Below on this page is the patient information like medical diagnosis and nursing diagnosis along with labs and assessment use the information about the patient below to do this paper. Use the other paper attached to do all those parts using this information. Each parts on the other paper should be it own topic and label. Use APA format and APA 7th edition maximum of 5 references. Clinical site: INOVA Fair Oaks Hospital, Address 3600 Joseph Siewick Dr, Fairfax, VA 22033 Unit: surgical ortho Patient: Mrs. Harpine is a 99 year old female who has dementia and fell at the assisted living where she lives she fracture her hip and had a arthroplasty on her right hip. Patient is Alert and orientated to person and place. Medical Diagnosis-Dementia (due to fall) (Make such to include Pathophysiology of medical diagnosis including definition, signs & symptoms, and treatment/diagnostic measures) cite your sources. Explain why this topic is important to you). Past medical history: Hypertension, Kidney disorder, and Alzheimer disease Past medical surgery: Cholecystectomy, Lithotripy, Chief complaint: Arthroplasty of the right hip Relevant Labs Reports and relevant data: Sodium 137, Potassium 4.7, Chloride 103, CO2 26, BUN 18, Creatine 1.0, Hemoglobin 11.0 (low), Hematocrit 33.8 (Low), WBC 11.07 (High), Platelets 190, Glucose 113(high). Relevant Data: Patient has an anti-infection and is on ceftriaxone 1 g in sodium chloride 0.9 % 100 ml IVPB mini-bag plus 1g, IV, Q24H. Lines/Drains/Airways: PIV Line- Peripheral IV 04/14/21. 22 gauge on Anterior Distal Left Forearm. Peripheral IV 04/14/21 18 gauge Anterior right forearm Drain: External urinary catheter with an output of 200 ml Wound: wound 04/14/21 surgical incision leg right Patient is allergic to ciprofloxacin Bleed precaution Patient is on regular diet Assessment What subjective or objective data was present with this type of patient? Objective Data: Vital signs: Temperature: 97.9 source oral, Heart 84, Resp Rate 16, o2 94, O2 device none, Blood pressure 105/62 blood pressure location right arm on the monitor in lying position, Intake 100ml, output 200ml, Subjective Data: Patient Stated her name, date of birth, and her current location, unable to state the year, current president and other long term memory. Patient states her pain level of 3 out of ten. Mobility: maintain at optimum level, risk for fall Diagnosis Primary physical- Risk for falls evidenced by fell at the assisted living she is currently staying. Psychosocial- Chronic confusion related to cognitive impairment evidence by disoriented to time and situation. Education- Self care deficit related to alteration to brain tissue evidenced by memory loss. Medications Acetaminophen tablet 1000 mg 3x daily. Alprazolam 0.25 oral PRN anxiety Ammonia inhaler 1 each inhalation PRN anxiety Ceftriaxone 1 g in sodium 0.9 100 ml IVPB mini-bag plus Dose 1 g 200 ml/hr intravenous every 24 hours Naloxone injection 0.2 mg PRN. Ondansetron injection 4 mg PRN Rubrics for Process Paper Write in a Word Document, using APA format (Adapted for T5/2020) Case presentation (10 points) • • Medical Diagnosis- (Pathophysiology of medical diagnosis including definition, signs & symptoms, and treatment/diagnostic measures) cite your sources. Explain why this topic is important to you. (8) Past medical history, Chief Complaints/Date, Relevant Labs Reports and Relevant Data (2) Nursing Process Assessment- (10 points) • • • • • • • • • • What subjective or Objective data was present with this type of patient? (2) What did you glean from the chart? (2) What information from report was most useful? (2) Was there any aspect of your education that helped with this assessment decision? (3) Explain why? (1) Diagnosis (10 points) Develop Nursing diagnoses related to medical diagnoses (include primary physical, psychosocial and education nursing diagnosis). (4) Why did you choose them for this patient? (1) Did you agree with them? (1) Did you speak to the preceptor about adding, deleting, or modifying them? (2) How did care planning at Stratford help with this? Explain your response. (2) Planning-(10 points) • • • How would you plan your care for such a patient? (2) Do you foresee any difficulties with planning when caring for this patient and what or how would it impact your care process? (4) Did your plan for this patient change as the day progressed? (2) Implementing- (10 points) • • What institutional resources played a factor in accomplishing your plan? (2 What are the Nursing Considerations for this medical diagnosis? (Are there particular aspects that should be monitored such as lab values or etc.?) (4) • What are some tasks that could be delegated if any, for this type of patient? Talk about that decision). (4) Evaluation-(10 points • • • • Identify one best practice that could impact your care for this patient’s quality of care or patient’s safety. (4) What have you learned from choosing and presenting this medical diagnosis? (1) How did your patient do? How did you do? (1) Were there any institutional barriers and/or facilitators during your shifts? (4) Format- (20 points) • • • • • 4-10 pages (5) Double-spaced with 1” margins (5) 12-point font (5) Spelling and grammar correct (5) APA and references (5) Running head: KLINEFELTER SYNDROME Klinefelter Syndrome Stratford University 11/19/20 Prof Gallegos 1 KLINEFELTER SYNDROME 2 Klinefelter Syndrome Case Presentation Medical Diagnosis Klinefelter syndrome (KS) is a genetic condition that affects males when they are born with extra X chromosomes. Typically, males need to possess XY chromosomes for normal development; however, some are born with extra X chromosomes making up XXY genetic composition that brings about the condition. It is also known as the XXY syndrome after its chromosomal composition, but in most cases, it is not inherited or attributed to parents' behaviors. The condition often goes unnoticed until later when they get to the child-rearing stage, when it becomes impossible. The disease affects the testicular growth making those affected have small testicles that a normal male should. The testes are also affected in a way that affects the production of testosterone. The reduced testosterone results in reduced muscle mass, less body and facial hair, and the presence of enlarged breast tissue. Moreover, males diagnosed with the condition may produce little or no sperms making it quite challenging to have children. However, applying the appropriate assistive reproductive procedures has proven to make these individuals possible to father children. Therefore, the paper will review the condition's signs and symptoms, the nursing process of assessment, diagnosis, and treatment to understand better the state and the appropriate treatment recommended for management. Signs The genetic composition of the males affected interferes with testosterone production due to the effect on testicular growth. The signs vary from one individual to the other depending on the number of extra X chromosomes they possess and the age (Close, Fennoy, Smaldone, & KLINEFELTER SYNDROME 3 Reame, 2015). For babies, they exhibit weak muscles, slower development of motor skills, delays in speaking, and the presence of problems such as testicles that haven't descended at birth. Boys and teenagers exhibit features such as being taller than usual with longer legs, shorter torso, and hips broader than normal males (Akcan, Poyrazoğlu, Baş, Bundak, & Darendeliler, 2018). Puberty may be delayed or incomplete, which results in less muscles and less facial and body hair. Also, they may have a smaller penis, testicles, weak bones, and low energy levels. They may also be quite shy and sensitive and may exhibit reading, writing, or math problems. Adult males with the condition may have low or little sperm count, small testicles and penis for their age, little or low sex drives, and flawed masculinity compared to others. Moreover, they may have enlarged breast tissue and increased belly fat. Furthermore, these individuals may have difficulty learning to talk, read, and write as they may have a hard time processing the things they hear. Therefore, it is a condition that affects the lives of those diagnosed with it and require treatment for positive life outcomes. Diagnosis of the disease may be conclusively made through carrying out a genetic test known as the karyotype. The tests reveal an extra X chromosome that should typically be present in females compared to males. The presence of slow development during infancy and boyhood could also be used in the diagnostic process. The presence of delays within growth is the first indicator of the problem that requires immediate treatment for higher chances of management. Male children should exhibit almost similar changes with those of their age groups so that any delays could result from an adverse condition as the Klinefelter. A physical examination could also inform the diagnosis as the physicians may examine the chest for enlargement of breasts and testes for the size as small one indicates a problem. Similarly, male infertility is another source of concern attributed to the disease since most males realize the problem when they experience KLINEFELTER SYNDROME 4 child-rearing issues. Hormone tests could be performed to reveal reduced testosterone and a sperm count investigation to verify the reduced fertility. The topic is important because it talks about a rare condition that affects several males secretly. The disease mostly goes unnoticed for a long time until these individuals notice issues with reproduction within adulthood. Moreover, some of the symptoms exhibited go under-diagnosed due to their resemblance to other conditions. According to surveys, only 10% of the cases are diagnosed during childhood, yet the disease starts early. In the end, about 25% of those affected ever get diagnosed and treated for the condition until later ages when they notice it. The diagnosis's complexity leaves out many males in the treatment procedures that could have had positive outcomes in increasing their fertility. Treatment Abnormalities that exist within the chromosomes have no direct means for correction since it is an incurable disease. Treatment measures set for managing the condition are only effective in reducing the symptoms for better living. However, early diagnosis of the condition could be essential in managing the chronic aspects of the condition. Treatment procedures for the disease vary depending on the severity of the condition and the exhibited symptoms. Testosterone replacement therapy is carried out in pills, gel, injections, or a patch. The treatment is crucial in improving the strength, body hair growth, and concentration affected by testosterone lev- els. Fertility treatment is another treatment option that helps manage the production of sperms for fertilization and reproduction. The treatment is highly effective if the disorder is diagnosed early since the semen and the appropriate testicular tissue tissues get preserved before further damage is experienced. The process of cryopreservation done, preferably during puberty, helps KLINEFELTER SYNDROME 5 maintain these reproductive cells by using shallow temperatures for preservation in a way that they can later be used (Masterson, Nassau, & Ramasamy, 2020). Intracytoplasmic sperm injection could also help treat the fertility problem by removing the sperm and injecting it directly to the egg for reproduction to be possible. Overdeveloped breasts could be quite embarrassing and are treated through a breast reduction surgery since there is no developed medication to manage the symptoms. The surgery may be quite risky, but it helps alleviate the social stigma and stress associated with a male having large breasts. Also, it helps reduce the chances of acquiring breast cancer. Psychological counseling is recommended to allow the males to manage the challenges associated with having the condition since issues such as feminine features and infertility affect these individuals' mental health. Therapeutic support could also be included in the treatment measures to help prevent difficulties associated with language, social interaction, and schooling. Speech therapy and physical therapy could help alleviate other challenges. Occupational therapy and behavioral therapy further assist in managing the associated symptoms. Consequently, it is a condition that can be managed well at any point of discovery, though early diagnosis results in better results. The topic is of great importance to me due to the severity of the issue, yet it is a condition that people have little information. The condition continues to affect a fraction of the population due to the little knowledge about it. Moreover, those diagnosed with the condition have to suffer some issues that would have been avoided with the correct management and treatment. My interest in the topic was mainly to learn how to manage the condition to alleviate some of the issues those diagnosed with it face for them to have better life outcomes and have a chance of reproducing their children. KLINEFELTER SYNDROME 6 Nursing Considerations The nursing consideration for the medical diagnosis of the condition is the recommended chromosomal composition of the individuals, which could be realized from genetic tests. They need to be aware of the chromosomal design associated with the condition. The presence of developmental delays such as late facial development and features related to the feminine X-chromosome, such as enlarged breasts or hips, need consideration. Similarly, they need to consider other physical characteristics, such as a small penis or testicles. The sperm count could also be dome to verify the presence of abnormalities or a history of infertility in male adults. Moreover, they could carry out the necessary tests to confirm the presence of abnormalities associated with the condition for appropriate planning of the treatment procedure to carryout for managing the anomaly. Nursing Process Assessment Objective and Subjective Assessment A patient with the disorder should exhibit primary testicular failure indicated by the presence of small testes, hypogonadotropic hypogonadism, a tall structure with longer legs than usual, impairment within neurocognitive aspects such as language processing and learning. Also, they need to exhibit some behavioral or social difficulties that affect their interaction with other individuals. Other abnormalities that contribute to the assessment include decreased penis size, deficiency of the growth hormones, psychiatric disturbances, mitral valve prolapse, hypothyroidism, among others (Akcan et al. 2018). In newborns, KS could be assessed by looking out for ambiguous genitalia, phenotype variations for the presence of genetic defects, deficiencies in an- KLINEFELTER SYNDROME 7 drogens, the sensitivity of the androgen receptor, or the presence of inactive additional X chromosomes. Comorbid conditions also need to be assessed for a chance of early diagnosis that could help ease the severe symptoms of the condition. Undescended testicles are another piece of evidence that helps in the diagnosis of the condition and are highly noticeable even at an early age. Additionally, the complications associated with the condition need to be assessed for the severity of the condition since having KS increases the risk of some conditions. These conditions include; infertility problems or sexual dysfunction, presence of weak bones commonly known as osteoporosis, cancer, especially that of the breasts, and disorders associated with autoimmune such as type 2 diabetes, hypertension, and high cholesterol (Close, Talboy, & Fennoy, 2017). Also, diseases such as lung disease and dental problems could be assessed due to the disorder's increased susceptibility. Therefore, KS's risk factors need to be evaluated, especially those resulting from low testosterone levels. Learning of the diagnostic criteria for different conditions during the course of my education has made it relatively easy to diagnose various conditions. Also, the knowledge of the minimum amount of symptoms to look out for as well as the main signs to avoid misdiagnosing or confusing with a disease with almost similar features, was acquired through the readings. Moreover, the constant practice through case study analysis has made me conversant with the diagnos- tic procedures. Lastly, the course materials regarding different diseases, symptoms, and probable solutions further equipped me with the necessary information for the verification of the resultant diagnosis. Diagnosis Sexual dysfunction R/T disease process KLINEFELTER SYNDROME 8 Low self-esteem R/T to rejection by peers. Knowledge deficient R/T unfamiliarity with information resources Klinefelter’s syndrome is diagnosed through analysis of the chromosomal composition karyotype on lymphocytes through blood testing to reveal the extent of the problem. Also, physical examination reveals the presence of abnormal physical features such as a small penis and testicles not descended. Evidence of inefficient production of testes and increased production of pituitary or luteinizing hormones is also an essential aspect for diagnosis as features related to hypogonadism like feminine fat distribution, reduced upper body muscles, or less facial hair represents the possibility of the condition (Close, Smaldone, Reame, & Fennoy, 2010). Other issues like sexual dysfunction or issues with reproduction need to be part of the diagnosis. Psychosocial difficulty in relating to other individuals or psychological distress related to the condition. These are the condition's leading indicators and would result in an efficient and precise diagnosis of the syndrome and inform the appropriate treatment options fit to manage the presenting conditions. Consequently, Stratford's care planning was highly beneficial in issuing information on the recommended diagnosis and symptoms for this condition that gave me insight into the correct diagnosis. Planning A patient experiencing these difficulties could be managed by performing testosterone replacement therapy to improve the fertility and production of sexual hormones that initiate the development of masculine features. If problems arise and the procedure does not work out, then fertility treatment could be undertaken to increase reproduction chances through practices such as intracytoplasmic sperm injection. Breast surgery could also be undertaken to help reduce their sizes that might be contributing to social stigma and other emotional issues for the individuals KLINEFELTER SYNDROME 9 and further reduce the chances of developing breast cancer. Also, therapeutic support needs to be included to help manage some of the condition's difficulties. Behavioral therapy needs to be present to address the challenges with social interaction and management of temperaments. Physical therapy also needs to be included to strengthen the muscles and other physical issues. Lastly, counseling could be incorporated to enable them to manage the condition and share some of the difficulties they may face due to the condition. Implementing The institutional resources played a significant role in issuing the needed materials and articles to make the treatment plan and understand the possible problems that may arise in the treatment course. From the materials, it was possible to make the appropriate treatment plan basing on the single symptoms and issues that need regard for the successful management of the syndrome. Therefore, it is an essential resource I hope to utilize in other conditions for an inclusive and critical treatment for patients. The medical diagnosis of the condition can only be verified by monitoring the hormonal composition of the patient. This could be done through blood tests to measure the hormone levels present in the blood; this could reveal the testosterone levels to understand how much they differ from those recommended of a normal male (Chang, Skakkebæk, & Gravholt, 2015). The test could also inform the treatment plan by understanding the extent of the condition. A chromoso- mal analysis could also be performed to review the extra X chromosome's presence that contributes to the condition through a Karyotype test that analyses the sex chromosomes. These tests need to be conducted throughout the treatment process to reveal the presence of positive changes. Similarly, a semen examination performance could further inform the treatment by analyzing the extent to which the condition affects sperm production and overall fertility. Samples KLINEFELTER SYNDROME 10 of the patient's semen could be examined to analyze the sperm count to inform the condition's appropriate treatment option. The patient requires medical health alongside other therapies to manage the syndrome since it has no cure. The psychological treatment would have to be delegated to a professional counselor who can provide psychological support and address the mental health issues associated with the situation. If the need for breast surgery is recommended, the duties would have to be delegated to the surgeons for safe surgery. Lastly, the lab tests for the different diagnostic processes would have to be charged to the lab technician's proper analysis of the other samples. Evaluation The KS manifests differently within different patients, which results in slightly personalized treatment modalities that manage these needs (Santana et al., 2018). In this regard, Descritoin The care aims to meet patient safety requirements, quality health care, and coordination of their medical objectives with their values and beliefs. Also, care is highly conscious of the patient's needs and could result in a positive medical outcome. In summary, the experience of choosing and presenting the medical diagnosis of KS was a highly educative one, as I learned more about the process of diagnosis. Also, the medical diagnosis exercise was a practical means of acquiring expertise in the process that I can apply later in real patient practice. Similarly, I learned that implementing the desired treatment plan might not be possible without delegating some of the duties to the professionals qualified in them for correct and reliable results. Moreover, I learned so much about the KS that silently affects a portion of males. The condition is genetic and results from extra X chromosomes that produce more feminine features in these males and affect their ability to reproduce from the inability to produce the male hormones and the relatively small reproductive organs. Furthermore, the condition has no KLINEFELTER SYNDROME 11 cure but could be managed through testosterone replacement fertility treatment, removal of the breasts, and psychological counseling to let out the condition's emotions. Consequently, it a serious condition that requires long term management and treatment through collaboration with other physicians to increase their quality of life. References Akcan, N., Poyrazoğlu, Ş., Baş, F., Bundak, R., & Darendeliler, F. (2018). Klinefelter syndrome in childhood: Variability in clinical and molecular findings. Journal of clinical research in pediatric endocrinology, 10(2), 100. Chang, S., Skakkebæk, A., & Gravholt, C. H. (2015). Klinefelter syndrome and medical treatment: hypogonadism and beyond. Hormones, 14(4), 531-548. Close, S., Talboy, A., & Fennoy, I. (2017). Complexities of care in Klinefelter syndrome: an APRN perspective. Pediatric endocrinology reviews: PER, 14(Suppl 2), 462-471. Close, S., Fennoy, I., Smaldone, A., & Reame, N. (2015). Phenotype and adverse quality of life in boys with Klinefelter syndrome. The Journal of pediatrics, 167(3), 650-657. Close, S., Smaldone, A., Reame, N., & Fennoy, I. (2010). Klinefelter Syndrome: Awareness and Index of Suspicion. Journal of Pediatric Nursing, 25(6), 592-594. Masterson, T. A., Nassau, D. E., & Ramasamy, R. (2020). A clinical algorithm for management of fertility in adolescents with the Klinefelter syndrome. Current opinion in urol- ogy, 30(3), 324-327. Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), 429-440. 
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