Cаse Study:A 75-yeаr-оld individuаl with histоry оf hypertension and coronary artery disease presented to the emergency department one week ago with complaints of difficulty breathing that worsened in bed at night, and increased fatigue. Further assessment reveals crackles to bilateral lungs and 2+ dependent edema. The patient was ultimately diagnosed with acute decompensated heart failure (ADHF) by the healthcare provider. The following prescriptions were placed.metoprolol (Lopressor) 25 mg once daily for hypertensionfurosemide (Lasix) 20 mg bid for fluid overloadlisinopril (Prinvil) 5 mg daily for heart failureONE WEEK LATER:At the patient's follow-up visit one week later, the nurse is evaluating the efficacy of each medication. The patient complains of less difficulty breathing with activity or while lying flat. Edema is 1+/4+ to lower extremities and lung sounds are now clear. The patient is still fatigued, but is able to carry out activities of daily living.Vital signs and diagnostic testing results for hospitalization and follow-up visit are below. Vital Signs:Vitals / Date-TimeTemperature Pulse Resp.Blood Pressure O2 Sat. Hospital (One Week Ago)98.1 94 26 156/83 mmHg90% (Room Air) Clinical (Today) 98.483 16 130/72 mmHg95% (Room Air) Lab Results:Lab ResultNormal Range ED (One week ago) TodayPotassium 3.5 – 5.0 mEq/L3.9 3.4 LHemoglobin12-17 g/dL13.2 13.0Hematocrit36-51%39.5 39.0Red blood cells4.1 -5.1 x 106 cells/ μL4.9 4.8Platelets150,000-350,000/ μL155,000155,000White blood cells4,000-10,000 μ/L9,500 9,300B-type natriuretic peptide (BNP)
Jаckie is а ten-yeаr-оld girl with a severe mоtоr disorder on your caseload. She uses a wheelchair, needs adaptive seating, and is dependent on adults for feeding, bathing, toileting and dressing. As you interact with Jackie, you realize that she consistently looks at things she wants and turns away from things she does not want. She vocalizes and smiles to indicate she wants more of an activity like singing, tickling or bouncing. Jackie’s vocalizations are primarily vowels; she produces the consonant /m and vowel combinations /ma/ she does not yet produce other CV or CVC combinations. Jackie will look at people and objects that you name (e.g., “where is Jake?” “find the big ball” “where are your shoes?”). Which is the one most accurate statement about Jackie's communication skills and recommendations for intervention?