According to the Section IV: Diagnostic coding and reporting guideline for Outpatient Services, how does the first-listed diagnosis in the outpatient setting differ from the selection of the principal diagnosis in the Inpatient Setting?

1. The nurse working in a long-term care facility incorporates a focused assessment of
the immune system for all newly admitted patients over the age of 65. Older adults

are more likely to develop problems related to immune function than are middle-
aged people. The focused immune assessment includes a systemic approach based

on age-related changes in immunologic function. (Learning Objective 4)
a. What changes in the immune system in the older adult increase the incidence of
infection and cancer in this population?
b. Explain why older adults may have decreased inflammatory responses.
c. Why are older adults at increased risk of gastroenteritis and diarrhea secondary
to proliferation of intestinal organisms?

2. The nurse educator for an oncology unit is preparing an in-service presentation for
new nurses about the care of patients with immunodeficiencies. Patients with cancer
who are receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection.
The nurse educator focuses on special care needs of this patient population.
a. What is the rationale for assessing the pulse and respiratory rates for 1 full
minute in a patient with immunodeficiency?
b. What special precautions about dietary restrictions and food preparation should
be included in the teaching for a patient with immunodeficiency?
c. What nursing actions should be implemented to decrease the risk of infection in
the patient with immunodeficiency?
3. Molly Baker, a 22-year-old patient, presents to the clinic with the diagnosis of
allergic rhinitis. She states that she develops paroxysmal sneezing, clear nasal
drainage and congestion, watery, red eyes, and nasal itching from the late spring
until the first frost in the fall. She states that she has a dry cough and voice
hoarseness. She complains of feeling extremely tired, unable to sleep at night, and
having difficulty concentrating on her collegiate course work.
a. What further assessment should the nurse provide?

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of
   fibromyalgia syndrome. The nurse at the clinic obtains a history and physical
   assessment of the patient. (Learning Objective 2)
   a. On what areas should the nurse concentrate when interviewing the patient
   during the history process?
   b. On what areas should the nurse concentrate when assessing the patient?
   c. What diagnostic tests are used with fibromyalgia syndrome?

Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months. She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms. Her past medical history includes stroke 6 months ago. She also smokes 20 cigarettes per day. On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left. She is obviously short of breath and presents with 4-word dyspnea. Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9.

1. Identify the infection of inflammatory response that Mrs. Tom is experiencing? (2)

2. Explain the pathology of how smoking affects the innate defense system of the lungs? (5)

3. What diagnostic tools could you expect to be used in this case? (xray,CT,laboratory data etc). (2)

4. Identify risk factors that Mrs. Tom has that are associated with the diagnosis? (3)

5. Internal medicine assesses Mrs. Tom and orders a STAT lactate and arterial blood gasses. Based on the patient’s vital signs above, what would you expect to see in the results of these tests? (5)

Include the following in your Day-in-the-Life Scenario:

In what setting are you located?

Who are your most regular patients?

What is the problem the client is presenting, e.g., weak heart due to perfusion/bypass, lack of range of motion due to knee injury, etc.?

What kind of very general activities would you prescribe?

What is the description of at least one tool from the list in the lesson, along with an interpretation of the data it produces? (You may need to do additional research, so be sure to include a list of Works Cited for your teacher.)

What is a situation in which there is a potential hazard for one of your clients, and how did you respond to that situation? This could be a heart attack, a fainting spell, dangerous equipment, etc.

What is a situation in which you had to work with another member of the health team in order to get the best outcome for your patient?

What is a situation in which you had to educate the patient on what kind of exercise you were providing and why?

What ethical situation came about in which you had to check out the ASEP Code of Ethics, or, base your reaction on your own understanding of past ethical discussions?

What situation occurred in which you had to explain certification and licensure to the client?

You can combine all of these sections into interaction with just one client or describe a whole day with various clients