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What patient care might the nurse delegate to nursing assistive personnel (NAP) when a patient’s nasogastric tube is removed?          

A nurse is preparing to insert an NG tube for a client who requires gastric decompression.  Which of the following actions should the nurse perform before beginning the procedure (Select all that apply).

Mr. Whitlock has been receiving a tube feeding of Ensure® via nasogastric tube for 3 weeks via a bolus infusion.  He has just started to have loose stools (300mL each-6 today).  You should first suspect the following to be responsible for the diarrhea: 

The nurse has just placed a nasogastric tube for gastric decompression secondary to a paralytic ileus.  What is the first thing that you need to do?  

Why does the nurse kink the nasogastric tube before removing it from a patient?          

Clinical Coding Workout Chapter 4, question 4.77 This full-term female infant was born in this hospital by vaginal delivery. Her mother has been an alcoholic for many Years and would not stop drinking during her pregnancy The baby was born with fetal alcohol syndrome and was placed in the NICU. The mother also refused any vaccinations for the infant. What codes are assigned?

Clinical Coding Workout Chapter 4, question 4.74 Hospital Summary: A male new-born, born at this hospital with pre axial polydactyly of the thumbs, bilateral claw hands and claw feet, had a harsh murmur heard posteriorly and faint femoral pulses on initial new-born exam. The new-born was 39 weeks gestation and was born vaginally. Cardiology was consulted and determined a diagnosis of coarctation of the aorta and a very small conoventricular ventricular septal defect. The newborn had surgical repair of the coarctation but the VSD could not be repaired at this Young age due to closeness to the aortic valve. Cardiology will follow to manage the VSD. Orthopedics was consulted for the hand and feet deformities and will schedule serial repairs after the age of about one Year. The family will be seen by Medical Genetics as an outpatient for possible determination of a syndrome that encompasses this combination of defects. Assign the correct diagnostic code(s)- 

Clinical Coding Workout Chapter 4, question 4.80  This 3-month-old infant was brought to the emergency department (ED) by the babysitter after she did not wake up from a nap. The babysitter admits to shaking the baby because she would not stop crying earlier in the day. She was admitted to ICU and was unconscious for eight hours. Diagnosis at discharge: Shaken infant syndrome, subdural hematoma, loss of consciousness for eight hours, and total retinal detachment, right eye. What codes are assigned?

Clinical Coding Workout Chapter 4, question 4.96 The patient is being seen due to right knee pain and decreased mobility. Previously the patient had a right total knee replacement for osteoarthritis. The patient also has extensive medical problems which were all monitored and treated while he was in the hospital: Parkinson’s disease, hypertensive heart disease, congestive heart failure, bilateral capsular glaucoma, old MI six months ago, and recent abnormal cardiac stress test. Evaluation of the right knee indicated that patient had aseptic loosening of the tibial component of the knee. The orthopaedic consultant indicated that the patient would need to be scheduled for a revision arthroplasty once he was cleared by cardiology for surgery. The cardiac clearance will be done as an outpatient and the procedurewill then be scheduled. Assign the correct diagnostic code(s).    

QUESTION 4                                                                                                               (15 marks)Pharmaceutical waste has a negative impact on already limited healthcare resources as well as detrimental effects on the environment. Another major concern from this waste is that patients may not be experiencing the intended outcomes of their prescribed treatment. As a pharmacy manager, one of your responsibilities is to help reduce and prevent the generation of pharmaceutical waste. It is important to identify the root causes and thereafter develop interventions to prevent the accumulation of pharmaceutical waste. 4.1 Describe factors that contribute to pharmaceutical waste. (5)4.2 Suggest possible interventions to mitigate these factors. (5)4.3 Briefly outline the legal framework governing the disposal of pharmaceutical waste in South Africa. (5)