492 CASE SCENARIO. GROUND LEVEL FALL.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CALIFORNIA 900000.INTERDISCIPLINARY KARDEX. Age/Sex: 64years female.

Admission date:03/21/21 @0430am.

Status : Inpatient admission.

Account Number: Q00269542.

MR # Q0006999328.

Location: MedTelemetry.

Room 42116.

Attending doctor: Tumtum,Worry.

Patient name: Monica Woodutter.

Allergy: NKDA.

Primary diagnosis: S/P Spinal Fusion by neurosurgery doctor Exceptional Tional MD. ( Ground level fall. Fell at home on 03/21/21@ 0230am)Posterior dressing intact/ dry and clean.

Secondary doctor: Htn,dm,hypothyroidism. Isolation Status: Standard precautions.

Is patient at risk for falls: yes.

Do patient have advance Directive:No.

Copy of advance Directive on the chart. Suicidal risk: No.

Transportation: bed.

Room air.Cough and deep breathe.

Incentive Spirometry every 1hour while awake

Doctor orders:

Physical therapy for evaluation and treatment. Transfer to Skilled Nursing Facility rehabilitation when medically stable.

Diet: Carb controlled cardiac health Mechanical Soft diet.

Follow up with Neurosurgery in 2- 3 weeks. Follow up with her Primary Care Physician in 12 weeks. CBC with differential, LFT ,Chem 7 in laboratory tests: WBC: 6.9.

H/H9.3/30.8%.

K=3.7.

NA: 138.

Medications: Norco 5/325mg 2tablets po Q6hours prn pain.

Tylenol 650mg po prn temperature.

Dilaudid 0.5mg IV Q3hours prn pain. Morphine sulfate 4mg IV Q4hours prn pain. Zofran 4mg IV Q4hours prn nausea/Vomiting. Hydrochlothyzide 25mg po Qday.

Colace 100mg po Qday.

Zosyn 3.375gm IV Q8hrs.

Accucheck Qac/Qhs.

0.9NS @ 75ml/hour right hand patent ,clean and dry.

NUTRITION DIETARY RECOMMENDATIONS.(1)RECOMMENDED FOOD GUIDELINES OF “MYPLATE”WAS UNVEILED IN ?.

A.2011.

B.2012.

C.2014.

D.2018.

Answer : A 2011.

(2).Myplate was unveiled by?.

A.Melania Trump.

B.Mrs Elizabeth Warren.

C.Mrs Michelle Obama.

D.Mrs Barbara Bush.

Answer: C.

(3). Myplate took the place of the iconic Food Pyramid. Myplate is presented by food divided into four sections fruits, vegetables, grains and protein. Small circle for diary products. The focus is to remind Americans about ?.

A.Vegetable.

B.Exercise.

C.Healthy diet.

D.Diary products and sodium intake.

Answer: C.

(4).In 2011 Havard Medical School developed its own graphic recommendation of food guidelines called?.

A.Honey my plate is empty.

B.Need balanced meal.

C.Healthy eating plate.

D.Omission in myplate.

Answer: C.

(5)The Havard Medical School developed food guidelines called Healthy Eating Plate because they felt that?.

A.Smaller is better.

B.Need for multivitamin.

C.There were omissions in Myplate because it does not tell consumers that whole grains are better for health, which protein is healthier and a discussion on fat and did not mention or comment on sugar drinks.

D.It was designed to knock off myplate away.It also talked about water and other calorie- free beverages.The March was a great one. Answer:C.

491 CASE SCENARIO. 20WEEKS IUP/ CERVICAL INCONTINENCE.

KINGDOM OF GOD HOSPITAL LOS ANGELES,CA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex: 28years old female.

Alert and oriented x4.

Allergy:NKDA .

Account number #Q0061432055.

MR# Q0004992935.

Admission date: 06/09/2021@09am.

Status: Inpatient.

Location: 5NorthEast.

Room 52114.

Resuscitation Status :Full Code.

Isolation Status: Standard Precautions.

Primary diagnosis:Cervical Incontinence (20weeks IUP) S/P Cerclage placement 06/10/ 21.

Suicidal risk: No.

Do patient have advance Directive:No.

Copy of advance Directive on the chart.

Diet: Clear liquid diet. Advance to full liquid diet for dinner.

Discontinue Foley catheter tomorrow @ 05am.

VS Q4hours.

CBC with differential and Chem 7 05am.

Medications:

Tylenol 650mg po Q8hours prn temperature. Tylenol #3 1tablet po Q4hours prn pain.

Tylenol #3 2tablets po Q6hours prn pain. Zofran 4mg IV Q4hours prn nausea/Vomiting. Ambulate in the hallway Qshift.

Discharge home tomorrow.

ARE NURSES IN IMPORTANT POSITION TO PROVIDE COUNSELING AND EDUCATION REGARDING GOOD NUTRITIONAL GUIDELINES AND HEALTHY EATING?.

Teaching patients and families about nutrition is an important component of healthcare management and illness prevention and this is within nurses scope of practice. As healthcare professionals it is extremely important that nurses include nutritional education as part of health promotion and disease prevention in patients and families teaching.

WHY THE NURSE SHOULD NOT 🤸‍♀️PUSH MEDICATION FOR ANOTHER NURSE?.

It is very wrong to pull out medications that you are not going to give patient .Here are the reasons why:

1.It will lead to medication errors.

2.Patient dissatisfaction because you are giving what you are not sure of.

3. It will lead to legal action against employer because patient got sicker or dissatisfied.

4.High turnover rate.Your license is at stake because you are not sure that the medications were given .The puller and pusher might lose their job.

Be a professional and support social, economic and professional growth. Do not create uncertainty and fear.Do it and say it right.

As a Nurse it is important to show complete compliance with the policy and practices.

If you pull out patient medication, give it ,do not leave medications at the bedside or pull it for another nurse.

Review your employee handbook policies and procedures on medication administration.

490 CASE SCENARIO. CEREBRAL VASCULAR ACCIDENT. (CVA)

KINGDOM OF GOD HOSPITAL LOS ANGELES,CALIFORNIA 900000.

INTERDISCIPLINARY KARDEX.

Age/Sex 75years old man.

Account number: Q00645743.

MR# Q0002299936.

Admitted date: 01/20/2010 @ 0520am.

Location: 5Northwest.

Room 52116.

Attending doctor: Miranda Lovingston.

Resuscitation status:Full Code.

Primary diagnosis CVA,left distal vetebral Stenosis. Secondary diagnosis dm,htn,hypothyroidism, IGT(Impaired Glucose Tolerance)

Weight 144lbs.

Height 5ft 5inches.

Procedures: CT scan of the head.

MRI of the head.CTA of head and neck.

Allergy : NKDA.

Diet: Cardiac heart health diet.Pureed diet, crush medications, feeder,no straws.Slurred Speech.

Right sided weakness. Right side is flaccid. Patient on room air.Reposition for comfort and pleasure redistribution.

GI/ GU: Incontinent of bowel and bladder.

IVF: D51/2ns at 80ml/hour.Accucheck Qac/Qhs.

Iv site patent intact clean. Rt Ac.

Hydralizine given for blood pressure of 170/90.

Plan: Discharge patient to SNF( SKILLED NURSING FACILITY) when medically stable. Need to follow up with Medical/Medicare.

WHAT IS SIRS?.(Systemic Inflammatory response syndrome)QUESTIONS.

This is a very serious condition in which there is inflammatory response throughout the body. It is known as a cascade of effects that are regulated response of the body to the infection. It is caused by:

Bacterial infection.(sepsis)

Pancreatitis or

Trauma.

It is marked by four SIRS criteria defined as:

Core body temperature >38.5°C(101.3°F).

Tachycardia (90beats per minute).

Tachypnea. That is increased respiration >20.

Leukocytosis or Leukopenia or bandemia.

Previously sepsis was defined as SIRS if is infection but not anymore.

Questions:

1.Step throat is a bacteria infection that can lead to rheumatoid fever, poststreptococcal glomerulonephritis or sepsis. True or False.

A.True.

B.False.

Correct answer A.

2.A patient develops a urinary tract infection after an indwelling urinary catheter has been inserted.This would be known as:

A.An opportunistic infection.

B.An Iatrogenic infection.

C.SIRS.

D.Viral Infection.

Correct answer B.

Rationale: Infection that develops as a result of insertion of indwelling catheter is known as Iatrogenic. Illness caused by medical treatment due to the mistake made by a medical professional.

3.The highest mortality rate is associated with nosocomial infections that will involve the:

A. Intestinal infection.

B.Urinary tract infection.

C. Respiratory tract infection.

D.Ring worms.

Correct answer C.

Rationale: The highest mortality is associated with infection of the respiratory tract. Urinary tract and surgical sites are common sites to develop nosocomial infections but respiratory is the highest.

4.The smallest infectious agents that can cause infection are:

A.Viruses.

B.Yeast.

C.Molds.

D.Bacteria.

Correct answer A.

Rationale :The virus is the smallest of all microorganisms and cannot be seen with a nake eyes. Whereas this is not the case with yeast,bacteria or mold.They are larger infectious agents.

5.In the case of late onset meningitis symptoms can include temperature instability, vomiting, bulging fontanelle or seizures.

True or False.

A.True.

B.False.

Correct answer A.

6. Mnemonic for SEPSIS are :

S: Slurred speech.

I:Extreme shivering.

P: Passing no urine in a day.

S: Severe breathlessness.

I: I feel like I might die.

S: Skin that is mottled or discolored.

Nurses can use it to educate patients who come in contact about the signs and symptoms. Another simple Mnemonic are Temperature, Pulse ,respiration (TPR) True or false.

A.True .

B.False.

Correct answer A.

7.Which hospitalized patients will be at risk for developing sepsis?.

A.A chain smokers.

B.A 34years old WBC of 6mm3.

C.70years man who who has indwelling catheter.

D.Hypertension and overweight.

Correct answer C.

Rationale: Indwelling catheters have been implicated in a majority of nosocomial infections.A,B,D are all wrong.

WHAT IS UTI?.

UTI is a urinary tract infection that is present in the urinary tract which will include the kidneys, urethra, ureters and the bladder.

The UTI that affects the kidneys is known as Pyelonephritis.

If the infection affects the bladder you call it Cystitis.

If affects the urethra it is called Urethritis.

UTI is caused by mostly bacteria. But can sometimes be caused by fungal especially in immunocompromised patients. It is more common in women , those that self catheterized themselves or indwelling catheter. Bacteria can easily by transferred during intercourse, unsanitary conditions, or during catheter placement.

The urinary tract infection that leads to sepsis is known as Urosepsis.

Most often the antibiotics that the doctors often orders for UTI is :

ROCEPHIN 1gm IV Q24hours.