1) Minimum 8 full pages  

                 Part 1: minimum 2 page

                 Part 2: minimum 2 pages 

                 Part 3: minimum 1 page

                 Part 4: minimum 1 page

                 Part 5: minimum 2 pages

                           

                 Submit 1 document per part

2)¨******APA norms  

            All paragraphs must be narrative and cited in the text- each paragraphs

            Bulleted responses are not accepted

            Dont write in the first person 

            Dont copy and pase the questions.

            Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

3) It will be verified by Turnitin and SafeAssign 

4) Minimum 12 references not older than 5 years

            Minimum 2 references per part

5) ******************* Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX+

6) You must name the files according to the part you are answering: 

Part 1.doc 

Part 2.doc 

_______________________________________________________________

Part 1:

Answer the questions in the attached “Case file 1” taking into account the scenario presented.

Part 2:

Answer the questions in the attached “Case file 2” taking into account the scenario presented.

Part 3:

 

1) Identify a common perceptual, neurological, or cognitive issue and discuss contributing factors. 

2) Outline steps for prevention or health promotion for the patient and family.

Part 4:

 

1) Discuss characteristic findings for a stroke and how it affects the lives of patients and their families. 

2) Discuss the nurse’s role in supporting the patient’s psychological and emotional needs. Provide an example.

Part 5:

 

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

  1. Temperature: 37.1 degrees C
  2. BP 123/78 HR 93 RR 22 Pox 99%
  3. Denies pain
  4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

  1. WBC: 19.2 (1,000/uL)
  2. Lymphocytes 6700 (cells/uL)
  3. CT Head shows no changes since previous scan
  4. Urinalysis positive for moderate amount of leukocytes and cloudy
  5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Questions

  1. Describe the clinical manifestations present in Mr. M.
  2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
  3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
  4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
  5. Discuss what interventions can be put into place to support Mr. M. and his family.
  6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

Urinary Obstruction

Case Studies

The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary

stream for several months. Both had progressively become worse. His physical examination

was essentially negative except for an enlarged prostate, which was bulky and soft.

Studies Results

Routine laboratory studies Within normal limits (WNL)

Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder,

indicating an enlarged prostate

Uroflowmetry with total voided

flow of 225 mL

8 mL/sec (normal: >12 mL/sec)

Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O)

Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O)

Electromyography of the pelvic

sphincter muscle

Normal resting bladder with a positive tonus limb

Cystoscopy Benign prostatic hypertrophy (BPH)

Prostatic acid phosphatase

(PAP)

0.5 units/L (normal: 0.11-0.60 units/L)

Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL)

Prostate ultrasound Diffusely enlarged prostate; no localized tumor

Diagnostic Analysis

Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical

examination indicated an enlarged prostate. IVP studies corroborated that finding. The

reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the

patient was found to have a normal total voided volume, one could not say that the reduced

flow rate was the result of an inadequately distended bladder. Rather, the bladder was

appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction.

The cystogram indicated that the bladder was capable of mounting an effective pressure and

was not an atonic bladder compatible with neurologic disease. The tonus limb again

indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was

normal, again indicating appropriate muscular function of the bladder. Based on these

studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA

indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis.

Cystoscopy documented that finding, and the patient was appropriately treated by

transurethral resection of the prostate (TURP). This patient did well postoperatively and had

no major problems.

Critical Thinking Questions

1. Does BPH predispose this patient to cancer?
2. Why are patients with BPH at increased risk for urinary tract infections?
3. What would you expect the patient’s PSA level to be

Inflammatory Bowel Disease

Case Study

The patient is an 11-year-old girl who has been complaining of intermittent right lower

quadrant pain and diarrhea for the past year. She is small for her age. Her physical

examination indicates some mild right lower quadrant tenderness and fullness.

Studies Results

Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL)

Hematocrit (Hct), 28% (normal: 31%-43%)

Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL)

Meckel scan, No evidence of Meckel diverticulum

D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL)

120 min: 6 mg/dL (normal: >20 mg/dL)

Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in

glucose)

Small bowel series, Constriction of multiple segments of the small intestine

Diagnostic Analysis

The child’s small bowel series is compatible with Crohn disease of the small intestine.

Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose

tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has

vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive

regimen, and her condition improved significantly. Unfortunately, 2 years later she

experienced unremitting obstructive symptoms and required surgery. One year after surgery,

her gastrointestinal function was normal, and her anemia had resolved. Her growth status

matched her age group. Her absorption tests were normal, as were her B12 levels. Her

immunosuppressive drugs were discontinued, and she is doing well.

Critical Thinking Questions

1. Why was this patient placed on immunosuppressive therapy?
2. Why was the Meckel scan ordered for this patient?
3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s

Disease? (always on boards)

4. What is prognosis for patients with IBD and what are the follow up recommendations for
managing disease?