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Brief ContentsPART ONE MEDICAL-SURGICAL CASES, 1Chapter 1Chapter 2Chapter 3Chapter 4Chapter 5Chapter 6Chapter 7Chapter 8Chapter 9Cardiovascular Disorders, 1Respiratory Disorders, 83Musculoskeletal Disorders, 149Gastrointestinal Disorders, 189Genitourinary Disorders, 235Neurologic Disorders, 273Endocrine Disorders, 341Immunologic Disorders, 367Oncologic and Hematologic Disorders, 393PART TWO PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES, 439Chapter 10Chapter 11Chapter 12Chapter 13Pediatric Disorders, 439Maternal and Obstetric Disorders, 505Women's Health Disorders, 533Psychiatric Disorders, 559PART THREE OTHER/ADVANCED CASES, 591Chapter 14 Alternative Therapies, 591Chapter 15 Patients with Multiple Disorders, 599Chapter 16 Emergency Situations, 625Appendix: Abbreviations and Acronyms, 663Illustration Credits, 669
5TH EDITIONCriticalThinking CasesIn NursingWinningham'sMedical-Surgical, Pediatric,Maternity, and PsychiatricMARIANN HARDING, MSN, RNAssociate ProfessorDepartment of NursingKent State University at TuscarawasNew Philadelphia, OhioJULIE S. SNYDER, MSN, RN-BCAdjunct FacultySchool of NursingOld Dominion UniversityNorfolk, VirginiaBARBARA A. PREUSSER†, PHD, FNPCFamily Nurse PractitionerVeterans Administration Medical CenterSalt Lake City, UtahDeceased†
3251 Riverport LaneSt. Louis, Missouri 63043WINNINGHAM'S CRITICAL THINKING CASES IN NURSING:MEDICAL-SURGICAL, PEDIATRIC, MATERNITY, AND PSYCHIATRICISBN: 978-0-323-08325-6Copyright 2013 by Mosby, Inc., an affiliate of Elsevier Inc.No part of this publication may be reproduced or transmitted in any form or by any means, electronic ormechanical, including photocopying, recording, or any information storage and retrieval system, withoutpermission in writing from the publisher. Details on how to seek permission, further information about thePublisher's permissions policies and our arrangements with organizations such as the Copyright ClearanceCenter and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.This book and the individual contributions contained in it are protected under copyright by the Publisher(other than as may be noted herein).NoticesKnowledge and best practice in this field are constantly changing. As new research and experience broadenour understanding, changes in research methods, professional practices, or medical treatment may becomenecessary.Practitioners and researchers must always rely on their own experience and knowledge in evaluating andusing any information, methods, compounds, or experiments described herein. In using such informationor methods they should be mindful of their own safety and the safety of others, including parties for whomthey have a professional responsibility.With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to beadministered, to verify the recommended dose or formula, the method and duration of administration, andcontraindications. It is the responsibility of practitioners, relying on their own experience and knowledge oftheir patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,and to take all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liabilityfor any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, orfrom any use or operation of any methods, products, instructions, or ideas contained in the material herein.Previous editions copyrighted 2009, 2005, 2001, 1996Library of Congress Cataloging-in-Publication DataHarding, Mariann.Winningham's critical thinking cases in nursing : medical-surgical, pediatric, maternity, and psychiatric /Mariann Harding, Julie S. Snyder, Barbara A. Preusser. – 5th ed.p. ; cm.Critical thinking cases in nursingRev. ed. of: Critical thinking in medical-surgical settings / Maryl L. Winningham and Barbara A. Preusser. 2nded. c2011.Includes bibliographical references.ISBN 978-0-323-08325-6 (pbk. : alk. paper)I. Snyder, Julie S. II. Preusser, Barbara A. III. Winningham, Maryl Lynne, 1947–2001. Critical thinking inmedical-surgical settings. IV. Title. V. Title: Critical thinking cases in nursing.[DNLM: 1. Nursing Process–Case Reports. 2. Nursing Process–Problems and Exercises. 3. Nursing Care–Case Reports. 4. Nursing Care–Problems and Exercises. WY 18.2]610.73–dc232012003221Executive Content Strategist: Lee HendersonContent Development Specialist: Jacqueline TwomeyPublishing Services Managers: Hemamalini Rajendrababu & Deborah L. VogelProject Managers: Anitha Sivaraj & John W. GabbertDesign Direction: Karen PaulsPrinted in the United States of AmericaLast digit is the print number: 9 876 54 321
To Drs. Maryl L. Winningham and Barbara A. PreusserDrs. Winningham and Preusser, authors of this text for the previous four editions,dedicated their lives to the care of others and the pursuit of excellence in nursing practice.They have bequeathed a nursing heritage of integrity, excellence, courage, and serviceto their students, colleagues, and readers.
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ContributorsAnn Campbell, RN, MSN, CPNPFacultySchool of NursingOld Dominion UniversityNorfolk, VirginiaSara B. Forbus, MSN, RNFacultySchool of NursingOld Dominion UniversityNorfolk, VirginiaContributors to Previous EditionsElizabeth Jane Bell, MSN, ANPcLesley A. Black, BSN, MS, ANPc, CWOCNKent Blad, MS, FNPc, ACNP-C, FCCMJamie Clinton-Lont, BSN, FNPcSusan L. Croft, BSN, MSJoyce Foster, PhD, CNM, FACNM, FAANShellagh Gutke, BSN, CWOCNNancy Hayden, MSN, FNPcSondra Heaston, MS, FNPc, CENJanice Hulbert, RN, MSLisa Jensen, BSN, MS, APRN, CSStephanie C. Kettendorf, MS, RN, CNS, NCBFJulie Killebrew, BSN, MSKaren Kone, BSN, ACRNKathleen Kuntz, MSN, APRN, SANEJanet G. Madsen, PhDDebra Ann Mills, RN, MSJeanie O'Donnell, MSNDeb Plasman-Coles, PAcLaura Lee Scott, MSN, FNPcMary Seegmiller, MSNSandra Smeeding, MS, FNPcDeborah D. Smith, BSNAnn Speirs, BSNRonald Ulberg, BSN, MSNKristy Vankatwyk, MSN, FNPcAnnette S. Wendel, BSNWendy Whitney, MSN, FNPc, CANPMary Youtsey, BSN, CDECopyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.v
ReviewersDiane K. Daddario, MSN, ACNS-BC, RN,BC, CMSRNNurse SpecialistGeisinger Medical CenterDanville, Pennsylvania;Staff NurseEvangelical Community HospitalLewisburg, Pennsylvania;Nursing InstructorPennsylvania College of TechnologyWilliamsport, PennsylvaniaJennifer Duhon, RN, MSDirector of Health ServicesLutheran Senior ServicesPeoria, IllinoisSara B. Forbus, MSN, RNFacultySchool of NursingOld Dominion UniversityNorfolk, VirginiaMimi Haskins, MS, RN, CMSRNNursing Staff Development InstructorRoswell Park Cancer InstituteBuffalo, New YorkSuzanne Jed, MSN, APRN-BCClinical Instructor, Family MedicineKeck School of MedicineUniversity of Southern CaliforniaLos Angeles, CaliforniaviJamie Lynn Jones, MSN, RNAssistant Professor, NursingUniversity of Arkansas at Little RockLittle Rock, ArkansasTamara M. Kear, PhD, MSN, RNAssistant Professor of NursingVillanova UniversityVillanova, PennsylvaniaCheryl A. Lehman, PhD, RN, CNS-BC,RN-BC, CRRNCNS Program CoordinatorDepartment of Health Restoration &Care Systems Management (HRCSM)Clinical Associate ProfessorThe University of Texas Health ScienceCenter at San AntonioSan Antonio, TexasCasey Norris, MSN, BSNAdjunct Instructor, NursingSouth CollegePulmonary Clinical Nurse SpecialistEast Tennessee Children's HospitalKnoxville, TennesseeBrenda K. Shelton, MS, RN, CCRN, AOCNThe Sidney Kimmel Cancer Center at JohnsHopkinsBaltimore, MarylandCopyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
IntroductionThere is an urgent need for nurses with well-practiced critical thinking skills. As new graduates,you will make decisions and take actions of an increasingly sophisticated nature. You will encounter problems you have never seen or heard about during your classroom and clinical experiences.You are going to have to make complex decisions with little or no guidance and limited resources.We want you to be exposed to as much as possible during your student days, but more importantly, we want you to learn to think. You cannot memorize your way out of any situation, but youcan think your way out of any situation. We know that students often learn more and faster whenthey have the freedom to make mistakes. This book is designed to allow you to experiment withfinding answers without the pressure of someone's life hanging in the balance. We want you to dowell. We want you to be the best. It is our wish for you to grow into confident, competent professionals. After all, someday we will be one of those people you care for, and when that day comes, wewant you to be very, very good at what you do!What Is Critical Thinking?Critical thinking is not memorizing lists of facts or the steps of procedures. Instead, critical thinking is an analytical process that can help you think through a problem in an organized and efficientmanner. Five steps are involved in critical thinking. Thinking about these steps may help you whenyou work through the questions in your cases. Here are the five steps with an explanation of whatthey mean.1. Recognize and define the problem by asking the right questions: Exactly what is it you needto know? What is the question asking?2. Select the information or data necessary to solve the problem or answer the question: Firstyou have to ask whether all the necessary information is there. If not, how and where canyou get the additional information? What other resources are available? This is one of themost difficult steps. In real clinical experiences, you rarely have all of the information,so you have to learn where you can get necessary data. For instance, patient and familyinterviews, nursing charting, the patient medical chart, laboratory data on your computer,your observations, and your own physical assessment can help you identify important clues.Of course, information can rapidly become outdated. To make sure you are accessing themost current and accurate information, you will occasionally need to use the Internet toanswer a question.3. Recognize stated and unstated assumptions; that is, what do you think is or is not true?Sometimes answers or solutions seem obvious; just because something seems obvious doesn'tmean it is correct. You may need to consider several possible answers or solutions. Considerall clues carefully and do not dismiss a possibility too quickly. Remember, “You never find ananswer you don't think of.”Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.vii
INTRODUCTION4. Formulate and select relevant and/or potential decisions. Try to think of as many possibilitiesas you can. Consider the pros and cons of the consequences of making each decision. What isthe best answer/solution? What could go wrong? This requires considering many differentangles. In today's health care settings, decision-making often requires balancing the wellbeing needs of the patient, the preferences and concerns of the patient and caregiver, andfinancial limitations imposed by the reimbursement system. In making decisions, youneed to take into account all relevant factors. Remember, you may need to explain why yourejected other options.5. Draw a valid, informed conclusion: Consider all data; then determine what is relevant andwhat makes the most sense. Only then should you draw your conclusion.It may look as if this kind of thinking comes naturally to instructors and experienced nurses.You can be certain that even experienced professionals were once where you are now. The rapid andsound decision-making that is essential to good nursing requires years of practice. The practice ofgood clinical thinking leads to good thinking in clinical practice. This book will help you practicethe important steps in making sound clinical judgments until the process starts to come naturally.The practice of good clinical thinking leads to good thinking in clinical practice.The “How to” of Case StudiesWhen you begin each case, read through the whole story once, from start to finish, getting a generalidea of what it is about. Write down things you have to look up. This will help you move throughthe case smoothly and get more out of it. How much you have to look up will depend on where youare in your program, what you know, and how much experience you already have. Preparing caseswill become easier as you advance in your program.viiiCopyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
AcknowledgmentsWe would like to express our appreciation to the editorial Elsevier staff—Kristen Geen, LeeHenderson, Jamie Horn, and Jacqueline Twomey—for their professional support and contributionsin guiding this text to publication. We extend a special thanks to our reviewers who gave us helpfulsuggestions and insights as we developed this edition.Mariann's gratitude goes to the most important people in her life—her husband, Jeff, and herdaughters, Kate and Sarah—for their giving of love, support, and time during the months of writing. She gives a special thanks to her students, colleagues, and patients; each has taught her muchand fueled her passion for nursing and education. Finally, Mariann gives her thanks to God, whomade all things possible.Julie thanks her husband, Jonathan, for his love, support, and patience during this project. She isgrateful for the encouragement from daughter Emily, son-in-law Randy, and parents Willis and JeanSimmons. Julie appreciates the hard work of colleagues Ann Campbell and Sara Forbus as contributors to this edition. She is especially thankful to the students, whose eagerness to learn is an inspiration. Most importantly, Julie gives thanks to God, our source of hope and strength.Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.ix
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ContentsPART ONE Medical-Surgical Cases, 11Cardiovascular Disorders, 1Case Study 1, 1Case Study 2, 5Case Study 3, 11Case Study 4, 17Case Study 5, 21Case Study 6, 25Case Study 7, 31Case Study 8, 35Case Study 9, 39Case Study 10, 43Case Study 11, 47Case Study 12, 53Case Study 13, 57Case Study 14, 63Case Study 15, 67Case Study 16, 73Case Study 17, 792Respiratory Disorders, 83Case Study 18,Case Study 19,Case Study 20,Case Study 21,Case Study 22,Case Study 23,Case Study 24,Case Study 25,Case Study 26,Case Study 27,Case Study 28,Case Study 29,Case Study 30,Case Study keletal Disorders, 149Case Study 32, 149Case Study 33, 153Case Study 34, 155Case Study 35,Case Study 36,Case Study 37,Case Study 38,Case Study 39,Case Study 40,Case Study 41,4Gastrointestinal Disorders, 189Case Study 42,Case Study 43,Case Study 44,Case Study 45,Case Study 46,Case Study 47,Case Study 48,Case Study 49,Case Study 50,Case Study 51,5189193197201207211217221225229Genitourinary Disorders, 235Case Study 52,Case Study 53,Case Study 54,Case Study 55,Case Study 56,Case Study 57,Case Study 58,Case Study 59,Case Study 69Neurologic Disorders, 273Case Study 61,Case Study 62,Case Study 63,Case Study 64,Case Study 65,Case Study 66,Case Study 67,273277281285289293299Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.xi
CONTENTSCase Study 68,Case Study 69,Case Study 70,Case Study 71,Case Study 72,Case Study 73,Case Study 74,Case Study 75,78303307311317323327331337Case Study 82,Case Study 83,Case Study 84,Case Study 85,Case Study 86,Case Study 87,Endocrine Disorders, 341Case Study 76,Case Study 77,Case Study 78,Case Study 79,Case Study 80,Case Study 81,Immunologic Disorders, 3679Oncologic and Hematologic Disorders, 393Case Study 88,Case Study 89,Case Study 90,Case Study 91,Case Study 92,Case Study 93,Case Study 94,Case Study 95,Case Study 96,Case Study 5409413419425429433PART TWO Pediatric, Maternity, and Psychiatric Cases, 43910Pediatric Disorders, 439Case Study 98, 439Case Study 99, 441Case Study 100, 447Case Study 101, 451Case Study 102, 455Case Study 103, 459Case Study 104, 465Case Study 105, 471Case Study 106, 475Case Study 107, 479Case Study 108, 483Case Study 109, 487Case Study 110, 491Case Study 111, 497Case Study 112, 50111xii12505509513517Women’s Health Disorders, 533Case Study 120,Case Study 121,Case Study 122,Case Study 123,Case Study 124,Case Study 125,13Maternal and Obstetric Disorders, 505Case Study 113,Case Study 114,Case Study 115,Case Study 116,Case Study 117, 521Case Study 118, 525Case Study 119, 529533537541547551555Psychiatric Disorders, 559Case Study 126,Case Study 127,Case Study 128,Case Study 129,Case Study 130,Case Study 131,Case Study 132,Case Study 133,559563567571575579583587Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
ContentsPART THREE Other/Advanced Cases, 59114Alternative Therapies, 591Case Study 134, 591Case Study 135, 59515Patients with Multiple Disorders, 599Case Study 136,Case Study 137,Case Study 138,Case Study 139,Case Study 140,59960560961561916Emergency Situations, 625Case Study 141,Case Study 142,Case Study 143,Case Study 144,Case Study 145,Case Study 146,Case Study 147,Case Study 148,Case Study 149,Case Study 150,625629633635639643647651655659APPENDIX: Abbreviations and Acronyms, 663ILLUSTRATION CREDITS, 669Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.xiii
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PART ONE Medical-Surgical Cases1 Cardiovascular1Cardiovascular DisordersCase Study 1NameClass/GroupDateGroup MembersINSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. Whenasked to provide several answers, list them in order of priority or significance. Do not assume information thatis not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you willneed to rewrite it.scenarioXXM.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure(HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to cometo the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her lasthospital admission. She reports gaining 1 to 2 pounds every day since her discharge.1. What error in teaching most likely occurred when M.G. was discharged 10 days ago?CAsE sTudY PRoGREssDuring the admission interview, the nurse makes a list of the medications M.G. took at home. Chart ViewNursing Assessment: Medications Taken at HomeEnalapril (Vasotec) 5 mg PO bidPioglitazone (Actos) 45 mg PO every morningFurosemide (Lasix) 40 mg/day POPotassium chloride 20 mEq/day PO2. Which of these medications may have contributed to M.G.'s heart failure? Explain.Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.1
PART 1MEdiCAl-suRGiCAl CAsEs1 Cardiovascular3. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), workto reduce heart failure? (Select all that apply.) ACE inhibitors:a. prevent the conversion of angiotensin I to angiotensin II.b. cause systemic vasodilation.c. promote the excretion of sodium and water in the renal tubules.d. reduce preload and afterload.e. increase cardiac contractility.f. block sympathetic nervous system stimulation to the heart.CAsE sTudY PRoGREssAfter reviewing M.G.'s medications, the physician writes these medication orders: Chart ViewMedication OrdersEnalapril (Vasotec) 5 mg PO bidCarvedilol (Coreg) 100 mg PO every morningGlipizide (Glucotrol) 10 mg PO every morningFurosemide (Lasix) 80 mg IV push (IVP) now, then 40 mg/day IVPPotassium chloride (K-Dur) 20 mEq/day PO4. What is the rationale for changing the route of the furosemide (Lasix)?5. You administer furosemide (Lasix) 80 mg IVP. Identify three parameters you would use tomonitor the effectiveness of this medication.6. What laboratory tests should be ordered for M.G. related to the order for furosemide(Lasix)? (Select all that apply.)a. Magnesium levelb. Sodium level2Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
CHAPTER 1CASE STUDY 1Complete blood count (CBC)Serum glucose levelsPotassium levelCoagulation studies1 Cardiovascularc.d.e.f.Cardiovascular Disorders7. What is the purpose of the beta blocker carvedilol? It is given to:a. increase the contractility of the heartb. cause peripheral vasodilationc. increase urine outputd. reduce cardiac stimulation by catecholaminesCASE STUDY PROGRESSThe next day, M.G. has shown only slight improvement, and digoxin (Lanoxin) 125 mcg PO daily is addedto her orders.8. What is the action of the digoxin? Digoxin:a. causes systemic vasodilation.b. promotes the excretion of sodium and water in the renal tubules.c. increases cardiac contractility and cardiac output.d. blocks sympathetic nervous system stimulation to the heart.9. Which findings from M.G.'s assessment would indicate an increased possibility of digoxintoxicity? Explain your answer.a. Serum potassium level of 2.2 mEq/Lb. Serum sodium level of 139 mEq/Lc. Apical heart rate of 64 beats/minuted. Digoxin level 1.6 ng/mL10. When you go to give the digoxin, you notice that it is available in milligrams (mg) notmicrograms (mcg). Convert 125 mcg to mg.Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.3
PART 1MEDICAL-SURGICAL CASES1 Cardiovascular11. M.G.'s symptoms improve with IV diuretics and the digoxin. She is placed back on oralfurosemide (Lasix) once her weight loss is deemed adequate to achieve a euvolemicstate. What will determine whether the oral dose will be adequate to consider her fordischarge?12. M.G. is ready for discharge. Using the mnemonic MAWDS, what key management conceptsshould be taught to prevent relapse and another admission?4Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
CHAPTER 1CARdiovAsCulAR disoRdERsCASE STUDY 2Case Study 2NameClass/GroupDateGroup Members1 CardiovascularINSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. Whenasked to provide several answers, list them in order of priority or significance. Do not assume information thatis not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you willneed to rewrite it.scenarioXXM.P. is a 65-year-old African-American woman who comes to your clinic for a follow-up visit. She wasdiagnosed with hypertension (HTN) 2 months ago and was given a prescription for a thiazide diureticbut stopped taking it 2 weeks ago because “it made me dizzy and I kept getting up during the night toempty my bladder.” During today's clinic visit, she expresses fear because her mother died of a cerebrovascular accident (CVA, stroke) at her age, and M.P. is afraid she will suffer the same fate. She states, “I'venever smoked and I don't drink, but I am so afraid of this high blood pressure.” You review the data on herpast clinic visits. Chart ViewFamily HistoryMother, died at age 65 years of CVAFather, died at age 67 years of myocardial infarction (MI)Sister, alive and well, age 62 yearsBrother, alive, age 70 years, has coronary artery disease, HTN, type II diabetes mellitus (DM)Patient Past HistoryMarried for 45 years, two children, alive and well, six grandchildrenCholecystectomy, age 42 yearsHysterectomy, age 48 yearsBlood Pressure AssessmentsJanuary 2: 150/92January 31: 156/94 (Given prescription for hydrochlorothiazide [HCTZ] 25 mg PO every morning)February 28: 140/901. According to the most recent Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure, M.P.'s blood pressure falls under whichclassification?2. What could M.P. be doing that is causing her nocturia?Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.5
PART 1MEDICAL-SURGICAL CASESCASE STUDY PROGRESSDuring today's visit, M.P.'s vital signs were BP: 162/102, P: 78, R: 16, T: 98.2 F (36.8 C). Her most recentbasic metabolic panel (BMP) and fasting lipids were within normal limits. Her height is 5 ft, 4 in., and sheweighs 110 lb. She tells you that she tries to go on walks but does not like to walk alone so has done soonly occasionally.1 Cardiovascular3. What risk factors does M.P. have that increase her risk for cardiovascular disease?CASE STUDY PROGRESSBecause M.P.'s BP continues to be high, the internist decides to put her on another drug and recommendsthat she try again with the HCTZ.4. According to national guidelines, what drug category or categories are recommended forM.P. at this time?5. M.P. goes on to ask whether there is anything else she should do to help with her HTN. Sheasks, “Do I need to lose weight?” Look up her height and weight for her age on a body massindex chart. Is she considered overweight?6. What nonpharmacologic lifestyle alteration measures might help someone like M.P. controlher BP? (List two examples and explain.)6Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
Cardiovascular DisordersCASE STUDY 21 CardiovascularCHAPTER 1CASE STUDY PROGRESSThe internist decreases M.P.'s HCTZ dosage to 12.5 mg PO daily and adds a prescription for benazepril(Lotensin) 5 mg daily. M.P. is instructed to return to the clinic in 1 week to have her blood work checked.She is also instructed to monitor her BP at least twice a week and return for a medication managementappointment in 1 month with her list of BP readings.7. Why did the internist decrease the dose of the HCTZ?8. You provide M.P. with education about the common side effects of benazepril, which caninclude which conditions? (Select all that apply.)a. Headacheb. Coughc. Shortness of breathd. Constipatione. Dizziness9. It is sometimes difficult to remember whether you've taken your medication. Whattechniques might you teach M.P. to help her remember to take her medication each day?(Name at least two.)10. After the teaching session, which statement by M.P. indicates a need for furtherinstructions?a. “I need to rise up slowly when I get out of bed or out of a chair before standing up.”b. “I will leave the salt shaker off the table and not salt my food when I cook.”c. “It's okay to skip a few doses if I am feeling bad as long as it's just for a few days.”d. “I will call if I feel very dizzy, weak, or short of breath while on this medicine.”Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.7
PART 1MEdiCAl-suRGiCAl CAsEsCAsE sTudY PRoGREssM.P. returns in 1 month for her medication management appointment. She tells you she is feeling fineand does not have any side effects from her new medication. Her BP, checked twice a week at the seniorcenter, ranges from 132 to 136/78 to 82 mm Hg.1 Cardiovascular11. When someone is taking HCTZ and an ACE inhibitor, such as benazepril, what laboratorytests would you expect to be monitored? Chart ViewLaboratory Test Results neBUNMagnesium3.6 mEq/L138 mEq/L100 mEq/L28 mEq/L112 mEq/L0.7 mg/dL18 mg/dL1.9 mEq/L12. What lab results, if any, are of concern at this time?13. You take M.P.'s BP and get 134/82 mm Hg. She asks whether these BP readings are okay. Onwhat do you base your response?14. List at least three important ways you might help her maintain her success.CAsE sTudY ouTCoMEM.P. comes in for a routine follow-up visit 3 months later. She continues to do well on her daily BP drugregimen, with average BP readings of 130/78 mm Hg. She participates in a senior citizens group-walkingprogram at the local mall. She admits she has not done as well with decreasing her salt intake but that sheis trying. She tells you she was recently at a luncheon with her garden club and that most of those womentake different BP pills than she does. She asks why their pills are different shapes and colors.8Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
CHAPTER 1Cardiovascular DisordersCASE STUDY 21 Cardiovascular15. How can you explain the difference to M.P.?Copyright 2013 by Mosby, an affiliate of Elsevier Inc.Copyright 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.9
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Brief Contents PART ONE MEDICAL-SURGICAL CASES, 1 Chapter 1 Cardiovascular Disorders, 1 Chapter 2 Respiratory Disorders, 83 Chapter 3 Musculoskeletal Disorders, 149 Chapter 4 Gastrointestinal Disorders, 189 Chapter 5 Genitourinary Disorders, 235 Chapter 6 Neurologic Disorders, 273 Chapter 7 Endocrine Disorders, 341 Chapt
The Project Brief can take two forms: A letter Brief may be used for projects less than 100,000 (total cost including GST and fees). Full Brief utilising a project specific brief with this Basic Brief. The Project Brief in its dra
SPURGEON,JOLENE M JSPURGEON@WISC.EDU STRELCHENKO,HANNAH B hstrelchenko@wisc.edu TERRIEN,CHRISTINE LAMP cterrien@wisc.edu THOMPSON,PAMELA M pamela.thompson@wisc.edu TOMAN,LORRAINE L lorraine.toman@wisc.edu TOMKO,KELLY ktomko@wisc.edu VANDER WAAL,MARY mary.vanderwaal@wisc.edu WHITE,JOANNE jo.white@wisc.edu WILSON,NINA MCCOY nina.wilson@wisc.edu .
Center for Substance buse Treatment . Brief Interventions and Brief Therapies for Substance buse . Treatment Improvement Protocol (TIP) Series . 34 . Brief Interventions and Brief Therapies. For Substance . Abuse. Treatment Improvement Protocol (TIP) Series . 34. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration . 1 Choke Cherry Road .
Meet the Team Counselors Brandon Landrum: brandon.landrum@csusb.edu Christopher Bohse: cbohse@csusb.edu Lucia Zarate: lzarate@csusb.edu Melissa Guerra: mdavila@csusb.edu Nicholas Clements: nicholas.clements@csusb.edu Brenda Machuca: bmachuca@csusb.edu Alejandra Quintero: alejandra.quintero@csusb.edu Salvador Perez Jr.: sperez2@csusb.edu Roger Griffin (Native American Counselor)
BAHAVEOLOS, CRISTINA J cbahaveolos@wisc.edu 877837 BALLENTINE,LAURIE S LSBALLEN@WISC.EDU 44498 BANASZAK,MEGAN A MBANASZAK@WISC.EDU 508092 BREUNIG,MINDY S mindy.breunig@wisc.edu 64025 BUDTKE,JODIE A BUDTKE@WISC.EDU 278830 CAHOON,JANE M jane.cahoon@wisc.edu 600123 CAO,LEONARD W lwcao@wisc.edu 264268
Brief 1.Gender and countering transnational organized crime and trafficking Brief 2.Gender and countering corruption Brief 3.Gender and terrorism prevention Brief 4.Gender and justice Brief 5.Gender and health and livelihoods Annexes Checklists for gender mainstreaming
Chart of Gregg Shorthand Simplified Brief Forms Word Brief Form (Text) Brief Form (Image) a, an [dot] about a b acknowledge a k advantage a v advertise a v t after a f t agent a j all o (turned sideways) allow a l always o l s am, more m . Page 2 among m ng and, end nd any n e are, our, hour r .File Size: 450KBPage Count: 16
Brief Pain Inventory Short Form Test Code Brief Pain Inventory Short Form test code. No C100161 BPI TEST Brief Pain Inventory Test Name Brief Pain Inventory test name. No C100162 BPI TESTCD Brief Pain Inventory Test C
