15 Jan Is renal cell carcinoma comm

Discussion 1.1 – Case Study One

A 39 year-old woman is brought to the emergency department by her husband. She is conscious but confused and keeps repeating that her head hurts so much she feels it might “explode.” The husband tells you that she has no health problems and takes no medications other than aspirin for occasional pain. He also tells you that she entered a contest earlier today to try and drink the most water in 1 hour. She drank 10 glasses but did not win the contest and came home. Her confusion and headache started about an hour later.

What type of fluid or electrolyte imbalance is she likely to have and from what cause? Explain your answer.

What physical assessment data are the priority to obtain? Explain.

What laboratory data would you expect to be ordered?

Is this patient at risk for heart failure or pulmonary edema? Why or why not?

For details regarding grading criteria and posting requirements, please see the grading rubric. Contact your instructor if you have issues or concerns.

Discussion 1.2 – Case Study Two

The patient is a 29 year old woman admitted 20 hours ago for an acute exacerbation of Crohn’s disease with intense abdominal pain. She is NPO and receiving normal saline intravenously at 175 mL per minute. She was last given hydromorphone (Dilaudid) 4 mg IV 30 minutes ago. Because she did have an episode of hypotension earlier after Dilaudid, you now take her vital signs. On inflating the blood pressure cuff, she develops palmar flexion. The flexion remains after the cuff is deflated.

What is most likely the cause of this problem?

What electrolytes are most likely to be out of balance and why?

What is your best first action?Should the Rapid Response Team be called? Why or why not?

What additional assessment data are most important to collect? Explain your answer.

For details regarding grading criteria and posting requirements, please see the grading rubric. Contact your instructor if you have issues or concerns.

Discussion 2.1 – Case Study One

The patient is a 21 year old college student brought to the emergency department by his friends when he was found unconscious during a fraternity party. He was seen drinking heavily at the party and had not eaten for 2 days before the event. He takes no prescription drugs, and his current vital signs are T = 97.8, P = 48, slightly irregular and thread; R = 28, deep and regular; B/P = 88/50; His arterial blood gas results are pH = 7.31, HCO 3 = 25 mEq/L; PaCo2= 28 mm Hg; PaO2 = 99 mm Hg.

What specific type of acid-base problem does this patient have? Explain.

What is the most probable origin of the acid-base imbalance?

Should oxygen be applied? Why or why not?

What nursing interventions for safety are most appropriate for this patient?

What additional laboratory and assessment data should be performed? Provide a rationale for your answer.

For details regarding grading criteria and posting requirements, please see the grading rubric. Contact your instructor if you have issues or concerns.

Discussion 3.1 – Case Study One Options Menu: Forum

At the start of the shift, you are assessing an 86 year old patient who is awaiting surgery for a hip repair after a fall 12 hours ago at home. You are collecting a clean-catch urine specimen, using a bedpan, as part of the preoperative preparation. You observe that when she voids, the urine odor is foul and the urine is cloudy and full of sediment. She reports some urgency but notes that she had urgency before her fall.

What assessment information will you document in the chart?

What additional information should you ask the patient and what else should you consider?

Organize your thoughts into a SBAR communication.

Who should you notify and why?

For details regarding grading criteria and posting requirements, please see the grading rubric. Contact your instructor if you have issues or concerns.

Discussion 3.2 – Case Study Two

The patient is a 52-year old perimenopausal woman who reports a small loss of urine with coughing, laughing, and occasionally bending over. Recently she has started to leak urine just as she arrives in the bathroom but before she sits on the toilet. She stated her mother has had a continuing problem with incontinence for years and seldom leaves her home. The patient wants to continue to lead an active lifestyle and wants to discuss options for preventing progression of this embarrassing condition.

What other information should you obtain from this patient?

What type or types of incontinence is she most likely to have from the information she has provided thus far?

Is this problem likely to be genetic? Why or why not?

What will you tell her regarding options for care?

She asks if there is anything she can do now to help reduce her urine leakage. How do you respond?

For details regarding grading criteria and posting requirements, please see the grading rubric. Contact your instructor if you have issues or concerns.

Discussion 4.1 – Case Study One

The 56 year old African-American woman is admitted for treatment of newly diagnosed renal cell carcinoma. You find her daughter in the hallway crying. She has heard that her mother has undergone genetic testing related to her cancer diagnosis and wonders if she is at increased risk for the same condition. She was with her mother during the renal scan before admission and is also worried that this exposure to a radioactive isotope will cause cancer in her.

Is renal cell carcinoma commonly inherited, and why is genetic testing done?

Do renal scan radioisotopes require radiation precautions? Why or why not?

What risk factors are associated with renal cell carcinoma?

How can you evaluate whether your information was understood by the daughter and if follow-up is