Rose Thatcher (R. T.), an 85-year-old recent widow, comes to the health clinic for her annual physical examination. She reports feeling more tired than usual and has noticed that her feet are swelling. R. T. states that sometimes she feels short of breath after climbing the steps to her bedroom on the second floor. Her intake vital signs are T 36.78° C (98.2° F), P 100 and slightly irregular, R 24 and shallow, and BP 116/68. The nurse is acquainted with R. T. and notices that she is walking more slowly than usual to the examination room.
1.What action is required by the nurse before initiating R. T.'s patient interview?
2. Identify four activities by the nurse that might communicate disinterest or the need to hurry through R. T.'s examination.
3. List three or more physical considerations that the nurse should address before having R. T. enter the examination room.
4. Write a minimum of 10 health assessment questions that the nurse would want to ask R. T. that are specific to the purpose of her examination.
5. What three body systems would be critical to assess during R. T.'s physical examination? State a rationale for each. Discuss a minimum of three additional actions that the nurse should take as part of the assessment process.
1.RT was identified with shortness of breath so a comfortable position of lyieng down with head end elevated to be provided .
2.The nurse providing a head end elevation , checking the saturation level of patient , providing privacy and planning to check ecg of the patient, checking the type of edema by palpating the leg should alert the doctor to hurry RTs examoination.
3.back rest to provide the head end elevation, bed height should be adjusted for RT to sit comfortably on the bed, foot end also to be slightly elevated for providing back flow of impure blood which is stagnated at the foot causing edema.
4.since how long you are experiencing the breathing difficulty?
Is the breathleasness triggered only when climbing steps?
Are you on any medication?
Tell about the past medical history?.
Since how long you have edema in your legs?
Do you have Hypertension?
How is your bowel and bladder pattern?
How was your BloOd glucose level during the latest blood test?
Since how long you feel lethargic?
Do you have any kind of chest pain during breathlessness?
5.the main three body systems to be assessed are circulatory system, Respiratory system and urinary system
The patient may have any circulatory failure which can cause LV disfunction due To LV enlargement due to circulatory overload, renal system defect may cause fluid overload and resulting edema in the lungs and legs which cause breathing difficulty, respiratory system to be checked for any pulmonary edema which can also trigger breathing difficulty and tiredness.
Assessment should be carried out by emergency ECG, ABG analysis to rule out Respiratory acidosis if any and Echo cardiogram / USG help to rule out any fluid overload in system, X ray also to be done as part of assessment to find ?pulmonary edema.
Rose Thatcher (R. T.), an 85-year-old recent widow, comes to the health clinic for her annual...
A.P. is a 73-year-old female who presents to the women’s health clinic for an annual physical examination. She states that she is having difficulty sleeping and has been having panic attacks for the past year, since the death of her son. Subjective Data Lives with husband Daughter, age 50, lives nearby Had a son, age 52, who died in the past year from a drug overdose Objective Data Vital signs: T 37 P 80 R 18 BP 140/68 Weight: 140...
Sofia Gomez (S.G.), a 24-year-old Latina mother, arrives at the community hospital's emergency department with her 4-year-old daughter, Maria. S.G. speaks broken English, and none of the nurses who speak Spanish are currently on duty. The nurse is able to determine that Maria has not been eating for the last several days. S.G. says that she has tried to make her daughter drink, but Maria refuses. On physical examination, Maria has sluggish skin turgor, is lethargic, and does not communicate...
Ms. Kline, a 55-year-old white woman, arrived at an urgent care center complaining of generalized malaise, an overwhelming feeling of exhaustion that was not relieved with rest, and difficulty walking more than 10 ft. She has thinning scalp hair, scaly skin, and puffiness around her eyes. She appears to be anxious. She is married and responsible for raising three grandchildren (2, 4, and 8 years old). She is employed full time as a college professor, and is worried that she...
R.H. is a 62-year-old woman who comes to the clinic for a routine physical examination. She works as a banking executive and gets little exercise. She says she is “just tired.” She has gained 18 pounds over the past year and eats a high-fat diet. Her blood pressure is 162/98, heart rate is 92, and respiration rate is 20 R.H. complains of some weakness in her right foot that began about a month ago. She says it also feels a...
Case 1 Clinic Note This 57-year-old female patient comes to the clinic today for her annual physical. HEENT: Normal LUNGS: Clear ABDOMEN: Soft, nontender RECTAL EXAM: Refused NEUROLOGICAL: Congenital spastic paralysis, left leg There are no physical findings that need to be addressed at this time. I have reviewed her care plan, and she should continue per her care plan at the residential home where she resides. ICD-10-CM Code Assignment.....x........ Case 2 Sleep Clinic Note This patient returns today following...
Emily, a 3-year-old toddler, presents to the pediatrician's office for her yearly physical. Her mother and 6-month-old brother accompany her. Emily's brother was seen first for immunizations and a checkup, and now it is Emily's turn for an exam and immunization check. The nurse notes that Emily's immunizations are up-to-date (she received the pneumonia vaccine in the fall, as well as her yearly flu shot). Emily's mother reports that her daughter is doing well in preschool and has had no...
Emily, a 3-year-old toddler, presents to the pediatrician's office for her yearly physical. Her mother and 6-month-old brother accompany her. Emily's brother was seen first for immunizations and a checkup, and now it is Emily's turn for an exam and immunization check. The nurse notes that Emily's immunizations are up-to-date (she received the pneumonia vaccine in the fall, as well as her yearly flu shot). Emily's mother reports that her daughter is doing well in preschool and has had no...
PLEASE HELP Case study Mrs. Wolford is a 46-year-old female being evaluated at her local walk-in clinic for dyspnea on exertion (DOE). She has noticed a gradual increase in shortness of breath (SOB), fatigue, and daytime sleepiness since “gaining a few pounds” several years ago. She has no known history of illness or disease and does not have a primary care provider. Mrs. Wolford claims she is rarely ill, except for the occasional cold or seasonal allergies, which she treats...
Baby Haley’s mother is a 26-year-old, G2P2002, married, black female. Her first child is a health 6-year-old girl. Mrs. Haley works as a cashier at Wal-Mart. There were no complications identified in the pregnancy, although she did not start prenatal care until her 24th week of pregnancy. Case Study: Baby Haley has just been born after a two-hour second stage of labor. Immediately at delivery the nurse notes the following: Baby Haley lacks tone. He feels like a “bean bag...
The patent was a 6-year-old female from North Carolina. She was in her usual state of good health until 10 days prior to admission, when she had a tick removed from her scalp. She developed a sore throat, malaise, and a low grade- fever 8 days after tick removal, she was seen by her pediatrician when she began developing a pink, .acular rash, which started on her palms and lower extremities and spread to cover her entire body. The pediatrician's...