Advance Med Surg Week 5 Discussion.
Week 5 – Discussion 1
94 unread replies.109109 replies.
Group 1 Scenario:
You are working on the postoperative unit and will be receiving a patient
from the recovery room. The post-anesthesia care unit nurse calls and gives
the following report:
C.P. is a 50-year-old woman with a subtotal thyroidectomy for papillary
carcinoma. The estimated blood loss was 25 mL. Vital signs (VS) are 130/82,
80 to 90, 20, and Sa O 2 94% on room air. She has a peripheral IV of
D5.45NS with 20 mEq KCl infusing at 100 mL/hr. She has received a total of
3 mg morphine sulfate IV push, and she remains awake, but drowsy, and
fully oriented. C.P.'s past medical history includes a total abdominal
hysterectomy for fibroids and low-level radiation treatments to the neck 30
years ago for eczema. Her medications include lovastatin (Mevacor) and
levothyroxine (Synthroid). Both parents are living; her father had a
myocardial infarction at 70 years of age; her mother has hypothyroidism but
never had thyroid tumors.
1. You receive C.P. from the recovery room. Discuss priorities for your
initial assessment, what complications will you monitor for post-op
specific to the surgical procedure performed? Include actions and
rationales.
2. During your initial assessment, you document negative Chvostek's and
Trousseau's signs. Describe data that would support this conclusion.
3. Identify the major risk factor that might have contributed to the
development of thyroid adenoma in C.P.
4. After surgery, C.P.'s thyroid hormone levels are elevated, and the
physician orders propranolol (Inderal) 80 mg ER orally twice daily for
“surgically induced thyrotoxicosis.” Is this reaction expected following
thyroid surgery, or did something go wrong during surgery? Explain.
5. As part of your discharge instructions to C.P. note five key teaching
points with rationale.
Group 2 Scenario:
You are working in a community outpatient clinic where you perform the
intake assessment on R.M., a 38-year-old woman who is attending graduate
school and is very sedentary. Her chief complaint is overwhelming fatigue
that is not relieved by rest. She is so exhausted that she has difficulty
walking to classes and trouble concentrating when studying. She reports a
recent weight gain of 15 pounds over 2 months without clear changes in her
dietary habits. Her face looks puffy, she has experienced excessive hair loss,
and her skin is dry and pale. She complains of generalized body aches and
, Advance Med Surg Week 5 Discussion.
pains with frequent muscle cramps and constipation. You notice she is
dressed inappropriately warm for the weather.
, Advance Med Surg Week 5 Discussion.
Vital Signs
Blood pressure 142/84 mm
Hg Heart rate 52 beats/min
Respiratory rate 12
breaths/min Temperature
96.8 ° F (36 ° C)
Laboratory Test Results
TSH 20.9 mU/L (2-10 mU/L)
TRH 18.8 ng/dL (2-10 ng/dL)
T 3 24 mU/L (70-205 ng/dL)
Free T 4 0.2 ng/dL (0.8-2.4 ng/dL)
1. What are the top priority assessments (specific to this patient)? Include at
least 3 with rationale.
2. Interpret R.M.'s laboratory results.
3. The family practitioner prescribes levothyroxine (Synthroid) 1.7
mcg/kg body weight/day. Patient weighs 130 pounds. What is the
daily dose in milligrams?
4. What teaching will you review regarding medication? List 5 key teaching
points with details.
5. Why are we concerned with Myxedema coma? What teaching will you
provide for prevention of myxedema coma?
Helpful Tip: Use the required textbook as a reference, paraphrase in your own words (do not
plagiarize!) and cite the reference in APA format. Your syllabus has the correct APA reference
for the textbook on page 2.
Discussion Requirements:
This discussion forum requires that the student create an initial post before
being able to see other student posts. Once you make your first post, your
classmates’ posts will appear and you can respond as directed below.
Students must first post a topic before they are allowed to view or reply to
other student’s posted topics.
Your initial response should be posted no later than midnight on Day 3. In
your responses, I want to see informed input. In other words, do not simply
recite the text and do not simply give your opinion. Your input should be in
your own words, demonstrating your understanding and comprehension of
the topic. Responses need to be substantive, thorough, offer new insight or
reasoning, or critical and analytical thoughts. One or two sentences are not a
substantive response. You are required to use correct spelling and grammar.
Then, I want to see you respond to your classmates on at least 2 other days
throughout the week. The purpose here is to generate discussion, to further
, Advance Med Surg Week 5 Discussion.
explore the topics, ask questions, add insight, agree or disagree, etc. Of
Week 5 – Discussion 1
94 unread replies.109109 replies.
Group 1 Scenario:
You are working on the postoperative unit and will be receiving a patient
from the recovery room. The post-anesthesia care unit nurse calls and gives
the following report:
C.P. is a 50-year-old woman with a subtotal thyroidectomy for papillary
carcinoma. The estimated blood loss was 25 mL. Vital signs (VS) are 130/82,
80 to 90, 20, and Sa O 2 94% on room air. She has a peripheral IV of
D5.45NS with 20 mEq KCl infusing at 100 mL/hr. She has received a total of
3 mg morphine sulfate IV push, and she remains awake, but drowsy, and
fully oriented. C.P.'s past medical history includes a total abdominal
hysterectomy for fibroids and low-level radiation treatments to the neck 30
years ago for eczema. Her medications include lovastatin (Mevacor) and
levothyroxine (Synthroid). Both parents are living; her father had a
myocardial infarction at 70 years of age; her mother has hypothyroidism but
never had thyroid tumors.
1. You receive C.P. from the recovery room. Discuss priorities for your
initial assessment, what complications will you monitor for post-op
specific to the surgical procedure performed? Include actions and
rationales.
2. During your initial assessment, you document negative Chvostek's and
Trousseau's signs. Describe data that would support this conclusion.
3. Identify the major risk factor that might have contributed to the
development of thyroid adenoma in C.P.
4. After surgery, C.P.'s thyroid hormone levels are elevated, and the
physician orders propranolol (Inderal) 80 mg ER orally twice daily for
“surgically induced thyrotoxicosis.” Is this reaction expected following
thyroid surgery, or did something go wrong during surgery? Explain.
5. As part of your discharge instructions to C.P. note five key teaching
points with rationale.
Group 2 Scenario:
You are working in a community outpatient clinic where you perform the
intake assessment on R.M., a 38-year-old woman who is attending graduate
school and is very sedentary. Her chief complaint is overwhelming fatigue
that is not relieved by rest. She is so exhausted that she has difficulty
walking to classes and trouble concentrating when studying. She reports a
recent weight gain of 15 pounds over 2 months without clear changes in her
dietary habits. Her face looks puffy, she has experienced excessive hair loss,
and her skin is dry and pale. She complains of generalized body aches and
, Advance Med Surg Week 5 Discussion.
pains with frequent muscle cramps and constipation. You notice she is
dressed inappropriately warm for the weather.
, Advance Med Surg Week 5 Discussion.
Vital Signs
Blood pressure 142/84 mm
Hg Heart rate 52 beats/min
Respiratory rate 12
breaths/min Temperature
96.8 ° F (36 ° C)
Laboratory Test Results
TSH 20.9 mU/L (2-10 mU/L)
TRH 18.8 ng/dL (2-10 ng/dL)
T 3 24 mU/L (70-205 ng/dL)
Free T 4 0.2 ng/dL (0.8-2.4 ng/dL)
1. What are the top priority assessments (specific to this patient)? Include at
least 3 with rationale.
2. Interpret R.M.'s laboratory results.
3. The family practitioner prescribes levothyroxine (Synthroid) 1.7
mcg/kg body weight/day. Patient weighs 130 pounds. What is the
daily dose in milligrams?
4. What teaching will you review regarding medication? List 5 key teaching
points with details.
5. Why are we concerned with Myxedema coma? What teaching will you
provide for prevention of myxedema coma?
Helpful Tip: Use the required textbook as a reference, paraphrase in your own words (do not
plagiarize!) and cite the reference in APA format. Your syllabus has the correct APA reference
for the textbook on page 2.
Discussion Requirements:
This discussion forum requires that the student create an initial post before
being able to see other student posts. Once you make your first post, your
classmates’ posts will appear and you can respond as directed below.
Students must first post a topic before they are allowed to view or reply to
other student’s posted topics.
Your initial response should be posted no later than midnight on Day 3. In
your responses, I want to see informed input. In other words, do not simply
recite the text and do not simply give your opinion. Your input should be in
your own words, demonstrating your understanding and comprehension of
the topic. Responses need to be substantive, thorough, offer new insight or
reasoning, or critical and analytical thoughts. One or two sentences are not a
substantive response. You are required to use correct spelling and grammar.
Then, I want to see you respond to your classmates on at least 2 other days
throughout the week. The purpose here is to generate discussion, to further
, Advance Med Surg Week 5 Discussion.
explore the topics, ask questions, add insight, agree or disagree, etc. Of
