M.H., age 6, fell while running down stairs and hurt his wrist and elbow. His arm was scraped and bleeding slightly, and the elbow became red, swollen, and painful period normal movement was possible, although painful.

1. Explain why the elbow is red and swollen.

2. Suggest several reasons why movement is painful.

3. State two reasons why healing may be slow in the striped area on the arm, and identify two factors that encourage healing in this boy.

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M.B. is a 73-year-old female, G4P4004 with a large bulge outside of the vagina. She complains of urinary frequency, urgency, difficulty with voiding, and pelvic pressure. Her history is significant for hypertension and a cerebral aneurysm, which was clipped in 2000 and has been stable since. Surgeries include the aneurysm clipping and knee and ankle surgeries in 1998 and 1999, respectively. She has had no problems with general anesthesia. Medications include hydrochlorothiazide, potassium, iron, Senokot, and vitamins. She is allergic to aspirin. Exam of the head, chest, heart, abdomen, and extremities are normal. Pelvic exam reveals vulvovaginal atrophy, small uterus, uterine procidentia, enterocele, urethral hypermobility, cystocele, and rectocele. (Note: Procidentia denotes complete failure of all the genital supports with either complete uterine prolapse and/or total eversion of the vagina.) Postvoid residual urine is 220 mL, the urinalysis is normal, and eGFR (estimated glomerular filtration rate) is 55.

1.   What would you recommend to this woman? How would you further evaluate her?

2.   What is your plan?

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What was the purpose of the initial role of the nurse practitioner, and does it differ from the role of the nurse practitioner in today’s healthcare system? What are the elements of the role transition from RN to NP?

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Healthcare does not occur in a vacuum, and neither will be changing it for the future. It takes collaborative efforts from all members of the healthcare team to develop systems that meet the needs of current and future patient populations. How might innovation and a true desire to create patient-centered care delivery look like?

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A 3-year-old child presents to the emergency department with his parents due to fever for 3 days, “looking weak and not his active self,” vomiting three times, and refusing to drink water or juices for the past 12 hours. The parent also reports that the child had no wet diapers for the past 8 hours. Home treatment included administration of acetaminophen syrup before the child started vomiting. The child has no significant medical or surgical history and no allergies to foods and drugs. The health care provider orders stat testing for white blood cell count, differential count, platelet count, C-reactive protein, serum sodium, serum potassium, and urinalysis. Highlight the client findings that are of immediate concern to the nurse.

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