Patients with Pharyngitis, Pulmonary Edema, and Hip Fracture

1. Patient K.S. is 16 years old with a sudden onset of problem swallowing and burning in her throat. Has felt excessively warm and light headed today with some blurred vision intermittently and headache pain in the forehead area. States gradual worsening hoarseness with some "post nasal drip" a couple of days ago. Denies other chronic disease history. On examination the patient has an elevated temperature, blood pressure and heart rate. The oral pharynx is red with enlarged glands.

Develop a Review of System (ROS) including objective data for this patient. Use appropriate terminology and discuss the probable problem with a potential plan for this patient. Describe the pathophysiology of the probable problem listed. Include both nursing and medical interventions if you can and ensure that you have supported your ideas/opinions here with scholarly references.  Provide 2 reference (100-150 words).

2. T.S. is a 60-year-old male who arrives at the emergency department complaining of shortness of breath for the past five days which has gotten progressively worse. He states his shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. The patient also notes increased swelling in his legs bilaterally and well as mild substernal chest pressure. 

The patient has a history of hypertension, diabetes, and a myocardial infarction one month ago. His vital signs are as follows:    BP 210/106, HR 118, RR 26, T 98.2. 

On exam you note rales in the lung bases bilaterally as well as 2+ pitting edema in the lower extremities bilaterally.

The patient is sitting up and in no acute respiratory distress. His oxygen saturation is 92% on room air.

Develop an ROS and plan of care for this patient and include the following:

-       What other tests are indicated at this time?

-       What community and homecare resources are available for his diagnosis?

Use appropriate terminology to describe objective findings and discuss the probable problem with a potential plan for this patient. Describe the pathophysiology of the probable problem listed. Include both nursing and medical interventions if you can and ensure that you have supported your ideas/opinions with 2 scholarly references. (100-150 words).

3. N. E. is a 78-year-old woman who presents to the emergency department after slipping on the ice in her driveway. She reports right hip pain and an inability to bear weight. She has no prior history of hip pain and is ambulatory with the use of a cane. She lives with her daughter and performs all activities of daily living independently. Her medical history includes hypertension, COPD, aortic stenosis, osteoporosis and hyperlipidemia. She is currently on low-dose aspirin, Advair, metoprolol, and pravastatin.  Other OTC medications include:  Advil, Vitamin D and calcium supplements, and daily stool softeners. 

Physical examination of the right hip shows a positive log roll test and patient complains of pain 10/10 with range of motion. The patient’s right leg is flexed and shortened. The skin over the hip and thigh is intact with no abrasions, and the knee and ankle are non-tender, with pain-free range of motion. The leg is also neurovascularly intact with good sensation, capillary refill, and pulses in the foot. Her fracture history includes pelvic, ankle and patella fractures all in separate incidents.

Develop a Review of System (ROS) include objective data for this patient. Use appropriate terminology, discuss the problem with a potential plan for this patient. What would be the possible complications with this diagnosis? What will her long-term needs be? Include family in the plan of care and ensure that you have supported your ideas/opinions here with scholarly references.  Include 2 additional reference. (100-150 words).