Critical Thinking Exercise related to Diagnostic Test Results (4 points) Column 1 lists categories of medical conditions.

Based on your patients medical history and/or current condition, choose two of the ten conditions to complete for this section of your prep. Once you identify the two medical conditions you wish to work on, delete the other medication conditions from your table. Answer the critical thinking questions in column two then insert the table into your binder where indicated. Complete two different categories of medical conditions when you submit Medication Preparation 2. Patients Medical History or Current Condition (2 pts; 0.4 pt/question) Anemia Review Pertinent Diagnostic Results: HGB= HCT= TIBC= Iron= Vitamin B12= Folate= Use the following questions to determine the impact of the diagnostic results on the patients plan of care Does your patient have a history of anemia or is this a new onset of anemia? 2. If your patient has had surgery, was he/she anemic prior to surgery (provide supporting lab values)? 3. Anemia may result from iron or B12 deficiencies. Identify 3 foods would you recommend to your patient to help resolve his/her anemia. (http://www.mayoclinic.com/health/anemia/DS00321)

4. Describe 2 ways in which anemia might impact your patients recovery from his/her illness and/or surgery. List patient medications treating this problem: 5. Describe 2 nursing interventions you can implement with your patient that will help him/her mange or improve his/her anemia.

(2 pts; 0.4 pt/question) Cardiac History: HTN, CAD, CHF, Dysrhythmias Review Pertinent Diagnostic Results: Sodium= Potassium= HGB= HCT= Digoxin Level= CXR EKG List patient medications treating this problem:

1. Explain why it is or is not safe to continue your patients cardiac medications based on his/her diagnostic results.

2. Some diuretics given to treat hypertension deplete potassium levels. Identify 3 foods you would recommend to your patient (other than citrus fruits) because they are high in potassium.
(http://www.americanheart.org/presenter.jhtml?identifier=2133)

3. Identify 3 signs/symptoms of heart failure and/or fluid overload that the nurse should observe for when completing his/her patient assessment. (http://www.americanheart.org/presenter.jhtml?
identifier=1486)

4. Describe 2 ways in which decreased cardiac function might impact your patients recovery from his/her illness and/or surgery.

5. Describe 2 nursing interventions you can implement with your patient that will help him/her manage or improve his/her cardiac function.

(2 pts; 0.4 pt/question) Coagulation Problems: Hx of/Risk For Blood Clots Review Pertinent Diagnostic Results: PLT= APTT= PT/INR= HGB= HCT=

1. Explain why it is or is not safe to continue your patients medications based on his/her physical assessment findings and diagnostic test results. Look in your drug handbook to determine which labs are used to monitor the anticoagulants your patient is taking.

2. Identify 3 signs/symptoms of deep vein thrombosis the nurse should observe for when completing his/her patient assessment. (http://www.mayoclinic.com/health/thrombophlebitis/DS00223)

3. Identify 3 signs/symptoms of pulmonary embolism the nurse should observe for when completing his/her patient assessment. List patient medications treating this problem:
(http://www.mayoclinic.com/health/pulmonary-embolism/DS00429)

4. The effectiveness of warfarin (Coumadin) therapy is impacted by the patients dietary intake. Identify 3 foods or medications the patient should avoid while on warfarin therapy.
(http://www.mayoclinic.com/health/warfarin-side-effects/HB00101)

5. Describe 2 nursing interventions you can implement with your patient that will help him/her manage or improve his/her coagulation status.

(2 pts; 0.4 pt/question) Depression (Your Pharmacology text is a good resource) Review Pertinent Diagnostic Results: BP: EKG: Wt: Sodium: List patient medications treating this problem:

1. Does your patient have a history of depression or is this a new problem? Does your patient take an anti-depressant to treat depression or another condition? If it is for another condition, please describe.

2. What tools might you use to screen for or validate improvement of depression? Go to http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatrypsychology/recognition-treatment-of-depression/ to review different tools available.

3. What are signs and symptoms of depression? What are cultural or age related changes that affect the presentation of depression in your patient? Review this web site to find this information. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatrypsychology/recognition-treatment-of-depression/

4. Is your patient experiencing any adverse effects from the medication used to treat depression? List 2 nursing interventions that you may suggest.

5. Are there any nutritional issues related to the medication your patient is taking?

(2 pts; 0.4 pt/question) Diabetes Review Pertinent Diagnostic Results: Glucose= Hgb A1C= Fingerstick blood sugar results in last 24 hours: Time Result

1. Identify 3 signs/symptoms of hypoglycemia the nurse should observe for while caring for a diabetic patient. (http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/)

2. Go to the American Diabetic Association website and read about healthy eating. Describe 2 dietary recommendations you would make to your patient to help him/her manage his/her blood sugar levels. (http://www.diabetes.org/food-and-fitness/)

3. Describe 2 long term complications of uncontrolled or poorly controlled diabetes.

(http://www.diabetes.org/living-with-diabetes/complications/)

List patient medications treating this problem:

4. Describe 2 ways in which poorly controlled blood sugars or poorly managed diabetes might impact your patients recovery from his/her illness and/or surgery.

5. Describe two nursing interventions you can implement with your patient that will help him/her manage or improve his/her diabetes.

(2 pts; 0.4 pt/question) Hyperlipidemia Review Pertinent Diagnostic Results: Cholesterol= HDL= LDL= Triglycerides= Liver Function Tests (see question 4)

1. Go to the American Heart Association website. Review the information on the website under headings of Manage Your Cholesterol and Learn Your Levels. Describe how you would help your patient understand his/her cholesterol numbers. (http://www.americanheart.org/presenter.jhtml?
identifier=1516)

2a.If your patient is less than 50 years of age, describe 2 ways in which poorly controlled blood cholesterol might increase your patients risk for future health problems.

2b. If your patient is greater than 50 years of age, describe 2 ways in which poorly controlled blood cholesterol has contributed to his/her current health problem(s).

3. Review the information on the website under Lifestyle Changes and Eating a Heart Healthy Diet. Describe 2 recommendations you could make to your patient related to his/her dietary habits that would lower their cholesterol.
(http://www.americanheart.org/presenter.jhtml?identifier=3046113)

List patient medications treating this problem: 4. Many medications that lower cholesterol can impact liver function. Search Medline Plus to identify 2 lab tests that would monitor for liver function changes in a patient taking cholesterol reducing medications. Include the reference ranges for the two tests. (http://medlineplus.gov/)

5. Describe 2 nursing interventions you can implement with your patient that will help him/her manage or improve his/her hyperlipidemia.

(2 pts; 0.4 pt/question) Osteoporosis/Decrease d Bone Density Review Pertinent Diagnostic Results: Calcium= x-rays of bones Bone density tests

1. Go to the National Osteoporosis Foundation website (www.nof.org). Use information under the About Osteoporosis: Fast Facts tab to describe your patients risk factors for development of osteoporosis.

2. Review the information on the website under About Osteoporosis and Prevention. Describe 2 recommendations you could make to your patient related to his/her dietary habits that would lower their risk to develop osteoporosis or promote bone growth if already diagnosed.

List patient medications treating this problem: 3. Review the information under Fast Facts related to fractures and cost. Describe 2 ways this information affects your diligence in patient assessment/intervention related to fall prevention.

4. Review the information under Prevention related to exercise. Describe 2 exercises that would assist your patient in maintaining his/her bone density.

5. Describe two nursing interventions you can implement with your patient that will help him/her manage or improve his/her osteoporosis.

(2 pts; 0.4 pt/question) Pulmonary History: Asthma, COPD, Pneumonia, Lung Cancer Review Pertinent Diagnostic Results: HGB= HCT= WBC= CXR CT Scans Theophylline level bronchoscopy

1. Go to http://www.lungusa.org/lung-disease/ website and find information regarding your patients identified lung disease by using the lung disease finder link. Describe 2 causes, 2 symptoms, and 2 treatment options associated with your patients pulmonary condition.

2. Describe your patients risk factors for developing respiratory distress.

3. List two signs and symptoms of respiratory distress for a patient with a pulmonary history.

List patient medications treating this problem:

4. Describe two education topics you can teach to your patient to help him/her manage his/her pulmonary condition.

5. Describe two priority nursing interventions you can implement to promote effective airway clearance when providing care for your patient.

(2 pts; 0.4 pt/question) Renal Impairment/Failure Review Pertinent Diagnostic Results: BUN= Creatinine= Potassium= Hemoglobin= Hematocrit=

1. Discuss your patients risk factors for developing kidney disease. (http://kidney.niddk.nih.gov/kudiseases/pubs/chronickidneydiseases/index.htm)

2. List 2 physical assessment or diagnostic findings of hyperkalemia that a nurse should assess for when caring for a renal impairment/failure patient.

3. List 2 physical assessment findings the nurse should include when assessing the renal impairment/failure patient for fluid retention. List patient medications treating this problem: 4. Go to the National kidney foundation website and review diet and nutrition information related to potassium (http://www.kidney.org/atoz/atozTopic_Nutrition-Diet.cfm). List 3 high potassium foods that should be avoided in the renal impaired/failure patient.

5. Describe 2 nursing interventions that can be implemented for a patient with renal impairment/failure that has fluid retention.

(2 pts; 0.4 pt/question) Seizure Disorder Review Pertinent Diagnostic Results: Therapeutic drug levels: Phenytoin= Valproic Acid= Carbamazepine= Keppra= Lamictal=

1. Name 4 types of seizures. (www.epilepsyfoundation.org)

2. List 3 causes of seizures. (www.epiepsyfoundation.org)

3. List 5 side effect warning signs for antiepileptic drugs (AEDs) (www.epilepsyfoundation.org).

List patient medications treating this problem:

4. Describe the diagnostic tests most commonly used to diagnose a seizure. (www.epilepsyfoundation.org)

5. Describe 3 priority nursing interventions with #1 being the highest priority to do for a patient who is having a seizure.

(2 pts; 0.4 pt/question) Substance abuse Review Pertinent Diagnostic Results: Urine drug screen: Amphetamines: Barbituates: Benzodiazepines: Cocaine: Marijuana: Methadone: Opiates: PCP: Blood alcohol level: List patient medications treating this problem:

1. What is the definition of drug addiction? What signs and symptoms would characterize drug addiction? (http://www.mayoclinic.com/health/drug-addiction/DS00183)

2. How would the nurse interpret a urine drug screen result that is reported as positive?

3. How would you interpret a blood alcohol level of 0.12?

4. Describe 2 nursing interventions for a hospitalized patient that has a tobacco addiction.

5. Describe 2 nursing interventions for a hospitalized patient experiencing alcohol withdrawal?

(2 pts; 0.4 pt/question) Wound Healing Infection Review Pertinent Diagnostic Results: WBC= Albumin= Total Protein= Culture & Sensitivity Reports Vancomycin Peak &/or Trough

1. Identify the risk factors your patient has for poor wound healing or the development of infection in the wound.

2. List 3 signs and symptoms that a nurse would assess when caring for an infected wound.

3. Go to the Cleveland clinic website and identify what nutrients are needed for wound healing. List 4 of the nutrients and a good food source for that nutrient. (http://my.clevelandclinic.org/healthy_living/nutrition/hic_nutrition_guidelines_to_improve_wound _healing.aspx ).

List patient medications or nutritional supplements treating this problem:

4. In your clinical facility who is the wound care expert and what is the procedure to collaborate with this wound expert?

5. Describe two nursing interventions you can implement to resolve the issues identified above when providing care for this patient.