UNIT 1:Ms. Esposito, a 58-year-old Latina female, is coming in to receive a comprehensive health assessment. According to her chart, she has a history of the following: occasional episodes of high B/P and systemic lupus erythematosus (a chronic inflammatory disease that can affect all body systems). She states she is not on medication for the blood pressure and experiences occasional shortness of breath and pain.Mrs. Esposito’s case is complicated by episodes of hypertension and systemic lupus erythematosus. She also has episodes of shortness of breath and pain. She is not currently taking any medication for her blood pressure.UNIT 2:You very briefly met Ms. Esposito in the discussion last week. When Ms. Esposito first entered the room, she looked right at you, smiled, and stated, in a clear voice, “How do you do?” When you introduced yourself, she gave a firm handshake, then rubbed both of her arms vigorously and commented, “Boy, this room is really cold.” She walked steadily to the chair you indicated but held onto the desk while getting seated and gingerly sat down. You informed the client of the purpose of the interview. When asked if she had any specific complaints or problems, she stated, “No.” She then shrugged her shoulders and commented, “I don’t think I have anything special going on. I’m here for my 3-month check and I have not experienced any new problems.” She goes on to say that “I should have eaten this morning; my stomach’s growling.†You asked her to sign an admission form. She put on reading glasses, perused the form, and signed. You completed the client interview.Ms Esposito clearly indicates that she is cold, could mean she is anemic, as she walked she is holding on to the desk, which indicates she has some mobility issues, when asked if she had any complaints, she said no, which meant she has ongoing issues that were still present since her last visit. She proceeds to say she is hungry and have not eaten this morning, which indicates there might be some nutritional issues as well. Based on the objective and subjective data given, I can analyze the situation a little closer by using general survey to give some more definitive answers about her current status. I will observe her mental status- I can determine her mood, as well as personal psychosocial and neurological status. I can determine her orientation. In gathering information I have already asked her name, dob and based on her response, she appears to be in sound mind and judgment, and shows no signs of confusion. I have determined this because of her responses to my questions.Mobility- Ms Esposito is having some difficulty walking independently. As a nurse I can identify possible signs of limping, stumbling, and shuffling. She might be overweight or had some type of injury. ROM should be fluid according to one’s age. Behavior of client-Includes facial expression, this can show signs of pain, mood and affect, image and self-esteem, and it can reveal confusion or disorientation. Appearance – Shows whether a person is clean, poor, observe for grooming, body odors, nutritional status, skin for sores, and dryness. Dry skin indicates a lack of H2O.•Please describe the techniques and equipment you would use during a physical assessment of Ms. Esposito.The four basic techniques that I will use are Inspection—general survey using observation, Palpation- requires touching the patient – using the right pressure of the hands to determine areas of concern and normality of body systems, percussion—using tools such as a reflex hammer to produce sound or movement, and auscultation—This technique requires the nurse to listen to the body, with a stethoscope. . The tools necessary to perform these techniques are Goniometer, skinfold calipers- to measure skin thickness (obesity), stethoscope to listen to sounds of the body, Doppler ultrasonic stethoscope for possible detection of pulses that cannot be heard by regular stethoscope, •Describe the steps you would take to complete a nutritional assessment of Ms. Esposito. Are there any cultural considerations you should take into account?Based on physical assessment, anthropometric measurements, laboratory values, nutritional history. Using the Braden scale during an assessment can help analyze Ms Esposito’s nutritional assessment. There would be cultural considerations to take into account, such as her race, gender and age. She is Latina female, who has a history of High blood pressure and systemic lupus, so family medical history, as well as family history of Hypertension to be taken into consideration, and current weight status to determine if she is obese ( because she is experiencing breathing problems).ReferencesD’Amico, D., & Barbarito, C. (2012). Health & physical assessment in nursing (2nd ed.). Upper Saddle River, NJ: Prentice Hall.UNIT 5:Ms. Esposito (age 58) shares that she is third-generation Latina American. Her father is deceased due to a heart attack, and her mom is alive and has occasional chest pain with exertion. Ms. Esposito had fasting lab work drawn last week in preparation for this examination. As you scan the lab results, you note the following values for the lipid profile.Total cholesterol 289 (normal 140–199), triglycerides 175 (normal 35–135), HDL 27 (normal 38–85), LDL 227 (normal < 130),="" and="" vldl="" 130="" (normal="" 25–50%="" of="" total="" cholesterol).she="" tells="" you="" she="" takes="" a="" baby="" aspirin="" once="" daily="" but="" is="" healthy="" and="" on="" no="" other="" medications.="" she="" receives="" physicals="" annually="" and="" has="" her="" blood="" pressure="" checked="" by="" an="" automated="" machine="" at="" the="" grocery="" store.="" she="" does="" not="" smoke="" and="" only="" drinks="" wine="" occasionally,="" but="" her="" diet="" is="" rich="" in="" saturated="" fats="" and="" she="" does="" a="" small="" amount="" of="" exercise.="" she="" denies="" allergies.="" she="" works="" as="" a="" ticket="" agent="" for="" an="" airline,="" for="" which="" she="" is="" up="" on="" her="" feet="" for="" long="" stretches="" of="" time.after="" the="" physician="" sees="" ms.="" esposito,="" you="" note="" that="" all="" of="" her="" laboratory="" results="" are="" within="" normal="" limits,="" with="" the="" exception="" of="" her="" lipid="" profile="" and="" her="" weight.="" after="" consultation="" with="" the="" physician,="" you="" prepare="" and="" implement="" a="" teaching="" plan="" on="" cholesterol="" reduction="" measures.="" she="" is="" to="" return="" in="" 3="" months="" for="" a="" repeat="" lipid="" profile="" and="" follow-up="" visit.="" the="" physician="" has="" told="" ms.="" esposito="" that="" she="" may="" have="" to="" go="" on="" antihyperlipidemics="" if="" her="" lipid="" profile="" continues="" to="" show="" elevation.="" ms.="" esposito="" tells="" you="" she="" will="" work="" hard="" to="" implement="" these="" measures,="" because="" she="" does="" not="" want="" to="" take="" any="" medications.unit="" 6:ms.="" esposito="" (age="" 58)="" shares="" that="" she="" is="" third-generation="" latina="" american.="" her="" father="" is="" deceased="" due="" to="" a="" heart="" attack,="" and="" her="" mom="" is="" alive="" and="" has="" occasional="" chest="" pain="" with="" exertion.="" ms.="" esposito="" had="" fasting="" lab="" work="" drawn="" last="" week="" in="" preparation="" for="" this="" examination.="" as="" you="" scan="" the="" lab="" results,="" you="" note="" the="" following="" values="" for="" the="" lipid="" profile.total="" cholesterol="" 289="" (normal="" 140–199),="" triglycerides="" 175="" (normal="" 35–135),="" hdl="" 27="" (normal="" 38–85),="" ldl="" 227="" (normal="">< 130),="" and="" vldl="" 130="" (normal="" 25–50%="" of="" total="" cholesterol).she="" tells="" you="" she="" takes="" a="" baby="" aspirin="" once="" daily="" but="" is="" healthy="" and="" on="" no="" other="" medications.="" she="" receives="" physicals="" annually="" and="" has="" her="" blood="" pressure="" checked="" by="" an="" automated="" machine="" at="" the="" grocery="" store.="" she="" does="" not="" smoke="" and="" only="" drinks="" wine="" occasionally,="" but="" her="" diet="" is="" rich="" in="" saturated="" fats="" and="" she="" does="" a="" small="" amount="" of="" exercise.="" she="" denies="" allergies.="" she="" works="" as="" a="" ticket="" agent="" for="" an="" airline,="" for="" which="" she="" is="" up="" on="" her="" feet="" for="" long="" stretches="" of="" time.after="" the="" physician="" sees="" ms.="" esposito,="" you="" note="" that="" all="" of="" her="" laboratory="" results="" are="" within="" normal="" limits,="" with="" the="" exception="" of="" her="" lipid="" profile="" and="" her="" weight.="" after="" consultation="" with="" the="" physician,="" you="" prepare="" and="" implement="" a="" teaching="" plan="" on="" cholesterol="" reduction="" measures.="" she="" is="" to="" return="" in="" 3="" months="" for="" a="" repeat="" lipid="" profile="" and="" follow-up="" visit.="" the="" physician="" has="" told="" ms.="" esposito="" that="" she="" may="" have="" to="" go="" on="" antihyperlipidemics="" if="" her="" lipid="" profile="" continues="" to="" show="" elevation.="" ms.="" esposito="" tells="" you="" she="" will="" work="" hard="" to="" implement="" these="" measures,="" because="" she="" does="" not="" want="" to="" take="" any="" medications.you="" completed="" the="" client="" interview.review="" and="" read="" ms.="" esposito’s="" case="" study="" from="" units="" 1,="" 2,="" 5,="" and="" 6.="" let="" us="" assume="" you="" took="" care="" of="" ms.="" esposito="" over="" the="" previous="" 4="" days.write="" nursing="" notes="" for="" the="" 4="" days="" you="" have="" cared="" for="" ms.="" esposito.="" document="" your="" nurses’="" notes="" under="" the="" titles="" day="" 1,="" day="" 2,="" day="" 3,="" and="" day="" 4.="" also="" cite="" everything="" in="" apa="" citation="" .an/"="">FORMAT.AN EXAMPLE SHOULD LOOK LIKE THISS- Ms Esposito, is coming in for a comprehensive health assessment, she has episodes of High B/P and systemic lupus erythematosus, and is not taking medications for her condition.B- She has a history of occasional high B/P, and flare ups of lupus erythematosus, also shortness of breath. She is a 58 year old woman and is high risk for cardiovascular disease.A-She may be at risk for stroke if she does not take her medications frequently or as needed, and could be having other issues such as pulmonary disorders, which is why she is having chest pains, and difficulty breathing. R-I recommend that we pay attention to her O2, and put her on oxygen for her shortness of breath PRN. Putting her on a good diet, and exercise plan. Would recommend anti flammatories and steroids once activated. She also needs a BP medication to help her control her BP levels.Day 2S-Ms Esposito appears cold, held on to the desk while walking, stated no to any specific problems during the interview. She is here for her 3 month check up with no new symptoms. She did not eat prior to coming and Is hungry, and puts on reading glasses before signing documents.B-Based on the fact that she is cold, can mean that she is anemic, probably running a temperature. Holding on to the desk as she walks indicate a past mobility problem, and probably obese issue, especially during seating. She responds well, indicating she is oriented and can understand English, despite that she is Latin descent. Based on her current status, she is accustomed to being the way she is, and demonstrates a sense of normality with her status . There seems to be no new issues, and she verbalizes that during the interview process. Patient appears to be hungry, probably her glucose levels are low or increased. Her eyes are weakened, and she needs glasses to see when reading, indicative of loss of elasticity of the eye muscles.A-My assessment of Ms Esposito concludes that she might be anemic, because she is cold. It is also common in older adults to experience coldness compared to younger adults. She has a history of mobility issues, and it does not concern her as much. Her condition have not changed since her last check up. Avoiding meals, is a problem for her sugar levels, therefore, causing an increased level, and increase in her weight.R-My recommendation to Ms Esposito is to get something to eat or drink to avoid increased blood sugar. Avoid skipping meals to prevent weight gain. Change her prescription of her lenses, recommend her a cane, or a walker to help with her mobility. Recommend a better exercise and diet plan.Day 3S-above normal lab results, which places her at risk for high cholesterol and cardiovascular diseases. She is of Hispanic descent, there might be some cultural barriers. She relies on BP read by machines at local pharmacies. No exercise with a diet full of saturated fats. No known allergies, stands on her feet for long periods at a time. Does not want to take antihyperlipidemics to reduce her lipid levels.B-She is a Latina, age plays a factor in her daily living, there are environmental factors like her stressful job, and she appears to have cultural barriers, which obstructs her notion of healthcare. She is not educated on exercise and diet, or treatment with medications that can potentially reduce her BP and cholesterol levels.A-My assessment will be focused on the results, and target the source of her problems. I will assess based on priority and needs, and help to get Ms Esposito back on a healthier diet and exercise regimen. Antihyperlipidemics should be recommended, however due to cultural considerations, it would be important to educate patient about the effects of the medication, and not push it upon her. Counsel her on her psychosocial status, to ensure she does not have any mental health issues that prevents her in any way.R-Patient’s response is that she does not take medication, with the exception of baby aspirin.Patient needs to be educated on the importance of a healthy diet, and fluid intake, as well as exercise. Patient needs to be educated, and possibly counselled about her everyday stressors, and educate on antihyperlipidemics and other medications.Day 4S- Based on lab results, her levels of cholesterol are high,B-Her background, such as her ethnicity plays an important factor concerning her health. Her parents medical history, places her at a higher risk for heart disease. Her father died of a heart attack, and her mother has occasional chest pains. Her lab results are indicative of high levels of lipids.A-since it is day four of the assessment, it is important to document the findings and assessment patient’s mental health. Primary preventative methods would include: educating patient regarding the importance of exercise to increase her strength and balance. I would review the medications given to her to determine its side effects, improve her vision, by examination. Educate her on thorough, more frequent screenings. Understand her psychosocial status, to assess her needs.R-educate her on family patterns, dietary patterns, and understand her health beliefs and health practices to understand why she is against taking medications. Discuss the importance of medication that would help her balance her lipid intake. Last but not least educate client on the importance of exercise and diet that would help reduce the risk of heart disease.ReferencesD’Amico, D., & Barbarito, C. (2012). Health & physical assessment in nursing (2nd ed.). Upper Saddle River, NJ: Prentice Hall

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