Nursing Care for Patients with Chronic Conditions, Exams of Nursing

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VSIM REFLECTIVE QUESTIONS SEM 1

What priority problem(s) did you identify for Christopher Parrish - ANSWERS-1) Nutritional status related to cystic fibrosis (CF);

2. Safe medication administration in a patient with CF;
3. Safety related to tube feeding What potential problems could arise due to Christopher Parrish's identified Vitamin D deficiency? - ANSWERS-Hypocalcemia, bone demineralization, and osteoporosis Discuss the relationship between pancreatic enzymes, malabsorption, and CF - ANSWERS-Patients with CF experience a loss of pancreatic enzymes. This results in a pancreatic inability to absorb fat and fat-soluble vitamins, including vitamin D. Thus, patients with CF experience malabsorption and a loss of a positive nutritional state, including a vitamin D deficiency (among other vitamin deficiencies). Therefore, nutritional needs for Christopher Parrish (and all patients with CF) include a high calorie, high fat, and high protein diet. What are important assessments related to administration of enteral feedings - ANSWERS-Assessment of placement of enteral feeding tube by checking tube placement (gastric pH is less than 5; observe routine chest x-ray to verify placement; check residual prior to administration of enteral feed while following agency protocol regarding reinstallation or withholding of feeding.) If medications need to be administered via enteral feeding tube, the tube should be flushed with 15-30 mL of sterile or tap water (depending on hospital protocol) before and after medications are administered. If the patient has more than one medication to be administered at a time, they should be administered one at a time with the tube flushed inbetween Using Erikson's developmental stages, discuss the importance of peer relationships/support group with other young adults with cystic fibrosis - ANSWERS- Christopher Parrish is in Erikson's stage late adolescence/early adulthood. During this phase, it is important for an individual to develop and maintain healthy and social relationships. Therefore, it is vital to encourage Christopher Parrish to reach out for psychosocial support options provided to CF patients by the medical team. Identify potential patient safety issues related to nutritional status in the care of Christopher Parrish. - ANSWERS-Pancreatic enzymes are necessary for the digestion and absorption of proteins and fats. CF patients have pancreatic insufficiency causing inadequate enzyme secretions. Therefore, pancreatic enzymes must be taken prior to eating to enhance adequate digestion and absorption of nutrients. What other interprofessional team members should be involved in Josephine Morrow's care - ANSWERS-Nursing, medicine, physical therapy, dietary, and wound specialists. Prior to discharge, the hospital health care team should discuss and review treatment with the health care team from Josephine Morrow's current nursing home.

What priority problem(s) did you identify for Kim Johnson - ANSWERS-Kim Johnson's priority problem is urinary retention related to paraplegia due to a complete spinal cord injury at the T8 level. Identify safety hazards in Kim Johnson's patient care situation - ANSWERS-The safety hazard that occurred was contamination of the urinary catheter by the nurse Identify potential complications from using improper sterile technique during intermittent catheterization. - ANSWERS-Contamination of the urinary catheter can lead to urinary tract infection (UTI). Urinary tract infection can be very serious and possibly lead to systemic complications if it goes unrecognized and is not treated. How would you would correct the nurse's actions specific to the contamination of the sterile field? - ANSWERS-1. Make an opening Q. Are you aware you just contaminated the sterile field?

2. State the concern A. I am concerned that you may not know the difference between sterile and clean.
3. State the problem A. By touching a sterile catheter with your bare hands, the potential for infection increases.
4. Offer a solution A. Let me demonstrate the procedure with a new sterile urinary catheter kit. After I am finished, we will review the procedure steps. 5.Reach an agreement on next steps A. Let's save the contaminated kit for you to practice your sterile technique on a manikin. Which federal and state programs offer benefits to support Kim Johnson's care - ANSWERS-Centers for Medicare & Medicaid Services What priority problem(s) did you identify for Rashid Ahmed? What information led to identification of the priority problems? - ANSWERS-1) Fluid and electrolyte imbalance related to dehydration; 2) Decreased cardiac output related to fluid loss; 3) Safety related to dehydration and decreased cardiac output. What potential problems could arise if the identified fluid and electrolyte imbalances are not corrected? - ANSWERS-Complications that could occur if the identified fluid and electrolyte imbalances are not corrected include vascular collapse, renal insufficiency, and potential life-threatening arrhythmias.

What other interprofessional team members should be involved in Christopher Parrish's care - ANSWERS-Dietary, case management/patient navigator, respiratory therapist/pulmonary rehabilitation, physical therapy (PT) consult, behavioral psychology, college/dorm student health services (Registered Nurse/Nurse Practitioner) What priority problem(s) did you identify for Josephine Morrow - ANSWERS-Josephine Morrow's priority problems include chronic venous insufficiency, venous stasis ulcer, high risk for infection, and complications related to immobility. Identify in Josephine Morrow's health history any factors that predisposed her to having chronic venous insufficiency. - ANSWERS-Impaired mobility related to COPD; overweight at 198 lbs and 5 feet tall, former smoker; 80-year-old female; unhealthy diet due to inability to care for self; and history of DVT Discuss the assessment findings and diagnostic studies that correlate with chronic venous insufficiency and venous stasis ulceration. Provide the reasons behind these findings - ANSWERS-Wound assessment to include: location, color, size, temperature, drainage and odor of ulcer. Chronic venous ulcers are thick skinned, have uneven edges, and have brown pigmentation. Pulses are normal because arterial system is not involved. Diagnostic results of low HGB, total protein, and albumin support the diagnosis due to poor nutrition. Iron deposits that are left behind due to breakdown of RBCs in the skin cause the brown pigmentation (hemosiderosis). Monitor WBCs, which are currently at the higher end of normal, for indication of infection. Monitor pain level after prolonged sitting and standing. Venous ulcers tend to cause calf or lower leg pain after prolonged sitting and standing. Monitor for signs of edema as it indicates that the disease is progressing. What is the rationale for the daily dose of ASA for Josephine Morrow - ANSWERS-The patient has a history of DVT. ASA has several therapeutic properties, one of which is preventing blood clots from forming by inhibiting platelet aggregation. Therefore, daily ASA therapy is appropriate for this patient. What is the rationale for compression therapy for Josephine Morrow? - ANSWERS-With chronic venous insufficiency, the valves of the veins function inadequately, impairing venous flow. Compression therapy promotes venous and lymph return, therefore reducing edema. Research has demonstrated that wound dressings placed beneath the compression devices aid in healing. What is the rationale for performing a Braden scale assessment on Josephine Morrow?

• ANSWERS-The Braden scale identifies an individual's risk for developing pressure ulcers. Josephine Morrow has a venous stasis ulcer, which is not a pressure ulcer. However, she does have contributing factors placing her at risk for developing a pressure ulcer. Pressure ulcers develop from sustained pressure on a part of the body. This pressure impairs blood supply (oxygen and nutrients), therefore damaging the tissue. Josephine

Morrow's contributing factors to development of a pressure ulcer include malnutrition, impaired mobility, chronic conditions, advanced age, and weight. Identify the rationale for weighing Rashid Ahmed at the same time each day wearing the same clothing. - ANSWERS-Weight is the best assessment for estimating gain or loss due to fluid retention or deficit. One kg is correlated to 1 liter. Discuss the rationale for infusion of 0.9% normal saline - ANSWERS-0.9% normal saline is an isotonic solution which has the same concentration of solutes as blood. Thus, the solution "stays" within the vascular system. Identify potential patient safety issues for Rashid Ahmed - ANSWERS-Rashid Ahmed is at high risk for falls related to his postural hypotension, dizziness, and potential changes in level of consciousness. What other interprofessional team members should be involved in Rashid Ahmed's care? - ANSWERS-Primary provider and dietary. Social services may be involved related to the possibility of food poisoning What priority problem(s) did you identify for Sara Lin? - ANSWERS-Sara Lin's priority problem is pain related to coughing and deep breathing. An additional priority problem includes transitioning to managing recovery at home. Sara Lin will require education about pain control, incision, diet, and activity. What should be included in Sara Lin's education plan to assist with her pain control - ANSWERS-Patient and family education should include: 1) Pain medication choices, including safe administration and potential side effects, such as constipation; and 2) Use of alternative pain therapies (e.g., guided imagery, music, distractors). What should be included in Sara Lin's education plan related to postoperative incision care? - ANSWERS-Sara Lin may shower with soap and water, but needs to place a plastic covering over the incision to protect the incision during the shower. Explain the need to monitor for signs and symptoms of infection (e.g., fever and chills; redness, warmth, or yellowish drainage at the incision site). Explain the need for Sara Lin to notify her provider if she experiences any signs of infection, nausea, vomiting, anorexia, or increasing pain. In addition to the above education on pain management and incision care for Lin, what discharge teaching should be included specific to home antibiotic therapy (levofloxacin/Levaquin)? - ANSWERS-Review the patient information sheet on education about levofloxacin (Levaquin) and ensure patient understanding of content. Identify potential patient safety issues related to nutritional status in the care of Christopher Parrish. - ANSWERS-Pancreatic enzymes are necessary for the digestion and absorption of proteins and fats. CF patients have pancreatic insufficiency causing

inadequate enzyme secretions. Therefore, pancreatic enzymes must be taken prior to eating to enhance adequate digestion and absorption of nutrients.