Case Study, Chapter 9, Chronic Illness and Disability

1. Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs.

1. What nursing considerations should be made for Mr. Edwards related to his disability?
2. What health promotion and prevention education does Mr. Edwards need?

2. Ms. Fulton is a 38-year-old mother who was recently diagnosed with myasthenia gravis, a chronic disease of the neuromuscular system. Management of this disease process requires strict adherence to a medication regimen. The disease also affects ADLs for the patient and her family. Additionally, because myasthenia gravis is characterized by exacerbations that may require hospitalizations, Ms. Fulton has had to resign from her position as president of a marketing firm. She has remained as an employee of the same company, but now serves as a consultant with more flexible work hours.

1. In discussing management of her chronic disease, the nurse focuses on what types of strategies?
2. Describe supportive nursing care that may be helpful to Ms. Fulton.

This week you have your choice of three discussion topics! Select the one that most interests you and answer the corresponding questions completely.

Remember to reference both the book or lesson, and an outside scholarly source.

Option #1:

You are the nurse assessing an Orthodox Jewish client with peptic ulcer. The client is strictly religious and refuses to eat the food provided at the health care facility.

1. Describe how you would further assess and provide care for this client.
2. What steps could you take to increase your cultural competence, if you were not familiar with this faith?

Option #2:

You are the nurse caring for a client with Crohn’s disease. The client believes he is being punished by God. The client is spiritually distressed and cannot come to terms with the illness.

1. How would you respond to this client?
2. What are some identified risk factors for spiritual distress, and recommended interventions?

Option #3:

Describe a time in your clinical nursing practice when you have cared for a client of cultural, religious, or spiritual practices different from your own.

1. What were some of the challenges you faced caring for this client?
2. What steps did you take (or could you have taken) to ensure the patient received culturally/spiritually competent care?

Assignment 1: Role of the Advanced Nurse Paper (24 points)

This assignment relates to the role of the master’s prepared nurse. Students will develop a scholarly paper utilizing the American Psychological Association (APA) 6th edition format. In review, when developing a scholarly APA paper, begin with an introductory paragraph that includes the purpose statement. The body of the paper should include levels of heading that keep the writer focused and on track. For example, this paper would have three level one headings not including the introductory paragraph or conclusion. The paper would then have a conclusion to summarize the main points of the paper. The last page would be the reference page.

Instructional Rubric:

Discuss the chosen specialty and reasons for pursuing an advanced nursing role.

Describe the role of the chosen specialty and the requirements for the master’s prepared nurse.

Discuss how an advanced practice role can impact the RNs career advancement. Utilize the Institute of Medicine (IOM) report: The Future of Nursing Leading Change, Advancing Health (found in Modules/Week 3) in the discuss

The scholarly paper should be in narrative format, 3 to 4 pages excluding the title and reference page.

Include an introductory paragraph, purpose statement, and a conclusion.

Include level 1 headings to organize the paper.

Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.

Include a minimum of three (3) professional peer-reviewed scholarly journal references to support the paper (review in Ulrich Periodical Directory) and be less than five (5) years old.

APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).

Submit the assignment to Turnitin prior to the final submission, review the originality report, and make any needed changes.

Submit by the posted due date.

Question 1:  Which of the following is a crucial element of developing a guideline?

a. Creating a physician expert panel
b. Reviewing the literature with ratings of available evidence
c. Conducting an external review of a guideline
d. Developing evidence-based tables

Question 2:  African American patients seem to have a negative reaction to which of the following asthma medications?

a. Inhaled corticosteroids

b. Long-term beta-agonist bronchodilators

c. Leukotriene receptor agonist
d. Oral corticosteroid

Question 3:  Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?

a. The tumor size cannot be evaluated, the cancer has not spread to the lymph nodes, and the distant spread cannot be evaluated.
b. The cancer is in situ, it is spreading into the lymph nodes, but the spread otherwise cannot be evaluated.
c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body.
d. The cancer is about 5 cm in size, nearby lymph nodes cannot be evaluated, and there is no evidence of distant spreading.

Question 4:  Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?

a. Meclizine
b. Diphenhydramine
c. Diamox
d. Promethazine

Question 5:  Mandy presents with a cauliflower-like wart that is in her anogenital region. You suspect it was sexually transmitted and document this as a:
a. Filiform/digitate wart.

b. Dysplastic cervical lesion.

c. Condyloma accuminata.
d. Koilocytosis.

Question 6:  Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of?

a. Dementia

b. Alzheimer’s disease

c. Parkinson’s disease

d. Delirium

Question 7:  You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?

a. “Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow.”
b. “Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.”
c. “Drive to the emergency room (ER) now.”
d. “Call 911.”

Question 8:  A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria?
a. NSAIDs

b. Beets

c. Vitamin A
d. Red meat

Question 9:  Which of the following is an example of tertiary prevention in a patient with chronic renal failure?

a. Fluid restriction
b. Hemodialysis 4 days a week
c. High-protein diet
d. Maintain blood pressure at 120/80

Question 10:  Which of the following conditions is associated with cigarette smoking?

a. Glaucoma

b. Increased sperm quality

c. Bladder cancer

d. Eczema

Question 11: A chronic cough lasts longer than:

a. 3 weeks

b. 1 month

c. 6 months
d. 1 year

Question 12: The ‘freezing phenomenon’ is a cardinal feature of?

a.Parkinson’s disease

b. Alzheimer’s disease

c. A CVA

d. Bell’s palsy

Question 13: When administered at the beginning of an attack, oxygen therapy may help this kind of headache?

a. Tension

b. Migraine

c. Cluster

d. Stress

Question 14: Which ethnic group has the highest lung cancer incidence and mortality rates?

a. African American men

b. Scandinavian men and women

c. Caucasian women

d. Asian men

Question 15: The most significant precipitating event leading to otitis media with effusion is:

a. Pharyngitis

b. Allergies

c. Viral upper respiratory infection (URI)

d. Perforation of the eardrum

Question 16:  Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of:

a. Severe asthma.
b. A common valvular lesion.
c. Severe hypertension.
d. A previous coronary artery bypass graft (CABG).

Question 17: A 34-year-old patient was treated for a urinary tract infection (UTI) and has not responded to antibiotic therapy. Which of the following actions should be taken next?
a. Send a urine specimen for microscopy looking for fungal colonies.
b. Increase the dose of antibiotic.
c. Order a cytoscopy.
d. Order a different antibiotic.

Question 18: Which statement best describes a carotid bruit?

a. It is felt with the middle three fingers over the carotid artery.
b. A bruit becomes audible when the lumen is narrowed to 1 mm or less.
c. A low-pitched bruit is a medical emergency.
d. The higher the pitch of the bruit, the higher the degree of stenosis.

Question 19: Which statement is true regarding chloasma, the ‘mask of pregnancy’?

a. It is caused by a decrease in the melanocyte-stimulating hormone duringpregnancy.

b. This condition only occurs on the face.

c. Exposure to sunlight will even out the discoloration.

d. It is caused by increased levels of estrogen and progesterone.

Question 20: Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause?

a. “You must be under a lot of stress lately.”
b. “It is hereditary. Did your father experience this also?”
c. “The cause is unknown, but we suspect it is due to an immunologic mechanism.”
d. “We’ll have to do some tests.”

Question 21: A blood pressure (BP) of 150/90 is considered:

a. Stage 2 hypertension

b. Hypertensive

c. Normal in healthy older adults

d. Acceptable if the patient has DM

Question 22: When teaching post MI patients about their NTG tablets, theclinician should stress that the tablets should remain in thelight-resistant bottle in which they are packaged and shouldnot be put in another pill box or remain in areas that are orcould become warm and humid. Once opened, the bottlemust be dated and discarded after how many months?

a. 1 month

b. 3 months

c. 6 months

d. As long as the tablets are kept in this special bottle, they will last forever

Question 23: Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?

a. He should stop smoking today.

b. He should stop smoking tomorrow.

c. His quit date should be in 1 week.

d. He will be ready to quit after the Frst 30 days

Question 24: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Spores

c. Pseudohyphae
b. Leukocytes

d. Epithelial cells

Question 25: The hallmark of an absence seizure is:

a. No activity at all.
b. A blank stare.
c. Urine is usually voided involuntarily.
d. The attack usually lasts several minutes.

Question 26: Which medication used for scabies is safe for children 2 months and older?

a. Permethrin cream

b. Lindane

c. Crotamiton lotion and cream

d. Ivermectin

Question 27: The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis?

a. Viral conjunctivitis

b. Keratoconjunctivitis

c. Bacterial conjunctivitis
d. Allergic conjunctivitis

Question 28: Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her?

a. “Most patients have complete recovery in a few weeks to a few months.”
b. “Unfortunately, you’ll probably have a small amount of residual damage.”
c. “Don’t worry, I’ll take care of everything.”
d. “You may have a few more episodes over the course of your lifetime but no permanent damage.”

Question 29: How often should drug levels be monitored when a seizure medication has controlled the seizures and the drug level is adequate

a. Every 3 months
b. Every 6 months
c. Annually
d. Whenever there is a problem

Question 30:  Immunizations are an example of which type of prevention?

a. Primary
b. Secondary
c. Tertiary

Question 31: The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?

a. Repeat the test.
b. Refer to a nephrologist.
c. Measure the serum protein.
d. Obtain a blood urea nitrogen (BUN) and creatinine.

Question 32:  Which cranial nerve is afected in a patient with acerebrovascular accident who has difficulty chewing?

a. CN V

b. CN VII

c. CN IX

d. CN X

Question 33: Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer?
a. KUB (kidneys, ureter, bladder) x-ray

b. Cystoscopy with biopsy

c. Magnetic resonance imaging (MRI)
d. Urine tumor marker (NMP22)

b

Question 34: The “B” in the ABCDEs of assessing skin cancer represents:

a. Biopsy. c. Boundary.
b. Best practice. d. Border irregularity.

Question 35: Which statement is true regarding driving and patients with a seizure disorder?

a. Once diagnosed with a seizure disorder, patients mustnever drive again.

b. After being seizure free for 6 months, patients may drive.

c. Each state has diferent laws governing driving forindividuals with a seizure disorder.

d. These persons may drive but never alone.

Question 36: Which high-density lipoprotein (HDL) level is considered cardioprotective?

a. Greater than 30

b. Greater than 40

c. Greater than 50
d. Greater than 60

Question 37: The most common cause of CAP is?

a. Incorrect octane gasoline

b. A loose gas cap

c. A clogged muffler

d. A bad spark plug

Question 38: Sandra has palpitations that occur with muscle twitching, paresthesia, and fatigue. What specific diagnostic test might help determine the cause?

a. Serum calcium

b. Electrocardiogram (ECG)

c. Thyroid-stimulating hormone test

d. Complete blood cell count

Question 39: A patient presents to the clinician with a sore throat, fever of 100.7?F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be?

a. The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment.
b. Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen.
c. A throat culture should be performed to confirm the results of the rapid strep test.
d. The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive.

Question 40: Patients with acute otitis media should be referred to a specialist in which of the following situations?
a. Concurrent vertigo or ataxia
b. Failed closure of a ruptured tympanic membrane
c. If symptoms worsen after 3 or 4 days of treatment
d. All of the above

Question 41: Which of the following tests is most useful in determining renal function in a patient suspected of chronic renal failure (CRF)?
a. Blood urea nitrogen (BUN) and creatinine
b. Electrolytes
c. Creatinine clearance
d. Urinalysis

Question 42: Marci has a wart on her hand. She says she  heard something about “silver duct tape therapy.” What do you tell her about his?

a. It is an old wives’ tale.
b. It is used as a last resort.
c. Salicylic acid is more effective.
d. It is a simple treatment that should be tried first.

Question 43: What is the first-line recommended treatment against Group A b-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?
a. Penicillin

b. Quinolone

c. Cephalosporin
d. Macrolide

Question 44: Which of the following is an example of sensorineural hearing loss?

a. Perforation of the tympanic membrane

b. Otosclerosis

c. Cholesteatoma
d. Presbycusis

Question 45: Which of the following is “a linear crack extending from the epidermis to the dermis?”

a. An ulcer

b. A fissure

c. Lichenification
d. An excoriation

Question 46: A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night visio0n, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma?

a. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma.
b. The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient.
c. Physical diagnosis relies on goniscopic evaluation of the angle by an ophthalmologist.
d. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.

Question 47: The majority of HSV-1 and HSV-2 infections are asymptomatic so that only which elevated antibody titer shows evidence of previous infection?

a. IgA

b. IgE

c. IgG
d. IgM

Question 48: A patient is seen with a sudden onset of ±ank painaccompanied by nausea, vomiting, and diaphoresis. Inaddition to nephrolithiasis, which of the following should beadded to the list of diferential diagnoses?

a. Pancreatitis

b. Peptic ulcer disease

c. Diverticulitis

d. All of the above

Question 49: Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test?

a. B-type natriuretic peptide

b. C-reactive protein

c. Serum albumin

d. Erythrocyte sedimentation rate

Question 50: You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex?

a. Baker phenomenon

b. Arnold reflex

c. cough reflex

d. Tragus reflex

Practicum Assignment 

As your practicum proceeds, consider the topics addressed this week. By tomorrow 5/11/19 6 pm, write a 550-word essays in APA format with a minimum of four scholarly references (see list below). Include the level one headers as numbered below:

1) Conduct research to further your understanding of how issues related to intra- and interdisciplinary collaboration and the design of outcomes could influence the implementation of your proposed change.

2) To further your understanding of how issues associated with multiple systems or spheres of influence relate to the implementation of your proposed evidence-based change.

Required Readings

White, K. M., & Dudley-Brown, S.(2016). Translation of evidence into nursing and health care practice. (2nd edition)  New York, NY: Springer Publishing Company.

• Review Chapter 14, “Creating a Culture that Promotes      Translation”
• Review Chapter 11  “Information Technology: A      Foundation and Enabler for Translation”
• Review Chapter 15 “Best Practices in Translation:      Challenges and Barriers in Translation”

Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A., & … Aiken, L. H. (2016). Nurse Engagement in Shared Governance and Patient and Nurse Outcomes. Journal of Nursing Administration, 46(11), 605-612. doi:10.1097/NNA.0000000000000412

Sung-Heui, B. (2016). CNE SERIES. The Centers for Medicare & Medicaid Services Reimbursement Policy and Nursing-Sensitive Adverse Patient Outcomes. Nursing Economic$, 34(4), 161-181.

Twigg, D. E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nurse-sensitive outcomes. Journal of Advanced Nursing, 71(7), 1564-1572. doi:10.1111/jan.12616

Yankovsky, A., Gajewski, B. J., & Dunton, N. (2016). Trends in Nursing Care Efficiency From 2007 to 2011 on Acute Nursing Units. Nursing Economic$, 34(6), 266-276.

Braithwaite, J., Westbrook, M., Nugus, P., Greenfield, D., Travaglia, J., Runciman, W., & … Westbrook, J. (2013). Continuing differences between health professions’ attitudes: the saga of accomplishing systems-wide interprofessionalism. International Journal for Quality in Health Care, 25(1), 8-15. doi:10.1093/intqhc/mzs071

Hoyle, C., & Johnson, G. (2015). Building skills in organizational and systems change. Nurse Practitioner, 40(4), 15-23. doi:10.1097/01.NPR.0000461948.38539. fc

Jeungok, C., & Zucker, D. M. (2013). Self-assessment of nursing informatics competencies for Doctor of Nursing practice students. Journal of Professional Nursing, 29(6), 381-387. doi:10.1016/j.profnurs.2012.05.014

Toussaint, J. S. (2015). The Framework for a Whole-System Transformation. Journal of Healthcare Management, 60(6), 386-389.