Inflammatory Bowel Disease 

Case Study The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine Diagnostic Analysis The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? 

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A seven (7) page APA style paper on Quality and Safety in Nursing.

Must have a minimum three (3) peer review articles Published within the last 10 years, referenced in the paper.

Must be typed and double spaced.

The main body of the paper must be a minimum 4 pages in length.

The peer review articles that are using must be attached to the paper as an appendix. And provide a reference page.

Please upload the link for the article so that I can print it out. Please do not use wikipedia! 

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Assignment: APA paper. This assignment should be between 750 and 1250 words in length and contain all four scholarly sources provided plus the textbook and one more scholarly source of your choice. Read the following 4 articles:

(from the ProQuest Library)

• Security InfoWatch. (2013). Responding to active shooters in hospitals. SecurityInfoWatch.Com. Retrieved from http://search.proquest.com/docview/1434488744?accountid=34574. Click Here for Article
• Balingit, M. (2012, March 9). Hospital shootings shock Oakland 2 dead, 7 injured at Western Psych; Police kill gunman in exchange of fire. Pittsburgh Post – Gazette. Retrieved from http://search.proquest.com/docview/926869011?accountid=34574
• Hospital Employee Health. (2013). Most hospital shootings are not preventable. Retrieved from http://search.proquest.com/docview/1282083457?accountid=34574

(from the World wide web)

• The Joint Commission. (2014, July). Preparing for active shooter situations. Quick Safety. Retrieved fromhttps://www.jointcommission.org/issues/article.aspx?Article=h1wY0qOAjXjKMD9Np15aXCoh6JDFt4iaFxb%2f%2fTKfNWE%3d

Part 1: Active Shooters

First: Compare and discuss the information in the 4 articles above (any similarities, differences, surprises).  

Next: Answer these questions on your personal experience: 

• Has your workplace prepared for an active shooter? What is the protocol? What preparations has your hospital taken?
• What is your responsibility as a nurse caring for patients?

Part 2. Bullying

Bullying in the nursing workforce has become an increasing topic of concern. Research this topic.

• Describe reasons why bullying is a problem in nursing.
• Provide suggestions for a new nurse who is being bullied by coworkers.
• What is your responsibility if you see a fellow nurse being bullied?

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ONLY PICK ONE OPTION

Reach Out Activity (10%) Option 1

Objective: The student will explore the role of nursing from a global perspective.

Assignment: This activity is meant to be informative and fun! Contact a nurse practicing in a country outside the United States. You may use any resources available to you: International Universities, International Nursing Organizations, Facebook, Twitter, LinkedIn, etc. Be creative!

This is a formal 2-3 page write-up and discussion that requires correct grammar, punctuation, and APA format.

Ask the following:

1. What is his/her scope of practice? How does this compare to yours?2. What does he/she identify as primary health concerns for their patients and country?3. Does he/she belong to any professional organizations that promote health in a global environment?4. If possible, obtain salary, specialty, and any other interesting information!• Feel free to add more questions

​Reach Out Activity (10%) Option 2

Objective: The student will be able to discuss issues that affect Nursing in a global environment

Assignment: Interview a first generation immigrant to determine cultural barriers to healthcare. (A foreign born citizen or resident who has immigrated to a new country of residence may be called a “first–generation” migrant)

This is a formal 2-3 page write-up and discussion that requires correct grammar, punctuation, and APA format.

1. Can you describe from your experience anything that was unexpected, unusual, or inappropriate in your medical care or treatment?2. What preceded and contributed to the event?3. What did you do or not do? How did you feel?4. What was the outcome or result?5. In what way did your ethnic or cultural background play a role? 6. How might the described event be avoided in the future?

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 Lyme Disease Case Study A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), 36% (normal: 42%-52%) Rheumatoid factor (RF), Negative (normal: negative) Antinuclear antibodies (ANA), Negative (normal: negative) Diagnostic Analysis Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. Critical Thinking Questions 1. What is the cardinal sign of Lyme disease? (always on the boards) 2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 3. Why was the ESR elevated? 4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatmen 

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