SITUATION: A Client with Pneumonia

Mary O neal is a 35 yr old executive assistant and a part time college student. On returning home from class one morning, she begins to chill. She alternates between chills and sweats all night. Staying home from work, she stayed in bed for the next day. Her fever continues and she develops a cough and a dull aching chest pain. When the cough becomes productive of rust colored sputum the following day, she seeks medical treatment from the family doctor. Debby Daniels, RN, the family practice clinic nurse, admits Mrs. Oneal to the clinic and obtains the nursing assessment. Mrs. Oneal denies any previous history of respiratory disease other than usual colds, flu, and such . She also denies any history of smoking or medication allergies. She says her symptoms began abruptly with the onset of the chills. She describes her chest pain as a dull ache that was initially substernal but now localized on her lower lateral right chest. The pain increases with deep breathing, coughing, and moving. Her cough is increasing in frequency and severity, and her sputum appears rusty brown. Her vital signs are: BP of 116/74 mmHg, Pulse of 104 and regular, Respiration of 16 and temperature of 101.8 F (38.7C). skin warm and flush with no signs of cyanosis. Respirations shallow and unlabored; respiratory excursion equal. Diminished breath sound in bases bilaterally, crackles noted in right posterior and lateral base. Faint pleural rub heard at right midaxillary line. A STAT CBC shows a wbc of 18,900/mm3; differential shows increased number of neutrophils and immature WBCs (bands). Ms. Daniels has Mrs. Oneal rinse with an antiseptic mouthwash and collect a sputum specimen for culture and a gram stain prior to seeing the physician. The physician orders a chest X-ray after examining mrs. Oneal. Based on her history, examination, and chest x-ray, he makes a diagnosis of Acute Bacterial Pneumonia, probably pneumococcal. He prescribes oral Penicillin V, 500 mg every 6 hrs for 10 days. He asks Mrs. Oneal to return for follow up appointment in 10 days and refers her back to ms. Daniels appropriate teaching.

1. Safe and Quality Nursing care Are the assessment date given in the situation enough to justify the presence of pneumonia? If not, what other data should be gathered? Do any of the factors identified in the case study increase Ms. Oneals risk for Acute bacterial Pneumonia? Enumerate the goals of treatment when caring for Mrs. Oneal with the corresponding independent nursing intervention. Prioritize appropriately.

2. Management of resources and Environment What particular interventions would be particularly appropriate to employ to prevent transfer of infection? 3. Health education Prepare a Health Education Plan for the patient with regards to her oral Penicillin use including objectives, content, teaching learning resources, time allotment, and evaluation parameters. 4. Legal Responsibilities Supposing Mrs. O neal wants the help of their local community health unit, what program of the DOH is directly involved in her paln of care? Elaborate the content of this program. 5. Ethico-Moral responsibilities How can you ensure that the pt bill of rights is respected in an out patient clinic like in the situation? 6. Personal and Professional Development Formulate an evaluation checklist to be used as a basis during the follow up appointment (after 10 days)? 7. Quality Improvement What monitoring parameters should you as a nurse routinely assess to note for the pt s progress? 8. Research Research an evidenced- based nursing research that would help Mrs. Oneal cope with her condition. 9. Record management Formulate a referral form needed when notifying the RHU nurse with Mrs. Oneal s condition 10. Collaboration and Teamwork Had Mrs Oneal required hospitalization to treat her pneumonia, interruption of her usual activities and responsibilities could lead to anxiety. Will she need referral to a psychiatrist or you as a nurse would do the counseling? If the latter, what aspects of her care would you implement.

11. Communication What would be the appropriate form of communication for an anxious patient? Explain briefly.

II. Situation: A Patient with Hyperglycemia

Mr. Jenaro is a 61 yr old Spanish speaking man who presents in the Emergency Room with his wife Dolores. Mrs. Dolores is also Spanish speaking, but understands some English. Mr jenaro complains of nausea and vomiting for two days and symptoms of confusion. His blood glucose is 796 mg/dl. Intravenous regular insulin (Novolin R) is prescribed and he is admitted for further evaluation. He will require teaching regarding his newly diagnosed diabetes.

CASE SCENARIO: Mr. Jenaro is newly diagnosed with diabetes. His hemoglobin A1C is 10.3%. Mr. jenaro is slightly overweight. He is 5 feet 10 inches tall and weighs 174 pounds (79kg). he reports no form of regular exercise. He does not follow a special diet at home. He states, I eat whatever Dolores puts in front of me. She is a good cook. For the past few months, Mrs. Dolores has noticed times a day. Neither can recall how long it has been these changes in Mr jenaro began. Dolores sates, it has been quite a while now. It just seems to be getting worse and worse.

1. Safe and quality Nsg care. Describes the ff serum glucose tests used to help confirm the diagnosis of diabetes mellitus and differentiate each: random, fasting, postprandial and oral glucose tolerance test. When evaluating Mr. Jenaro s postprandial result, what is important to consider regarding his age and tobacco use? Explain what hemoglobin A1C (HbA1C) lab test tells the health care provider.

2. Management of resources and the environment Managing the nutritional requirements of a diabetic affects the goal of managing the disease. Discuss what a food exchange list is and give examples.

3. Health Education Discuss the info the nurse and/or diabetes educator should include when teaching the pt about proper foot care. 4. Legal responsibility Discuss the dietary recommendations for a diabetic based on the diabetes food pyramid 5. Ethico-moral responsibility Discuss how culture may influence Mr, Jenaro s diabetes management in terms of food choices, diet and exercise, and used of an alternative health care provider 6. Personal and professional development Inquire about how you as a nurse be a member of Association of Diabetes Nurse Educator of the Philippines (ADNEP) 7. Quality improvement To improve care for a diabetic pt, what interventions would you employ to prevent the different causes of morning hyperglycemia. 8. Research Supposing you want to determine the relationship of health compromising behavior and diabetes mismanagement among adolescent and young adults with diabetes, what would be a possible research title? What would your problem statement be? 9. Records Mangement Prepare a form that would be filled up by a pt to facilitate his self monitoring of blood glucose (SMBG) levels. 10. Collaboration and Teamwork What community support group available for the pt to be referred to? What are the advantages of these groups that would benefit the pt? 11. Communication The nurse does not speak Spanish. Discuss what the nurse should keep in mind to facilitate effective communication using an interpreter. What is the different between the role of medical interpreter and that of a medical translator.