John King, 60 years of age, is a male patient who is admitted

Case Study, Chapter 34, Management of Patients With Hematologic Neoplasms

1. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple
myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is
scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and
should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The
patient has hypercalcemia. The patient’s uric acid level is elevated. The patient has orders for
zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen,
and Vicodin. (Learning Objective 5)

a. What nursing management should the nurse provide the patient?

b. Explain the indication and action of the various medications ordered to treat the patient’s
symptoms.

2. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia
(AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized
pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On
physical assessment, you find her liver and spleen to be enlarged on palpation. (Learning
Objective 3)

a. What laboratory results would you anticipate due to her ecchymosis and petechia?

b. Why would it be important to inspect her gums and teeth?

c. Why is her liver enlarged?

Case Study, Chapter 37, Management of Patients With HIV Infection and AIDS

1. The nurse is planning to provide education on HIV infection transmission and prevention
strategies at a local senior center. (Learning Objectives 1 and 4)

a. What should the nurse include in the session considering the needs of the older
population?

2. Sallie Jefferies, 28-year-old patient, is at the obstetric clinic for a pregnancy visit. The
physician informs the patient that her HIV screen test is positive. The patient has no evidence of
AIDS. The nurse provides patient education regarding what HIV is and what the clinical
management entails. (Learning Objective 5)

a. What clinical management is recommended for the patient during the pregnancy to help
decrease the risk of transmitting HIV to the unborn child?

b. The patient asks the nurse how zidovudine (Retrovir) will help her unborn child from
getting HIV. How should the nurse respond?

c. What explanation about Retrovir should the nurse provide?

d. The patient asks the nurse if it will be safe to breast-feed her infant after the delivery. The
nurse should provide what explanation?

e. The patient asks the nurse what testing schedule for the HIV antibody is needed after her
baby is born. How should the nurse respond?

Case Study, Chapter 31, Assessment and Management of Patients With Hypertension

1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the
diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly
because of the cost of the medications and she recently lost her job to outsourcing. The patient is
slightly drowsy and complains of a headache and blurred vision. The patient’s blood pressure is
220/130 mm Hg upon presentation.
(Learning Objective 6)

a. According to the definitions set by the Seventh Report of the Joint National Committee
on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type
of hypertensive crisis is the patient currently experiencing?

b. Describe the treatment goals for handling the hypertensive crisis and apply the goals to
the case study. Determine the current mean arterial pressure (MAP) and the goals for
treatment.

The physician orders nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV
starting at 2.5 mg/hr, and titrate by 2.5 mg/hr every 15 minutes to reach the goal for the first
hour, which is to achieve 25% reduction of the initial MAP.
 Call the physician if the dosing range of 15 mg/hr has been reached and the MAP is still
not at target goal for the first hour of treatment, or up to four dose increases.
 Lower the BP within 6 hours to 160/100 mm Hg.
 Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100
mL/hr, in total. Call the physician if the IV fluids must go above 100 mL/hr to provide
the nicardipine.
c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids.
d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP
goal of 25% reduction of the original MAP.

2. The community health nurse is preparing a program about hypertension for a local community
center. The focus of the program is on the reduction of risk factors and compliance for those who
have been diagnosed with high blood pressure. The target population includes older adults.
(Learning Objectives 1 to 4)

a. The nurse focuses on primary hypertension because it accounts for 90% to 95% of
hypertension in the United States. What risk factors does the nurse include for this
population?

b. The nurse prepares to discuss the changes in how the JNC 7 defines hypertension.
What ranges and descriptions should the nurse include?

c. Because this is a gerontologic audience, the nurse needs to review why blood pressure
increases with age. Explain how the structural and functional changes of aging
contribute to higher blood pressure in the older adult.

d. What information does the nurse include about lifestyle modifications that may
decrease risk of hypertension (or complications associated with diagnosed
hypertension)?

Case Study, Chapter 23, Management of Patients With Chest and Lower Respiratory Tract
Disorders

1. Harry Smith, 70 years of age, is a male patient who is admitted to the medical-surgical unit
with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3
years ago. The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago. The
patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The
patient presents with confusion as to time and place. The family stated that this is a new change
for the patient. The admission vital signs are as follows: blood pressure 90/50 mm Hg, heart rate
101 bpm, respiratory rate 28 breaths/min, and temperature 101.5°F. The pulse oximeter on room
air is 85%. The CBC is as follows: WBC 12,500, platelets 350,000, HCT 30%, and Hgb 10 g/dL.
ABGs on room air are pH 7.30, PaO 2 55, PaCO 2 50, HCO 3 25. Chest x-ray results reveal right
lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural
effusion in the right lower lobe. Lung auscultation reveals severely diminished breath sounds in
the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the
lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot
finish a short sentence before the respiratory rate increases above the baseline and his nail beds
and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic
and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum.
(Learning Objective 3)

a.  What nursing assessment findings support the diagnosis of pneumonia?

b. What diagnostic findings support the diagnosis of pneumonia?

c. What NANDA nursing diagnoses should the nurse formulate for the patient?

d. What goals should the nurse develop for the patient?

e. What overall interventions should the nurse provide?

2. Marie Perez, a 53-year-old patient, is day 1 after a gastric bypass. She complains of shortness
of breath; her respiratory rate is 30 breaths/min, heart rate is 110 bpm, pulse oximetry 89% on
room air, temperature is 100°F, and her blood pressure is 90/50 mm Hg. She complains of
feeling anxious and having stabbing chest pain which gets worse with inspiration. She complains
that she feels like she is going to pass out or possibly die.
(Learning Objective 7)

a. What could possibly be going on with the patient and what measures should the nurse
provide immediately?

b. What risk factors does the patient have for a pulmonary embolus?

c. What measures are appropriate to manage a pulmonary embolism?

a. What measures are appropriate to help the patient in this case study prevent the
reoccurrence of a pulmonary embolism?

Case Study, Chapter 29, Management of Patients With Complications From Heart Disease

1. George Brown, 72 years of age, is a male patient who is admitted with the diagnosis of acute
pulmonary edema secondary to acute left ventricular heart failure. The patient has a history of
coronary artery disease that has been treated medically. The patient is anxious, pale, cold,
clammy, and dyspneic. The vital signs are: blood pressure 88/50 mm Hg, heart rate 110 bpm,
respiratory rate 32 breaths/min, and temperature 97°F. There are bubbling crackles and wheezing
throughout the lung fields and the patient is raising frothy blood-tinged clear sputum. The
patient’s admission weight is 100 kg.

a. What first actions should the nurse take and what are the rationales for these actions?
The physician ordered furosemide (Lasix) 40 mg IVP STAT.

b. What are the actions of furosemide that will help the patient?

c. What nursing actions should be implemented when administering a diuretic?

2. Carl Edwards is a 75-year-old man with congestive heart failure. Having sustained three
myocardial infarctions in the last 10 years, he has decreased left ventricular function. Mr.
Edwards takes Digoxin, Capoten, Coreg, and Lasix for management of this disease. Today he
presents to the emergency department with fatigue, generalized weakness, and feelings of
“skipping” heartbeats. Upon arrival, he is placed on the cardiac monitor, his vital signs are
assessed, and an IV is inserted. He currently denies chest pain, but is experiencing some
shortness of breath, and is placed on 2 L of oxygen via nasal cannula.

a. Which of his medications might be contributing to his symptoms of generalized weakness
and heart irregularities?

b.  For what clinical manifestations should you assess to correlate to his left-sided heart
failure?

c. How do his medications treat his congestive heart failure?

d. How does the hypokalemia affect the effects of Digitalis?

Case Study, Chapter 39, Assessment and Management of Patients With Rheumatic
Disorders

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of fibromyalgia
syndrome. The nurse at the clinic obtains a history and physical assessment of the patient.
(Learning Objective 2)

a. On what areas should the nurse concentrate when interviewing the patient during the
history process?

b. On what areas should the nurse concentrate when assessing the patient?

c. What diagnostic tests are used with fibromyalgia syndrome?

2. Julie Walker, a 22-year-old patient, is newly diagnosed with systemic lupus erythematosus
(SLE). She presented with extreme fatigue; muscle and joint aching and swelling; a butterfly-
shaped, flat, red rash across the bridge of the nose; patchy alopecia; a low-grade fever; and loss
of appetite. Further workup revealed a positive antinuclear antibodies (ANA) titer, anemia,
leucopenia, and mild thrombocytopenia. She has an abnormal lipid profile, proteinuria, and
hypertension. The liver and renal profiles are within normal range. The physician ordered over-
the-counter ibuprofen as needed for joint discomfort, but not to exceed 1,200 mg/day;
hydroxychloroquine sulfate (Plaquenil) before meals at the same time each day; and prednisone
in tapering doses over the next month. The physician also started the patient on lisinopril, an
ACE inhibitor for the hypertension and a statin for the elevated lipids. The clinic nurse is asked
by the physician to provide patient and family education. (Learning Objective 5)

a. What teaching-plan topics should the nurse provide for the patient?

HEAD TO TOE ASSESSMENT as part of your NCP

Watch www.youtube.com/watch?v=gG8kh8MfnGY
HOW TO WRITE:  YOU ARE TO CREATE A PICTURE OF YOUR PATIENT
These are topics for you to consider documenting as applies to your client.
General appearance:
 Affect/behaviour/anxiety
 Level of hygiene
 Body position
 Patient mobility
 Speech pattern and articulation
This is not a specific step. Evaluating the skin, hair, and nails is an ongoing element
of a full  body assessment as you work through steps 3-9.
2. Skin, hair, and nails:
 Inspect for lesions, bruising, and rashes.
 Palpate skin for temperature, moisture, and texture.
 Inspect for pressure areas.
 Inspect skin for edema.
 Inspect scalp for lesions and hair and scalp for presence of lice and/or nits.
 Inspect nails for consistency, colour, and capillary refill.
Head and neck:
 Inspect eyes for drainage.
 Inspect eyes for pupillary reaction to light.
 Inspect mouth, tongue, and teeth for moisture, colour, dentures.
 Inspect for facial symmetry.
4. Chest:
 Inspect:
o Expansion/retraction of chest wall/work of breathing and/or accessory muscle
use
o Jugular distension
 Auscultate:
o For breath sounds anteriorly and posteriorly
o Apices and bases for any adventitious sounds
o Apical heart rate/rhythm
 Palpate:
o For symmetrical lung expansion
 Breasts

Abdomen/GI:
 Inspect:
o Abdomen for distension, asymmetry
 Auscultate:
o Bowel sounds (RLQ)
 Palpate:
o Four quadrants for pain and bladder/bowel distension (light palpation only)
 Check urine output for frequency, colour, odour.
 Determine frequency and type of bowel movements.
Genitourinary:
Check urine output for frequency, colour, odour.
Female: vaginal discharge
Male: circumcision, discharge
Musculoskeletal:
 Check if full or partial weight-bearing.
 Determine gait/balance.
 Determine need for and use of assistive devices.
Inspect:

o Arms and legs for pain, deformity, edema, pressure areas, bruises
o Compare bilaterally
 Palpate:
o Radial pulses
o Pedal pulses: dorsalis pedis and posterior tibial
o CWMS and capillary refill (hands and feet)
 Assess handgrip strength and equality.
 Assess dorsiflex and plantarflex feet against resistance (note strength and equality).
Back area (turn patient to side or ask to sit up or lean forward):
 Inspect back and spine.
 Inspect coccyx/buttocks.
Tubes, drains, dressings, and IVs:
 Inspect for drainage, position, and function.
 Assess wounds for unusual drainage.

Sample format for documentation:

General Status
Vital signs
Head, Ears, Eyes, Nose, Throat
Neck
Respiratory
Cardiac
Abdomen/GI
GU
Pulses
Extremities
Skin
Neurological

Writing these case studies you are creating a review tool for when you are in HESI/NCLEX
prep.  The time and effort invested in completing these fully is an investment in your success.
Complete each case study utilizing collegiate, essay format, New Times Roman, 12 point font
double spaced.
Each chapter has 2 case studies to be completed; typed in Cambria or New Times Roman 12 point
font in ONE document.  Citations required.
Include the case study and questions in your response.  Place your answer to the question
directly below the question being answered.
Objective: the student will demonstrate gained knowledge of the disease process and apply it using
critical thinking skills to the specific data in the case study.
Case studies and NCPs are case specific. Your answers should reflect the assessment and your
analysis of the information in the case study… no generalized answers of all matters regarding the
content.
Your answers should reflect the critical thinking and application of knowledge gained.
These case studies count toward your Final Grade for Medical-Surgical Nursing.
Submit your work as you complete it.  Each case study in a separate email.
Do not send all the case studies at once, this keeps your progress moving.  If you send all at once
you will wait till all are read and corrected before receiving new modules. Submit each case study
in an individual email.

NURSING CARE PLANS (NCP)
NCP are to be written using the included Rubric. Do NOT use a grid format… use an “essay” style
format.
Complete one NCP per unit using one case study of your choice from the ones already completed.
For MS1/Adult 1 = 4 NCPs. Only choose case studies that include a client.

Format: New Times Roman, 12 point font double spaced.          Include the case study.
NCP are to be written using the included Rubric. Do NOT use a grid format… use an “essay” style
format or bullet point using the included Grading Rubric.
Send case studies in a separate email from NCPs or other work.
Submit finished case studies Please allow 7 business days for an email response to your submitted
work as they are read and commented upon.  DO not send all at once.. You will likely get them all
back. Send one a time.
Submit each case study/NCP  in an individual email. Do not submit all case studies/NCP in one
document.
Submit your first case study or NCP to receive feedback of your work before completing all.  This
will help to prevent re-doing it.

These are not group assignments. They are to be completed individually.

Case studies and NCPs may take me up to 7 business days to return.
Preview

 

NURSING CARE PLAN RUBRIC
Include the case study in your document.

Do not write the NCP using a grid format… use an essay format/ bullet point using the numbers
of this rubric.

All NCP will be graded according to the following rubric.
1) Definition of the medical diagnosis __________10
etiology/pathophysiology
2) Common signs and symptoms ___________5
3) Potential complications ___________5
4) Head to toe physical assessment you are to write one….use the data in the case if there is
none you create it as if this was your patient.

____________10

5) Diagnostic and lab studies ___________5
normal values
expected abnormalities
6) ALL NANDA Nursing diagnoses             __________10
https://nurseslabs.com/nursing-diagnosis/
https://ar.israa.edu.ps/uploads/documents/2020/02/4gcM0.pdf

7) Develop 3 NANDA priority nursing diagnoses __________10
8) State a patient plan/goal for each of the __________10
3 priority nursing diagnosis
9) Write interventions for each of __________10
3 priority nursing diagnosis
10) Write scientific rationales for your ___________5
interventions
11) Write evaluation of your interventions __________10
or make changes

12) List of typical medications __________10
category
usual dosage
side effects
patient teaching

MEDICAL SURGICAL 1, ADULT NURSING 1, 2 AND 3 SYLLABUS

Students will receive this work in 3 parts as MS1/ Adult 1, Adult 2 and lastly Adult 3. All work due for each
part will be posted at one time.

Course Description: The continuing nursing student will integrate content from classroom learning
activities and skills lab when caring for individuals with commonly occurring human responses
progressing to less commonly occurring responses to health challenges. Practice involves, but is not
limited to: well childbearing families, adult, geriatric clients in a variety of settings within the community.
Special fee required. Course Learning Outcomes: As a result of taking this course, using commonly
occurring and progressing to less commonly occurring human responses to health challenges from within
the concepts of oxygenation, cellular integrity, regulation, sensory/ perception/cognition, and mobility, the
student will be able to:
1 Apply the nursing process in the care of clients across the life-span utilizing the principles of growth and
development.
2 Utilize theories of Holism and Goal Attainment while implementing the nursing process.
3 Describe interventions based on personal, interpersonal and social system transactions to promote
optimum health in acute care, and community health settings.
4 Identify effective communication skills utilized with clients, families and interdisciplinary health team
members, to meet the identified health teaching/learning needs of individuals with commonly and
selected less commonly occurring human responses to health challenges
5 Utilize critical thinking in the development of nursing plans of care in diverse settings to client
populations across the lifespan to facilitate the ability to facilitate wellness and the ability to progress to an
optimum level of health.
6 Apply ethical and legal concepts relevant to the practice of professional nursing.
7 Initiate leadership and management skills necessary for effective delegation and supervision of peers,
LPNs and UAPs.
8 Apply the principles of nutrition and diet therapy to promote wellness in individuals with selected
commonly and less commonly occurring human responses to health challenges.
9 Identify safe, accurate, technical skills in rendering direct client care across the lifespan, demonstrating
proficiency in use of computer technology.
10 Incorporate health care teaching as appropriate across the lifespan assisting clients and their families
to attain and maintain wellness or an optimum level of health.
11 Describe the flexibility of nursing roles as a member of the health care interdisciplinary team in acute
care settings and diverse settings.
12 Distinguish the pharmacologic interventions for client populations experiencing selected commonly
and less commonly occurring human responses to health challenges.

REQUIRED TEXTBOOKS AND RESOURCES:
Medical-Surgical Nursing required textbooks:

Medical Surgical AND ADULT NURSING

Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Thirteenth
Edition <http://thepoint.lww.com/Book/Show/402801>

Janice L. Hinkle; Kerry H. Cheever
*ISBN: *978-1-4511-3060-7
Recommended:
Pharmacology
This textbook is also used for the Pharmacology course.

Focus on Nursing Pharmacology, Sixth Edition

<http://thepoint.lww.com/Book/Show/287300> Amy M. Karch
*ISBN: *978-1-4511-2834-5

Resources required:
HESI Case Studies: Complete RN Collection 1 Year Version), 1st Edition

SAUNDERS COMPREHENSIVE REVIEW FOR NCLEX RN 8TH EDITION

Class requirements for completion:
Complete all web-assisted exams with a score of 85% or better
Submission of case studies
Submission of 1 per unit (except unit 73) NCPs
Saunders Comprehensive for NCLEx-RN exams; submit corrections as posted on your Edubrite account:
these are will be added in Adult 3
HESI case studies; Medical-Surgical  submit snapshots of your scores: these are will be added in Adult 3
Satisfactory completion of the clinical experience when assigned your clinical time.
The student may be assigned to sit the Medical/Surgical competency exam at the discretion of the
instructor/professor.