below.  Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months.

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Discussion Question #1 

For this questions, please read the following case stud and then respond to the questions noted below. 

Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR’s physical assessment includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

  1. What would you add to the current treatment plan? Why?
  2. Would you discontinue any of the currently prescribed medication? Why or why not?
  3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
  4. Why is the patient prescribed more than one antihypertensive?
  5. What is the benefit of the aspirin therapy in this patient?

Discussion Question #2

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication? Your response should be at least 350 words.

Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

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pply information from the Aquifer Case Stud to answer the following discussion questions:

  • Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
  • Describe the physical assessment and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not? 
  • Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?
  • What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

use references in apa style. case stud is attached

1- Develop your position about the individual rights to control the spread of communicable diseases for the good of society.

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1- Develop your position about the individual rights to control the spread of communicable diseases for the good of society.

2-Survey the role of boards of health in your community and state to determine how communicable diseases are prevented and controlled.

(150-word /250-word maximum without the reference(s). Minimum of one reference, APA format.)

Enhancing Quality and Safety For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting.

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Assessment 1 Instructions: Enhancing Quality and Safety For this assessment, you will develop a 3-5 page paper that examines a safety quality issue pertaining to medication administration in a health care setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.

Scenario

Consider a previous experience or hypothetical situation pertaining to medication errors, and consider how the error could have been prevented or alleviated with the use of evidence-based guidelines.

Choose a specific condition of interest surrounding a medication administration safety risk and incorporate evidence-based strategies to support communication and ensure safe and effective care.

For this assessment:

● Analyze a current issue or experience in clinical practice surrounding a medication administration safety risk and identify a quality improvement (QI) initiative in the health care setting.

Be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so that you know what is needed for a distinguished score.

● Explain factors leading to a specific patient-safety risk focusing on medication administration.

● Explain evidence-based and best-practice solutions to improve patient safety focusing on medication administration and reducing costs.

● Explain how nurses can help coordinate care to increase patient safety with medication administration and reduce costs.

 

 

● Identify stakeholders with whom nurses would coordinate to drive safety enhancements with medication administration.

● Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

Additional Requirements

● Length of submission: 3–5 pages, plus title and reference pages. ● Number of references: Cite a minimum of 4 sources of scholarly or professional

evidence that support your findings and considerations. Resources should be no more than 5 years old.

● APA formatting: References and citations are formatted according to current APA style.

Mr. Will, a 67-year-old patient, is postoperative day 2 after a coronary artery bypass graft operation to revascularize his coronary arteries that were significantly blocked.

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Pain Management

1. Mr. Will, a 67-year-old patient, is postoperative day 2 after a coronary artery bypass graft operation to revascularize his coronary arteries that were significantly blocked. He has a midline incision of his chest and a 7-inch incision on the inner aspect of his right thigh where a saphenous vein graft was harvested and used to vascularize the blocked coronary artery. The surgeon ordered Oxycodone 5 mg every 4 hours PRN for moderate pain and Oxycodone 10 mg every 4 hours PRN for severe pain. (Learning Objectives 7 and 8)

  1. Considering the patient’s age, what medication administration considerations should the nurse incorporate into the pain management plan and why?
  2. What measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring?
  3. What nonpharmacologic pain management methods should the nurse teach to Mr. Will to assist with pain management?

2. Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

  1. What are benefits of epidural versus systemic administration of opioids?
  2. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?
  3. The nurse monitors Mr. Rogers for what other complications of epidural analgesia?
  4. Mr. Rogers complains of a severe headache. What should the nurse do?
  5. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

Discussion questions week 3

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Critical thinking is essential when analyzing memories. How should critical thinkers evaluate someone’s claim that they repressed memories of bizarre, traumatic experiences that went on for years, and only remembered what happened decades later, in therapy? What other explanations can account for these apparent memories?

Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis.

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Shock and Multiple Organ Dysfunction Syndrome

1. Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

  1. What predisposed the patient to develop septic shock?
  2. What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?
  3. The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?
  4. Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient?
  5. Explain the importance for nutritional support for this patient and which type of nutritional support should be provided?

2. Carlos Adams was involved in a motor vehicle accident and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following orders are written for the patient:

Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line

Obtain complete blood count, serum electrolytes

Oxygen at 2 L/min via nasal cannula

Type and cross for 4 units of blood

Flat plate of the abdomen STAT

(Learning Objectives 1, 4, and5)

  1. Describe the pathophysiologic sequence of events seen with hypovolemic shock.
  2. What are the major goals of medical management in this patient?
  3. What is the rationale for placing two large-bore IVs?
  4. What are advantages of using 0.9% NS in this patient?
  5. What is the rationale for placing the patient in a modified Trendelenburg position?

1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension

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Fluid and Electrolytes: Balance and Disturbance

1. Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)

  1. What are possible causes of a low potassium level?
  2. What action should the nurse take in relation to the serum potassium level?
  3. What clinical manifestations might the nurse assess in Mrs. Dean?

2. Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas. (Learning Objective 7)

The following results are returned from the laboratory:

Sodium (Na+)  150

Potassium (K+)  5.5

Chloride (Cl¯)  110

BUN    42

Creatinine   0.8

Glucose   86

pH   7.32

PaCO2    35

HCO3¯    20

PaO2    90

O2 Sat    98%

  1. What is your interpretation of this arterial blood gas sample?
  2. Explain the high potassium in this patient.
  3. Calculate the patient’s anion gap:
  4. What is the interpretation of this anion gap?

Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patterns of knowing (ethical, personal, aesthetic, empirical, emancipatory) exemplified with the experience.

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Patterns of Knowing Paper (20%): Maximum 3 pages excluding title page and references. Do not include an abstract with this paper. Upload the paper including the title page and reference page(s) into the Assignment Link located in Unit 4 in Course Materials. Review the directions regarding Safe Assign on Blackboard.

Reflect on your practice and select an experience that you had with a patient or family and explore the five fundamental patterns of knowing (ethical, personal, aesthetic, empirical, emancipatory) exemplified with the experience. Develop a paper that includes the following:

  • Introduction (15 points)      – Briefly introduce the paper      ending the introduction with a purpose statement (The purpose of this      paper is to…)
  • Description of the experience (20      points) – In one paragraph, describe the experience including who was      present, what was happening, who you were engaged with, and what you were      thinking, doing, and saying. Include background information as      appropriate.
  • Patterns of Knowing (50 points) –  Briefly define each pattern of knowing      (sentence or two). Examine which fundamental patterns of knowing were in      evidence. Explain how each pattern was evident in the experience. If any      of the patterns were not evident (for example, if the Emancipatory Pattern      of Knowing was not evident) state that it was not evident and propose what      could have happened in the experience for it to be evident.
  • Social Justice Problem (5 points) – Identify a social      justice problem that was evident in the experience or could have been part      of the experience and propose a solution to it.
  • Conclusions (10 points) –      Completely summarize your thoughts without introducing new content.

APA – This paper must be presented in an organized and scholarly fashion following APA 7th edition guidelines. Up to seven (7) points can be deducted for the following:

  1. Clarity – 3 points
  2. References – 2 points
  3. APA Format – 2 points

Provide an article that is an example of qualitative research.

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Provide an article that is an example of qualitative research. Give a brief overview of the article and why you think it is substantial for your chosen health care topic with apa references  my topic is Women veterans mental healthcare during pregnancy