Nursing Research And Pathophysiology
Part 1: Pharmacology 1
Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH: Diabetes Mellitus, type 2.
Surgeries: None
Allergies: Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History: Immunization is up to date and she received her flu shot this year.
Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH: Normal affect. Cooperative.
Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infection.
1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.
Provider
Patient
DOB
Date
Medication
Amount dispensed
Refill
2. What labs for baseline and follow up of therapy would you order for this patient? Give rationale.
Part 2: Pharmacology 2
Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH: Diabetes Mellitus, type 2.
Surgeries: None
Allergies: Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History: Immunization is up to date and she received her flu shot this year.
Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH: Normal affect. Cooperative.
Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infection.
1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.
Provider
Patient
DOB
Date
Medication
Amount dispensed
Refill
2. What labs for baseline and follow up of therapy would you order for this patient? Give rationale.
Part 3: Nursing Research 1
Suppose you were planning to conduct a statewide study of the work plans and intentions of nonemployed registered nurses in your state (florida).
1. Would you ask mostly open-ended questions or closed-ended questions?
2. Defend your answer, explain why.
Part 4: Nursing Research 2
1. Which level of measurement would you prefer to utilize for quantitative research?
2. Defend your answer.
Part 5: Pathopysiology 1
Eleven-month-old Bianca is being assessed in the chest clinic today by the respiratory nurse. Bianca requires continuous portable oxygen via nasal prongs at 0.5 L/min. Her mother has tried to wean Bianca from oxygen during the night, but Bianca’s O2 saturation often will drop to 92% and her respiratory rate will increase. Bianca was born at 30 weeks gestation and was ventilated for the first 2 weeks of life. She has been on continuous oxygen since birth. There is a student nurse observing today. Outside the exam room, she states to the respiratory nurse that Bianca must have asthma.
1. How would the respiratory nurse respond?
2. What things would you be concerned about as Bianca gets older?
Part 6: Pathopysiology 2
A patient on a medical floor has an indwelling catheter that has been in for 2 weeks.
1. Why are patients with indwelling urinary catheters at an increased risk for urinary tract infections?
In caring for a patient with an indwelling urinary catheter
2. What nursing actions can be employed to decrease the patient’s risk for the development of a urinary tract infection?
Part 7: Nursing Research Master
´Project: Prevalence of Overweight and Patterns of Physical Activity in a Population of Children Aged 7 To 11 in a State of Schooling.
Topic: Childhood Obesity
Study: Quantitative
Based on your course reading assignments and your pending research problem
1. What type of study do you believe you are conducting, and please explain why?
