Name of Body System and Developmental Age: Infant Respiratory
Patient Presentation: Include historical information including family history and genetic considerations, background as well as symptomology and tentative diagnosis.
Maria is a six month old infant girl who was born at 40 weeks weighing 7 lbs. 4 oz. and 21 inches long. She is developmentally on track and up to date on all immunizations. Maria currently weighs 15 lbs. and 5 oz. and is 24 inches. She is breast feed and eats baby cereal in the morning. She is starting to be introduced to baby food and finger foods such as baby crackers. Her parents are married and work leaving Maria in daycare 3 days a week. They attend church on Sunday mornings and stays in the nursery during services. Her mother had gestational diabetes which was controlled during the pregnancy. Mom had a bought of post-partum depression which is now controlled by citalopram. Her mother has no other significant health history and neither does the father. Maria is currently an only child. See pathophysiology and diagnosis below. She takes no regular medications.
Questions you MUST answer, providing scholarly sources for rationales.
1. Thorough and concise pathophysiology description showing connection to manifestations or signs and symptoms of the client.
Maria was brought to the pediatrician today for symptoms of runny nose, cough, fever 101.1, cough, and wheezing, decreased feedings, fussy and restless and has had a dry diaper for the last 10 hours. The initial symptoms began 5 days ago but worsened overnight. Mom has treated the fever with infants Tylenol. Temp 101.1 P 165 R 40.The doctor is sending Maria home rotating Tylenol and ibuprofen every 4 hours, give pedialyte in between feed...
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... attention (Newfield et al., 2007).
3. Assess changes in vital signs and lung sounds they may indicate in a change of health status
4. Sit in upright position to help promote lung expansion and improved air exchange (Gulanick and Myers, 2007).
5. Administer medications as prescribed.
References
Cox, H. C., & Newfield, S. A. (2007). Cox's clinical applications of nursing diagnosis: Adult, child, women's, mental health, gerontic, and home health considerations. Philadelphia: F.A. Davis Co.
Gulanick, M., & Myers, J. L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis, MO: Mosby.
Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing. St. Louis, MO: Mosby/Elsevier.
Murray, R. B., Zentner, J. P., & Yakimo, R. (2009). Health promotion strategies through the life span. Upper Saddle River, NJ: Pearson
Gulanick, M., & Myers, J. L. (2007). Nursing care plans: Nursing diagnosis and intervention. St. Louis, MO: Mosby.
Potter, P. & Perry, A. (2014). Fundamentals of Canadian nursing. 5th. Ed. Toronto: Elsevier 383
"Symptoms."Mayo Clinic. Mayo Foundation for Medical Education and Research, 28 May 2011. Web. 06 May 2013
Craven, R., & Hirnle, C. (2009). Fundamentals of nursing: Human health and function (6th ed.). Philadelphia: Lippincott.
The purpose of the paper is to discuss the activities involved during the evaluation of a patient. Evaluation of a patient can be seen as the process of examining a patient critically. It comprises of gathering and analyzing data about a patient and the illness (Allan, 2012). The core reason is to make judgment about the disease one is suffering from. Such judgment will guarantee proper treatment and diagnosis. Typically, gathering of information from the patient is the role of nurses while making judgment and prescription is the doctor’s role (Jacques, 1988). In any case all practitioners are required to know how to evaluate a patient.
Potter, P., Perry, A., Ross-Kerr, J., & Wood, M. (2009). Canadian fundamentals of nursing fourth edition.
Describe the pathology/condition from a reputable source. Include its etiology (how, when and why it occurs)
in taking patient clinical history, also describe the desirable qualities of an exceptional patient interviewer. Explain the value of six categories of question used in obtaining patient histories. Describe the importance of clarifying the chief complaint. Detail the components of each of the sacred elements is a clinical history. The six types of interview questions and skills are: open ended, facilitation, silence, subtle repetition, and summarization. Soon after the sacred seven develop which are: localization, chronology, quality, severity, onset, and aggravating or alleviation on the affected area. All of these questions are prior to the x-ray
Heat-to-To assessment, including focused assessment based on current diagnose and body systems that are indicating signs and/or symptoms that of concern and require nursing interventions.
The nursing process is one of the most fundamental yet crucial aspects of the nursing profession. It guides patient care in a manner that creates an effective, safe, and health promoting process. The purpose and focus of this assessment paper is to detail the core aspects of the nursing process and creating nursing diagnoses for patients in a formal paper. The nursing process allows nurses to identify a patient’s health status, their current health problems, and also identify any potential health risks the patient may have. The nursing process is a broad assessment tool that can be applied to every patient but results in an individualized care plan tailored to the most important needs of the patient. The nurse can then implement this outcome oriented care plan and then evaluate and modify it to fit the patient’s progress (Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P., 2011). The nursing process prioritizes care, creates safety checks so that essential assessments are not missing, and creates an organized routine, allowing nurses to be both efficient and responsible.
Moving forward I want to continue connecting the pieces of my patients’ care and health history. I plan on accomplishing this by continuing analyzing the lab values, medications, and physiology of the diagnosis to establish diagnosis and interventions specific to my patients and finding the connections between the
Hospitalizations affect a large number of the population in the United States (US). A large number of those Americans are hospitalized due to a surgical procedure that needs to be performed. Many people may suffer from postoperative complications while in the hospital that can be extremely serious or even cause death. The Agency for Healthcare Research and Quality (AHRQ) has established Quality Indicators (QIs) called Patient Safety Indicators (PSIs). The PSIs are used with hospital inpatient data to reflect quality of care and patient safety, primarily focusing on potential avoidable complications. The purpose of this paper is to define the purpose of the PSIs-90 and role in healthcare today. Discuss
Potter, P. & Perry, A. (2009). Fundamentals of Nursing (7th ed.) St. Louis: Mosby Elsevier, 1029-1084.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.
Inadequate data collection from patients is unacceptable, which is why it is necessary to have and implement health assessment frameworks or strategies. Health or nursing assessments are continuous cycles of data collection and making inferences. There are steps to be taken to ensure adequate collection of objective and subjective data, these steps need to be taken in order otherwise an inaccurate assessment may occur. These steps are: assessment, diagnosis, planning, implementing and evaluation (Lewis, Foley, Weber, & Kelley, 2011, p. 2-5). Nursing assessments aim to collect subjective and objective data to determine a patient's overall functionality in order to make a clinical judgment, the nurse collects data relating to all areas of individual health. It is my opinion that appropriate health assessments are necessary to ensure a patient receives the correct treatment plan. All health assessment frameworks follow the same steps in organizing treatment, due to the wide scope of nursing disciplines there are varying focuses on these individual steps i.e. the emergency room could be more focused on the assessment in order to triage the patient. To help alleviate the patients or family members who may be distraught a health professional should take the time to expla...