Group Worksheet Student name(s)_____________________________________________ Congratulations, you started your internship! It’s your first day and you will be working with your mentor on the Medical/Surgical ward at Memorial Hospital. You have just been briefed from the second shift nursing staff on your patient status. Your mentor has assigned you to care of the following patients below. Assignment Instructions • Look in your medication cart (at the end of this worksheet) for your available drugs and calculate the correct dosage for each of your patients. • Assume all tablets and caplets in your medication cart can be scored. • For patient receiving nutrient feeding: Calculate how much water and how much nutrient feeding. Do this for each feeding and for the entire day. • For diabetes patients: When combining two insulins in the syringe, describe the process you would use, and draw on your syringe showing the placement and units of the two types of insulin in the order they would be drawn. • Patients receiving injections (non-insulin and non-heparin) calculate the dosage to the nearest tenth. Patients receiving heparin calculate to the nearest hundredth. Submission Instructions • Print out this worksheet, Beds 1 – 14. • Write your answers directly on this worksheet, in the space/box provided. • Submit ALL work. No work, no credit. Your patients (Beds 1 – 14) Bed 1: Ramsey Snow is a 32 y/o male recently diagnosed with a chronic hepatitis B virus infection from blood to blood contact. Patient has a history of bipolar disorder and has an order for Lithium carbonate. Patient refused to take his Lithium carbonate last night. Patient has attempted to leave clinical care and return to Winterfell. His doctor’s order is: Med #1: Baraclude (entecavir) 500 mcg via NG tube _________________________________________________ Med #2: Lithium carbonate 300 mg po daily ________________________________________________________ Bed 2: Tywin Lannister a 60 y/o male has a history of type II diabetes mellitus, angina, hypertension, hyperlipidemia, and has had a cardiac catheterization. 5’8” and weighs 275 pounds, and is the King’s hand. His vital signs are stable. His surgical site is normal and healing. Mr. Lannister is waiting for discharge. Calculate for a single dose and patient’s needs for 30 days. Medications on discharge orders: Medication found in medication cart. • Sitagliptin/metformin HCl 50/1000 mg po bid ___________________________________________________ • Lansoprazole 30 mg po daily before breakfast___________________________________________________ • Alprazolam 2 mg po prn anxiety (assuming they need one dose per day) _____________________________ • Lipitor 40 mg po daily ______________________________________________________________________ • Lovaza 2 g po bid __________________________________________________________________________ • Lisinopril/hydrochlorothiazide 20/12.5 mg po daily _______________________________________________ • Tricor 48 mg po daily _______________________________________________________________________ • Amaryl 2 mg po daily with breakfast __________________________________________________________ • Plavix 75 mg po daily _______________________________________________________________________ • Coreg 12.5 mg 12.5 mg po bid _______________________________________________________________ • Tetracycline HCl 500 mg po bid _______________________________________________________________ Bed 3: Lysa Arryn 45 y/o female is recovering from a L5-7 spinal injury and hip surgery resulting from a long (really long) fall. Her vitals: BP: 135/85, P:86 R:24 Her pain level last night is a 8 (scale of 1-10, 10 is severe). Patient has an NG tube. Her doctor’s order is: Med #1: 1/3 strength Ensure 12 oz. by NG tube q8h. Calculate mixture and flow rate in mL/h. _______________ Extra question – is this recorded on the patient’s I & O chart? _________________________________________ Med #2: Lovenox 30mg subcut q12h for 21 days or until discharged. ____________________________________ Bed 4: Stannis Baratheon 51 y/o male has a history of hypertension. We were unable to get vitals. Patient appears in a state of confusion this morning, because he dreamt he is the king of the north, and the Lord of the light will take care of him. His doctor’s order is: Med #1: Quinapril HCl 10mg p.o. daily. ____________________________________________________________ Med #2: Hydrochlorothiazide 12.5mg p.o. q12h. ____________________________________________________ Bed 5: Arya Stark 16 y/o female with lower respiratory infection from her travels throughout Westeros. Vital signs are normal. Temperature is 38 °C. What is her temp in °F? _______Her doctor’s order is: Med #1: Tazicef 250mg IM q8h. _________________________________________________________________ Bed 6: Mance Rayner 58 y/o male is healing from an arrow through the UL quadrant of his stomach and chest, requires NG feeding by Kangaroo pump. His doctor’s order is: Med #1: ¼ strength Pulmocare 450mL q8h followed by 100mL of water after each feed. Calculate mixture, and determine the pump rate in mL/h. Start first feeding at 0730hrs. What other times (military time) does he need to be fed? ___________________________________________________________________________________________ Bed 7: Olenna Tyrell, a 65 y/o female with a history of obesity, hypertension, hyperlipidemia and type II diabetes comes to see the Measter (healer) complaining of nausea, vomiting, chills, fever, and sharp pain to the upper right quadrant that radiates to her shoulder and back. She has been diagnosed with gallstones. After her surgery, her post-op orders are as followed: • NPO • V/S q4h • IV D5/RL @ 130 mL/h • Compazine 4 mg IM q4h prn nausea • Demerol 75 mg and Vistaril 25 mg IM q3h • Merrem 1 g IVPB q8h Available drugs: How much will you give to your patient? • Compazine 5mg/mL. ____________________________________________________________________ • Demerol 75 mg/mL and Vistaril 25 mg/mL (show the combined drug in syringe with line between drugs). _____________________________________________________________________________________ • Merrem 500 mg/mL. ____________________________________________________________________ Bed 8: Sansa Stark, 20 y/o female has had hip surgery after jumping from the wall to escape Winterfell, and to prevent pulmonary embolism, her doctor’s order is: Med #1: Lovenox 30mg subcut q12h for 21 days or until discharged. ____________________________________ Available: see medication cart Bed 9: King Robert Baratheon, 52 y/o male is diagnosed with heart failure. Patient’s weight is 61.2kg. His doctor’s order is: Med #1: Lisinopril and hydrochlorothiazide 40 mg/25 mg _____________________________________________ Available: see medication cart Bed 10: Queen’s guard, Grey Worm, 24 y/o male requires a blood thinner after surgery. His doctor’s order is: Med #1: Heparin 500 units subcut b.i.d. ___________________________________________________________ Available: see medication cart Bed 11: Samwell Tarly 32 y/o male is diabetic. His doctor’s standing order is: Med #1: Humulin Regular U-100 to finger stick q8h. You did a finger stick and his blood glucose level is 250mg/dL. His standing order is: 0-180 mg/dL 181-240 mg/dL 241-300 mg/dL 301-400 mg/dL Greater than 401 mg/dL No coverage 2 units subcut 4 units subcut 6 units subcut 8 units subcut STAT, call doc Bed 12: Maester Aemon has lower respiratory tract infection from S. aureus. His doctor’s order is: Med #1: Rocephin 0.7g IM q12h _________________________________________________________________ Med #2: Oxygen 6 liter p.r.n. by nasal tube. Available: see medication cart Fill in the correct syringe and justify your choice.____________________________________________________ Bed 13: John Snow, Lord Commander of the Wall, has Type I diabetes. His doctor’s order is: Med #1:Insulin R U-500 200 units subcut b.i.d. (hint: look at medication in medication cart, and 100 units = 1 mL Critical Thinking Problem You have one more patient temporarily admitted to this floor. Bed 14: Tyrion Lannister is recovering from pneumonia, but has a history of seizures. Patient weighs 50 lbs. His doctor’s order for Tyrion seizure is: Med #1: Phenobarbital 300 mg IM STAT Recommended dose: 10-20 mg/kg load, may repeat 5mg/kg every 15-30 min until seizure is controlled or total dose of 40 mg/kg. What is his minimum and maximum dose? _____________________________________________________ Is his dose safe (justify mathematically)? _______________________________________________________ And what is the max mg he can have? ____________________ How many repeat dosages would be allowed (justify mathematically)?_______________________________ Medication Cart 1. Pfizerpen™ (penicillin G potassium): 2. Aspirin: 3. Insulin: 4. Quinapril: 5. Hydrochlorothiazide: 6. Synthroid: 7. Ibuprofen: 8. Tazicef: 9. Lovenox: 10. Allegra: 11. Lisinopril: 12. Heparin: 13. Rocephin (Ceftriaxone) : 14. Phenobarbital: 15. Janumet (sitagliptin/metformin) 16. Lansoprazole: 17. Xanax (alprazolam): 18. Lipitor: 19. Lovaza: 20. Tricor: 21. Amaryl: 22. Plavix: 23. Coreg: 24. Tetracyline HCl The Case Study in Cancer Part I Ann is a 27-year-old nurse working at the local hospital in surgery. She had worked hard to move into the specialty, and she was enjoying her career, friends, and family. She and her partner had been living together for about a year, and she was content. As a nurse, Ann knew the importance of doing breast self-exams, and did them regularly. In the shower one morning, she felt a lump she wasn’t familiar with. Ann was a bit worried, even though there was no history of breast cancer in her family, so she made an appointment with her doctor. 1. If Ann has a tumor in her breast, is it necessarily cancerous? Differentiate between a benign tumor and cancer at the cellular level. INSERT ANSWER Part II Ann’s doctor is worried enough to send her to a breast cancer specialist, just to be safe. Ann makes an appointment and is referred for a mammogram, which will image the soft tissue in the breast. After the mammogram and an exam, she meets with the surgeon, Dr. Hernandez. Dr. Hernandez is also concerned, as she felt and has images from the mammogram of a small tumor. She recommends a biopsy of the tumor as soon as possible. Ann goes in the same day for the quick surgical procedure where a needle is inserted and part of the tumor is taken for analysis. The tumor will be analyzed by a pathologist, a specialist in looking for disease in tissue samples. 1. The pathologist examines the cells taken from the tumor, particularly the number of cells in mitosis. Below are the results. In normal breast cells, one would expect 0-4 cells per 10 high-powered field of view (microscopy) undergoing mitosis. Cell Cycle Stage Interphase Prophase Metaphase Anaphase Telophase Number of Tumor Cells in 10 High-Power Fields 120 7 2 10 0 Based on the above results, what can you conclude about the tumor cells? Can you say definitively that they are cancerous? Be sure to support your answer with the data above. INSERT ANSWER 2. The pathologist also looks for three receptors on the tumor cells: estrogen receptors, progesterone receptors, and HER2 receptors. a. What type of macromolecule class are cell receptors? What is the monomer? INSERT ANSWER b. What is the role of cell receptors in cellular function? INSERT ANSWER c. Ann’s tumor was positive for estrogen and progesterone receptors, but negative for the HER2 receptor. What is the role of estrogen receptors on a cell? Remember to cite your sources using APA Style. INSERT ANSWER Part III Dr. Hernandez sits down with Ann and her partner. The doctor is sorry to report that Ann has breast cancer; however, because it was caught early and responds to estrogen and progesterone, the prognosis is good. At this point it looks like the cancer is stage 1. However, as Ann is young, the doctor wants to perform a couple tests. The first test is a genetic sequencing test for BRCA1 and BRCA2, as well as testing for other genes known to increase the risk of cancer. The other test is an Oncotype DX test on the tumor cells. This is a gene expression test, where the results correlate with how aggressive the cancer cells are. Ann is overwhelmed, but wants to do everything she can to get rid of this disease. 1. As a result of your discussions, you know that mutations in BRCA1 and BRCA2 increase the risk of breast cancer. Because of this, a positive test for these mutations would mean different treatment for Ann, including removal of both her breasts (bilateral mastectomy) as well as her ovaries to prevent ovarian cancer. Ann decides to have the test done, but she is a little hazy on the biology of DNA. a. Describe the basic structure and function of a gene. INSERT ANSWER b. At the molecular level, what is a mutation? Are all mutations harmful? What type of mutation does not lead to a change in protein structure? INSERT ANSWER c. The polymerase chain reaction (PCR) is a method that can be used to detect mutations. It uses machinery similar to your cells to replicate a specific DNA sequence, which in this case would be only the mutated gene. Describe the basic process of DNA replication in a cell. INSERT ANSWER 2. Also, as a result of your discussion, you know that the expression of genes can change in cancerous cells versus noncancerous cells. The Oncotype test will look at the expression levels of several genes in her tumor cells by looking at the mRNA produced. a. What role does mRNA play in the flow of information in the cell? (Hint: Remember the central dogma of molecular biology.) Please include the basic flow of information in the cell. INSERT ANSWER b. Cancer cells and noncancerous cells may have almost identical DNA; however, gene expression can change. Explain the concept of differential gene expression using cancer versus noncancerous cells as an example. INSERT ANSWER c. This Oncotype test uses microarray analysis to determine gene expression. Explain to Ann what a microarray is. INSERT ANSWER d. The results of Ann’s Oncotype test showed a decrease in the expression of BRCA1. How can this decrease lead to an increase in cell division? (Hint: What is the normal role of BRCA1?) INSERT ANSWER 3. Both these tests take time and will inform Ann’s treatment plan for the best possible outcome. While she is waiting on results, Ann begins to research the main types of treatments that are available to treat breast (and many other) cancers. One of these is chemotherapy. There are many types of chemotherapy, but in general: a. How does chemotherapy work? INSERT ANSWER b. What are some side effects of chemotherapy? INSERT ANSWER c. Based on your knowledge of chemotherapy and cell division, why do you think chemotherapy leads to these side effects? INSERT ANSWER Part IV Dr. Hernandez calls Ann with the test results a couple weeks later. She is negative for the BRCA1 and BRCA2 mutations, which is good news. But her Oncotype score is borderline high, meaning the cancer is somewhat aggressive, and chemotherapy will decrease the chance that cancer recurs elsewhere in her body and increase her chances of survival long term. The surgeon recommends a medical oncologist to start chemotherapy, who in turn recommends a course of chemotherapy that includes paclitaxel, also known as Taxol. 1. What cell structure does Taxol target? INSERT ANSWER 2. What are the functions of this structure in the cell? INSERT ANSWER 3. How does the targeting of this structure treat cancer? INSERT ANSWER Part V After four rounds of chemotherapy and a unilateral mastectomy, Ann was exhausted but relieved to be through the worst of treatment. Radiation was not necessary, and the cancerous cells had not spread to any of her lymph nodes. These were all good signs that the cancer was caught early and had not spread. Ann was back to work, and aside from some fatigue, things were slowly getting back to normal (or as normal as they ever would be again). Ann and her partner were to be married in a year. They figured if they could get through this, they could get through anything together. Ann was excited to get on with planning the rest of her life! 1. Why is it a good sign that cancerous cells had not spread to her lymph nodes? INSERT ANSWER 2. What does metastatic mean in cancer diagnosis? Based on the above information, had Ann’s cancer metastasized? Support your answer. INSERT ANSWER Your Name goes here Pl e as e t ype t h e an sw er s t o yo ur l ab qu e st ion s in f ul l s ent enc e , us ing an alt e rn ate col or o r f on t , so t ha t you r an sw e rs ar e e a s y to g ra de . B e a s d et ai le d as pos si bl e in e a ch r es p ons e. R em emb e r t o r efe r en c e you r l ab ma nua l and you might ev en t h in k abo ut b ac k ing up yo ur a nsw e rs w ith o uts id e sou r ce s, bu t b e su re to c it e and ref e r en ce t h em a ll ac co rd i ng to AP A g uid e lin e s Biomolecular Techniques Pre-Lab Questions 1. Transformation, conjugation, and transduction were discovered in the laboratory. How important are these mechanisms of genetic recombination in nature? 2. Use the internet to investigate DNA fingerprinting. What is this process, and how is it used in criminal forensics? 3. How can plasmids be used to manufacture proteins such as insulin for diabetic patients, or antibiotics for bacterial infections? 4. Research a genetic disease that may be cured through the use of genetic engineering. What techniques are being explored to correct the problem? How do concerns of designer embryos stem from this technology? © eScience Labs, LLC 2013 Experiment 1: DNA Extraction Post-Lab Assessment 1. Which DNA bases pair with each other? 2. How is DNA information used to make proteins? 3. What is the purpose of the following reagents in the experiment: a. Salt (in the DNA Extraction Solution): b. Detergent (in the DNA Extraction Solution): c. Ethanol: 4. What else might be in the ethanol/aqueous interface? How could you eliminate this? 5. What is the texture and consistency of the DNA? 6. Is the DNA soluble in the aqueous solution or alcohol? © eScience Labs, LLC 2013 Experiment 2: Restriction Enzymes Table 1: Enzyme Analysis Enzyme Cuts Between Fragment Size Gel Banding Pattern Enzyme 1 Two Blue Enzyme 2 Yellow/Blue Enzyme 3 Red/Blue OR Blue/Red Enzyme 4 Green/Yellow Enzymes 2 and 3 See above Post-Lab Assessment 1. How can DNA be fragmented into very specific sections? 2. Where do restriction enzymes come from? What is their function in nature? 3. How do molecules of varying sizes separate in electrophoresis? What is the purpose of the gel? What about the electricity? 4. Investigate one way in which electrophoresis is used in medicine today. Write one © eScience Labs, LLC 2013 or two paragraphs to explain your findings. Experiment 3: Cloning a DNA Fragment from a BacteriallyDerived Vector NEB Cutter Website: http://nc2.neb.com/NEBcutter2/ Data How long was the foreign DNA? How long was the plasmid DNA? Post-Lab Questions: 1. What is the expected size of the plasmid plus the cut foreign DNA? 2. What type of ends do the enzymes BamHI and EcoRI produce? How does this type of end facilitate cloning? 3. What enzyme is necessary to permanently link the digested foreign and plasmid DNA together to form the recombinant DNA molecule? How does this enzyme work? 4. How would you clone a gene into a plasmid if there were no common restriction sites between the two DNA sequences? © eScience Labs, LLC 2013 Experiment 4: Gel Electrophoresis Data Tables and Post-Lab Assessment Table 3: Electrophoresis of Dye Samples Well Sample 1 Pyronin 2 Methyl Orange 3 Ponceau G 4 Xylene Cyanol 5 Unknown 1 6 Unknown 2 # of Bands Migration Post-Lab Questions 1. What is in each of the unknown samples? 2. Why is electrical current necessary to separate molecules using electrophoresis? 3. Why is agar an appropriate medium to use for separating molecules? Research another type of gel and provide a brief explanation regarding why it could be used rather than an agar gel? 4. What is the charge of the samples? What do you think would happen if the molecules held © eScience Labs, LLC 2013 the opposite charge? 5. How is electrophoresis similar to, and different from, chromatography? References: © eScience Labs, LLC 2013 Your Name goes here Pl e as e t ype t h e an sw er s t o yo ur l ab qu e st ion s in f ul l s ent enc e , us ing an alt e rn ate col or o r f on t , so t ha t you r an sw e rs ar e e a s y to g ra de . B e a s d et ai le d as pos si bl e in e a ch r es p ons e. R em emb e r t o r efe r en c e you r l ab ma nua l and you might ev en t h in k abo ut b ac k ing up yo ur a nsw e rs w ith o uts id e sou r ce s, bu t b e su re to c it e and ref e r en ce t h em a ll ac co rd i ng to AP A g uid e lin e s Lab 12: Transcription and Translation Pre-Lab Questions 1. What is a gene? Describe the function, structure, and location within the cell. 2. What are the three stop codons? What is the start codon? 3. Compare and contrast bacterial and eukaryotic ribosomes. Experiment 1: Transcription Data Tables and Post-Lab Assessment Lab Questions 1. Transcribe the following DNA sequence: Hb A: 5’ AGT AAC GGC AGA CTT CTC CTC AGG AGT CAG GTG CAC CAT 3’ © eScience Labs, LLC 2013 2. Translate your new RNA sequence using the genetic code. Remember that when determining your amino acid sequence, the RNA sequence is read from 5’ to 3’. Note: the first amino acid will be Met. 3. Transcribe the following DNA sequence. Hb S: 5’ AGT AAC GGC AGA CTT CTC CAC AGG AGT CAG GTG CAC CAT 3’ 4. Translate your Hb S transcript. Note: the first amino acid will be Met. Post-Lab Questions 1. How long are each of your peptide chains (how many amino acids are present)? 2. What differences exist between your two transcripts? What about your translated product? 3. Hb A represents a section of the 626 base normal hemoglobin beta mRNA sequence. Hb S is from the sickle cell hemoglobin. Is the mutation found in sickle cell hemoglobin a point mutation or a frameshift mutation? 4. Does the sickle cell mutation result in a missense mutation, silent mutation or nonsense © eScience Labs, LLC 2013 mutation? Why? Experiment 2: Genetic Mutations Data Tables and Post-Lab Assessment Lab Questions 1. Translate the following sequence. 5’ AUG GAG GUC UUU AAG AGA CAU UUA GAU GUA GCC CUU AGU GAU GUU UAG 3’ 2. Create one or more point mutations in this sequence. 5’ AUG GAG GUC UUU AAG AGA CAU UUA GAU GUA GCC CUU AGU GAU GUU UAG 3’ 3. Translate your mutated sequence. 4. Now create a frameshift mutation by adding one or more bases. 5’ AUG GAG GUC UUU AAG AGA CAU UUA GAU GUA GCC CUU AGU GAU GUU UAG 3’ 5. Translate your mutated sequence. 6. Create a frameshift mutation by deleting one or more bases. 5’ AUG GAG GUC UUU AAG AGA CAU UUA GAU GUA GCC CUU AGU GAU GUU UAG 3’ 7. Translate your mutated sequence. 8. Align the amino acid sequences that you determined for each of the four transcripts. 1 ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 2 ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ © eScience Labs, LLC 2013 3 ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 4 ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ Post-Lab Questions 1. How does each of your mutations affect the amino acid sequences? Are the mutations missense mutations, silent mutations or nonsense mutations? a. Point mutation? b. Frameshift-insertion? c. Frameshift-deletion? 2. What differences did you notice between the point mutation and the frameshift mutations? 3. Is it possible to determine the DNA sequence from the following amino acid sequence?: Leu Pro Arg. Why or Why not? References: © eScience Labs, LLC 2013
Purchase answer to see full attachment