Assigment 19023335

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In a short essay (500-750 words), answer the Question at the end of Case Study 2. Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite.

This is the case study:

Max Points: 20.0

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5 kg
  2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
  5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

 
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Assigmnent 5

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  •  abd_assess.pdf (310.787 KB)

Abdominal Assessment Article

1. What six (6) factors independently predicted GI complications?

2. What were the nine (9) variables that independently predicted major GI complications?

3. Name three (3) ways in which mechanical ventilation affects splanchnic perfusion?

4. Name at least twelve (12) reasons given for hypomotility of the gut?

5. Etiologies of diarrhea include these six (6) items.

6. What is the pathophysiology of diarrhea that starts between the 5th and 10th day of treatment?

7. What are the three (3) broad categories of abdominal pain? Give an example of each…

8. What are the three (3) clinical signs that are indicative of active bleeding?

 
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Assigmnent 4

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After reading the article presented in the lesson, try to answer the following questions regarding the article:

1. What does the term “self-efficacy” mean and how is it beneficial for the management of pain?

2. What role does postoperative anxiety level have in the control, or, lack of control in                        

          postoperative control of pain?

3. Are there any cultural considerations in taking care of oriental clients, and, their response to

          pain that is suggested in the article due to the country of origin of the article?

4. Since you have read this article, are there any changes you might consider in utilizing

         alternatives in treating pain for orthopedic clients, either pre- or post-surgically?

 
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Assigmnent 18929299

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Several years ago, researchers discovered a part of the nuclear chromosome called a telomere.  The telomere is found at the end of chromosomes and they fall off at regular intervals of a year or two. Since they are just a segment of chromosomes of 4-6 base pairs it appears to be insignificant except for their reliability over time of the organism or person’s life.  Researchers were fascinated by these small segments and the apparent correlation with the aging of the person.  In addition, these segments accelerated their action of dropping off when the person was diagnosed with cancer or a disease that was categorized as eventually fatal.  Review the Telomeres video below.

Watch VideoTelomeres and Aging | IsagenixDuration: 3:13
User: n/a – Added: 10/22/13YouTube URL: http://www.youtube.com/watch?v=de0aSMxeYmg

Instructions:

  1. Reread Chapter 3 and answer the following questions.
    1. Would you classify telomere-based aging as stochastic or non-stochastic?
    2. What theory would you classify this under considering those listed in the chapter?
    3. How would you, if you were a gerontological researcher, manipulate the telomeres through telomerase to assist persons to live longer? Be specific about each step. 
  2. Your paper should be:
    • One (1) page or more.
    • Use factual information from the textbook and/or appropriate articles and websites.
    • Cite your sources – type references according to the APA Style Guide.

 
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Assigmnent 18929283

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structions:

  1. Review the five (5) Greeting Cards PowerPoint and answer the following questions.
    1. Do you think that those greeting cards showed how ageism is at work in our society? Why or why not?
    2. Select one of the cards and discuss how it demonstrates ageism.
    3. Are there other examples of advertising, either television or radio that is also an example of ageism that you have heard or viewed?
    4. How do you think that ageism passes from one generation to the next, or is this unique to each generation?
  2. Your paper should be:
    • One (1) page or more.
    • Use factual information from the textbook and/or appropriate articles and websites.
    • Cite your sources – type references according to the APA Style Guide.

 
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Assigmnent 18925425

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nstructions:

  1. Read the Case Study 11-2: Go to the Hospital and Come Back with Four More Medications in Chapter 11 of the textbook. 
  2. Once you have read the Case Study thoroughly, answer the following questions:
    1. What does the administration of antibiotics have to do with a Clostridium difficile (C. diff infection) infection?
    2. List all the inappropriate medications prescribed for K.L. and describe the reason why they are inappropriate.
    3. What kind of treatment regimen is utilized for a patient with a C. diff infection?
    4. Do any of these treatments regimens raise suspicion as being inappropriate for K.L.?
    5. List the therapy and if contraindicated, give a reason why it is inappropriate.  
  3. Your paper should be:
    • One (1) page or more.
    • Use factual information from the textbook and/or appropriate articles and websites.
    • Cite your sources – type references according to the APA Style Guide.
  4. Upload your file by clicking “Browse My Computer” for Attach File.
  5. View rubric for grading. 
 
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Assigmnent 18925411

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  1. Elder Abuse and Neglect
    You are a charge nurse in the emergency department. An elderly woman arrives with bruises all over the upper torso of her body and down her left arm. She was brought in by her grandson who resides with her, and the grandson shares that he brought her in to be checked out because he thinks she may have fractured her wrist when she fell on the last step going down in the cellar to do laundry. He appears extremely stressed and states that his grandmother suffers from Alzheimer disease. When you put the patient’s name and demographic information into the electronic medical record it indicates that this patient was in 2 weeks prior with a concussion. 

    Instructions:

    1. Read the scenario above and answer the following question:
      1. How would you assess the situation?
      2. What nursing interventions would you utilize to help both the elderly woman and the grandson?
    2. Your paper should be:
      • One (1) page or more.
      • Use factual information from the textbook and/or appropriate articles and websites.
      • Cite your sources – type references according to the APA Style Guide.

 
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Assigmnent 18925403

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  1. Ms. B was told that she had a brain aneurysm.  She made an advance statement of wishes saying that she did not want surgery if the aneurysm burst.  However, shortly after she made this statement of wishes, the aneurysm burst and a team of surgeons took her to surgery believing that if not treated with surgery she would surely die.  The hospital (Hospital #1) backed the decision of the surgeons thinking if there was no intervention the hospital would be liable for her death. This all happened as the family were alerted to the emergency and were making travel arrangements as they were all from out-of-town.  

    Unfortunately, the outcome of the surgery was that she became ventilator-dependent paralyzed from the neck down and needing 24-hour care.  Once the family was in the hospital, they held a family conference agreeing that Ms. B would not want to continue on in this state, and they petitioned the hospital to remove her from the ventilator. The hospital refused still believing the potential for legal ramifications.  The family was distraught; but eventually, with the guidance of a lawyer they retained, they were able to have her transferred to another facility (Hospital #2) that was willing to take her off the ventilator knowing that the chances of her making it were slim.  The felt that they were honoring her wishes along with her families’ wishes.
    A day later Ms. B was taken off the ventilator and she expired within the hour.  The family felt like they had done the right thing and they retained the lawyer to sue the initial hospital stating that they had not honored the wishes of their loved ones.  In the trial, the hospital claimed that there was not enough evidence that Ms. B wished to not be placed on machines as the family claimed, even though it was witnessed by a nurse that the anesthesiologist for the care engaged her in a conversation about this very topic before her aneurysm burst.  The hospital maintained that without documentation to that claim, they could not honor her wishes. 

    In a surprising turn of events, the family filed suit in the Court of Appeals and won.  The appellate court agreed with the family stating that any conversation, whether it be personal or professional could be used to reach a conclusion about one’s desire about the nature of their own death. 

    Instructions:

    1. Read the Ms. B’s case study above. 
    2. Answer the following questions:
      1. Do you agree with the original court or the court of appeals?  Why?
      2. What kind of ethical theories was hospital #1 acting upon (beneficence, malfeasance, etc.)?
      3. What kind of ethical theories was hospital #2 acting upon (beneficence, malfeasance, etc.)?
      4. How did the family act in this ethical realm?
      5. Did you find that the result of this case was fair to Mrs. B and her family?
      6. Why is it so important that one put in writing their exact wishes to the nature of their death and how they envision it should be? 
    3. Your paper should be:
      • One (1) page or more.
      • Use factual information from the textbook and/or appropriate articles and websites.
      • Cite your sources – type references according to the APA Style Guide.
    4. Upload your file by clicking “Browse My Computer” for Attach File.
    5. View rubric for grading. 
    6. Need help with Blackboard Learn?Review the How to Submit An Assignment tutorial.
  2. By submitting this paper, you agree: (1) that you are submitting your paper to be used and stored as part of the SafeAssign™ services in accordance with the Blackboard Privacy Policy; (2) that your institution may use your paper in accordance with your institution’s policies; and (3) that your use of SafeAssign will be without recourse against Blackboard Inc. and its affiliates.

  

 
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Assign 1 Wk 7a

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1) THE ASSIGNMENT IS ATTACHED AS ——Captain of the Ship Project – 

      Obsessive- Compulsive  Disorders. (Assign 1-WK 7(A)

                                             &

(2) SEE THE ATTACHED EXAMPLE FOR  “Captain of the Ship Project” FOR 

      GUIDANCE)

 
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Assigmt 2 Practicum Assessing Client Family Progress

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Assignment 2: Practicum – Assessing Client Family Progress

Learning Objectives

Students will:

· Create progress notes

· Create privileged notes

· Justify the inclusion or exclusion of information in progress and privileged notes

· Evaluate preceptor notes

To prepare:

· Reflect on the client family you selected for the Week 3 Practicum Assignment.

The Assignment

Part 1: Progress Note

Using the client family from your Week 3 Practicum Assignment, address in a progress note (without violating HIPAA regulations) the following:

· Treatment modality used and efficacy of approach

· Progress and/or lack of progress toward the mutually agreed-upon client goals (reference the treatment plan for progress toward goals)

· Modification(s) of the treatment plan that were made based on progress/lack of progress

· Clinical impressions regarding diagnosis and or symptoms

· Relevant psychosocial information or changes from original assessment (e.g., marriage, separation/divorce, new relationships, move to a new house/apartment, change of job)

· Safety issues

· Clinical emergencies/actions taken

· Medications used by the patient, even if the nurse psychotherapist was not the one prescribing them

· Treatment compliance/lack of compliance

· Clinical consultations

· Collaboration with other professionals (e.g., phone consultations with physicians, psychiatrists, marriage/family therapists)

· The therapist’s recommendations, including whether the client agreed to the recommendations

· Referrals made/reasons for making referrals

· Termination/issues that are relevant to the termination process (e.g., client informed of loss of insurance or refusal of insurance company to pay for continued sessions)

· Issues related to consent and/or informed consent for treatment

· Information concerning child abuse and/or elder or dependent adult abuse, including documentation as to where the abuse was reported

· Information reflecting the therapist’s exercise of clinical judgment

Note: Be sure to exclude any information that should not be found in a discoverable progress note.

Part 2: Privileged Note

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client family from the Week 3 Practicum Assignment.

In your progress note, address the following:

· Include items that you would not typically include in a note as part of the clinical record.

· Explain why the items you included in the privileged note would not be included in the client family’s progress note.

· Explain whether your preceptor uses privileged notes. If so, describe the type of information he or she might include. If not, explain why.

By Day 7

 
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