Mrs. S confides in the nurse that

Mrs. S confides in the nurse that she is terrified of her husband. She reports that at times, he is so kind, and then later he is angry and has become physically abusive at times. She also reports that he frequently wakes up at night screaming and trying to crawl under the bed. 1. What does the nurse suspect? Additional questioning reveals that Mr. S has just returned to the United States following a 3-year deployment in the military. The nurse strongly recommends that Mr. S see a health care provider as soon as possible. 2. What questions might be helpful in identifying the cause of these manifestations? 3. What other manifestations would make the nurse suspect PTSD? 4. What three criteria must be met to confirm the diagnosis of PTSD? 5. Other than combat, what are some other causes of PTSD? Disorders of Nutritional Status Mr. O presents to the clinic today reporting joint pain and “just feeling run down.” He reports a lack of energy and just wants to sit and do nothing. Significant findings from the initial assessment include a blood pressure of 184/92, height of 5′11″, and a weight of 284 pounds. 1. What is Mr. O’s body mass index (BMI)? 2. According to the World Health Organization and the National Institutes of Health, what does his BMI indicate? 3. What are some potential health problems associated with obesity? 4. What are some factors that may be associated with obesity? 5. What are the types of obesity and what are the implications related to health risks? 6. What are some possible treatments for obesity? Disorders of Hemostasis Mr. D is a 32-year-old white male admitted last week following a motor vehicle accident in which he sustained a massive head injury, multiple fractured ribs, a pneumothorax, and a spinal cord injury. He has been unresponsive since admission and is completely ventilator dependent. This morning his white blood cell (WBC) count is 25,000/µL, and his temperature is 102°F. His blood pressure (BP) is now 98/50, which is a significant drop from his BP on admission, and his heart rate is 102. 1. Based on his lab results and vital signs, what does the nurse suspect? The nurse notices oozing of serosanguineous fluid from previous IV sites. The nurse alerts the health care provider (HCP) about her concern that Mr. D may be developing disseminated intravascular coagulation (DIC). 2. Based on the nurse’s assessments, what labs does she anticipate the HCP order and what findings does she anticipate? 3. What other manifestations are typically associated with DIC? 4. Discuss the pathophysiology associated with DIC. Disorders of Red Blood Cells S is a 12-year-old African American girl who is brought to the emergency department by her day camp counselor. She is in excruciating pain and keeps saying something about a crisis situation. No one has any knowledge of her previous medical history, and no one has been able to make contact with any family members. The counselor shared that she became short of breath and started reporting pain when they got to the top of the mountain they were climbing. The nurse immediately suspects a sickle cell crisis. 1. What is sickle cell disorder? 2. The nurse finally made contact with S’s mother, who confirmed that S did indeed have sickle cell anemia. What factors in the scenario prompted the crisis at this time? 3. What are other risk factors for a sickle cell crisis? S’s mother begins to cry and says, “If only I had known, I would have never had children. When she had her first crisis at 2 weeks of age, I decided then I would never have any more children since they would all have sickle cell disease.” 4. How would the nurse respond? 5. Why did S not have a crisis at birth? 6. What are some possible complications associated with repeated sickle cell crises? Mechanisms of Infectious Disease Mrs. C, aged 78 years, presents to the clinic today reporting severe pain in her side. 1. What questions could be helpful in identifying the source of her pain? Mrs. C points to a 2-inch region of pain that starts in the middle of her back and travels to the front of her rib cage. She describes the pain as burning and rates the severity as an 8. She is unable to identify any alleviating or aggravating factors. When she was getting dressed this morning, she did notice a “bump or two” on her side. Physical assessment reveals vesicles on an erythematous base that have a segmental distribution along a dermatome. 2. Mrs. C is diagnosed with shingles, and she wants to know what caused it. What information will guide the response? 3. How is shingles diagnosed? 4. Mrs. C wants to know if an antibiotic will cure the problem. How will the nurse respond? 5. Since antibiotics will not work, how are shingles treated? 6. Mrs. C wants to know what she could have done to prevent this horrible problem. How would the nurse respond? SCIENCE HEALTH SCIENCE NURSING NU 296

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