Laura Santos, a 32-year-old patient at Kingstown Medical Clinic, is seeing Dr. Santos for the first time since her last wellness visit last year. Sarah, the clinical medical assistant, takes Laura's vital signs and measures her weight and height. Laura has gained 25 pounds since her last visit, and complains of fatigue every day. Laura tells the medical assistant that she often feels drowsy, her nails have become brittle, and she's very sensitive to cold temperature. Sarah documents this information in the patient's medical record and kindly tells the patient that Dr. Santos will be with her momentarily.

Based on Laura's symptoms, you would suspect ______ to be the physician's diagnosis.

A. hyperthyroidism

B. hyperparathyrodisim

C. hypothyroidism

D. Conn's syndrome

Mr. Swanson is a 72-year-old patient with alcoholism. He is seeing Dr. Pugh at the Clearview Wellness Clinic because he is experiencing nausea, indigestion, and weakness. When the medical assistant records Mr. Swanson's weight, she notices that he has lost 25 pounds since his last visit with Dr. Pugh. The patient also tells the medical assistant that he vomited blood yesterday. Based on Mr. Swanson's symptoms and personal history, you would suspect ______ to be the physician's diagnosis.

A. hepatitis A

B. cirrhosis

C. HIV

D. jaundice

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)