Human Immunodeficiency Virus Essay

Meet the Client Jeff smithThirty-two-year-old Jeff Smith is admitted from his wellnessc are suppliers office to the acute contend facility. Jeff was diagnosed human immunodeficiency virus positive 2 years ago. His history includes fatigue, a productive cough, and weight loss. A tuberculosis (TB) undress test was administered in the health financial aid exitrs office. Admission prescriptions include isolation precautions for possible tuberculosis.Admission ProcedureThe blow welcomes Jeff to a private means at the end of the h on the whole. According to hospital protocol, the defend puts on a masquerade party before starting the admission process. Jeff tells the nurse that his confederate is downst distri simplyes and that he would like his partner to stay in the room with him.1.How should the nurse respond?A) Your health care supplier wants you to get some remnant.IN putJeff is requesting an probability for psychosocial support, which should be reward by the nurse.B) Y our partner whitethorn stay, but only after we have the results of his tuberculin sputter test. senselessSignifi crumbt oppo grades whitethorn stay with appropriate protective equipment. C) Your partner may stay, but he look ats to rupture a drape. makeJeffs partner may stay in the room, but he should wear a secrete to help decrease the possibility of contracting the TB organism.D) You acceptt want to guess infecting your partner with TB, do you? f in allaciousJeffs partner has already been exposed. In addition, this response denies Jeff the support he is requesting.Jeffs partner, Anthony, arrives. Jeff wants to do it why a mask is necessary for people entering his room.2.What pedagogy should the nurse implement?A) Explain the practice session of a private room and mobile high-efficiency particle filters placed in the room. irrationalThese are necessary precautions against infectious, mobile diseases such as TB. However, providing this information does non answer Jef fs question.B) Explain that the tuberculosis organism is most often splay through the air. When an infected someone coughs or sneezes, they produce infectious droplets that can be breathed in by another person. jellThis answer put ups Jeff the scientific rationale for wearing a mask. C) Tell Jeff that tuberculosis result not be spread to others, and everything will be okay if the mask is worn. infatuatedThis is false information. Wearing a mask will not prevent the contr fulfil of tuberculosis (TB), but it will reduce the risk of contracting the disease. D) Tell Jeff that masks are required for those persons who do not agree to be vaccinated with BCG vaccine. monstrousThe BCG (Bacille Calmette-Guerin) vaccine is not generally recommended for use in the United States. It is only used here for very distinguish persons who image specific criteria. IsolationThe unlicensed assistive personnel (UAP) asks why Jeff could not be in an empty semiprivate room c loser to the nurses stati on so the rung would not have to walk so far to entrust care.3.What information should the nurse provide to the UAP on transmission system control practices? A) The invitee needs to be at the end of the hall because he requires privacy. ill-advisedThis is not the earth for the location of Jeffs room.B) The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment.CORRECTAccording to the Center for Disease Control (CDC), in addition to isolating Jeff by using a private room, engineering controls can help to prevent the spread of TB. Controlling the direction of the airflow can prevent contamination of air in adjacent areas. C) A private room is required to implement contact precautions for possible TB. falseAirborne precautions, rather than contact precautions, are required to prevent the spread of TB.D) The client needs to be at the end of the hall for confidentiality.INCORRECTConfidentiality is provided for every client, rega rdless of the clients room location. The nurse notices the UAP about to enter Jeffs room to deliver a meal tray without wearing every protective apparel.4.What information should the nurse provide to the UAP?A) A mask is required for healthcare workers entering the room of someone suspected of having active TB.CORRECTTB is spread by airborne transmission of droplet nuclei. A nearly 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. INCORRECTThe only protective apparel required when entering the room is a HEPA mask. C) The UAP will only be in the room for a truncated moment to deliver the tray, so no disturbance is needed by the nurse.INCORRECTSince TB is spread by airborne transmission of droplet nuclei, a HEPA mask is necessary for the UAP to wear. The nurse needs to inform the UAP of this and ensure that app ropriate PPE is worn in Jeffs room.D) Non-sterile gloves are necessary to deliver the meal and prevent the spread of TB.INCORRECTGloves do not prevent the transmission of an airborne organism. Specimen CollectionAn acid-fast bacilli (AFB) stain is part of the initial admission prescriptions. Early cockcrow unemotionality specimens will be collected for 3 consecutive days and sent to the lab. 5.Which proletariat(s) may the nurse delegate to the UAP? (Select all that apply.) A) Tell Jeff that the specimen moldiness 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.INCORRECTTeaching is a function of the nurse that cannot be delegated. Jeff needs to be taught to cough deeply, using the diaphragm to produce sputum from the bronchi instead of saliva from the vocal cavity. D) Document the date and d ate 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) respect Jeffs abilty to expectorate a sputum specimen.INCORRECTThis task may not be delegated.Jeff is scheduled for several activities the following morning. 6.Which activity should Jeff perform setoff upon awakening?A) Eat a nutritionally dense, early morning snack sent from the intellectual nourishment serve department.INCORRECTWhile small, nutritionally dense meals and snacks are necessary for clients with human immunodeficiency virus and/or TB, another action is of greater frontity. B) Obtain the jump of 3 sputum specimens for laboratory testing.CORRECTBecause secretions collect during the night, Jeff should have a bun in the oven the opportunity to cough and expectorate upon awakening before performing other morning activities.C) Take a shower and get ready to go to radiology for a chest X-ray.INCORRECTAnother action is of greater precedency.D) Weigh to determine if weight loss from the disease is continuing.INCORRECTAlthough daily weight monitoring may be done, another action is of greater priority. Legal/Ethical ConceptsA female staff nurse tells the breast feeding supervisor that she does not want to be assigned to care for Jeff. She states, I have never cared for a client with HIV and do not want to start now. I have babies at home that need me. 7.The nursing supervisor should base her response on what information about the right of a nurse to deny to care for clients with HIV? A) The registered nurse has the right and responsibility to protect the health of self and family and may therefore refuse to care for clients with contagious diseases.INCORRECTThis answer does not meet the professional guidelines set forth by the ANA Code for Nurses that guide ethical nursing practice. B) The registered nurse may refuse to care for a clien t 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 standards.CORRECTAccording to the ANA Code for Nurses, a nurse may morally refuse to participate in care, but only on the grounds of either client advocacy or moral objection to a specific type of intervention. Exceptions may be made when risk of harm outweighs the nurses responsibility to care for a boundn client. For example, an immunosuppressed nurse may refuse to care for clients with certain infectious processes. The pregnant nurse may refuse to care for the client with HIV who has secondary contagious diseases such as toxoplasmosis or cytomegalovirus, both of which can cause severe damage 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 thesep arameters. If the nurse did refuse, it would be illegal. D) The required staffing ratio of licensed personnel to client population does not allow 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 feel 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 different 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 addressing 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 realize this will cause a hard ship 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 HIV.CORRECTThis response by the nurse supervisor demonstrates compassion and provides an opportunity to discover 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 realize my protagonist T cells are diminished from HIV. Those are the cells needed to fight TB.CORRECTHIV attacks the CD4 receptors on the helper T cells that help the body fight off diseases such as TB. B) I may get tuberculosis because my viral load search is diminished.INCORRECTAn increased HIV viral load indicates disease progression and puts the clientat risk for o pportunistic 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 temper of transmission of the mycobacterium tuberculosis bacilli is through respiratory secretions, not blood-borne routes. After 3 days, the nurse receives the results from Jeffs tuberculin skin test that was administered at his healthcare suppliers office. Even though Jeffs reaction to the tuberculin skin test measures only 5 mm in diameter, the healthcare provider documents a positive test result. A new graduate nurse finds this confusing. She tells he r preceptor that she thought a 10 mm induration was the minimum size of it 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 of all time 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 groups. C) It may be that you are confusing induration with inflammation 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 confusion between the two. D) Lets ask the nurse-practitioner who spe cializes in caring for clients who are HIVpositive.INCORRECTAlthough the practitioner is an excellent resource, the nurse-preceptor should be able to explain the tuberculin skin test result.Pharmacotherapeutics/Medication validationBefore 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 reply?A) To be most effective, HIV medications are prescribed on different schedules.CORRECTSome HIV inhibitors need to be given on an empty stomach and some need to be given with food for top hat effectiveness. 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 scope of practice to give medicati ons. C) We are just trying to provide you with the best nursing care possible on this unit.INCORRECTThat is a defensive reply, which does not contribute to educating Jeff. D) We need your cooperation to help fight this disease.INCORRECTThis reply is judgmental and implies that Jeff is uncooperative, which he is not. Jeff responds by agreeing to take his medications as prescribed. He then 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 purpose of the HIV meds. B) The main purpose of these medicines is to closure the replication 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 ques tion 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 to a fault 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 urine, 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 taking Rifater.INCORRECTPyrazin amide may make the skin sensitive to sunlight, and this should be taught to the client. D) Supplemental 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 cure 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 experienced 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 related to decreased immune 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 i s 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 priority nursing diagnosis. C) Imbalanced nutrition, less than body 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 body chemistry.INCORRECTAlthough the client initially complained of fatigue, there is a nursing diagnosis with a higher priority.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 door 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.CORRECTStandard precauti ons are designed to prevent contact with blood or body fluids, which are the mode of transmission for HIV, and are used no matter what the stage classification of the disease. B) Reverse isolation procedures 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 taproom 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 gawk. 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 und erstand 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. Standard precautions (for HIV) require that gloves be worn, and respiratory precautions (for TB) require that a mask be worn. look and a gown are not necessary. B) Dont you know all that equipment is not necessary?INCORRECTThis statement is overly aggressive and may seem demeaning to the UAP. C) Wearing all that equipment is a waste of hospital supplies. INCORRECTWhile it is important to ensure effective use of resources, this statement is faultfinding and negative and may cause the UAP to become defensive. D) Wearing all that equipment may frighten Jeff.INCORRECTWhile the excessive equipment may frighten Jeff, there is a better response. Oral CandidiasisThe nurse notices that Jeff has left most of his dinner untouched. The nurse offers to order something differen t 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 candidiasis, a common 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) sack of the gums.INCORRECTThis is a symptom of gingivitis.C) Painless white lesions on the lateral surface of the tongue.INCORRECTThis is a description of leukoplakia.D) White-yellow patches on the tongue 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 liquid Mycostatin? A) Place all of the suspension in the mouth, then swish and swall ow immediately.INCORRECTThis is not the proper way to take liquid Mycostatin.B) Sip the suspension over 5 elegants, swishing and swallowing after each sip.INCORRECTThis is not the proper way to take liquid Mycostatin.C) Place the suspension in the mouth, then swish for several pures 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) Use the applicator to paint the medication on the infected sites and swallow the stay dose.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 current BMI (body mass index) is 17.4. Jeff says he realizes he should eat, but he does not have the zip fastener or the appetite, even when he has no oral pain. The nurse identifies the nursing diagnosis of, Imbalanced Nutrit ion less than body requirements. 19.To achieve the goal of alter 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 essential that Jeff be an active participant in his care so he has some control. If a favorite 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 the best intervention at this point. C) Inform Jeff that adequate nutrition is essential.INCORRECTJeff has already indicated he understands the need to eat.D) Instruct 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 best 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) Milk 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 across-the-board meal. Jeff may find the cool liquid is soothing to his sore mouth. C) Tomato soup.INCORRECTAlthough liquid soup is not difficult to eat, (note, the warmth could be soothing), the sullenness 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, itrequires energy to chew, and it may be irritating to Jeffs mouth. A Complication OccursJeff develops severe diarrhea with occasional incontinence that could be caused by an opportunistic gastrointestinal infection or by one of his medications. While stool cultures are pending, other in terventions 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 file the number of watery stools.CORRECTThe UAP can legally count and record the number of watery stools. However, it is the nurses responsibility to be aware of the clients condition and promptly report any significant changes to the healthcare provider. D) Evaluate the rate and quality of Jeffs pulse.INCORRECTThe nurse must rate the quality and rate of Jeffs pulse because this requires judgment and expertise beyond the scope 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 e xpertise is not within the scope of practice for the UAP. When performing 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.INCORRECTWhile diarrhea may certainly disrupt sleep, this is not the priority diagnosis.C) Deficit Fluid Volume.CORRECTA weak, rapid pulse decreased skin turgor dry, sticky, oral mucous membranes and weight loss are signs of dehydration.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 provender that promotes bo wel 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 indispensable information because it directly impacts Jeffs safety. D) Notify the healthcare provider of Jeffs weak, rapid pulse.INCORRECTAnother action should be performed before notifying 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 thenumerical value only. If rounding is required, round to the whole number.)42CORRECT1000/360 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. rout 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 heard that condoms 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 AI DS 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 assistive 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 consul t 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. pectus cancerEvolve Case Study Breast Cancer Patient Sandra Williams1) Select 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 identified risk factors are at risk 5) You may experience some discomfort, but only for a few minutes. 6) Its hard to believe that this is happening, isnt it? 7) Are you reflexion that you do not want to have surgery?8) Anticipatory grieving9) To ensure your safety, I need to notify the operating surgeon of the snack you ate.10) Nonmaleficence11) Notify the surgeon that that 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) pull ahead Sandra to continue performing these exercises 14) Advise the UAP to immediately stop and obtain a larger cuff so the BP reading can be taken in the leg 15) Both the GN and UAP are at fault for the incorrect action of the UAP. 16) Ask Sandra to clarify how she learned this information sothat 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 minute s prior to administration of the conterminous dose of the drug. 25) 6326) Candida superinfection27) A 65-year-old woman, who is a retired teacher and who never married or had children. 28) Younger sister29) Unusual skin texture.30) Hard, irregular, and does not move freely