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NR 442
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NR 442 NNA Bioterrorism Self-Study Exam Questions with Answers
NR 442 NNA Bioterrorism Self-Study Exam Questions with Answers 1. Which of the following biological agents is not contagious? a. Smallpox b. Anth... [Show More] rax c. Pneumonic Plague d. Bubonic Plague 2. Which of the following biological agents does not occur naturally in the U.S.? a. Anthrax b. Tularemia c. Ebola d. Plague 3. Which biological agent forms a spore? a. Plague b. Anthrax c. Smallpox d. Tularemia 4. Which of the following is a true statement regarding smallpox? a. Smallpox rash is typically distributed more on the trunk than the extremities. b. A victim with smallpox is contagious. c. Cases of smallpox are still found occasionally in Africa. d. The recommended treatment for smallpox is ciprofloxacin or doxycycline. 5. What is the minimum length of isolation for people exposed to smallpox? a. 10 days b. 14 days c. 17 days d. 4 weeks 6. Aside from pregnant women, which of the following population should NOT receive a prophylactic smallpox immunization (ie. Immunization without history of confirmed smallpox exposure)? a. Healthcare workers. b. Children below the age of eight. c. People with a history of atopic dermatitis or eczema. d. People with a history of a previous smallpox vaccination. 7. CASE: You are working as a first aid nurse in a large convention center. Approximately 500 people have been attending an all day community health conference. By mid-afternoon, however, more than a hundred attendees have developed complaints of double vision, dry mouth, and weakness. Some have even left to go to the hospital. What is the most likely biological agent causing these symptoms? a. Plague b. Anthrax c. Smallpox d. Botulinum toxin 8. CASE: You are a home health nurse in your hometown. You live in a rural suburb of a large west coast city. You respond to a 911 call from a private residence where a 30 year old male is complaining of fever, headache, and vomiting. Upon arrival, you find him with mild shortness of breath. T= 101.2F, heart rate 98, blood pressure 112/68, respiratory rate 28. He appears ill. Because you’ve seen a number of similar patients tonight, you suspect a biological attack has taken place. After your initial assessment, your first course of action should be to: a. Immediately notify the local health department b. Retrieve and put on personal protective equipment c. Undress the patient to look for any rashes. d. Establish intravenous access, give a fluid bolus, administer supplemental oxygen, and arrange for transport to the nearest hospital as soon as possible. 9. Which of the following is a true statement regarding personal protective equipment (PPE) for biological weapons: a. Level A is an encapsulated suit with a self-contained air supply. b. An N95 mask is recommended for first responders because it does not require fit testing. c. A first responder wearing a chemical resistant suit with a powered air purifying respirator is considered Level B. d. Level B is the recommended PPE level for first responders entering a building where a box filled with powdered anthrax has just been opened. 10. CASE: You work at a local clinic. Your co-worker has developed a fever, nonproductive cough, headache, and skin lesions over the past day or two. They are primarily on his arms and face. They are red, tender, and appear to have a very small bit of bleeding in their center. Which of the following is the most likely cause of his symptoms? a. Bubonic plague b. Pneumonic plague c. Cutaneous anthrax d. Smallpox [Show Less]
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NR 442 Assignment: Clinical Reflection Journal # 1
NR 442 Assignment: Clinical Reflection Journal # 1 When arriving at the Perspective High School, security was located at the main entrance all visitors ne... [Show More] eded to show ID and sign in the log book. The actual program was located on the 3rd floor were four stations were centered around the room with equal amount of space between each station for privacy purpose. All duties were divided. For example: two nursing students were stationed at the boys/girls’ bathroom, one student nurse was stationed ANSWER When arriving at the Perspective High School, security was located at the main entrance all visitors needed to show ID and sign in the log book. The actual program was located on the 3rd floor were four stations were centered around the room with equal amount of space between each station for privacy purpose. All duties were divided. For example: two nursing students were stationed at the boys/girls' bathroom, one student nurse was stationed in the room to direct each student to the stations, and two student nurses were in charge of taking students back to their classes. The start was a little chaotic and unorganized until the next set of students. Before, starting the testing process each student received a presentation for preventing STI’s. After, the presentation each student was given a specimen cup to collect urine for testing of chlamydia and gonorrhea only if they decided to test. When the process was over, the students took the specimen cups to a privacy station where they were allowed to ask questions and decide whether, they wanted to actually test. If testing came back positive students will be contacted and provided with where to go for treatment. The overall experience was informative and interesting. This is a good experience for interacting with adolescence in the community, especially providing information that is needed. The most problematic thing was explaining STI’s to the freshmen and sophomore class, they were immature in listening wasn’t on their agenda, made everything seem like a joke. The experience could have been better, if all students was told to leave their cell phone in the lockers until after the presentation, just to make sure of their undivided attention. Other, approaches could have been taken different grades at once instead of taking a whole freshmen and sophomore grade together. For example, taking two freshmen classes, two sophomore classes, two junior classes, and two senior classes together for presentation, other than that this was a great clinical experience. The population being cared for at this clinical setting is considered a community because these students live within the same neighboring area. [Show Less]
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NR 442 Clinical Debriefing
NR 442 Clinical Debriefing Course Objectives: Provide comprehensive care with increasing autonomy to individuals, families, aggregates, and communities ... [Show More] in a variety of healthcare settings based on theories and principles of nursing and related disciplines (PO #1). Communicate effectively with client populations and with other healthcare providers in managing the healthcare of individuals, families, aggregates, and communities (PO #3). Accept accountability for personal and professional development as part of the life-long learning process (PO #5). Name of community agencies/events attended: South West Human Development Mission/Goal(s) of the agency attended or responsible for the event: Reach out to first time moms and give them resources. Location(s): 2850 N. 24th St. PHOENIX, AZ 85008 What is the funding for the agency? Is it a non-profit or for profit agency? It is a non-profit agency that is government funded. What is/are the Population(s) served at the community agencies/events: First time Moms. Many of the patients my nurse and I had were Hispanic. What are the role(s) of CH nurse at the community agencies/events: The role of the nurse is to educate the mother and explain what to expect while pregnant and wh.t to expect when the baby is actually there. I realized the nurse was a big listener and more of a friend for the patients. What is the CH nurse’s involvement of local, state, and national government in health care policy and legislation? If no involvement is identified, give examples how a CH nurse can become involved in contributing to policy and legislative advancement pertaining to the agency. I do not know if my nurse is involved in the health care policy and legislation but for her to get involved would be to understand what it is to be able to advocate for all her patients. She might be able to get more grants for the company to be able to get even more resources for the patients, but the key factor is to be educated first. What ethical issues did you identify (if any)? There was not any ethical issues that I came across at my time at Southwest Human Development. What are services/education provided (be specific) at the agencies/event(s) you attended: For every visit we had a pamphlet or a video for the mothers. We were able to educate them on pregnancy and how their bodies are going to change. Also, if the baby was already there we were able to speak to them about how each week their baby is changing and what to expect month to month as the baby is learning to crawl, walk, talk, eat solid foods and so on. Levels of prevention (primary, secondary, tertiary) and provide examples: I believe this is all primary because we are always teaching each client about the different stages of pregnancy and what toe expect as well as being able to answer any questions they had. Education is the biggest thing this company does. Did you enjoy the community health experience? Do you recommend this/these event(s) for future students? No, I personally did not enjoy this experience. I liked my nurse and the idea of what this company has to offer but it is not something I enjoy doing. I do not like pregnancy and everything that goes on with it. However, I do recommend it for future students that are passionate about helping mothers and want to learn more about community health. [Show Less]
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NR 442 Assignment: Clinical Reflection Journal # 4
NR 442 Assignment: Clinical Reflection Journal # 4 The overall experience at Gage Park High school was great, this school was very diverse. The school was... [Show More] huge on the inside, this school was unexpectedly filled to capacity. The school seemed fairly updated and did not need any repairs, the presentation was held in the first gym. There were an equal amount of restroom on each floor, they were clean and very spacious. This was a good experience by providing information to these teenagers. …… ANSWER The overall experience at Gage Park High school was great, this school was very diverse. The school was huge on the inside, this school was unexpectedly filled to capacity. The school seemed fairly updated and did not need any repairs, the presentation was held in the first gym. There were an equal amount of restroom on each floor, they were clean and very spacious. This was a good experience by providing information to these teenagers. I can tell from the presentation most of these students did not have any knowledge of STI, and how they can protect themselves, so I was happy to be a part of this experience and explaining any questions that is concerning to them. The most problematic, we were told at first condoms could not be given to students from the educators as well as the principle did not allow a condom demonstration. There were a large amount of students, we were testing each period with a small amount of time. A few students did not take this education serious, some had bad attitudes and were not receptive to learning any of the information, but some students were interested in the information in had questions. The experience could have been better, if the principal would have supported the demonstration portion of the presentation, it just seems like he was just allowing this testing because he had too. The security guard had questions, he really did not understand why students needed to be tested if they were abstinent. I can tell that he really did not agree with the services that was being provided. One other approach that can be used is educating the teachers as well as the students, so they can provide support and answer questions if needed and leaving supplies for students that feel uncomfortable about getting protection. • Fourth Journal: Identify vulnerable populations in your own community. Describe what resources are available to support them in the community. The vulnerable population within my community will be the elderly. Resources that are provided for support are senior health assistant programs, retired senior programs, senior daycare facilities, transportation, meals on wheels, and weekly programs for activities like bingo, and going to the casino, and the mall. [Show Less]
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NR 442 Assignment: Clinical Reflection Journal # 2
NR 442 Assignment: Clinical Reflection Journal # 2 When arriving at Harper High school, security was located at the student entrance where there were meta... [Show More] l detectors all visitors needed to show ID. The overall experience was very surprising, especially since several people in my family had gone to this school in the past. The school was huge on the inside, but barely no students in the school. I was amazed how ancient the schooled looked, it needed lots of repairs, and the auditorium where the presentation was held was very small.. ANSWER When arriving at Harper High school, security was located at the student entrance where there were metal detectors all visitors needed to show ID. The overall experience was very surprising, especially since several people in my family had gone to this school in the past. The school was huge on the inside, but barely no students in the school. I was amazed how ancient the schooled looked, it needed lots of repairs, and the auditorium where the presentation was held was very small. There were only one boy’s restroom on each floor, which seem very odd since there were Serval restrooms for the girls. It made me feel like they assume that more girls will be in attendance then boys, which is very sad, but I did notice that they had a unisex restroom which was the first time I have ever seen in any school. This was a good experience by providing information to these teenagers. I can tell from the presentation most of these students did not have any knowledge of STI, and how they can protect themselves, so I was happy to be apart of this experience and explaining any questions that they might have when taking them to the restroom. The most problematic thing was explaining this information to the juniors and seniors. They were doing a lot of showboating as if they knew the information. The freshmen and sophomore were more attentive, but when going to the restroom for testing they begin to make fun of their fellow classmates that disclosed they were not having sexual intercourse so they did not need to participate. The experience could have been better, if their teachers was a part of the process at least letting them know they care and they too are worried about their health. Other, approaches that can be used is educating the teachers as well as the students, so they can provide support and answer questions if needed. Some of the community resources that I have utilized in the past was planned in Parenthood for Birth Control, and the WIC program. The WIC program assists young mothers and women who are low income by providing formula and important nutritional information. [Show Less]
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NR 442 Assignment: Clinical Reflection Journal # 3
NR 442 Assignment: Clinical Reflection Journal # 3 The overall experience at Tilden High school was very surprising, I was amazed how diverse this school ... [Show More] is. The school was huge on the inside, there were a nice amount of students in attendance, just not filled to capacity like when I attended high school. The school needed minor repairs with undated heating systems, and the room where the presentation was held was very small. There were an equal amount of restroom on each floor, which made me feel good because they were not making assumption and being bias concerning attendance. … ANSWER The overall experience at Tilden High school was very surprising, I was amazed how diverse this school is. The school was huge on the inside, there were a nice amount of students in attendance, just not filled to capacity like when I attended high school. The school needed minor repairs with undated heating systems, and the room where the presentation was held was very small. There were an equal amount of restroom on each floor, which made me feel good because they were not making assumption and being bias concerning attendance. This was a good experience by providing information to these teenagers. I can tell from the presentation most of these students did not have any knowledge of STI, and how they can protect themselves, so I was happy to be a part of this experience and explaining any questions that is concerning to them. The most problematic thing was explaining this information to the all grade levels. The idea was to bring a different grade level down doing their block periods, unfortunately we did not have any idea who we were educating because somehow everything was not organized as it should have been and teachers were sending students down at random times. A few students were showboating, some had very bad attitudes and were not receptive to learning any of the information, and some students were interested in the information in had lots of questions. The experience could have been better, if their teachers was a part of the process at least letting them know they care and they too are worried about their health. We had one teacher drop her students off in say please take your time as if she did not want to be bothered with her students. One other approach that was used is educating the teachers as well as the students, so they can provide support and answer questions if needed and leaving supplies for students that feel uncomfortable about getting protection. • Third Journal: Knowledge of health and welfare services is essential when nursing in the community. Suppose you were the CHN in a specific community. Mrs. Jones contacts you. She is 23-years-old, pregnant, and has 3 children under 10 years of age, and is about to be evicted from her apartment for failure to pay rent. She has no money and no resources. She is currently unemployed. She quit school at 16 and has not returned. What would you do? When dealing with this sort of situation, I will first contact the local community resources for rental assistance, if funding is not available at that current time I will contact the local shelters within her community for women and children, put her in contact with job placement assistance, Set her up with a case worker to help her with public assistance, and give her information on how to complete her GED. [Show Less]
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NR 442 Assignment: Clinical Reflection Journal # 5
NR 442 Assignment: Clinical Reflection Journal # 5 The overall experience of Richards’s academy high school was interesting, this school was mainly Hisp... [Show More] anic or Black. The school was huge on the inside, and designed like a maze with only about 175 students within the whole school. The school is in need of updates, where the presentation was held, it was cold in not that large. There were an equal amount of restroom on each floor, they were clean and very spacious as well as providing a unisex restroom. This was a good experience by providing information to these teenagers. ANSWER The overall experience of Richards’s academy high school was interesting, this school was mainly Hispanic or Black. The school was huge on the inside, and designed like a maze with only about 175 students within the whole school. The school is in need of updates, where the presentation was held, it was cold in not that large. There were an equal amount of restroom on each floor, they were clean and very spacious as well as providing a unisex restroom. This was a good experience by providing information to these teenagers. I can tell from the presentation most of these students did not have any knowledge of STI, and how they can protect themselves. I was excited to be a part of this experience and explaining any questions that is concerning to them. The most problematic, majority of the students were disrespectful and had behavior issues. We were testing during English period, which was two classes at a time. Each class consist of freshmen and sophomores together or juniors and seniors together. The majority of the students did not take this education serious, some had bad attitudes, did not want to participate, were not receptive to learning any of the information, and only a handful were interested in the information in had questions. The experience could have been better, if the authority figures had a better system for maintaining their student’s behavior. I can tell that there were no consequences for the inappropriate behavior that these students were displaying, it just seems as if the student was the one running the school not the teachers or security. One other approach that can be used is educating the teachers as well as having the teachers participate during the presentation and testing. The targeted audience were teenagers from the age of 14 to 19 years of age. It is known that this particular age group has the highest rate for STI for not using protection. The only time this age group is known to seek treatment for STI is when they are having symptoms. The health issue presented during the program is two STI’s commonly known as Chlamydia and gonorrhea. The learning objective is to become aware that we rank number 2 in the state among teenagers from ages 14 to 19 years of age for these two STI’s that are easily curable. What is the treatment for the infection, what is the process to find out whether or not the person is infected, how can a person protect themselves from getting an infection, how to properly use condoms to prevent the infection or unwanted pregnancies, how long will the result take, where they can receive treatment, what is the cost. The material presented during the presentation was important and age appropriate. The communicate styles that were used was therapeutic, open ended questioning and active listening. Learning activities that were used was demonstrating the proper method of putting on a women/ men condoms and using a dental dam. During the presentation a PowerPoint slide was used and during the testing everyone meet up with an educator in private to ask questions and get reading material as well as supplies. These items were important because it assists with any questions a student have after meeting an educator who might have questions later. After, the presentation was done and the testing portion begins, students are quizzed on the information that was given in the presentation. This assists with knowing who was paying attention during the presentation, and did the students understand what they are being tested for, if they decided to test. The strength of this program has provided free testing and information for teenagers within the community. One weakness is the length of the presentation, maybe figuring out a way to limit the information to keep the students attention. When providing programs that give free assistance to individuals that are in need, it is very important to have funding to be able to provide these services and decrease the STI rates among our teenagers. When funding is cut individual are not being treated for these STI because they cannot afford medical insurance as well as medications, so in turn they are walking around untreated. [Show Less]
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NR 442 Assignment: Community Windshield Survey Form.
NR 442 Assignment: Community Windshield Survey Form. Directions: Refer to the Community Windshield Survey Guidelines and grading rubric for specific instr... [Show More] uctions in order to complete the information below. 1. This assignment is 8 hours of MANDATORY scheduled clinical hours. 2. NO POINTS ARE AWARDED BUT PARTICIPATION IN WINDSHIELD SURVEY AND COMPLETION OF THIS ASSIGNMENT ARE MANDATORY AND CONSIDERED INTO THE OVERALL CLINICAL EXPERIENCE AND ARE “PASS/FAIL”. 3. Each team member must submit this form individually—not as a group. 4. Type your name, date, and observations directly on this form. Click Save as and save the file with the assignment name and your last name; for example, Smith_NR442 Windshield Survey Form. When you are finished, submit the form Windshield Survey Dropbox by the deadline indicated in your guidelines. 5. Submit to Dropbox. Your Name: Date: Criteria Your response 1. Introduction of Community (P/F) Identify the city and state of your community and briefly describe the community you will be using for this assignment. It should be the area where you live or the area surrounding your work setting but must include a residential area. Demographic data are not needed. The area our group chose for our windshield survey is in the area of North Las Vegas with the zip code 89115. This are is a little unique to Las Vegas, in that this is the area that includes Nellis Air Force Base. The Base is gated and guarded as well as the off base housing provided for military and family. This zip code is comprised of areas of North Las Vegas, Nellis Air Force Base, and Sunrise Manor, Nevada. This area is closer to the area where I attend school, and is an area I was not very familiar with prior to embarking on this group project. Our group thought it would be interesting to explore the area that included the military base, the nice military housing immediately surrounding it, and the much poorer area just outside that. What I found most interesting in our first drive thru (Gabby’s boyfriend is military and was able to get us on base to drive around) was the on base housing is not kept up very well. 2. Windshield Survey (P/F) a. Vitality: Use a majority of the questions from Box 6-2 in your text to describe your observations about the community vitality. The day we chose to drive the area was a Sunday and the weather was nice. I would have expected to see lots of people out and around enjoying the weather, playing at parks, engaging in sports, and I didn’t really see any of that. There wasn’t too many people out and about. The people we saw were mostly African American and either in small groups of teenagers or single males walking around. Of the people we saw most seemed to be overweight, lots of jaywalkers and people just standing around. Most people appeared well kept and clean and I didn’t notice any pregnant women or women with small babies and I did not notice any tourists or what looked like people visiting the community. b. Indicators of social and economic conditions: Use a majority of the questions from Box 6-2 in your text to describe your observations about the social and economic conditions. The Nellis on base housing was run down, weeds in the yards and not kept up very well, which was surprising to me. It seemed to match all the surrounding neighborhood, with the exception of the Nellis off base housing, which was a gated and guarded neighborhood that was much better kept. I noticed children playing in the yards there, as well as riding around on their bikes. The neighborhood had a central community pool and park for it’s residents to use. Once outside of the nice Nellis neighborhood there was some homeless I saw, even a group of people living under a tree. There was a large industrial area and the housing was mostly apartment housing. This area had people outside on their porches hanging out, people watching and talking. c. Health Resources: Use a majority of the questions from Box 6-2 in your text to describe your observations about the health resources. We drove by a Hope Christian Health Center and I noticed in a strip mall a Clinica Naturista, which I imagine was a holistic clinic serving the Hispanic population. We drove past a closed and abandoned Rite Aid and Walmart, and besides the hospital on base for the military and their families, the closest one would have to be North Vista Hospital. The area didn’t seem to have any doctors offices, fitness centers or gyms. What I did notice was several check cashing facilities, liquor stores, and adult entertainment shops. d. Environmental conditions related to health: Use a majority of the questions from Box 6-2 in your text to describe your observations about the environmental conditions. The area seems very poor surrounding the Base. There is a lot of litter on the streets and it is clear there are no HOA regulations for any of the surrounding neighborhoods. Some homes had bars on the windows, graffiti on the sides of apartments. The area inside the off base housing had nicer kept street that were well lit. The streets outside that area were not as nice and did not seem to be well lit. I did not notice any stray animals. e. Social functioning: Use a majority of the questions from Box 6-2 in your text to describe your observations about the social functioning. Driving thru the neighborhoods there were several teenage kids out, hanging in their yards, on their phones, the music was loud. Several people had their garage doors up and I noticed they were jam packed with all kinds of junk, almost like they were hoarders. Some people were working on or fixing things while in their garage. I did not see very many young children once we were outside the Nellis housing area. f. Attitude toward healthcare: Use a majority of the questions from Box 6-2 in your text to describe your observations about the attitudes toward healthcare. As far as attitudes toward healthcare, I didn’t see much in the way of health promotion. As I had mentioned before, there were no visible gyms or fitness centers, and well as no health food or vitamin stores. I did see an excessive amount of fast food restaurants. There is more offered for those on the military base. Gabby was able to provide us with some information regarding all the health services that are provided for the military and their families. The military provides Tricare health insurance, which is basically free healthcare services that include medical, dental, and vision care. 3. Vulnerable population (P/F) Describe a vulnerable population or aggregate that you identified during your survey. What did you observe about this group such as their appearance and actions? Our group had talked about the homeless initially, but once we got in the neighborhood and drove around and didn’t see a large amount of homeless, so we felt that the young males were more of a vulnerable population. Because the area is impoverished and most living there do not seem to have higher educations and there did not seem to be any sort of services to help the youth, it would stand to reason that these young men will have a harder time getting out of the area and making a better life for themselves without support. 4. Conclusion (P/F) Provide a summary of your findings. Describe several potential community health problems for the vulnerable population that you identified. This area is a poor area, with rundown neighborhoods and older unkempt homes. There was not a lot of visible community services, healthy food choices, healthy lifestyle choices to be seen. I saw some schools, but no parks or libraries or community centers for the youth of the area. But what I did see was several liquor stores, fast food restaurants, and adult entertainment shops. This is why I would say the biggest concern would be surrounding health issues and unhealthy lifestyles. 5. References: References are not required for this survey: If you used references, they must be listed in APA format. If you include any references here, you must also include an in-text citation (author, year) in the body of the form. \ [Show Less]
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NR 442 ELO Experience
NR 442 ELO Experience This ELO must be submitted to the Dropbox at the end of week 3, Sunday, March 19th, no later than 1159. NO POINTS ARE AWARDED BUT P... [Show More] ARTICIPATION IN THIS ELO AND THIS ASSIGNMENT ARE CONSIDERED INTO THE OVERALL CLINICAL EXPERIENCE AND ARE “PASS/FAIL”. A “Passing” score for this assignment requires a thorough and specific completion of the questions below. ANSWERS Unfolding Case Study: Seymour Jones Mr. Jones is a 69-year-old who was discharged from the hospital yesterday following a short hospitalization to treat a leg ulcer that became increasingly worse (increased pain and inflammation) over a two-week period prior to admission. In addition, he has a diagnosis of congestive heart failure (CHF) and diabetes. Mr. Jones lives alone in a senior citizens’ high-rise. Donna Atkins, BSN, RN is the home care nurse assigned to visit Mr. Jones. She prepares to make his initial home visit. What steps should Donna take to prepare for the initial home visit? Remind herself of all things regarding diabetes, CHF and leg ulcers in order to teach her patient about how to care for himself. She can research the area he lives of healthy food options, transportation options, exercise options. She should also review his charts and when she sets his appointment find out if he needs her to bring anything to the visit. As Donna reviews the “Continuing Patient Care Form” received from the discharge planner at the hospital, she notes the following: • 67-year-old male • admitted to hospital with two-week history of infection; right leg ulcer with progressive pain • treatment with intravenous antibiotics • history of CHF with shortness of breath for 10 years • history of diabetes for 10 years • home oxygen What is the top priority for the home care nurse during this initial home visit? The top priority in the first visit is to establish a good relationship with Mr. Jones. It is very important he feels he can trust her and feel he can speak to her and share his issues. Education will be a top priority on the first visit as well. An important role for the home care nurse is that of patient or family education. Review the “Continuing Patient Care Referral Form” (below). What patient education materials should Donna consider bringing with her for this initial home visit? Heart and diabetic healthy diet Information on wound care Information on diabetes and CHF Continuing Patient Care Form Patient Name: Jones, Seymour Address for Care: 700 Shadyside Manor Dr., Apt. 804, Somerville, MN Sex: male Marital status: widow Report by physician: • Diagnosis: right leg ulcer, CHF X 10 years, diabetes X 10 years • Complications: none • Rehabilitation or treatment goal: wound healing, stable CHF and diabetes • Prognosis: good • Patient informed of diagnosis: yes • Family informed of diagnosis: yes • Brief medical history: admitted to hospital with two-week history of infection; right leg ulcer with progressive pain; treatment with IV antibiotics; history of CHF and history of diabetes • Date and place of physicians next visit: visit in office in two weeks Medical Orders and Plan of Treatment: • Diet: 1800 ADA • Dressing or treatment: drive dressing right leg ulcer BID, clean technique • Medications: Prandin 3.5 mg PO before meals Lasix 40 mg every day: new medication Keflex 500 mg two tabs PO Q6 hours for seven days • Activity: as tolerated • Patient uses: Walker • Physical Therapy and Occupational Therapy Consult for home therapy Hospital Nurses Assessment • TPR: 99.8-90-28 • BP 136/90 • Blood Sugar: 100 • Weight: 165 ibs. • Activity limitations: ambulatory with assistance • Mental state: alert and oriented, Patient states, “I really feel down about my leg” • Disabilities and impairments: wears glasses, decreased sensation to lower extremities (diabetes) • Allergies: NKA • Oxygen: 2 L per minute per nasal cannula • Activities of daily living: needs assistance • In Hospital Teaching: copy of diet to patient • Weight daily; Call Dr. Smith if weight gain over 2 lbs. in 24 hours or over 5 pounds in 7 days Donna arrives at Mr. Jones apartment at 10:30 AM. She introduces herself and explains the purpose of this home visit. “Mr. Jones, your doctor has made this referral to provide you some additional support and care during the transition from the hospital to the home. He has given specific instructions for your care so that you can recover.” Mr. Jones expresses concern regarding the cost of the service. “I am on a fixed income, you know, and I can’t afford to pay for any service.” Donna reviews the continuing patient care referral form again before responding. To provide additional information regarding home care benefits under Medicare, Donna provides Mr. Jones with the following pamphlet, “Medicare and Home Healthcare”. Find this pamphlet on the Internet. Review the pamphlet, and paste the web address below. What two things did you learn about Medicare and home health coverage? http://www.medicare.gov/publications/pubs/pdf/10969.pdf. Medicare covers skilled nursing visits, PT, OT, speech therapy & medical supplies. A patient has to be homebound in order to qualify Question: Select All that Apply Related to Home Health. A. “Home healthcare services are provided free to all seniors living in the community.” B. “You will have to pay a small amount of money for this service. Medicare requires a you are charged $5 dollars co-pay for each home visit.” C. “You won’t need to pay anything out of pocket because you need intermittent skilled nursing care.” D. “You won’t need to pay anything out of pocket because you meet the criterion of being homebound.” E. “You are eligible to receive home healthcare services because you have an order for occupational therapy.” After washing her hands, Donna begins the initial assessment, taking vital signs and reviewing the discharge materials provided to the patient upon discharge from the hospital. Mr. Jones vital signs are: BP: 140/88, Tim: 99 2°, heart rate: 90 bpm, respiratory rate 32. He has a soiled dressing on his right lower leg. Bilateral edema present: worse on right leg than left; right leg is 3+ pitting; left leg is 2+ pitting. Mr. Jones denies any chest pain but does report being short of breath more than before the hospitalization. He complains that he tires more easily than before. He uses two pillows in order to sleep comfortably. Mr. Jones reports an occasional cough that sometimes raises some frothy white sputum. Donna notices the chart for recording daily weights and asked the patient has he weighed himself today. He replies, “No, I figured you would do it when you came.” Donna looks around the room and notices that Mr. Jones Walker is across the room. She brings the walker within his reach and observes his ability to get up and ambulate. Donna observes that Mr. Jones is able to ambulate slowly using a walker but appears to get short of breath with minimal exertion. Mr. Jones expresses frustration regarding his decreased ability to ambulate. She provides encouragement. What additional instruction is warranted for Mr. Jones regarding safe ambulation in managing activities with CHF? He needs to be educated more on CHF, weighing himself daily at the same time every day, on the importance of using a walker for ambulation, keeping his legs raised when sitting or laying down. Also, he should be reminded of signs and symptoms of CHF worsening . Mr. Jones ambulates to the bathroom where the digital scale is located. Donna makes sure that the scale is functioning properly and stands close to Mr. Jones as he stands on the scale. Mr. Jones weight is 166.1 lbs. Donna documents the weight on the chart and compares it with the weight recorded on the Continuing Patient Care Form. Weight Chart Date Weight 3/16 165.0 3/17 166.1 3/18 3/19 3/20 3/21 Multiple-choice Question Donna notices that Mr. Jones weight is higher than it was in the hospital yesterday. Mr. Jones asks, “Is that a bad thing?” What is the best response for Donna to give? A. This is nothing to worry about, but it is something we should monitor. B. We need to call your doctor. He will want to adjust your medication C. This is something that we need to monitor closely because weight gain can be an early signal that you are retaining fluid. D. Have you been eating foods high in salt? That can be the cause of your weight gain. What specific instructions should Donna provide to Mr. Jones about weight, signs and symptoms, follow-up and other information related to managing his CHF? Weighing himself everyday, at the same time, wearing the same clothes. Weight gain can be a sign of retaining fluid and CHF acting up. He needs to watch for fatigue, shortness of breath, palpitations, dizziness, edema, weight gain, coughing, wheezing, bloating, nausea, coughing up pink foaming mucus. Donna asks Mr. Jones about his diabetes and how he has been managing it. He shows her his blood sugar record. “I’ve been a diabetic for more than 10 years now and have been managing that pretty well. This leg pain is what messed me up. I just don’t understand why. I have been doing everything the same as always and taking my sugar pill.” Blood Sugar Chart Date Morning BS Evening BS 3/15 100 140 3/16 110 160 3/17 98 134 3/18 120 3/19 3/20 3/21 Multiple Choice Question What would be the best response for Donna to give to Mr. Jones? A. “You must have eaten something that you shouldn’t have and that’s what has thrown off your blood sugar levels.” B. “Diabetes affects how your body responds to infection. It was good that you went to the doctor when you started having problems with your leg.” C. “When your body is fighting an infection, it is important to increase your dietary calories to provide nutrients for healing.” D. “When your body has an infection, it really doesn’t matter what you do, you just have to let it run its course.” Donna reviews the blood sugar record and asks Mr. Jones to show her how he checks his blood sugar. He pulls out his glucometer and very proficiently demonstrates how he performs a blood sugar test. Donna asks Mr. Jones about his diabetes medication. He reports that he takes his as directed without fail. Donna refers to the drug guide, Epocrates, to review the common side effects and potential adverse reactions to his diabetes medication: Go to the site below and list the top three side effects and potential adverse effects. https://online.epocrates.com Top three side effects are: hypoglycemia, URI sx, and headache Top three adverse effects are: Stevens-Johnson syndrome, anaphylactoid rxn, any myocardial ischemia Donna asks Mr. Jones about his diet. “Well, I was always on a 1800 cal diet, from the beginning when I was first diagnosed. I know that I am supposed to use a different method for my diet but I am a little fuzzy on that new method.” Donna tells Mr. Jones, “The new method focuses on portion sizes so it makes it easier to eat healthy.” Mr. Jones uses his new tablet that his son gave him for Christmas, so Donna reinforces the instruction she provided, by showing Mr. Jones the website: http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/ Go to this site and “make” your plate for dinner. List the foods you put on your plate: 8oz. steak, roasted brussel sprouts, roasted red potatoes, and sugar free tea Donna asks Mr. Jones to do a 24-hour dietary recall: Breakfast yesterday at the hospital: two scrambled eggs, two slices of toast with butter and jelly, coffee, orange juice Lunch, at home: cans tomato soup with crackers and grilled cheese sandwich Dinner, Stouffers chicken pot-pie, coleslaw, and a glass of 2% milk Breakfast today: oatmeal, coffee, and a banana What additional dietary teaching should Donna provide to Mr. Jones? Cut back on foods high in sodium and should also eat more foods high in protein to promote healing of his wounds. Mr. Jones reports that he tests his blood sugar twice a day. He denies being excessively thirsty. “I think it seems like I am going to the bathroom more than before I was in the hospital, maybe it just seems that way because I get tired so easily.” Donna reviews the medications on the “Continuing Patient Care Form” and verifies the labels on the prescriptions bottles. Mr. Jones medications are: • Prandin 3.5 mg orally before meals • Lasix 40 mg orally every day (new medication) • Keflex 500 mg, two tabs orally every six hours for seven days What additional teaching does Mr. Jones need about his medications at this time? He needs to know he will urinate more from the Lasix. The purpose of the drug is to prevent retaining of water by preventing the body from absorbing too much salt. He may experience polyuria, tinnitus , and drowziness To reinforce medication teaching she has done with additional patient education materials, Donna refers to the drug guide, Epocrates. Go to https://online.epocrates.com List the four most important pieces of information the patient should know about furosemide. Avoid “mycin” antibiotics if he is being treated for high blood pressure to continue using even if he feels fine avoid using if he is unable to urinate do not take more than what is prescribed. Donna continues the home visit and learns the following about Mr. Jones • He has been widowed for the past 15 years. • He has several friends in the building who became call and ask for help. • He is highly motivated to resume his independent life, but seems afraid it will not be possible. • His hobbies included cooking for friends, playing poker with friends. When Donna learned that Mr. Jones enjoys cooking, she shows him the American Diabetes Association’s website where there are some good recipes that he can try out. To provide additional dietary and diet management support, including access to recipes, meal plans, tips, and other tools, she helps him sign up for the ADA’s “My Food Advisor Program”. http://www.diabetes.org/mfa-recipes/log-in/recipes-for-healthy-living.html?loc=ff-diabetesmealplans Sign-up for this site and choose a recipe from the “Budget-Friendly Recipes.” Fill in the information below: Name of the recipe: Budget-Friendly Cilantro Lime Roasted Chicken Calories 130 Carbohydrate: 4 g Protein: 18 g Fat 4.5 g Saturated Fat: 1.2 g Sugars: 3 g Dietary Fiber: 0 g Cholesterol: 55 mg Sodium: 55 mg Potassium: 165 mg Search for a free mobile app that Mr. Jones could use to track his diabetes. Write the name of the app below with a brief description. BG Monitor Diabetes: Free, for Android users, easy interface to navigate, tracks everything, can calculate how much insulin is needed, sets reminders, creates spreadsheets and graphs of patient’s data, organizes all entries with tags. Can photo log all of meals in case patient is out and about. Donna turns her attention to assess the leg wound. She washes her hands again and sets up her workspace. She positions Mr. Jones leg so that he is comfortable and she is able to safely provide care. She verifies the order on the Continuing Patient Care Form. When providing wound care, what characteristics of the wound must be assessed? The wounds size and depth and extent of undermining need to be documented, as well as the appearance of the surface (necrosis, viability, etc), amount and characteristics of exudate, and the status of the periwound tissues (pigmented, scarring, and cellulite. Find a resource guide for wound care that Donna might use in the home setting for additional information on wound assessment. What is the name of the resource that you found? How would this resource be useful for Donna as a home health nurse? I thought Medscape was quick and easy to find and navigate. It can be easily accessed by phone and breaks things down easy to read. Mr. Jones looks at his wound and asks Donna how the wound looks to her. She responds that the wound is still in the inflammatory phase of wound healing. He is puzzled and asks more questions. To help Mr. Jones understand the basis of wound healing, locate a brief video on the phases of wound healing that Donna might use. Copy the web address below. Briefly describe what you learned about the stages of wound healing. https://www.youtube.com/watch?v=f9kQ4MQNMy0 This video does a great job at explaining the different stages of a wound and how the cells are involved. Donna completes the wound care and provides verbal and written instruction regarding caring and monitoring the wound. What additional instructions should Donna provide to Mr. Jones concerning his wound? It is important to keep it clean and dry. He needs to take showers and not baths. He needs to avoid scratching it if it itches and to keep his leg elevated if he is sitting. Donna completes her initial home visit. She summarizes all the information she has shared and provide specific instructions in writing, being mindful that patient safety is a priority concern, she reviews the signs and symptoms of complications that warrant immediate action and when to call the nurse or doctor Donna provides a list of emergency phone numbers. Finally, she makes arrangements for a follow-up home visit in two days. [Show Less]
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