By E. Stan. Curry College. 2018.

He has bilateral corneal arcus order cleocin 150mg on-line, xanthelasmata around his eyes and xanthomata on his Achilles tendons trusted 150mg cleocin. He has many clinical features to go with the high cholesterol and prema- ture vascular disease order cleocin 150 mg with visa. The homo- zygous condition is rare and affected individuals usually die before the age of 20 years due to premature atherosclerosis. Corneal arcus, xanthelasmata and xanthomata on Achilles tendons and the exten- sor tendons on the dorsum of the hands develop in early adult life. The other major causes of hypercho- lesterolaemia are familial combined hyperlipidaemia and polygenic hypercholesterol- aemia. Familial combined hyperlipidaemia differs from familial hypercholesterolaemia by patients having raised triglycerides. Patients with polygenic hypercholesterolaemia have a similar lipid profile to familial hypercholesterolaemia but they do not develop xanthomata. Hypercholesterolaemia may commonly occur in hypothyroidism, diabetes mellitus, nephrotic syndrome and hepatic cholestasis. This patient is at extremely high risk for further vascular events and especially occlusion of his coronary artery bypass grafts. His risk depends on the combination of his risk fac- tors, and all of these need attention. He should be advised to stop smoking, reduce his alcohol intake (which is also affecting his liver as judged from the raised gamma-glutamyl transpeptidase), take more exercise and eat a strict low-cholesterol diet. He should have pharmacological treatment with a statin but may need combined treatment for this level of hyperlipidaemia. His children should have their lipid profile measured so that they can be treated to prevent premature cor- onary artery disease. There is clear evidence from clinical trials that primary prevention of coronary artery disease can be achieved by lowering serum cholesterol. In patients who have evidence of cardiovascular disease secondary prevention is even more important, aiming for a cho- lesterol level as low as possible. He has a 12-year history of chronic cough and sputum production, but she thinks that these symptoms may have increased a little over the last 8 weeks. He has smoked 20 cigarettes daily for the last 50 years and he drinks around 14 units of alcohol per week. Two years ago he became depressed and was treated with an antidepressant for 6 months with good effect. There are no abnormalities to find in the cardiovascular, respiratory or abdominal systems. Addison’s disease might be linked with respiratory problems through adrenal involvement by metastases or tuberculosis. This can be confirmed by measurement of serum and urine osmolarities to show serum dilution while the urine is concentrated. Fluid restriction to 750 mL daily produced an increase in serum sodium to 128 mmol/L with improvement in the confusion and weakness. Such treatment often produces a response in terms of shrinkage of the tumour, improved quality of life and increased survival. Small-cell undifferentiated carcinomas of the lung are fast-growing tumours, usually unresectable at presentation. Her 20-year-old son has asthma and she has tried his salbutamol inhaler on two or three occasions but found it to be of no real benefit. She has tested herself on her son’s peak flow meter at home and she has obtained values of about 100 L/min. On direct question- ing she says that the shortness of breath tends to be worse on lying down but there are no other particular precipitating factors or variations through the day. There is a generalized wheeze heard all over the chest but no other abnormalities. It is similar in both inspiration and expiration as shown in the flow volume loop (Fig. The spirometry trace of volume against time in such cases shows a straight line of the same reduced flow right up to the vital capacity. On examination, this airway narrowing is likely to produce a single monophonic wheeze which may be heard over a wide area of the chest. Differential diagnosis of rigid large-airway obstruction The situation may easily be confused with asthma if the peak flow and the wheezing are accepted uncritically. The wheezing in asthma comes from many narrowed airways of different calibre and mass, and the wheezes are often described as polyphonic. The fixed flow in inspiration and expiration in this case suggest a rigid large-airway nar- rowing. If the narrowing can vary a little with pressure changes, then the pattern will depend on the site of the narrowing (Figs 99. If it is outside the thoracic cage, as in a laryngeal lesion, it will be more evident on inspiration. Large-airway narrowing can be caused by inflammatory conditions such as tuberculosis or Wegener’s granulomatosis, damage from prolonged endotracheal intubation or by extrinsic pressure such as a retrosternal goitre. The great majority of symp- tomatic lung tumours are visible on plain chest X-ray but central lesions in large airways may not be seen. In this case, fibre-optic bronchoscopy showed a carcinoma in the lower trachea reducing the lumen to a small orifice.

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The problem statement of a nursing diagnosis recovering from a mastectomy generic cleocin 150 mg overnight delivery, cries at identifies the physiologic purchase cleocin 150mg, psychological cheap 150 mg cleocin fast delivery, soci- night, refuses to eat, and sleeps all day. A nurse determines that a man with a his- the nurse suspects that a health problem tory of diabetes is highly motivated to exists but needs to gather more data to develop a healthy pattern of nutrition in confirm the diagnosis. In the diagnosing step, the nurse collects underlined word or words to make the statement patient data. Actual or potential health problems that can be prevented or resolved by independent Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. What questions would you ask a patient to appetite validate the following nursing diagnoses? No problem: Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Possible problem: from degenerative joint disease and has talked for years about having “just a touch of arthritis,” this never kept him from c. Recently, however, he spends all day sitting in a chair and seems to have no desire to engage in self-care d. He tells the visiting nurse that he diagnosis: doesn’t get washed up anymore because he’s “too stiff” in the morning to bathe and “I just don’t seem to have the energy. Give three examples of how standards may be visiting nurse notices that his hair is matted used to identify significant cues. List five questions a nurse should consider when using critical thinking in diagnostic reasoning. In her book on the nursing process, Alfaro- bed—this while she was in a private room. At approach focuses on early evidence-based present, she cannot move either her left intervention to prevent and manage problems arm or leg. Describe Nursing Diagnosis: the three activities nurses need to perform to follow this approach in daily nursing care. In each and that he was selected because he resem- one, underline the cues that form a data clus- bled Ted. Rosemary became pregnant after ter indicating a nursing diagnosis, and write the second in-vitro fertilization attempt and the appropriate nursing diagnosis as a three- delivered a healthy baby girl named Sarah. Klinetob, age 86, has been seriously Rosemary have learned from blood tests depressed since the death 6 months ago of that their fertility specialist is the biologic his wife of 52 years. Although he suffers Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Interview members of your family or several to some couples about using sperm from close friends. Use the following expanded scenario from Rosemary tells the nurse in her pediatri- Chapter 13 in your textbook to answer the cian’s office that she is concerned about questions below. Questioning reveals that problems with constipation and I’ve seen Rosemary has found herself yelling at Sarah some blood when I wipe myself after a bowel for minor disobedience and spanking her, movement. Prescott’s about Sarah’s striking physical resemblance father and an uncle both died in their early to the fertility specialist but attributed this 50s from colon cancer. What nursing diagnosis would be appropriate I see her now, I can’t help but see Dr. Rosemary express great remorse that Sarah, who is innocent, is bearing the brunt of something that is in no way her fault. With a partner or several classmates, write and/or ethical/legal competencies are most appropriate nursing diagnoses for the likely to bring about the desired outcome? She is overwrought and says she feels God is punishing her for an abortion she had when she was in college. She and her husband have been trying to have children for years and were counting on this pregnancy to come to term. Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care, 7th Edition. Identification of factors causing undesirable success or failure response and preventing desired change d. Which of the following is a correctly written desired change goal for a patient who is scheduled to ambulate d. Over the next 24-hour period, the patient 50-year-old executive, is being discharged will walk the length of the hallway assisted from the hospital after undergoing coronary by the nurse. The nurse will help the patient ambulate strates an affective goal for this patient? Patient will become mobile within a demonstrate breathing techniques to 24-hour period. Which of the following patient sufficiently to reduce the cholesterol in his goals for Mr. Nursing interventions are a separate entity carry out necessary self-care behaviors at from the original goal/outcome. According to Maslow, which of the following ten and when the plan of care is reviewed.

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Narcotic antagonists order cleocin 150mg with amex, such as naloxone (Narcan) 150mg cleocin with amex, naltrexone (ReVia) generic 150 mg cleocin free shipping, or nalmefene (Revex), are administered intravenously for narcotic overdose. Substitution therapy may be instituted to decrease withdrawal symptoms using propoxyphene (Darvon), methadone (Dolophine), or buprenorphine (Subutex). Substitution therapy may be instituted to decrease withdrawal symptoms using a long-acting barbiturate, such as phenobarbital (Luminal). When stabilization has been achieved, the dose is gradu- ally decreased by 30 mg/day until withdrawal is complete. Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide (Librium) and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be adminis- tered with caution because of their propensity to lower seizure threshold. Withdrawal treatment is usually aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as is needed or desired. Desipramine has been especially successful with symptoms of cocaine withdrawal and abstinence (Mack, Franklin, & Frances, 2003). Client is no longer exhibiting any signs or symptoms of sub- stance intoxication or withdrawal. Client shows no evidence of physical injury obtained during substance intoxication or withdrawal. Possible Etiologies (“related to”) [Weak, underdeveloped ego] [Underlying fears and anxieties] [Low self-esteem] [Fixation in early level of development] Defining Characteristics (“evidenced by”) [Denies substance abuse or dependence] [Denies that substance use creates problems in his or her life] [Continues to use substance, knowing it contributes to impair- ment in functioning or exacerbation of physical symptoms] [Uses substance(s) in physically hazardous situations] [Use of rationalization and projection to explain maladaptive behaviors] Unable to admit impact of disease on life pattern Goals/Objectives Short-term Goal Client will divert attention away from external issues and focus on behavioral outcomes associated with substance use. Long-term Goal Client will verbalize acceptance of responsibility for own behavior and acknowledge association between substance use and personal problems. Ensure that he or she understands, “It is not you but your behavior that is unacceptable. Client may rationalize his or her behavior with Substance-Related Disorders ● 93 statements such as, “I’m not an alcoholic. Factual information presented in a matter-of-fact, nonjudgmental way explaining what behaviors constitute substance-related disorders may help client focus on his or her own behaviors as an illness that requires help. Identify recent maladaptive behaviors or situations that have occurred in client’s life, and discuss how use of substances may have been a contributing factor. The first step in decreas- ing use of denial is for client to see the relationship between substance use and personal problems. Confrontation interferes with client’s ability to use denial; a caring attitude preserves self- esteem and avoids putting client on the defensive. Do not accept the use of rationalization or projection as client attempts to make excuses for or blame his or her be- havior on other people or situations. Rationalization and projection prolong the stage of denial that problems exist in client’s life because of substance use. Peer pressure can be a strong factor as well as the association with individuals who are experiencing or who have experi- enced similar problems. Offer immediate positive recognition of client’s expres- sions of insight gained regarding illness and acceptance of responsibility for own behavior. Positive reinforcement en- hances self-esteem and encourages repetition of desirable behaviors. Client verbalizes understanding of the relationship between personal problems and the use of substances. Client verbalizes understanding of substance dependence and abuse as an illness requiring ongoing support and treatment. Possible Etiologies (“related to”) [Inadequate support systems] [Inadequate coping skills] [Underdeveloped ego] [Possible hereditary factor] [Dysfunctional family system] [Negative role modeling] [Personal vulnerability] Defining Characteristics (“evidenced by”) [Low self-esteem] [Chronic anxiety] [Chronic depression] Inability to meet role expectations [Alteration in societal participation] Inability to meet basic needs [Inappropriate use of defense mechanisms] Abuse of chemical agents [Low frustration tolerance] [Need for immediate gratification] [Manipulative behavior] Goals/Objectives Short-term Goal Client will express true feelings associated with use of substances as a method of coping with stress. Long-term Goal Client will be able to verbalize adaptive coping mechanisms to use, instead of substance abuse, in response to stress. Establish trusting relationship with client (be honest; keep appointments; be available to spend time). Be sure that client knows what is acceptable, what is not, and the consequenc- es for violating the limits set. Client is unable to Substance-Related Disorders ● 95 establish own limits, so limits must be set for him or her. Unless administration of consequences for violation of limits is consistent, manipulative behavior will not be eliminated. Verbalization of feelings in a nonthreaten- ing environment may help client come to terms with long- unresolved issues. Many clients lack knowledge regarding the deleterious effects of substance abuse on the body. Explore with client the options available to assist with stress- ful situations rather than resorting to substance abuse (e. Client may have persistently resorted to chemical abuse and thus may possess little or no knowledge of adaptive responses to stress. Provide positive reinforcement for evidence of gratifica- tion delayed appropriately. Positive reinforcement enhances self-esteem and encourages client to repeat acceptable behaviors. Provide positive feedback for independent decision-making and effective use of problem-solving skills. Client is able to verbalize adaptive coping strategies as alter- natives to substance use in response to stress. Client is able to verbalize the names of support people from whom he or she may seek help when the desire for substance use is intense. Long-term Goal Client will exhibit no signs or symptoms of malnutrition by dis- charge.

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