You are caring for a 17-year-old female African American patient with sickle cell disease who has been admitted for treatment of sickle cell crisis. Sickle cell disease is a genetic abnormality that affects hemoglobin in the red blood cells. The defect is found primarily in African Americans. In a sickle cell crisis weakened red blood … Read more
Mrs. Andrews did well after her spinal surgery and was discharged home on the third postoperative day. Two weeks later she told her family that she was having increased pain in her back. She stated that she was not always wearing her back brace as instructed at the time of surgery because “it makes me … Read more
Mr. Coburn, the 56-year-old school teacher who was seen earlier in the week for hyperthermia, arrives at the walk-in health center complaining of feeling dizzy and nauseated. You immediately note that he appears to be having some difficulty catching his breath during coughing spells. A new graduate nurse takes Mr. Coburn’s admitting vital signs as: … Read more
You receive morning report for Ms. Malone, age 63, admitted to the hospital yesterday with fatigue, a cough, and dyspnea; she is diagnosed with chronic heart failure. She states that she had increasing difficulty with shortness of breath and swelling in her legs. Pedal pulses are +1 bilaterally. On auscultation you hear bilateral crackles in … Read more
On the second postoperative day you enter the room and find Mrs. Johnson crying. She states that she has just gotten off the phone with her 23-year-old daughter and has agreed to care for her 3-month-old granddaughter while the daughter returns to work. You were informed in shift report that Mrs. Johnson had a restless … Read more
As a part of your home care experience, you are assigned to visit Mrs. Johnson who, in addition to caring for her infant granddaughter, is also caring for her mother, who is increasingly agitated and aggressive secondary to Alzheimer’s disease. When you go to the home, you find Mrs. Johnson tearful. She says, “I can’t … Read more
Jose continues to regularly visit the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) clinic. The nurse wants to incorporate a spiritual assessment with the physical assessment. During the assessment the nurse asks Jose if he has any questions. Jose asks her about a Buddhist ritual that he heard about from a friend. The nurse has … Read more
Carl is admitted to the hospital with a fractured hip sustained from a fall when he got up during the night to check on Evelyn who was wandering in the house. Before his injury he cared for Evelyn, who suffers from advancing Alzheimer’s disease. While he is hospitalized, Evelyn stays with a niece who lives … Read more
Mrs. Smith has experienced some success in initiating an exercise program. However, maintaining her exercise plan is becoming challenging, and she is not seeing the improvements that she expects. She states, “I feel like I’m doing everything right, but I’m getting few results for my efforts.” · Mrs. Smith states, “I don’t want to … Read more
Forty-eight hours after admission to the hospital, Mr. Edwards had abnormal lung sounds (crackles) in the left base and both upper lobes. His vital signs were as follows: temperature, 102.4° F (39.1° C); blood pressure, 140/92 mm Hg; pulse, 110 beats/min; respirations, 32 breaths/min; and SpO2, 82%. He could not lie flat, and it was … Read more