DIS 5

Read the Critical Thinking story on page 162 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  What information in the story indicates that Randi might be a candidate for heart disease? Explain why these items lead to CVD.

Topic 2  Discuss why Randi thought this was not a heart attack.

Topic 3  What can Melanie do immediately to try to save Randi’s life?

Topic 4  Assuming that Randi is suffering a myocardial infarction, discuss why it is important that she receive appropriate treatment quickly.

DIS 6

Read the Critical Thinking story on page 197 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Do you think Hernani should reveal his HIV status to South Hills Middle School? If so, why? If not, why not?

Topic 2  Do you think South Hills Middle School would hire Hernani for a coaching job if they knew he was HIV positive? Why or why not? Would the possibility of a team or coaching injury, and the bloodborne transmission of HIV, affect their decision?

Topic 3  If South Hills Middle School decided that Hernani was not suitable for a coaching job, would they still consider him for the teaching position?

Topic 4  How would you feel if your child were in a class Hernani was teaching or on one of the teams he was coaching? Why?

DIS 7

Read the Critical Thinking story on page 230 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Discuss which environmental factors might cause an asthma attack.

Topic 2  Discuss what Sylvia might do to find out if her building has an air quality problem.

Topic 3  What factors did Sylvia and Kelly consider as possible triggers for Sylvia’s frequent attacks?

Topic 4  If Sylvia’s inhaler does not control her attack and her condition worsens, what steps should be taken promptly? Why?

DIS 8

Read the Critical Thinking story on page 267 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Gabby is concerned about her emotional eating. What reasons besides hunger might cause people to eat?

Topic 2  If her weight wasn’t causing any health problems, should she consider having the surgery if she thought it would make her look more attractive?

Topic 3  Why is there a very strict diet that patients must follow after bariatric surgery, and why is it sometimes difficult to follow this regime?

Topic 4  What are some of the dangers associated with any type of surgery?

DIS 9

Read the Critical Thinking story on page 297 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Discuss the long-term repercussions of being a living organ donor?

Topic 2  Imagine that you are Josie’s mom or dad and one of your children has the opportunity to save the life of another one of your children. Would you encourage him or her to donate an organ?

Topic 3  If Josie decides to donate her kidney and then later chooses to continue playing hockey, what advice should her parents give her?

Topic 4  What options might be open to Josie’s brother other than having his sister donate a kidney?

DIS 10

Read the Critical Thinking story on page 335 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Which symptoms of Calle’s condition might affect her job? She has been working with the youngest children. Should she consider resigning, or could she ask for a different assignment?

Topic 2  Calle and Gabe decide to go ahead with the wedding. If they have children, is there a risk that Calle will transmit this condition? If Calle cannot have children, what other options would enable them to have the family they both want?

Topic 3  After their marriage, Calle will be covered by her husband’s health insurance. Calle is ethical in completing her application for this coverage and mentions the MS diagnosis. But she has questions. Where could Calle get information as to whether or not the insurance company will ever cover her for this disease? Will her coverage begin immediately?

Topic 4  Calle is an excellent teacher and the children love her. In the past, her coworkers have commented, “I wish I could learn to be as good at this as you are.” Even with multiple sclerosis, could Calle have a future in training other teachers? What other positive steps might she contemplate taking?

 

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Your written assignment for this module should be a 1-2 page paper (not including title page and reference page) that describes the following:

• You are caring for a patient with c-diff as part of your workload assignment. Discuss what c-diff is and how it is transmitted (how you can get it)?
• What actions will you take as a nurse to protect yourself and the other patients on the unit when taking care of your patient?

You should include a minimum of 3 scholarly references. Include a title page, in-text citations, and a reference page in APA format.

 

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Case Study, Chapter 8, Overview of Genetics and Genomics in Nursing

1. A patient who is 38 years of age is diagnosed with autosomal dominant polycystic kidney disease, a hereditary disease that results in fluid-filled cysts occupying space in the kidneys. The cysts can interfere with the function of the kidney and may burst and cause bleeding inside the kidney. The patient with polycystic kidney disease may or may not have a berry aneurysm of a blood vessel in the brain that could lead to bleeding and death, cysts on the ovaries, and a mitral valve prolapse (in females) that can lead to dysrhythmias (irregular heart rhythms), or diverticula (outpouching of the bowel) that are susceptible to infection and inflammation and may lead to gastrointestinal bleeding. The patient is susceptible to retaining fluid in the abdomen so the abdomen is large to constipation, and to hypertension. There is no cure for the disease. The patient receives supportive care for the various symptoms or complications the patient may have. 

1. When explaining to the patient and family about polycystic kidney disease, the nurse should explain what characteristics about an autosomal dominant genetic disease?
2. How does variable expression of genetic characteristics play a role in the course of polycystic kidney disease and how can the nurse further predict the level of the disease?
3. Identify the roles of the nurse in integrating genetics in the nursing care provided for the patient.

2. Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition.

1. Describe the pattern of autosomal dominant inheritance.
2. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?
3. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

 

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Getting Started

Pharmacy calculations are very important for prescribing, especially in regards to renal function and pediatric dosing. This assignment will focus on calculating renal function and medication doses for pediatric patients. Review the information below and then follow the subsequent instructions.

Upon successful completion of the course material, you will be able to:

• Successfully calculate dosing for renal functions

Background Information

Renal function

Renal function can be calculated different ways but the most common ways are using the Cockcroft-Gault and CKD-EPI equations (see below). If adjustments to dosing are required due to decreased renal function, it is important to know which equation should be used. This can be found in a drug reference or the package insert for a particular medication. In general, if renal cutoffs are expressed as mL/min the Cockcroft-Gault equation should be used but if renal cutoffs are expressed in mL/min/1.73m2 then the CKD-EPI equation should be used. Different equations are necessary to calculate renal function in the pediatric population.

The Cockcroft-Gault equation is as follows:

• CrCl = [(140-age) (ideal body weight)]/[(72) (SCr)] x 0.85 (if female)
  • age is expressed in years
  • weight is expressed in kg [ideal body weight (IBW) should be used except for obese patients, in which case adjusted body weight is typically used]
  • SCr is serum creatinine expressed in mg/dL
  • IBW (male) = 50kg + 2.3 kg for each inch of height over 5 feet
  • IBW (female) = 45.5kg + 2.3 kg for each inch of height over 5 feet
  • Adjusted body weight = IBW + [0.4 x (actual body weight – IBW)]

The CKD-EPI equation is as follows:

• eGFR = 141 x min(SCr/κ, 1)α x max(SCr /κ, 1)-1.209 x 0.993Age x 1.018 [if female] x 1.159 [if Black]
  • eGFR (estimated glomerular filtration rate) = mL/min/1.73 m2
  • SCr is serum creatinine expressed in mg/dL
  • κ = 0.7 (females) or 0.9 (males)
  • α = -0.329 (females) or -0.411 (males)
  • min = indicates the minimum of SCr/κ or 1
  • max = indicates the maximum of SCr/κ or 1
  • age = years

Pediatric Dosing

In general, medication dosing for pediatric patients is based on weight. This makes it particularly important to be able to calculate doses appropriately. The most basic calculation is dose (ie. mg/kg) times weight (in kg).

Example

• Cefdinir (Omnicef®) for acute otitis media is 14 mg/kg/day in 1-2 divided doses
  • What would the recommended dose be for a 22 lb patient?
  • First, lbs must be converted to kg.
    • 22 lb x (1 kg/2.2 lb) = 10 kg
  • Now, the dose can be calculated.
    • 14 mg/kg x 10 kg = 140 mg
  • Based on the dosing recommendation above, this could be given 2 different ways:
    • 140 mg once daily
    • 70 mg two times daily

For liquids or suspensions, medication doses are often given as the volume to be given to the patient. One must be aware of the available concentrations for a particular medication.

Example

• Cefdinir (Omnicef®) is available in the following concentrations:
  • 125 mg/5 mL
  • 250 mg/5 mL
• Using the example above, how many mL would be needed for 140 mg daily?
  • [140 mg / 125 mg] x 5 mL = 5.6 mL
  • [140 mg / 250 mg] x 5 mL = 2.8 mL
  • Often, we have to round to the nearest 0.5 mL to make it easier to administer using an oral syringe. Rounding the first option to 5.5 mL would give the patient 137.5 mg (5.5 mL x 125 mg/ 5 mL)

Instructions

1. Print out the Calculations Quiz.
2. Complete each question by hand and show your work.
3. Scan the completed quiz and submit via the Assignment.

This assignment is worth 50 Points

Access the Assignment submission page

 

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Write a short (50-100-word) paragraph response for each question posed below. Submit this assignment as a Microsoft Word document.

1. Define CAM.
2. Describe the patient who uses CAM the most.
3. List some common misconceptions about CAM.
4. Identify methods of including the use of CAM in patient education.
5. Discuss the safe use of CAM.
6. List ways in which conventional medicine and CAM can be integrated.
7. Define ethical theories, ethical principles, and values.
8. Provide examples of ethical issues in patient education and compliance, and describe ways in which an effective professional/patient relationship and a poor health professional/patient relationship can impact these issues.
9. Explain what is meant by “ethical patient education practices”.
10. Explain the purpose of informed consent.
11. Discuss what factors determine the patient’s ability to give informed consent.
12. Compose a sample informed consent form. .
13. Discuss the process of communication to use with the patient and the family when obtaining informed consent.

 

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