Unit 1 Clinical Questions
A physician orders Tylenol for a temperature greater than 101 degrees F. The patient's temperature is 100.4 F. Explain the rationale for not medicating a fever of 100.4 F.
A mild or moderate fever benefits the body. Fevers help reduce the bacteria production.
What is the most important nursing intervention when caring for a patient with Cushing's syndrome?
Because of enhanced anti-inflammatory effects, infections may become overwhelmingly severe. Therefor the nurse should protect the client from infection.
A 36-year-old man enters the hospital in an extremely debilitated condition. He has purple-brown skin lesions (a symptom of Kaposi's sarcoma) and a persistent cough. A physical examination reveals swollen lymph nodes, and laboratory tests find a very low lymphocyte count. Information taken during the personal history reveals that he has multiple sex partners with whom he frequently engages in unprotected sex. What is likely to be the man's problem and what is his outlook?
He is probably suffering from AIDS and his outlook is poor once it has reached this advanced stage.The disease wipes out your entire immune system. There is no cure.
Why would there be cause for concern if a young pregnant mother is Rh-, her husband is Rh+, and this is their second child?
If the second child is Rh+ and the mother did not take RhoGam, there is a chance that the child will develop erythroblastosis fetalis and die before birth.
Explain how antidiuretic hormone can help regulate an abnormal increase in solute concentration in the extracellular fluid.
It can cause re-absorption of water by the kidney. With re-absorption blood water volume increases, decreasing solute concentration.
A young girl requires a liver transplant due to failure of her liver to function. What is required for her to have a good prognosis and why?
It is good to try and match the tissues and blood type of her and the donor as best one can. Also she must receive immunosuppressive therapy to keep the body from rejecting the new liver.
Max is bitten by a rattlesnake while on a camping trip. His friends immediately apply ice packs to the bitten area to slow the spread of the protein-based toxin; they then rush him to an emergency facility. What treatment would be given and why?
Max should be given an epinephrine shot as well as anti-venom. They should also try to identify the snake.
A 52-year-old woman was diagnosed with leukemia and has been receiving chemotherapy as an outpatient. She tells the RN that she hasn't been feeling well. The patient's skin is warm to the touch and she has a low-grade fever of 100.2°F. The neutrophil blood count is less than 1000/μl. The nurse is concerned about the possibility of infection because of the neutropenia and low-grade fever. Explain why.
Neutropenia is a concern because of the neutrophils role in the phagocytosis of bacteria. A low-grade fever suggests that the patient has an infection, and an infection with someone who has neutropenia is a major concern for survival.
A man involved in a traffic accident is rushed to the emergency room of a hospital with severe internal bleeding. Examination reveals a ruptured spleen. What is the treatment of choice and what is the likely long-term outcome (prognosis)?
Spleenectomy is not as necessary as once believed. If the spleen doesn't need to be removed the prognosis is very good, as the spleen can repair itself. Functions of the spleen are taken over by the liver and bone marrow.
A nurse palpated enlarged lymph nodes. Describe signs and symptoms that help to distinguish cancerous lymph nodes from infected lymph nodes.
Tender nodes are usually due to inflammation (warm), whereas hard, fixed nodes are suggestive of malignancy (cold).
Thomas is a diabetic. While at work, he began to tremble, was somewhat disoriented, and showed signs similar to that of a drunk. One of his colleagues gave him some hard candy, which seemed to help him return to normal functions. Why? Was this a proper action, considering that Thomas is diabetic?
The candy raised his blood sugar back up to a normal level. This was a proper action because he was hypoglycemic.
Mrs. James appeared at the clinic complaining of extreme nervousness and sweating, saying that she could feel and hear her heart thumping when she tried to sleep at night. She was found to have a severely elevated and fluctuating blood pressure. Although laboratory testing revealed hyperglycemia and increased basal metabolic rate, tests of thyroid function were normal. What is your diagnosis? What treatment should be used?
The diagnosis is hypersecretion of catecholamines, sometimes arising from a rate chromaffin cell tumor called a pheochromocytoma. Treatment is removal of the tumor and or irradiation of the adrenal medulla.
The parents of a 17-year-old boy are concerned about his height because he is only 5 feet tall and they are both close to 6 feet tall. After tests by their doctor, a certain hormone is prescribed for the boy. What is the probable diagnosis, and what hormones were prescribed? Why might the child still expect to reach his growth potential?
The diagnosis is insufficient growth hormone. The prescription is commercial pituitary growth hormone. The reason the child still might reach his growth potential is that the epiphyseal plates of the long bones have not yet closed, allowing for additional growth.
A man of Mediterranean ancestry goes to his doctor with the following symptoms. He is very tired all of the time. He has difficulty catching his breath after even mild exercise. His doctor orders the following tests: CBC, hematocrit, differential WBC count. The tests show immature erythrocytes, fragile erythrocytes, and less than 2 million RBCs per cubic millimeter. What would be a tentative diagnosis and suggested treatment?
The diagnosis is thalassemia. The treatment is blood transfusions.
While passing through a village on safari you notice a man with one enormous leg and one normal-sized leg. What could have caused the increased size of the swollen leg?
The man has elephantiitis, which is caused by parasitic worms that get in the lymph system and reproduce to proportions that block the vessels. The swelling is due to edema.
After receiving penicillin intravenously, a 32-year-old male patient has an anaphylactic reaction. The nurse understands that therapeutic management includes what critical items?
The nurse must mainly maintain an open airway because the bronchiolles constrict making it difficult to breathe. The patient should also be given antihistamine or epinephrine.
A 25-year-old male was admitted to the medical/surgical unit with a blood glucose of 600 mg/dl. On assessment, the nurse observed his breathing was deep and rapid, and his breath smelled of acetone. His face was flushed and his skin was dry. His pH was low. Describe the physiological response that is occurring.
The patient has diabetes mellitus. Keytones, the strong organic acids are accumulating faster than they are being used or excreted causing the blood pH to drop. He is experiencing ketoacidosis and keytones are spilling into his urine.
Nursing care of a patient with acquired immune deficiency syndrome (AIDS) includes monitoring of T lymphocyte counts. Explain why.
The primary deficit in patients with AIDS is the depletion of helper T cells, and therefor cell mediated response. The immunodeficiency makes the patient more susceptible to infection.
A 17-year-old black male is admitted to the hospital in sickle-cell crisis. Pain management is a top priority for patients in sickle-cell crisis. Explain why.
The sickled cells tend to pile up in the capillaries and smaller blood vessels, making the blood more viscous. Normal circulation is impaired, causing swelling and severe pain.
A mother takes her son to the doctor and describes the following symptoms that she has observed. The child is running a fever, has flu-like symptoms, and his lymph glands are very swollen and sore to the touch. Of what significance are the swollen and sore lymph glands?
The tissues are inflamed due to a bacterial infection. Lymphatic capillaries develop openings that permit the uptake of pathogens.
An elderly patient tells the nurse that she has been very tired lately and has difficulty walking to her mailbox without getting very short of breath. The nurse notes the mucous membranes are pale. The patient states that since her husband died three months ago, she has not been eating well. The physician confirms that she has iron-deficiency anemia. How are the patient's clinical manifestations and iron-deficiency anemia related?
They are attributed to the reduction int he amount of oxygen available to the tissues because of iron deficient anemia. The iron deficiency is most likely coming from not eating well after her husband died.
Describe why the prognosis of cancer is best when there is no detectable spread from the region of the primary tumor to the lymph nodes.
When cancer cells break free from the primary tumor it can metastasize via the meandering network of lymphatic vessels that make up the lymph system.
Following workup for symptoms of decreased libido and erectile dysfunction, a patient is told that his pituitary is hypersecreting prolactin. Is there need for concern about this young man?
Yes. There should be great concern because hypersecretion of prolacin will lead to impotence.
A 68-year-old male is admitted to the hospital for emphysema. He is hypoxic and his lab tests reveal low oxygen levels. His hematocrit is 65%. The physician has told him that he has a type of polycythemia in which he has an increased number of erythrocytes circulating in his bloodstream. The patient tells the nurse that he does not understand what that means. How would the nurse explain this in terms the patient could understand?
You have decreased oxygen levels in your blood, so your body has responded by producing more RBCs, causing this polycythemia, just meaning excess RBC production. It is also referred to as having "thick blood".
List three blood tests that might be ordered if anemia is suspected.
hematocrit, complete blood count, and microscopic study of erythrocytes