As a family nurse practitioner you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes complaining of having a difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills. Explain the following questions in a 2 page Word document:
1. What are some initial areas for concern?
2. What screening tools can help lead you closer to your diagnosis?
3. Describe 1 health promotion strategy you can discuss with the patient.
4. Make a plan of care that addresses the following: possible pharmacological and non-pharmacological (OTC) interventions, labs, follow-up, teaching, and referrals.
Support your work with a minimum of two (2) evidence-based guidelines and/or articles published within 3-5 years.
Centers for Disease Control and Prevention. (2013). Youth risk behavior surveillance system (YRBSS). Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/index.htm
Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.
Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is so exhausted she cannot eat or drink by herself.
- Height 175 cm; Weight 95.5 kg
- Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
- Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
- Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
- Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin
Critical Thinking Questions
What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.