Human Immunodeficiency Virus Essay

Meet the Client Jeff metalworkerThirty-two-year-old Jeff Smith is admitted from his health worry submitrs office to the acute c ar facility. Jeff was diagnosed human immunodeficiency virus supportive 2 years ago. His history includes fatigue, a productive cough up, and weight loss. A terabyte (TB) flake discharge was administered in the healthcare suppliers office. Admission prescriptions include isolation precautions for possible terabit.Admission ProcedureThe throw welcomes Jeff to a private populate at the rest of the h all(prenominal). According to hospital protocol, the moderate puts on a mask in the lead starting the addition process. Jeff tells the cling to that his render is downstairs and that he would like his partner to confront in the means with him.1.How should the value respond?A) Your healthcare supplier complimentss you to set up few rest. ill-advisedJeff is requesting an fortune for psychosocial support, which should be honored by the go d own on.B) Your partner whitethorn stay, al mavin be fonts if after we conduct the issuings of his tuberculin skin test. in reprobateSignifi sack upnistert others may stay with appropriate defending(prenominal) equipment. C) Your partner may stay, yet he needs to discontinue a mask. coifJeffs partner may stay in the room, but he should wear a mask to help decrease the possibility of contracting the TB organism.D) You dont ask to excise chances infecting your partner with TB, do you? ludicrousJeffs partner has al lay down been exposed. In addition, this response denies Jeff the support he is requesting.Jeffs partner, Anthony, arrives. Jeff wants to know why a mask is needful for lot entering his room.2.What teaching should the draw implement?A) Explain the use of a private room and mobile high-efficiency particle filters placed in the room.IN determineThese are necessity precautions against septic, mobile diseases such as TB. However, providing this info does non answer Jeffs question.B) Explain that the tuberculosis organism is most a equitable deal crack through the air. When an infected person coughs or sneezes, they produce infectious droplets that deal be br breakhed in by a nonher person. clearThis answer glide bys Jeff the scientific rationale for wearing a mask. C) evidence Jeff that tuberculosis lead non be spread to others, and e precisething bequeath be sanction if the mask is worn. anomalousThis is false information. Wearing a mask entrust non pr tear downt the contr save of tuberculosis (TB), but it will humiliate the risk of contracting the disease. D) Tell Jeff that masks are need for those persons who do non agree to be vaccinated with BCG vaccine. irrationalThe BCG (Bacille Calmette-Guerin) vaccine is non mostly recommended for use in the United States. It is unless use here for very select persons who meet specific criteria. IsolationThe unlicensed assistive effect (UAP) asks why Jeff could non be in an empty semiprivate room closer to the maintains station so the weighty would non have to walk so far to provide care.3.What information should the nurse provide to the UAP on infection control practices? A) The customer needs to be at the end of the hall because he requires privacy.IN make betterThis is not the condition for the location of Jeffs room.B) The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment. line upAccording to the Center for illness Control (CDC), in addition to isolating Jeff by using a private room, engineering controls cannister help to keep back the spread of TB. coercive the direction of the airflow can prevent contamination of air in adjacent regions. C) A private room is inevitable to implement strive precautions for possible TB. chimericalAirborne precautions, rather than contact precautions, are required to prevent the spread of TB.D) The knob needs to be at the end of the hall for confidentiality. defectiveConfidentiality is provided for every invitee, regardless of the clients room location. The nurse notices the UAP almost to enter Jeffs room to forgo a meal tray without wearing any protective apparel.4.What information should the nurse provide to the UAP?A) A mask is required for healthcare workers entering the room of person suspected of having active TB.CORRECTTB is spread by airborne transmittance of droplet nuclei. A well fitting, high-efficiency particulate air (HEPA) mask is necessary to filter the mycobacterium tuberculosis bacillus. B) Wearing a mask, gown, and gloves is required for healthcare workers entering Jeffs room for any reason. preposterousThe solely protective apparel required when entering the room is a HEPA mask. C) The UAP will only be in the room for a brief moment to deliver the tray, so no intervention is needed by the nurse. wildSince TB is spread by airborne transmission of droplet nuclei, a HEPA mask is necessary for t he UAP to wear. The nurse needs to inform the UAP of this and ensure that appropriate PPE is worn in Jeffs room.D) Non-sterile gloves are necessary to deliver the meal and prevent the spread of TB. untimelyGloves do not prevent the transmission of an airborne organism. archetype CollectionAn acid-fast bacilli (AFB) stain is part of the initial admission prescriptions. untimely morning sputum patterns will be dupeed for 3 unbent days and sent to the lab. 5.Which task(s) may the nurse de levelate to the UAP? (Select all that apply.) A) Tell Jeff that the specimen must be collected in the early morning. CORRECTThis task may be delegated.B) Provide Jeff with 3 sterile specimen cups at his bedside.CORRECTThis task may be delegated.C) Teach the client how to cough to obtain sputum from deep in the bronchi. improper education is a righteousness of the nurse that cannot be delegated. Jeff needs to be taught to cough deeply, using the diaphragm to produce sputum from the bronchi instea d of saliva from the viva voce cavity. D) Document the time and date that each sputum specimen was collected.CORRECTThis task may be safely delegated. However, it is the nurses responsibility to ensure that the documentation is completed and sent with the specimen to the lab. E) Assess Jeffs abilty to expectorate a sputum specimen. nonsensicalThis task may not be delegated.Jeff is scheduled for several activities the following morning. 6.Which activity should Jeff commit prototypical upon awakening?A) Eat a nutritionally wooden-headed, early morning chomp sent from the forage services department.INCORRECT slice small, nutritionally dense meals and snacks are necessary for clients with human immunodeficiency virus and/or TB, another(prenominal) do is of great anteriority. B) Obtain the first of 3 sputum specimens for laboratory testing.CORRECTBecause secretions collect during the night, Jeff should take the opportunity to cough and expectorate upon awakening before perform other morning activities.C) Take a shower and fill ready to go to radiology for a chest X-ray.INCORRECT some other action is of greater priority.D) Weigh to determine if weight loss from the disease is continuing.INCORRECTAlthough daily weight monitoring may be d 1, another action is of greater priority. Legal/Ethical ConceptsA female staff nurse tells the nursing executive program that she does not want to be assigned to care for Jeff. She states, I have never cared for a client with human immunodeficiency virus and do not want to start now. I have babies at syndicate that need me. 7.The nursing supervisor should base her response on what information some the right of a nurse to refuse to care for clients with human immunodeficiency virus? A) The registered nurse has the right and responsibility to protect the health of self and family and may at that placefore refuse to care for clients with contagious diseases.INCORRECTThis answer does not meet the professional aimlines s et forth by the ANA Code for Nurses that guide ethical nursing practice. B) The registered nurse may refuse to care for a client in circumstances where risk to the nurse outweighs the nurses responsibility to care for a client or if the assignment conflicts with the nurses ethical tireds.CORRECTAccording to the ANA Code for Nurses, a nurse may deterrent mental testingplely refuse to participate in care, but only on the grounds of either client advocacy or m ad-lib objection to a specific type of intervention. Exceptions may be do when risk of h spike outweighs the nurses responsibility to care for a overtaken client. For example, an immunosuppressed nurse may refuse to care for clients with authorized infectious processes. The pregnant nurse may refuse to care for the client with human immunodeficiency virus who has secondary infections such as toxoplasmosis or cytomegalovirus, both of which can cause severe dam get along with or death to the fetus. C) Refusal to treat or care for a person based on race, gender, or age is discrimination, which the federal government prohibits.INCORRECTThe nurse in this case is not refusing to care for the client based on these parameters. If the nurse did refuse, it would be illegal. D) The required staffing ratio of licensed personnel to client population does not furnish for professional nurses to refuse to care for a client.INCORRECTStaffing ratio is a budgeting issue. Nurses in many states may claim safe harbor if they detect staffing is unsafe, but this is not the reason given for refusal in this case.8. How should the nursing supervisor respond to the staff nurse who does not want to care for Jeff? A) I understand. I will assign you to a unalike client and give Jeff to one of the other nurses.INCORRECTThis response does not provide an opportunity to assess if something else is needed. B) I understand you are concerned, but I am concerned about you losing your job over this.INCORRECTNot only is addressin g possible dismissal of the nurse premature, this response does not provide an opportunity to assess whether something else is needed. C) I understand your fears, but do you recognize this will cause a hardship on your fellow staff members?INCORRECTThis response does not help develop the nurse as a team member, nor does it provide an opportunity to assess if something else is needed. D) I understand you want to protect your children. Please tell me your concerns regarding caring for a client with human immunodeficiency virus.CORRECTThis response by the nurse supervisor demonstrates compassion and provides an opportunity to point out if education of the staff nurse is needed. Client EducationThe nurse checks on Jeff and finds him reading a brochure about TB. 9.Which statement by Jeff indicates that he understands why he is at risk for TB? A) I defecate my helper T jail cells are diminished from human immunodeficiency virus. Those are the cells needed to combat TB.CORRECThuman i mmunodeficiency virus attacks the CD4 receptors on the helper T cells that help the personify fight off diseases such as TB. B) I may get tuberculosis because my viral load count is diminished.INCORRECTAn increased human immunodeficiency virus viral load indicates disease progression and puts the client at risk for opportunistic infections. A decreased viral load count is desirable. It is a goal of anti-HIV therapy. C) I am at risk for developing TB because I was born with a low number of helper T cells.INCORRECTThis may indicate Jeff is in denial or lacks correct information. The human immunodeficiency virus is acquired rather than genetic in origin. D) I realize I am at risk for acquiring TB because I used intravenous drugs in the past.INCORRECTJeff could have been exposed to HIV and hepatitis virus from a contaminated needle. However, the mode of transmission of the mycobacterium tuberculosis bacilli is through respiratory secretions, not kin-borne routes. After 3 days, the nurse receives the results from Jeffs tuberculin skin test that was administered at his healthcare providers office. even off though Jeffs reaction to the tuberculin skin test measures only 5 mm in diameter, the healthcare provider documents a substantiative test result. A new graduate nurse finds this confusing. She tells her preceptor that she thought a 10 mm induration was the minimum size for a positive reading. 10.How should the nurse-preceptor respond?A) This confuses me, too. I think we need to consult with the healthcare provider.INCORRECTThe nurse-preceptor should be able to explain the tuberculin skin test result. B) That is not everlastingly true. A 5 mm induration is considered positive for TB in a person with HIV.CORRECTThe person with HIV has diminished T cell immunity, which compromises their ability to react to skin tests. Therefore, an induration of 5 mm is considered a positive reaction, rather than the standard of 10 to 15 mm for other classifys. C) It may b e that you are confusing induration with firing in skin testing results.INCORRECTThe hardened, raised area of induration at the site of the skin test is measured. Any flat, reddened area of inflammation is not measured. The graduate nurse did not indicate astonishment between the two. D) Lets ask the nurse-practitioner who specializes in caring for clients who are HIV positive.INCORRECTAlthough the practitioner is an excellent resource, the nurse-preceptor should be able to explain the tuberculin skin test result.Pharmacotherapeutics/Medication AdministrationBefore breakfast, the nurse brings Jeff the HIV medicines that are due. Jeff inquires about his other medications, stating, I take all my HIV pills at once before breakfast. I dont want to bother with this disease all day long11. How should the nurse state?A) To be most useful, HIV medications are prescribed on diametric schedules.CORRECTSome HIV inhibitors need to be given on an empty stomach and some need to be g iven with pabulum for surpass force. Many need to be taken around the clock, even if sleep is disrupted, to ensure drug efficacy. B) All right. I will give the rest to the UAP to bring in as soon as possible.INCORRECTThis is not the correct way for Jeff to take his medication, nor is it within the UAPs circumstance of practice to give medications. C) We are just trying to provide you with the vanquish nursing care possible on this unit.INCORRECTThat is a en garde rejoinder, which does not contribute to educating Jeff. D) We need your cooperation to help fight this disease.INCORRECTThis reply is mindal and implies that Jeff is uncooperative, which he is not. Jeff responds by agreeing to take his medications as prescribed. He wherefore states, However, I dont know what good they will do. Do you? 12. How should the nurse respond?A) I honestly do not know, but I would give it a try. What is there to lose?INCORRECTThis response does not educate Jeff about the manipulation o f the HIV meds. B) The main purpose of these medicines is to block the restitution of the HIV virus.CORRECTThe purpose of the antiretroviral and inhibitor medicines is to block the replication of the HIV virus and prevent opportunistic diseases. C) You should talk to your healthcare provider about your medications.INCORRECTThe nurse should be able to answer Jeffs question about his medications. D) Tell me about the experiences your friends have had with these medicines.INCORRECTexploration of how Jeff formed his opinion would be better if left until after the nurse answers Jeffs question. Jeffs healthcare provider has also prescribed the antibiotic Rifater. This drug is a combination of isoniazid, rifampin, and pyrazinamide. 13. What information is important to teach Jeff about the use of Rifater? (Select all that apply.) A) Rifampin stains weewee, stool, saliva, sweat, and tears reddish-orange.CORRECTThis teaching can help Jeff prepare for this side effect without anxiety. B) Liver function tests should be routinely conducted and monitored. CORRECTThe major side effect of isoniazid, rifampin, and pyrazinamide is drug-induced hepatitis. Therefore, Jeff must be taught the importance of having blood samples drawn to monitor his liver function. C) There is no need to wear sunscreen when exposed to sunlight while fetching Rifater.INCORRECTPyrazinamide may make the skin sensitive to sunlight, and this should be taught to the client. D) adjunct Vitamin B6 may be prescribed.CORRECTJeff may be prescribed Vitamin B6 to prevent peripheral neuritis, a side effect of isoniazid (INH). E) Rifater has been known to remediation HIV within a few months of taking it.INCORRECTRifater is a first-line anti-tubeculin drugNursing DiagnosisJeff has been diagnosed with the opportunistic disease TB. He has experience weight loss and has a CD4 cell count of 240 cells/mm3. The healthcare provider moves Jeff from the HIV asymptomatic stage (CDC HIV Infection Stage 1) to the HIV Infection Stage 3 (AIDS). 14.What is the priority nursing diagnosis for Jeff at this time? A) Risk for new opportunistic infections relate to decreased insubordinate function.CORRECTSince Jeffs immune system is no longer competent, he is at risk for additional opportunistic infections. Immune problems start when the CD4 cell count drops below 500 cells/mm3. Preventing infections is a basic need and is a high priority in the immunocompromised client. B) Social isolation related to worsening of condition.INCORRECTSocial isolation should be addressed, but there is a higher(prenominal) priority nursing diagnosis. C) Imbalanced nutrition, less than torso requirements related to medication side effects.INCORRECTAlthough this is frequently a side effect of taking HIV and TB medications, there is a higher priority nursing diagnosis.D) Fatigue related to altered torso chemistry.INCORRECTAlthough the client initially complained of fatigue, there is a nursing diagnosis with a higher priori ty.Infection ControlOne of the unlicensed assistive personnel (UAP) says, Now that Jeffs condition has worsened and he has been moved to the HIV Symptomatic stage, shouldnt added precautions be posted on Jeffs approach to protect staff members? 15.What information should the nurse give the UAP?A) Following standard precautions will minimize the exposure to blood and body fluids.CORRECT ensample precautions are designed to prevent contact with blood or body fluids, which are the mode of transmission for HIV, and are used no function what the stage classification of the disease. B) Reverse isolation uses should be implemented to protect the staff.INCORRECTReverse isolation protects the immune-compromised client, not the staff. C) Respiratory precautions are all that are needed, and those are already posted on the door.INCORRECTThis does not address the UAPs concerns about prevention of HIV transmission from client to staff. D) Staff members caring for Jeff should begin prophylaxis medications. INCORRECTUnless HIV exposure occurs, staff should not begin the postexposure prophylacis regimen. The UAP has been assigned to help Jeff bathe. As the UAP prepares to enter Jeffs room, the nurse observes her putting on a gown, gloves, mask, and goggles. 16.What should the nurse say to the UAP?A) I see you are putting on a gown, gloves, mask, and goggles to go into the clients room. Help me understand this choice.CORRECTThis type of open-ended statement seeks clarification and invites the UAP into a dialog where teaching can take place. The nurse can then educate the UAP concerning the proper use of equipment. amount precautions (for HIV) require that gloves be worn, and respiratory precautions (for TB) require that a mask be worn. Goggles and a gown are not necessary. B) Dont you know all that equipment is not necessary?INCORRECTThis statement is to a fault aggressive and may seem demeaning to the UAP. C) Wearing all that equipment is a waste of hospital supplies. INC ORRECTWhile it is important to ensure effective use of resources, this statement is critical and negative and may cause the UAP to lead defensive. D) Wearing all that equipment may frighten Jeff.INCORRECTWhile the extravagant equipment may frighten Jeff, there is a better response. Oral moniliasisThe nurse notices that Jeff has left most of his dinner untouched. The nurse offers to order something different for Jeff, but he replies that his mouth is sore and he just doesnt feel like eating. 17.Which assessment finding by the nurse would be indicative of oral examination candidiasis, a commonplace secondary infection in persons with compromised immune systems? A) Blisters on the tongue or oral mucosa.INCORRECTThis is a sign of herpes simplex type virus 1 (HSV-1) infection. B) rubor of the gums.INCORRECTThis is a symptom of gingivitis.C) Painless white lesions on the squinty surface of the tongue.INCORRECTThis is a description of leukoplakia.D) White-yellow patches on the tongu e or oral mucosa.CORRECTThis sign is indicative of a Candida albicans infection. It is a common finding in people with HIV, and it frequently occurs with a falling CD4 cell count. The nurse notifies the healthcare provider, who prescribes nystatin (Mycostatin) 6 ml PO 4 times per day.18.What instruction should the nurse give Jeff about the use of liquified Mycostatin? A) Place all of the reprieve in the mouth, then lick and swallow immediately.INCORRECTThis is not the proper way to take politic Mycostatin.B) Sip the suspension over 5 delicates, swishing and swallowing after each sip.INCORRECTThis is not the proper way to take limpid Mycostatin.C) Place the suspension in the mouth, then swish for several minutes before swallowing.CORRECTThis swish and swallow technique is the proper way to take liquid Mycostatin. Providers also recommend gargling, as well as swishing, prior to swallowing. D) employ the applicator to paint the medication on the infected sites and swallow the r emain loony toons.INCORRECTThis describes the recommended procedure for young children or infants taking Mycostatin.Nutritional InterventionsJeff Smith is 5 feet, 11 inches tall. He has a large frame and weighs 152 pounds. His menstruation BMI (body mass index) is 17.4. Jeff says he realizes he should eat, but he does not have the energy or the appetite, even when he has no oral pain. The nurse identifies the nursing diagnosis of, Imbalanced Nutrition less than body requirements. 19. To come upon the goal of improving Jeffs nutrition, which nursing intervention should the nurse perform? A) Consult with Jeff to assess his food preferences.CORRECTDetermining Jeffs food preferences is a good first step. It is of the essence(p) that Jeff be an active role player in his care so he has some control. If a favourite food is not on the menu, it can be requested. B) Request a prescription for total parenteral nutrition (TPN).INCORRECTWhile this may eventually be needed, it is not th e outmatch intervention at this point. C) certify Jeff that adequate nutrition is essential.INCORRECTJeff has already indicated he understands the need to eat.D) enlighten Jeff to focus on breakfast, the most important meal of the day.INCORRECTIt is not necessary to focus on breakfast. Adequate nutrition can be achieved from meals eaten throughout the day. 20. Since Jeff now has thrush, in addition to fatigue and anorexia, which food vanquish contributes to improving Jeffs nutrition? A) Broiled steak.INCORRECTAlthough steak is a good source of protein, it requires energy to chew, and it may be irritating to Jeffs mouth. B) draw shake.CORRECTA milk shake is a nutrient-dense food. It provides needed calories, calcium, and protein. Jeff can drink the nutritious snack without using the energy it would take to eat a full meal. Jeff may find the cool liquid is assuasive to his sore mouth. C) Tomato soup.INCORRECTAlthough liquid soup is not baffling to eat, (note, the warmth coul d be soothing), the acidity of the tomato soup may be irritating to Jeffs mouth.D) Lettuce salad with raw vegetables.INCORRECTAlthough a salad with raw vegetables is a good source of vitamins, it requires energy to chew, and it may be irritating to Jeffs mouth. A Complication OccursJeff develops severe profligacy with occasional incontinence that could be caused by an opportunistic gastrointestinal infection or by one of his medications. While stool cultures are pending, other interventions can be initiated. 21. Which task(s) should be delegated to the UAP? (Select all that apply.) A) Weigh Jeff each morning before breakfast.CORRECTWeights can be obtained by the UAP.B) Measure the urine output.CORRECTMeasurement of the urine output can be delegated to the UAP, then reported to the RN. C) Count and degrade the number of watery stools.CORRECTThe UAP can legally count and depict the number of watery stools. However, it is the nurses responsibility to be aware(predicate) of the clients condition and promptly report any profound changes to the healthcare provider. D) Evaluate the rate and quality of Jeffs pulse.INCORRECTThe nurse must evaluate the quality and rate of Jeffs pulse because this requires judgment and expertise beyond the setting of practice of unlicensed personnel. E) Check Jeffs skin turgor to determine if he is dehydrated.INCORRECTThe nurse conducts physical exam procedures, including assessing for alterations in skin turgor, to determine hydration status. This expertise is not within the scope of practice for the UAP. When execute Jeffs morning physical assessment, the nurse discovers that he has a weak, rapid pulse. He also has decreased skin turgor and dry, sticky, oral mucous membranes. His weight is 2 pounds less than it was yesterday morning. 22. What is the priority nursing diagnosis?A) Fatigue.INCORRECTFatigue may be present with diarrhea, but it is not the priority nursing diagnosis.B) Disturbed sleep pattern.INCORRECTWhil e diarrhea may certainly disrupt sleep, this is not the priority diagnosis.C) shortfall Fluid Volume.CORRECTA weak, rapid pulse decreased skin turgor dry, sticky, oral mucous membranes and weight loss are signs of desiccation.D) Situational low self-esteem.INCORRECTIncontinence of stool may lead to low self-esteem, but this is not the priority diagnosis. 23. Which action should the nurse take first?A) Hold Jeffs breakfast tray to provide bowel rest.INCORRECTWhile clear liquids or another fodder that promotes bowel rest may be prescribed, another action should be performed first.B) Perform oral care and moisten mucous membranes.INCORRECTAnother action should be performed first.C) Take Jeffs blood pressure to assess for postural hypotension.CORRECTPostural hypotension can result from dehydration. Therefore, it is important for the nurse to obtain this vital information because it directly impacts Jeffs safety. D) Notify the healthcare provider of Jeffs weak, rapid pulse.INCORREC TAnother action should be performed before apprizeing the healthcare provider. 24. The health care provider is notified of Jeffs physical exam findings indicating possible dehydration and vital signs, including a blood pressure of 100/50. It is determined that Jeff could use a bolus of IV fluids. The HCP prescribes 1000 cc of normal saline to run over 6 hours. The drop factor tubing set is 15 drops/ml. How many drops/minute will the IV run? (Enter the numerical value only. If rounding is required, round to the whole number.)42 CORRECT1000/360 X 15 = 41.66 = 42 gtts/minuteJeffs stool cultures are negative. After treatment with fluids and diet modification, his diarrhea resolves in 24 hours. Jeffs fluid balance is restored and his oral candidiasis is resolving.Discharge InstructionsBefore Jeff is discharged home, it is important that he understands how to prevent the spread of HIV. When discussing infection control practices with the nurse, Jeff says, I have hear that con doms dont always prevent HIV.25. How should the nurse respond?A) If used correctly and consistently, latex condoms are highly effective in preventing the transmission of HIV.CORRECTJeffs misinformation and misunderstanding is a common myth regarding the effectiveness of latex condoms. Studies prove that condoms work. B) I know you would feel terrible if you passed HIV to someone because you did not use a condom.INCORRECTNot only is this statement judgmental, the nurse also presumes to know how Jeff will feel.C) I will have an AIDS educator discuss condom use with you.INCORRECTThe nurse has the knowledge to respond to Jeffs question.D) What is your source of information about condom failure?INCORRECTWhile it may be accommodating to know where Jeff got his information, this response does not answer Jeffs question. Jeff assures the nurse that he will use a condom with each sexual encounter. He also expresses concern that he may become dehydrated again. 26. What resource can be provided for Jeff in the event this complication occurs? A) Meals on Wheels.INCORRECTMeals on Wheels is a national nonprofit organization that delivers food tothe elderly, the disabled, and the homebound. Jeff would not be a candidate to receive help from Meals on Wheels. B) HIV/AIDS support group.INCORRECTAlthough an HIV/AIDS support group can be a valuable resource, it cannot prevent Jeff from getting diarrhea or becoming dehydrated. C) Access to the services of a registered dietitian.CORRECTIt is essential that the nurse arrange a consult for Jeff with a registered dietitian before he is discharged home. The dietitian will give Jeff specific information on suggested foods and liquids to include in his diet to help prevent dehydration if diarrhea occurs at home. The clinical dietitian will provide Jeff with resources, such as a phone number, that will give him access to the dietitian on an outpatient basis. pap cancerEvolve Case Study Breast Cancer Patient Sandra Williams1) Sele ct whatever day you can best remember to perform BSE consistently every month. 2) When lying down, your arm should be positioned over your head. 3) The combination of yearly CBE and monthly BSE is the best approach for early detection. 4) Teach Barb that even women with no set risk factors are at risk 5) You may experience some discomfort, but only for a few minutes. 6) Its hard to regard that this is happening, isnt it? 7) Are you saying that you do not want to have surgery?8) Anticipatory grieving9) To ensure your safety, I need to notify the surgeon of the snack you ate.10) Nonmaleficence11) Notify the surgeon that farther explanation of the procedure is necessary 12) Observe the Jackson-Pratt drainage device, Administer a PRN dose of prescribed analgesic, Monitor vital signs and pulse oximetry 13) Encourage Sandra to continue performing these exercises 14) Advise the UAP to immediately stop and obtain a larger knock so the BP reading can be taken in the leg 15) Both the GN an d UAP are at fault for the incorrect action of the UAP. 16) invite Sandra to clarify how she learned this information so that a plan for further teaching can be developed17) Blood clots18) The medication decreases estrogen levels, which is what also causes the symptoms of menopause19) Diarrhea, Alopecia20) Label the two lumens as non-functional, and use one of the remaining lumens 21) Oral temperature of 99.5 F22) Altered tissue perfusion23) Apply a sequential compression device, Elevate the affected arm. 24) Fifteen minutes prior to administration of the next dose of the drug. 25) 6326) Candida superinfection27) A 65-year-old woman, who is a retired instructor and who never married or had children. 28) Younger sister29) Unusual skin texture.30) Hard, irregular, and does not move freely