ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

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ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

TO PREPARE:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient. ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

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BY DAY 7 OF WEEK 8

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment:Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes:What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

 

 

DIFFERENT CASE STUDIES (SELECT ONE)

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

 

 

USE THESE CASE HISTORIES TO SUPPLEMENT THE INFORMATION ABOUT THE PATINETS IN THE VIDEO CASE STUDIES.

Week 8 Substance-Related and Addictive Disorders

Training Title 82

Name: Lisa Tremblay
Gender: female
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is
considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates,
approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”),
and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest.  Her admission
labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS
positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within
normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went
to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx
of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10
years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Allergies: azithromycin  . ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

Symptom Media. (Producer). (2017). Training title 82 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-82

 

Training Title 114
Name: Ally Chen
Gender: female
Age: 44 years old
Background: Only child, raised by parents in Philadelphia, PA. Has PhD in biology and master’s
degree in high school education (8–12). Her supervisor has asked the school EAP counselor to
intervene with concerns regarding potential substance use in effort to facilitate getting her help
and be able to retain her. She is divorced, has a 4-year-old son who lives with his father. Appetite
healthy, sleeping 9 hours/24 hrs., wakes 2-3 times during the night. Denied drug use. had DUI
when she was age 21.
Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-114-2

Training Title 151
Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years
old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family
mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx;
Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at
Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on
average, appetite good.

Symptom Media. (Producer). (2018). Training title 151 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-151

 

 

 

 

Week (enter week #): (Enter assignment title)

 

 

 

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

 

 

 

 

 

 

 

 

 

 

 

 

Subjective:

CC (chief complaint):

HPI:

Past Psychiatric History:

  • General Statement:
  • Caregivers (if applicable):
  • Hospitalizations:
  • Medication trials:
  • Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

 

  • Current Medications:
  • Allergies:
  • Reproductive Hx:

ROS:

  • GENERAL:
  • HEENT:
  • SKIN:
  • CARDIOVASCULAR:
  • RESPIRATORY:
  • GASTROINTESTINAL:
  • GENITOURINARY:
  • NEUROLOGICAL:
  • MUSCULOSKELETAL:
  • HEMATOLOGIC:
  • LYMPHATICS:
  • ENDOCRINOLOGIC:

Objective:

Physical exam: if applicable

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections: ASSESSING AND DIAGNOSING PATIENTS WITH SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

References

 

Literature Review Paper

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Literature Review Paper

Assessment Description

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.

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A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question and Literature Evaluation Table to develop a review (750-1,000) that includes the following sections:

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further research

Prepare this  according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This uses a rubric. Please review the rubric prior to beginning the  to become familiar with the expectations for successful completion.

You are required to submit this to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.  Literature Review Paper

Week 8_LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES

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Week 8_LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES

LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES

 

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.

In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.  Week 8_LEGAL AND ETHICAL ISSUES RELATED TO PSYCHIATRIC EMERGENCIES

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THE ASSIGNMENT

In 2–3 pages, address the following:

  • Explain your state (Florida) laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
  • Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
  • Explain the difference between capacity and competency in mental health contexts.
  • Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
  • Identify one evidence-based suicide risk assessment that you could use to screen patients.
  • Identify one evidence-based violence risk assessment that you could use to screen patients.
  • Attach copies of or links to the suicide and violence risk assessments you selected.

RESOURCES

 

CAUTI Prevention Paper

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CAUTI Prevention Paper

CAUTI Prevention

create an interview transcript of your responses to the following interview questions:

Tell us about a healthcare program, within your practice ( CAUTI PREVENTION). What are the costs and projected outcomes of this program?

Who is your target population?

What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?

Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why? CAUTI Prevention Paper

ADVOCATING FOR THE NURSING ROLE IN PROGRAM DESIGN AND IMPLEMENTATION

TOPIC: CAUTI Prevention

In 4-page paper, create an interview transcript of your responses to the following interview questions:

  • Tell us about a healthcare program, within your practice ( CAUTI PREVENTION). What are the costs and projected outcomes of this program?
  • Who is your target population?
  • What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
  • What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
  • What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
  • Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

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                                                  Rubric

 

This criterion is linked to a Learning OutcomeProgram DesignIn a 2- to 4-page paper, create an interview transcript of your responses to the following interview questions.·   Tell us about a healthcare program within your practice. What are the costs and projected outcomes of this program?·   Who is your target population?·   What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?·   What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design? Response provides a clear and complete summary of the healthcare program, including an accurate and detailed description of the costs and projected outcomes of the program. …Response provides a clear and accurate description that fully describes the target population. …Response provides a clear and accurate explanation of the role of the nurse in providing input for the design of the program, including specific examples. …Response provides an accurate and detailed description of the role of the nurse advocate for the target population for the healthcare program selected. …Response provides an accurate and detailed explanation of how the advocate’s role influences design decisions as well as fully explaining impacts to program design. CAUTI Prevention Paper

 

Program Implementation·  What is the role of the nurse in healthcare program implementation?How does this role vary between design and implantation of healthcare programs? Can you provide examples?·  Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why you think this? Response provides a clear, accurate, and complete explanation of the role of the nurse in healthcare program implementation. …Response provides an accurate and detailed explanation of how the role of the nurse is different between design and implementation of healthcare programs, including specific examples. …Response provides an accurate and detailed description of the members of a healthcare team needed to implement the program selected.

 

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, low logically, and demonstrate continuity of ideas.Sentences are carefully focused– neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. Paragraphs and sentences follow writing standards for flow, continuity, and clarity. …A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

 

Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation. Uses correct grammar, spelling, and punctuation with no errors.

This criterion is linked to a Learning OutcomeWritten Expression and Formatting:The paper follows correct APA format for title page, font, spacing, margins, indentations, parenthetical/in-text citations, and reference list (if sources are cited). Uses correct APA format with no errors.

 

Require reading for Referencing

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.

Chapter 5, “Public Policy Design” (pp. 87–95 only)

Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)

Chapter 9, “Interprofessional Practice” (pp. 152–160 only)

Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)

American Nurses Association (ANA). (n.d.). Advocacy Links to an external site.. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/

Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation Links to an external site.. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdf

Congress.gov Links to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation Links to an external site.. Academy of Management Review, 21(4), 1055–1080.

Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient Links to an external site.. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017.

Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion Links to an external site.. Public Management Review, 16(4), 527–547. CAUTI Prevention Paper

 

Nursing Informatics Assignment

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Nursing Informatics Assignment

Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.

Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.” Nursing Informatics Assignment

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Identify and select 4 peer-reviewed research articles from your research.

For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographiesLinks to an external site.

The Assignment: (4-5 pages not including the title and reference page)

 

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

 

Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.

Include an introduction explaining the purpose of the paper.

Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.

Use APA format and include a title page. Nursing Informatics Assignment

 

Hematopoietic Case Study

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Hematopoietic Case Study

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately, there have been 6 days of heavy flow and cramping. She denies abdominal distension, backache, and constipation. She has not had her usual energy levels since before her last pregnancy. Hematopoietic Case Study

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Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5 with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study 1 Questions:

  1. Name the contributing factors on J.D. that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important for erythropoiesis? What abnormalities their deficiency might cause in the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Lab results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe appropriate recommendations and treatments for J.D.

 

  •  post should be at least 500 words for each case study, formatted and cited in the current APA style with support from at least 2 academic sources. Hematopoietic Case Study

Ethical Dilemma in Professional Nursing Paper

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Ethical Dilemma in Professional Nursing Paper

Scenario

You are a member of your organization’s ethics committee. As a nurse preceptor and member of the ethics committee, you have been asked to do a presentation at the upcoming orientation to educate new nursing hires on ethical dilemmas they may encounter in nursing practice. The nurse manager wants to ensure that new hires understand essential considerations when facing conflicts over what is best for patient care. Therefore, the nurse manager has requested that you review issues, impacts, and nursing strategies related to ethical dilemmas in nursing practice. You are excited to share your enthusiasm and passion for the importance of ethics in client care.

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Instructions

Select an ethical dilemma you have experienced in nursing or recent news to use as the basis for your presentation.

Create a PowerPoint® presentation with referenced in-text citation that includes the following:

The ethical dilemma encountered by a nurse. Ethical Dilemma in Professional Nursing Paper

The ethical issues related to the dilemma. Support with credible referencing.

The impact on nursing and patient care. Support with credible referencing.

Strategies that support person and family centered care. Support with credible referencing.

References for the last 5 years. Ethical Dilemma in Professional Nursing Paper

 

Cardiovascular Discussion Paper

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Cardiovascular Discussion Paper

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. En route to the hospital, the patient was placed on a nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg PO) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills. Cardiovascular Discussion Paper

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Case Study 2 Questions:

  1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarction, describe the modifiable and non-modifiable risk factors.
  2. What would you expect to see on Mr. W.G. EKG and which findings described in the case are compatible with the acute coronary event?
  3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarction, which would be the most specific laboratory test you would choose and why?
  4. How do you explain that Mr. W.G’s temperature has increased after his Myocardial Infarction, when can that be observed, and for how long? Base your answer on the pathophysiology of the event.
  5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarction. Elaborate and support your answer.
  • post should be at least 500 words for each case study, formatted and cited in the current APA style with support from at least 2 academic sources. Cardiovascular Discussion Paper

Case Study- Nursing (Anemia-AIDS)

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Case Study- Nursing (Anemia-AIDS)

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer..

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Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words.

Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
Iron-Deficiency Anemia
Case Study
A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on
stopping his activity. He has no history of heart or lung disease. His physical examination was
normal except for notable pallor. Case Study- Nursing (Anemia-AIDS)
Studies Result
Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads
Chest x-ray study, p. 956 No active disease
Complete blood count (CBC), p.
156
Red blood cell (RBC) count, p.
396
2.1 million/mm (normal: 4.7–6.1 million/mm)
RBC indices, p. 399
Mean corpuscular volume
(MCV)
72 mm3
(normal: 80–95 mm3
)
Mean corpuscular hemoglobin
(MCH)
22 pg (normal: 27–31 pg)
Mean corpuscular hemoglobin
concentration (MCHC)
21 pg (normal: 27–31 pg)
Red blood cell distribution width
(RDW)
9% (normal: 11%–14.5%)
Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 18% (normal: 42%–52%)
White blood cell (WBC) count, p.
466
7800/mm3
(normal: 4,500–10,000/mcL)
WBC differential count, p. 466 Normal differential
Platelet count (thrombocyte
count), p. 362
Within normal limits (WNL) (normal: 150,000–
400,000/mm3
)
Half-life of RBC 26–30 days (normal)
Liver/spleen ratio, p. 750 1:1 (normal)
Spleen/pericardium ratio <2:1 (normal)
Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)
Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)
Blood typing, p. 114 O+
Iron level studies, p. 287
Iron 42 (normal: 65–175 mcg/dL)
Total iron-binding capacity
(TIBC)
500 (normal: 250–420 mcg/dL)
Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)
Transferrin saturation 15% (normal: 20%–50%)
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)
Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)
Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L)
Diagnostic Analysis
The patient was found to be significantly anemic. His angina was related to his anemia. His
normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..
His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.
His marrow was inadequate for the degree of anemia because his iron level was reduced.
On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of
packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain. Case Study- Nursing (Anemia-AIDS)
The transfusion was stopped, and the following studies were performed:
Studies Results
Hgb, p. 251 7.6 g/dL
Hct, p. 248 24%
Direct Coombs test, p. 157 Positive; agglutination (normal: negative)
Platelet count, p. 362 85,000/mm3
Platelet antibody, p. 360 Positive (normal: negative)
Haptoglobin, p. 245 78 mg/dL
Diagnostic Analysis
The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs
test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count
dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the
RBC reaction.
He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal
examination indicated that his stool was positive for occult blood. Colonoscopy indicated a rightside colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the
surgery well.
Critical Thinking Questions
1. What was the cause of this patient’s iron-deficiency anemia?
2. Explain the relationship between anemia and angina.
3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for
the answer
4. What other questions would you ask to this patient and what would be your rationale for
them?

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Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
AIDS (Acquired Immunodeficiency Syndrome)
Case Studies
The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic
diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed
right-sided pneumonitis. The following studies were performed:
Studies Results
Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)
Chest x-ray, p. 956 Right-sided consolidation affecting the posterior
lower lung
Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen Positive
Enzyme-linked immunosorbent assay
(ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 274
Total CD4 280 (normal: 600–1500 cells/L)
CD4% 18% (normal: 60%–75%)
CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis
The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP is
an opportunistic infection occurring only in immunocompromised patients and is the most
common infection in persons with AIDS. The patient’s diarrhea was caused by Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his
prognosis is poor. Case Study- Nursing (Anemia-AIDS)
The patient was hospitalized for a short time for treatment of PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes and the likelihood of
clinical complications from AIDS?
2. Why does the United States Public Health Service recommend monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your responsibility as a
provider? Case Study- Nursing (Anemia-AIDS)

Nursing homework help

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For this assignment, you will use the latest ACHE Healthcare Executive Competencies Assessment Tool, located under the week’s Resources.

After reading the introductory section, complete the self-assessment and formulate your development plan found at the end of each section within the booklet. Note: Also at the end of each section, you will find the authors’ references and notations to resources located at the end of the booklet.

To complete your assignment, you will submit a report reflecting on your findings from the leadership competencies self-assessment, listing your strengths, areas for improvement, and your plan to improve and develop your leadership skills. In your development plan, use the S.M.A.R.T. goal-setting technique: Specific, Measurable, Attainable, Realistic, and Timely first presented by Doran (1981).

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In updated versions of this technique, researchers substitute Doran’s (1981) word assignable with the word attainable. The table below may provide guidance as you set your goals.

Length: Minimum 5 pages, not including the title page and reference page

References: Minimum of 5 peer-reviewed scholarly resources including the ACHE resource. Nursing homework help