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HOW VALUES AFFECT CHOICES: STUDENT INTEGRITY 3
Culture and Health Care System
Should be 0ne page.
should be submitted in APA style (7th edition)
Requires at least 2 outside source (Please choose a reliable source, sources such as Wikipedia are unacceptable.
You are working in an ICU where a 16-year-old girl is in critical condition after an auto accident. Her mother comes in and begins to sing, sprinkle tobacco around the bed, hang eagle feathers and crystals around the room, and move her hands back and forth above the girl’s body. The girl’s nurse tells the mother that visiting time is over and that she should take all these dirty things out of the room. The mother insists on staying by the bedside and says that if she had placed rosary beads or Bibles in the room she would not have been questioned.
· What cultural and spiritual issues are evident in this situation?
· Apply cultural competence to this case
· Discuss complementary therapies evident in this situation
· How would you incorporate spiritual care?
· How would you approach this situation?
· What principles would guide you?
Clinical Day 6- Outline
NUR2349 PN I
Infection
1. Morning Simulation Preparation 0830
0. Watch the following videos:
0. CDC 0:33
0. https://www.youtube.com/embed/H_IArvYx_vo
0. Recognize Sepsis Early- Lippincott 4:35
1. What is MRSA? 3:58
0. https://www.youtube.com/watch?v=oN0nJC_6pGg
1. Morning Simulation 0845
1. Each student will watch all 3 simulations.
1. There is a clinical companion to follow for each one- fill in your answers to those questions.
1. OSCE Clinical Skills Videos- Headache
0. https://batesvisualguide.com/MultimediaPlayer.aspx?multimediaid=14727422
0. Bates’ Visual Guide to Physical Examination- OSCE Clinical Skills Video
1. If these videos do not work from the link, then go to the Online School of Nursing page scroll down to ADN and click to open the courses Open Health Assessment Click on the tab General Survey then choose General Survey and Vital Signs in Adult Videos this will open the Bates’ Visual Guide to Physical Examination Click on the tab OSCE Clinical Skills Videos
1. Montgomery College Simulation Video: Sepsis
1. 360o Simulation: Caring for a Septic Patient (this one is really cool- interactive, you can move the camera view)
2. (Part 1) 8:42 https://www.youtube.com/watch?v=3E9HF39O2y0
2. (Part 2) 6:48 https://www.youtube.com/watch?v=AK77PipelRk
2. (Part 3) 5:07 https://www.youtube.com/watch?v=XardU0rCKnE
Bates’ Physical Exam Case #13
David is a 21-year-old college student who comes into the provider’s office with a complaint of headache. As you watch this encounter, you will be asked to answer questions while the image on the screen freezes. These questions will engage you in practicing the skills of focused history taking, physical examination, and clinical reasoning as you develop your preliminary differential diagnosis.
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You are expected to develop three diagnoses with supporting history and physical examination findings, and to list the diagnostic workup studies you would order.
You will have time to record your findings and receive feedback. You may go back to review the video again. |
What are 3 potential diagnoses? Explain your rationale to support each diagnosis. |
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What symptoms does he offer? |
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Summarize how David describes his headache. |
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What other associated symptoms does he report? |
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David’s vital signs are: BP 100/60 HR 100 RR 20 T 99.1
Are any of these vital signs abnormal or concerning? If so, why? If not, why not?
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What areas of the assessment are important to complete at this time? |
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What abnormal assessment findings are identified? |
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Describe the Babinski reflex. Why is this important? |
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Describe the Brudzinski sign. Why is this important? What does a positive sign indicate? |
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Describe the Kernig sign. Why is this important? What does a positive sign indicate? |
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Now that you have obtained information and completed the assessment on David, what are 3 potential diagnoses? List in order of priority and give your rationale. |
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What are 3 diagnostic studies you will complete? List in order of priority. What is the purpose of each diagnostic study? |
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360o Simulation: Caring for a Septic Patient
Mr. Jerry Smith, 59 y/o male, arrives via ambulance to the emergency department. He reportedly has a fever. EMS inserted a 22 g IV to the left hand and Normal Saline is infusing.
Hx- Paraplegia, HTN
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EMS Vital Signs:
BP 140/80 HR 110 RR 16 SpO2 98% Room Air |
Patient is met by the ED team. He reports a fever since the morning, staff gave him one ES Tylenol and he says “I think it helped a little”.
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Currently the patient denies pain.
He has an indwelling urinary catheter.
He reports that his paraplegia starts at the level of his umbilicus.
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What are the initial assessment findings by the nurse? Doctor Barker?
Are you concerned about this patient upon arrival to the ED? Please explain your rationale.
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The nurse is attempting to insert an IV, but the patient has poor vascular access. After a couple attempts, the nurse was able to obtain some of the blood for labs.
What problems can this lead to?
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Mr. Smith has reported that he was hospitalized for a UTI about one year ago. He has had the indwelling urinary catheter in place since his accident about 5 years ago. His current catheter has been in place for one month.
How often should a urinary catheter be changed?
How do you obtain a urine sample from the catheter?
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Dr. Barker states the patient has SIRS criteria and has ordered the following: CBC CMP Lactate Blood cultures Urinalysis and urine culture Chest X-ray
What would you expect to find that is consistent with infection?
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Since this is a small hospital, they utilize eICU nursing. The patient is started on Zosyn 3.375 Gm for the UTI and previous history of pseudomonas. They added Vancomycin one gram for antibiotic coverage for the sacral wound. Staff still have not been able to obtain additional IV access, so Dr. Barker places an intraosseous line in the left humerus. The patient is given IV fluids at 30 mL/kg. The patient weighs 100kg. How much IV fluid should he receive? Over what period of time?
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While monitoring the patient, the eICU nurse alerts the staff to a change in the patient’s mental status. After his IV fluids have infused his BP remains low. |
Dr. Barker has ordered the patient to be transferred to the larger hospital. Additionally ordered Norepinephrine 4 mcg/min, and to titrate to keep the MAP > 65 mmHg.
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Calculate the infusion rate for the Norepinephrine 4 mcg/min.
Available is 8mg in 250 mL % Dextrose.
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www.CrosswordWeaver.com
ACROSS
1 an acute state that often requires hemodynamic monitoring
2 written document needed prior to the procedure
3 this is calulated by multiplying the heart rate by the stroke volume
8 the force that stretches muscle fibers of the resting heart
10 what happens to the PAWP in hypovolemia
11 the PAWP measures pressure of which ventricle
13 study of motion of blood through the body
14 what should be done to the transducer every 4 to 12 hours
15 this index is a more precise measurement of cardiac function
DOWN
1 the volume that is pumped out of the heart with each beat
2 measurement of the right heart filling pressure
4 the resistance that the ventricle must overcome
5 the position the balloon should never be left in
6 the technique used during the insertion process
7 which ventriclular preload is reflected by the PAWP
9 the most common artery used for an arterial line
12 which ventricle is more thin walled and compliant

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