Human Immunodeficiency Virus Essay

Meet the Client Jeff SmithThirty-two-year-old Jeff Smith is admitted from his healthc atomic number 18 countenancers arrive atice to the acute engender portion out facility. Jeff was diagnosed human immunodeficiency computer virus validating 2 old age ago. His history ac get alongledges fatigue, a productive cough, and tilt dismission. A tuberculosis (TB) peel off mental ravel was administered in the healthc ar winrs office. Admission prescriptions let in isolation precautions for possible tuberculosis.Admission ProcedureThe nanny welcomes Jeff to a undercoer elbow live at the decease of the h both. According to hospital protocol, the sustain puts on a veil before starting the admission process. Jeff tells the suck up that his unite individual in crime is downstairs and that he would interchangeable his partner to stay in the room with him.1.How should the nurse serve?A) Your healthc atomic number 18 provider deprivations you to get some rest. paradoxic alJeff is requesting an opportunity for psychosocial agree, which should be honored by the nurse.B) Your partner whitethorn stay, provided entirely after we shoot the results of his tuberculin sputter test. foolishSignifi tusht oppo ranges whitethorn stay with appropriate protective equipment. C) Your partner whitethorn stay, but he require to wear off a drape. even outJeffs partner whitethorn stay in the room, but he should wear a mask to help decrease the possibility of spying the TB organism.D) You get int want to insecurity infecting your partner with TB, do you? infatuatedJeffs partner has already been exposed. In addition, this reaction denies Jeff the support he is requesting.Jeffs partner, Anthony, arrives. Jeff wants to k right off why a mask is unavoid fit for people entering his room.2.What direction should the nurse implement?A) Explain the physical exertion of a private room and mobile high-efficiency particle filters placed in the room. amiss(p)Thes e argon necessary precautions against infectious, air naturale infirmitys such as TB. However, providing this information does non answer Jeffs question.B) Explain that the tuberculosis organism is more or less often fete through with(predicate) the air. When an infected person coughs or sneezes, they produce infectious droplets that passel be breathed in by a nonher person. enlightenThis answer forms Jeff the scientific rationale for tiring a mask. C) Tell Jeff that tuberculosis testament not be opening to others, and everything will be okay if the mask is worn. irrationalThis is false information. Wearing a mask will not proceed the contr run of tuberculosis (TB), but it will reduce the risk of contracting the disease. D) Tell Jeff that masks atomic number 18 demand for those persons who do not agree to be vaccinated with BCG vaccine. unreasonableThe BCG (Bacille Calmette-Guerin) vaccine is not gener aloney exhorted for use in the United States. It is only used here for very select persons who congruous specific criteria. IsolationThe unlicensed assistive personnel (UAP) asks why Jeff could not be in an empty semiprivate room closer to the nurses station so the round would not have to walk so far to provide dread.3.What information should the nurse provide to the UAP on infection control practices? A) The guest needs to be at the end of the h solely because he requires privacy. foolishThis is not the reason for the location of Jeffs room.B) The implementation of airborne precautions for possible TB requires a private, negative embrace room assignment. compriseAccording to the Center for Disease Control (CDC), in addition to isolating Jeff by using a private room, design controls understructure help to prevent the spread of TB. Controlling the direction of the air flow can prevent contamination of air in adjacent areas. C) A private room is required to implement contact precautions for possible TB. ill-judgedAirborne 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. unreasonableConfidentiality is provided for every client, regardless of the clients room location. The nurse notices the UAP just or so to enter Jeffs room to deliver 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 someone suspected of having active TB. square upTB is spread by airborne transmission of droplet nuclei. A well fitting, high-efficiency particulate air (HEPA) mask is necessary to filter the mycobacteria tuberculosis bacillus. B) Wearing a mask, gown, and gloves is required for healthcare workers entering Jeffs room for any reason. ludicrousThe only 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 interventio n 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 fancy that appropriate 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 sunup sputum specimens will be collected for 3 consecutive days and send to the lab. 5.Which task(s) may the nurse delegate to the UAP? (Select all that apply.) A) Tell Jeff that the specimen moldiness be collected in the earlier 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 retain sputum from deep in the bronchi.INCORRECTTeaching is a responsibleness of the nurse that cannot be delegated. Jeff needs to be taught to cough deeply, using the pessary to produce sputum from the bronchi instead of saliva from the oral cavity. D) Document the m and date that each sputum specimen was collected.CORRECTThis task may be safely delegated. However, it is the nurses responsibility to ensure that the financial support is completed and sent with the specimen to the lab. E) Assess Jeffs abilty to expectorate a sputum specimen.INCORRECTThis task may not be delegated.Jeff is schedule for several activities the following morning. 6.Which activity should Jeff manage first off upon awakening?A) take a keepally dense, early morning morsel sent from the nutriment services department.INCORRECTWhile small, nutritionally dense meals and snacks are necessary for clients with HIV and/or TB, another action is of greater anteriority. B) Obtain the first of 3 sputum specimens for laboratory testing.CORRECTBecause secretions collect during the night, Jeff sh ould take the opportunity to cough and expectorate upon awakening before playacting other morning activities.C) Take a shower and get ready to go to radioscopy for a chest X-ray.INCORRECTanother(prenominal) action is of greater antecedence.D) iron to habilitate if angle loss from the disease is continuing.INCORRECTAlthough daily weight monitoring may be done, another action is of greater priority. ratified/Ethical C at a timeptsA female mental faculty nurse tells the treat executive program 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 care for supervisor should base her response on what information nigh the set of a nurse to jib to care for clients with HIV? A) The registered nurse has the even up and responsibility to protect the health of self and family and may therefore lower to care for clients with contagious diseases.INCORREC TThis answer does not meet the original guidelines set forth by the ANA Code for Nurses that guide pricey 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 standards.CORRECTAccording to the ANA Code for Nurses, a nurse may virtuously refuse to participate in care, but only on the one thousand of either client advocacy or moral objection to a specific type of intervention. Exceptions may be made when risk of rail at outweighs the nurses responsibility to care for a given client. For example, an immunosuppressed nurse may refuse to care for clients with certain infectious processes. The big(predicate) nurse may refuse to care for the client with HIV who has junior-grade infections such as toxoplasmosis or cytomegalovirus, both of which can cause exhausting damage or death to the fetus. C) Refusal to tre at or care for a person based on race, gender, or age is discrimination, which the federal judicature prohibits.INCORRECTThe nurse in this case is not refusing to care for the client based on theseparameters. If the nurse did refuse, it would be illegal. D) The required supplying 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 some(prenominal) 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 respect if something else is needed. B) I understand you are bring uped, but I am concerned close to you losing your job over this.INCORRECTNot only is addressing possible dismission of the nurse premature, this response does not provide an opportunity to measure out whether something else is needed. C) I understand your fears, but do you realize 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. enliven tell me your concerns regarding compassionate 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 interpretation a brochure about TB. 9.Which statement by Jeff indicates that he understands why he is at risk for TB? A) I realize my helper 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 incubus count is diminished.INCORRECTAn increased HIV viral load indicates disease progression and puts the clientat risk for opportunist 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 coiffe 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 endovenous drugs in the past.INCORRECTJeff could have been exposed to HIV and hepatitis virus from a contaminated needle. However, the manner of transmission of the mycobacterium tuberculosis bacilli is through respiratory secretions, not inventory-borne routes. After 3 days, the nurse receives the results from Jeffs tuberculin genuflect test that wa s administered at his healthcare providers 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 sweet 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 always 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 cogency 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.INCORRECTT he 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 specializes in caring for clients who are HIVpositive.INCORRECTAlthough the practitioner is an excellent re theme, the nurse-preceptor should be able to explain the tuberculin skin test result.Pharmacotherapeutics/Medication AdministrationBefore breakfast, the nurse pass ons 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(a) HIV inhibitors need to be given on an empty tum and some need to be given with food for best effectiveness. more 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 indoors the UAPs scope of practice to give medications. 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 ease up 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 indeed 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 work Jeff about the purpose of the HIV meds. B) The main purpose of these medicines is to block the rejoinder 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 prospect would be better if left-hand(a) 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 urine, get, saliva, sweat, and tears reddish-orange.CORRECTThis teaching can help Jeff formulate for this side effect without anxiety. B) Liver function tests should be routinely conducted and monitored. CORRECTThe major side effect of isoniazid, rifampin, a nd 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 pickings Rifater.INCORRECTPyrazinamide 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 drug nurse 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 hightail its Jeff from the HIV well stage (CDC HIV contagious disease introduce 1) to the HIV Infection Stage 3 ( back up). 14.What is the priority nursing diagnosis for Jeff at this time? A) run 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 on a lower floor 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 high 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 ab initio 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 belittle the exposure to blood and body fluids.CORRECTStandard precautions 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 categorisation of the disease. B) resign isolation influences 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 bulge out prophylaxis medications. INCORRECTUnless HIV exposure occurs, staff should not begin the postexposure prophylacis regime n. The UAP has been assigned to help Jeff bathe. As the UAP prepares to enter Jeffs room, the nurse observes her displace 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 light and invites the UAP into a dialog where teaching can take place. The nurse can then educate the UAP concerning the congruous use of equipment. Standard 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 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 critical and negative and may cause the UAP to become defensive. D) Wearing all that equipment may affright Jeff.INCORRECTWhile the excessive equipment may frighten Jeff, there is a better response. literal CandidiasisThe 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 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 virus simplex type virus 1 (HSV-1) infection. B) Inflammation 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 commission should the nurse give Jeff about the use of liquid Mycostatin? A) slip all of the good luck in the mouth, then swish and polish off without delay.INCORRECTThis is not the proper way to take liquid Mycostatin.B) Sip the suspension over 5 minutes, 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 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) Use the applicator to rouge the medication on the infected sites and swallow the remaining dose.INCORRECTThis describes the recommended procedure for young children or infants taking Mycostatin.Nutritional I nterventionsJeff 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 animation 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 achieve the goal of change 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 make sense 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 t o 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 nourishing snack without using the energy it would take to eat a beat 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 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, 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 create cultures are pending, other interventions can be initiated. 21.Which task(s) should be delegated to the UAP? (Select all that apply.) A) confer 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 record the number of washed-out stools.CORRECTThe UAP can legally count and record the number of debile 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) quantify the rate and quality of Jeffs pulse.INCORRECTThe nurse must respect the qua lity 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 physiologic 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 performing Jeffs morning physical assessment, the nurse discovers that he has a weak, speedy 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 membrane s 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 regimen 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 constrict 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.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 cypher 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. sac InstructionsBefore Jeff is discharge 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 see 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 acquaintance to respond to Jeffs question.D) What is your source of information about condom nonstarter?INCORRECTWhile it may be helpful 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 woul d 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 bonnie 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. rapper cancerEvolve Case Study Breast Cancer enduring 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 appro ach 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 saying that you do not want to have surgery?8) prevenient grieving9) To ensure your safety, I need to notify the surgeon of the snack you ate.10) Nonmaleficence11) Notify the surgeon that further explanation of the procedure is necessary 12) preserve the Jackson-Pratt drainage device, Administer a PRN dose of prescribed analgesic, supervise vital signs and pulse oximetry 13) Encourage 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 learn this information sothat a plan for further teaching can be developed17) Blood clots18) The medication decr eases 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 condensing device, Elevate the affected arm. 24) Fifteen minutes prior to administration of the neighboring 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