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What factors are likely to affect Christian’s adaptation to his amputation and rehabilitation?
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- Mrs. Thomas was on vacation out of state when she stepped off a curve and injured her left ankle. Due to severe pain she was seen at an urgent care center where she underwent a left ankle x-ray, which was negative. She was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect her left ankle. She was provided with appropriate discharge instructions and instructed to follow up with her primary care physician upon returning home. When she presented her BlueCross BlueShield insurance card at check out, Mrs. Thomas was informed that the physician who provided treatment is a nonparticipating provider (nonPAR) and that the urgent care center accepts credit cards for payment in full. The total due was $1,500, and Mrs. Thomas assured the office staff that her insurance company would reimburse the urgent care center for services provided. The office staff further explained that their providers had not signed a contract with her insurance, and thus Mrs. Thomas…Mrs. Thomas was on vacation out of state, stepped off a curve, and sustained a left ankle injury. Due to severe pain, Mrs. Thomas was seen at an urgent care center where a left ankle x-ray was performed, which was negative. Mrs. Thomas was diagnosed with a left sprained ankle. A walking boot was provided to stabilize and protect the left ankle. Mrs. Thomas was provided with appropriate discharge instructions and instructed to follow up with the primary care physician upon returning home. When presenting the BlueCross BlueShield insurance card at check out, Mrs. Thomas was informed that the physician who provided treatment is a nonparticipating provider (nonPAR) and that the urgent care center accepts credit cards for payment in full. The total due was $1,500, and Mrs. Thomas assured the office staff that the insurance company would reimburse the urgent care center for services provided. The office staff further explained that their providers had not signed a contract with that…Ms. M is 42 years old and has had rheumatoid arthritis for six years. At baseline, her fingers are stiff and show slight ulnar deviation. She has come to see you as she is currently experiencing an exacerbation, and her wrists are red and swollen. She finds it to be painful when something such as clothing touches the skin over her wrists. Her elbows and knees are also stiff and painful, especially after she has been resting. She is feeling extremely tired and depressed and has not been eating well. Describe the pathophysiologic process that leads to the appearance and the pain occurring at her wrists. Is this an acute or chronic process? Could it be both? Describe the pathophysiology contributing to the stiff, deformed fingers. What terms can be used to describe this?
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- Mr. Anwari, age 73, is brought to the physician’s office by his daughter, Lucy, who is a licensed practical nurse (LPN). She states her concerns about her father: During the past 2 months he has been found wandering in the neighborhood because he forgets where he lives. Neighbors see him, note that he appears confused, and bring him home. Lucy is worried that her father is showing signs of early Alzheimer’s disease.1. Describe the physical changes that occur in the cortex of the brain.2. Describe the stages of Alzheimer’s disease.3. Describe the physiological and psychological changes that occur during Alzheimer’s dementia.4. What are the functions of the frontal lobe of the cerebral cortex?5. What parts of the limbic system may be affected in Alzheimer’s disease?6. What would be the concerns of the family when a person is diagnosed with this disease?Mrs. C is a 50-year-old woman who presents with joint pain. She reports the pain has been present for about 2 years. The pain affects her hands and her wrists. She describes the pain as a “dull aching” and “a stiffness.” It is worse in the morning and improves over 2 to 3 hours. She says that on particularly bad days she uses aspirin with moderate relief. She is otherwise well, except for a history of mild hypertension managed with angiotensin-receptor blocker. She reports no other joint pain. She does not have a history of psoriasis. Her vital signs are: 37.1 C; B/P 128/84; P 84; R 14. There is a 2/6 systolic ejection murmur. Joint exam revealed limited range of motion of the MCPs and wrists bilaterally. There is swelling of the third and fourth MCP on the right and the third on the left. There is pain at the extremes of motion and a boggy quality to the joints. A detailed skin exam is normal. Rheumatoid arthritis (RA) is suspected. 1. What type of hypersensitivity is rheumatoid…N, a 65-year-old woman, had sustained a fall at home causing hip fracture. She had undergone a Dynamic Hip Stabilization (open reduction and fixation) 5 days ago.Currently she is in the post-operative unit. Medical history Type 2 diabetes since 15years Hypertension since 20years Coronary artery disease 2 years ago, was resolved by PTCA Ischemic stroke 5 years ago that left her with some residual right-sided weakness. Medications Tab. Metoprolol 50 mg OD Tab. Lisinopril 40mgOD Tab. Atorvastatin 10mg OD Tab. Aspirin 75mg OD Tab. Metformin 500g BD Tab. Multivitamin 1 OD Assessment You are the nurse assigned to her this morning. You notice that Ms. J.N. is increasingly drowsy and lethargic as compared to the previous day. You are doing physical examination, Ms. J N is pale, diaphoretic, and lethargic. She arouses to voice but is able only to state her first name.Her vital signs are as follows: Blood pressure, 78/60 mm Hg; Heart rate 70 Respiratory rate, 26; Temperature, 36.9°C.…
- N, a 65-year-old woman, had sustained a fall at home causing hip fracture. She had undergone a Dynamic Hip Stabilization (open reduction and fixation) 5 days ago.Currently she is in the post-operative unit. Medical history Type 2 diabetes since 15years Hypertension since 20years Coronary artery disease 2 years ago, was resolved by PTCA Ischemic stroke 5 years ago that left her with some residual right-sided weakness. Medications Tab. Metoprolol 50 mg OD Tab. Lisinopril 40mgOD Tab. Atorvastatin 10mg OD Tab. Aspirin 75mg OD Tab. Metformin 500g BD Tab. Multivitamin 1 OD Assessment You are the nurse assigned to her this morning. You notice that Ms. J.N. is increasingly drowsy and lethargic as compared to the previous day. You are doing physical examination, Ms. J N is pale, diaphoretic, and lethargic. She arouses to voice but is able only to state her first name.Her vital signs are as follows: Blood pressure, 78/60 mm Hg; Heart rate 70 Respiratory rate, 26; Temperature, 36.9°C.…Ralph , is 5 months post congestive heart failure (CHF), he is... Ralph , is 5 months post congestive heart failure (CHF), he is confined to a wheel chair due to advanced peripheral neuropathy and foot drop. His care is managed at home by a family nurse practitioner (FNP) who visits once a week and as necessary. On one of her visits, the FNP notes that Ralph has developed a Grade 3 sacral decubitus ulcer, lower extremity edema, and dyspnea while sitting. He is also confused and not oriented to person, place or time. Questions 1. 2. What risk factors for tissue break down are present? Explain in detail, the cellular changes that led to the sacral decubitus, now with necrotic dermal tissue. (Hint: the etiology and pathogenesis of the ulcer from injury to cellular death)Mrs. Jones is a 43 yr old mother of three children, ages 8, 10, and 13. She has been married for 16 years, is employed at a salesclerk at a local department store, and is active at her local church. The family members are Jehovah witnesses. Mrs. Jones health have been deteriorating over the past few months, and she has now been admitted for surgery for her aortic value insufficiency. She and her husband discuss the upcoming surgery with the surgeon; both she and her husband relate to the surgeon that she will not accept blood or blood byproducts from other individuals. They are fully receptive to the use of cell-saver and auto-transfussion of her own blood, but will not sign the form for other blood transfusion. The informed consent is signed, noting that non-acceptance of any blood products other than the patient's own blood. Following the surgery, Mrs. Jones hematocrit and hemoglobin values continue to decline, and it becomes apparent that she will not survive without additional…
