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Discussion

Help: Case Study Guidance

68 year old white female reports that she sometimes has trouble hearing. Judy, her daughter, reports that mom has lived alone for the past several years, doing her own cooking and caring for herself. Her daughter, Judy, who lives in another city, calls Mrs. Livingstone each week although she has not seen her mother for about 6 months. During the last phone call, Judy became concerned. Her mother seemed distracted, frequently interrupted the conversation and repeatedly said that she was "so worried." When asked what worried her, Mrs. Livingstone said, "I just don't know." She repeatedly asked the same question. Alarmed, Judy drove to her mother's home six hours away. When she arrived, Judy was shocked to see how thin her mother had become. There was little in the house to eat except tapioca pudding, gelatin and applesauce. Judy was able to figure out that Mrs. Livingstone had broken her dentures and was having difficulty chewing. She smelled of urine and it appeared that her pants were damp. Mrs. Livingstone said the coffeemaker and the TV did not work. The daughter used both and found them to be working. Mrs. Livingstone often started tasks but did not finish them, she seemingly forgot what she was doing. Often could not think of words, such as the name of the dresser in her bedroom. As evening approached Mrs. Livingstone became more agitated and was unable to sleep. She said she had to "see about the children." Often during the interview, Ms. Livingstone states that nothing wrong with me except hard of hearing and my legs don't work. I can't get to the bathroom quick enough anymore.” Ms. Livingstone denies injury, fall, dysuria, urinary frequency, fever, abdominal pain, and back pain. Her last bowel movement was yesterday and she is feeling hungry.

Medical History: HTN, CHF, Rheumatoid Arthritis

Allergies: PCN anaphylaxis

Medications: ASA 81mg qd, Motrin 800mg BID as needed, Coreg qd, Lasix 20mg qd, metoprolol 50 mg BID, Prilosec 20mg qd

Labs/Imaging: CBC – Hgb/Hct , 14.0/36.0; WBC 10,000; Plt 200,000; Differential – nml. Comprehensive Chemistry Panel normal. U/A -- ph 7.0, sp gravity 1.025, ketones neg, blood neg, nitrate neg, glucose negative. CXR – enlarged heart, no infiltrates or effusion.

PE: VS 98.9, 96, 20, 140/88; Neuro: Alert, Oriented to person. NAD, but seems a little agitated during exam. Frequently asks what are you doing during the exam? Otherwise cranial nerves intact. Lungs: CTA, no crackles or rhonchi or use of accessory muscles; Heart:S1S2, regular, Abd: BSx4, no masses or organomegaly. GU; pelvic exam normal. Underwear damp with urine.

What is the likely medical diagnosis(s)? What nursing diagnosis would be priority for this patient? What medication(s) do you expect to be prescribed? What assessments should be made prior to the patient beginning the prescribed medication treatment regimen? Assuming your diagnosis and expected medications are correct, what patient education will be important to stress for this patient and/or family (regarding medications and nursing diagnoses)? If treatment is effective, identify four expected outcomes in order of priority (from highest priority to lowest)?

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    First thing I'm going to tell you (because I don't start nursing school until Monday so I have no ideas what the answers are) is that AN is not going to do your homework, so you are going to have to provide what you already have, what are your rationales, and what exactly you need help with

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    What is your question? Surely you aren't asking for us to do your homework?

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    T.gibson, I see this is your first post and somebody probably told you that you could get help with schoolwork here. This is true.

    However, it is not true that you can get all the answers to your homework questions here, because you can't. Some, yes, maybe even many. And because we care about you learning AND because part if nursing school is learning how to learn in more ways than hitting "Send," we will insist upon you showing us what efforts you have done on your own behalf.

    So, in this case, you have cut-and-pasted your assignment. Now, you show us what you think, why, and how you found that information-- your textbook(s), nursing journals, clinical experiences, supporting info from your prerequisites (like anatomy, physiology, and the like).. If you haven't taken those yet, look those up and think about how you would apply them.

    Then you tell us what you aren't clear about, and we lead you to the ways to figure it out. This way, you learn, and others reading your thread learn not just the answer to this specific scenario, but how to approach similar ones in your academic and working future.

    Now, as to your specifics. Your last paragraph is full of classic questions for nursing education. This is because, well, this is what we do. Start with the first one: what is likely wrong with this lady? When you answer that, you look that up in your med/surg book and your physiology book and your pharmacology book to start to get a handle on things. This will take you some time, and doing it you will learn how all these things are interrelated.

    Then you you will go to the AllNurses Search bar at the top of this page and type in "GrnTea NANDA nursing diagnosis" and "Esme nursing diagnosis," and read what we teach students about that, and see how students work with it.

    If you do these things, I promise you will be on your way to a successful nursing education. And you will know how to ask your own questions, and let us help you with what puzzles you. That's the beginning of nursing collegiality, another thing you'll learn in school.

    Welcome to AllNurses.

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