Blog

A 72‑year‑old patient presents with recurrent CDI, having completed vancomycin 125 mg QID x 10 days three weeks ago. He refuses fidaxomicin due to cost. What is the next most appropriate treatment?

Using the “Lund and Browder” chart, calculate the approximate percentage of total body surface area injured for a 48-year-old client with partial-thickness burns to bilateral anterior and posterior lower arms, deep partial thickness burns to anterior chest and abdomen, full thickness burns to bilateral anterior hands.  (Round to the nearest whole number, after calculations are complete.)

A 14‑month‑old girl has fever, left‑sided ear tugging, irritability, and otorrhea. Exam shows a bulging, erythematous tympanic membrane with drainage. What is the appropriate management?

Which clinical scenario(s) suggests bacterial sinusitis rather than viral? (select all that apply)

Fat is the predominant fuel at what intensity? 

The patient is an 80-year-old female who has been treated at the University Medical Center Glaucoma Clinic for many years. She has been seen several times in the past few months with increasing right eye pain. The patient’s chronic eye pain exists in a visually useless eye. The severe eye pain is the result of long-standing glaucoma, which is now considered absolute glaucoma. The patient is requiring increasing amounts of pain medications and is very tired of the constant eye pain. Surgical options were discussed with the patient and her daughter. Today, the patient was admitted to the hospital and underwent an open evisceration of the ocular contents with placement of an ocular implant. Admission was warranted since the physician was concerned about post-operative bleeding due to the patient’s long-standing hemophilia A condition. Principal Diagnosis: Secondary Diagnoses: Hint: pain is not always present with absolute glaucoma Add’l Diagnosis: Principal Procedure:

The nurse and graduate nurse care for a client diagnose with superficial partial thickness burns and inhalation injury from a house fire.  Vital signs are HR 130 bpm, respiratory rate 24, oxygen saturation 100% on 100% non-rebreather mask.  The GN decreases the oxygen to 4L nasal cannula.  Which is the BEST response by the nurse?

The patient is a 65-year-old male who was brought to the emergency department by his wife after he complained of acute worsening of his chronic lower back pain and a sudden ­difficulty in urinating. The patient is also experiencing numbness and weakness in his legs. The patient states that he has been diagnosed with lumbar spinal stenosis with neurogenic claudication in the past. Imaging studies are performed and severe spinal stenosis at the level of L5 is confirmed. The patient is diagnosed with cauda equina syndrome and is taken to the operating room for an emergent decompression of the spinal cord. An L5 laminectomy is performed to relieve the pressure on the spinal cord. The patient is kept in the hospital for further monitoring of his neurological condition after the surgery. The patient’s final diagnoses are cauda equina syndrome and lumbar spinal stenosis with neurogenic claudication. Principal Diagnosis: Secondary Diagnosis: Principal Procedure:

This figure shows the bones of the ankle and foot. Which color indicates the cuboid bone?

The patient is a 40-year-old female with Down syndrome who was admitted to the hospital for a repeat penetrating keratoplasty (corneal transplant). The patient lives 120 miles away from the hospital with elderly parents and, because of the distance to be traveled, was being admitted instead of having an outpatient procedure. The patient had a penetrating keratoplasty on the left eye in the past. She developed a corneal ulcer and perforation, requiring a repeat penetrating keratoplasty via percutaneous approach in the left eye. The patient did understand the procedure and agreed to it, but the consent form was signed by her father. At the time of the corneal transplant, it was noted again that her eye was soft and appeared to be perforated, with a flat anterior chamber. The donor cornea was prepared. The previous donor cornea was removed from the patient’s eye. Four interrupted 10-0 nylon cardinal sutures were placed to secure the new donor tissue to the host, and a symmetrical rhomboid crease on the donor was noted. A total of 12 more interrupted 10-0 nylon sutures were placed equally distant from each other to secure the donor to the host, and the chamber was intermittently formed. The wound was checked for leaks, and none were seen. Subtenon injections of 80 mg Depo-Medrol and 40 mg gentamicin were administered as part of the procedure. Vigamox eye drops were placed in the eye. A bandage contact lens was placed in the eye with a shield on top. The patient was awakened and transferred to the recovery room. She stayed in the hospital overnight for pain control and management. She was examined the next morning by the ophthalmic surgeon and discharged to the care of her adult brother and parents to be driven home. Principal Diagnosis: Secondary Diagnosis: Hint:  This is a Z code to show the patient’s corneal transplant status. Add’l Diagnosis: Principal Procedure: Secondary Procedure: HINT: There are no extra blanks.