Day: August 31, 2020

Textbook Link
https://ufile.io/7xmsrjkb

please read
Read Chapter  47 & 48 pg 1108-1155

Patient Profile

Tony Chadwick is a 16-year-old African American male admitted to ICU from the urgent care with newly diagnosed type 1 DM with DKA. His mother took him to the local urgent care with a 2-day history of vomiting and abdominal pain. Tony also complained of thirst, blurry vision, and fatigue. His mother smelled a fruity odor on his breath this morning. The nurse at the urgent care clinic found that Tony had a blood glucose level of 520 mg/dL and urine positive for ketones. Tony was immediately transferred to the local hospital, where he was admitted to ICU. He is in the 11th grade and was doing well in school until about 2 weeks ago, when he started to become easily fatigued and irritable. His mother thought that he was just staying up too late and not getting enough sleep. Tony has been well except for an upper respiratory viral infection about 2 months ago that kept him home from school for 3 days.

On arrival in the ICU, Tony is drowsy but wakes to verbal stimuli. He complains of nausea and is vomiting green-colored bile in small amounts. He complains of abdominal pain and a need to urinate.

His mother accompanies him and expresses fear that he will not survive this acute episode. She was told at the urgent care clinic that Tony has diabetes, but she does not believe it. She says no one in her family or her husband has diabetes.

Lab Results:

AIC 12%
Anion gap 20
ABGs pH 7.22
pCO2 21
Bicarb 18
Electrolytes are pending.
Chest x-ray is negative.

Physical Assessment:

Vital signs: T 99.5F orally; P 120 bpm, thready; R 28/min, deep and labored; BP 90/60 mmHg
Neuro: As above
Resp: Lungs clear to auscultation
CVS: All pulses palpable with radial pulses thready. HS are S1, S2.
Skin: Cool and clammy but skin turgor poor
GI: Diminished bowel sounds in all quadrants
GU: Has not voided
An IV is started and 0.9% NaCl is infusing. An insulin drip is started per protocol. Tony is connected to a cardiac monitor and exhibits sinus tachycardia. A Foley catheter is inserted and connected to an hourly drainage chamber (for hourly urine output measurement).
Please answer the following questions regarding the Case Study.

Question 1

Tony is a 16-year-old male who is involved in sports. What are some of the fears and anxieties that he may have as he resumes his normal life? How can the nurse help Tony deal with these issues?

Question 2

At the urgent care clinic, Tonys mother said this couldnt be diabetes because no one in the family has ever had it. What could the nurse tell Tonys mother to help her understand the disease and its etiology?

Question 3

Discuss the electrolyte imbalance and blood gas results that occurred on the first day of Tonys admission. How do his vital signs reflect the pathophysiology of DKA?

Question 4

Tony is concerned about being embarrassed when he has to check his blood sugar and take his insulin at school. What interventions could the nurse suggest helping him with privacy?

Question 5

Tony admits to drinking alcohol occasionally. What should the nurse teach Tony about alcohol use and diabetes?

Question 6

List and explain at least four nursing diagnoses for Tony.

Until the mid-1960s, it was generally believed that the common interests of individuals or firms would lead necessarily to an organization to represent those interests. However, this reasoning was faulty; it neglected an important aspect of organizational development, the problem of free riders. This is the topic of this week’s discussion question.
First, in your own words, discuss what a free rider is.  Why is this an issue for associations/organizations formed to represent the interest of specific groups of people/firms?  The ADA and ANA found ways to overcome the free rider issue.  Discuss three of these initiatives. Why do you think these worked? In what ways could these have failed? It maybe that these are not as useful in 2019.  Identify and discuss a new initiative for the ANA and ADA that are more suited to 21st century healthcare. Be sure to provide a rationale for why these will work.

Use 3 legitimate internet sources

The student will prepare a well-developed purpose statement, which should complete the following passage: The purpose of this study is to In addition, the student will be expected to develop appropriate research questions and associated hypotheses (if appropriate) to support the proposed study.

Suggested length: The purpose statement is one sentence; however, it is standard to have at least 2 or 3 sentences for this section. I would write the purpose statement, and then provide a couple of clarifying sentences to make sure the reader knows what is meant by the content within the purpose statement. The research questions and/or hypotheses should be listed out and NOT IN NARRATIVE FORM (paragraphs).

You are to locate a healthcare industry-based, peer reviewed (refereed) study. The research design (or methodology) isnt important for this particular assignment. You will be expected to properly identify the purpose of the study and its research question or questions. Please keep in mind that these components of the study may not be clearly identified by name or set apart in their own sections within the publication. If either or both components are missing, you will propose a purpose statement and/or research question or questions relying on the available information within the existing study. If any component is present, you will critique their clarity and appropriateness using the supplemental sources made available for this unit or other credible sources you locate. Remember, there should be a clear linkage between the purpose of the study and the research questions. You are to point out the strengths with supporting rationale and tangible suggestions for strengthening these components of the study.

To complete this assignment, you should provide a link to the study if available in the Internet OR source information,