The American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists recently released a new guidance document surrounding the use of CPR during the COVID-19 pandemic. The guidelines state, “it is reasonable to consider age, comorbidities, and severity of illness in determining the appropriateness of resuscitation and balance the likelihood of success against the risk to rescuers and patients from whom resources are being diverted.” The full guidelines are available at https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047463

Answer the following:

If you were applying the consequential approach – how would you feel about these guidelines?

Would you be for them or against them? If you were applying the deontology approach – how would you feel about these guidelines? Would you be for them or against them?

Identify which approach – consequential, deontology or virtue-based ethics most closely applies to these guidelines. Justify in a sentence or two why you have chosen your answer.

Melanie, the director of a day-care facility, read an article in the morning paper about an E. coli outbreak at another day-care center across town. She was especially concerned to read that the outbreak was caused by one of the volunteer parents who had changed a soiled diaper and then helped make the afternoon snack for the children. Melanie and her staff are fully committed to the safety of the children in their care. She is determined to ensure that good personal hygiene is practiced not only by all the adult teachers and caretakers, but also by the children. In just two weeks she will be starting a new program for the children called "Kid's Kitchen." Children ages four and up will be able to help prepare the daily snack. She felt this was the ideal place to start her personal hygiene program. Melanie decided to observe the staff and the children in preparation for the new program. She noted that one staffer, after changing a soiled baby diaper, wiped the changing table with a paper towel. She then washed her hands. This staffer was also scheduled to help the children prepare the afternoon snack. In the restroom, Melanie observed that the children, often in a hurry to get back to playing, forgot to wash their hands after using the toilet unless reminded to do so. She also noticed that a few of the younger children had difficulty reaching the soap, although they could reach the sink. This situation was not helped by the fact that the soap in one of the soap dispensers was low, while the other dispenser was empty. Realizing that both staff and children come in contact with each other throughout the day, she implemented two different personal hygiene programs: one for teachers and caretakers and one for children. What things would you change or fix in this operation? What would you include when designing the personal hygiene programs? How would you introduce this to the staff and to the children?

A nurse is preparing to lead an older adult group. What should the nurse need to keep in mind when leading this group?

A. Focus the group in order to promote learning of new information

B. Keep the pace of the group meetings slow

C. Discourage the use of life-review strategies

D. Teach entirely new methods for coping

what should you do is a patient who uses a walker tells you there are steps in his house?

You are working in A&E where you are allocated to assess and care for . Mr Smith is a 35-year-old man who became unwell with community acquired pneumonia (CAP). Smith went to his local GP a week ago with a fever, difficulty breathing and a productive cough. At that time, the GP diagnosed Smith as having pneumonia and prescribed a course of oral antibiotics. When the GP assessed John today, he appeared lethargic and drowsy, and stated that he is nauseous and feels “achy all over”. The GP called an ambulance to take Mr Smith to hospital because the antibiotics had not worked, and he was now in acute respiratory distress.

John has a past history of rheumatoid arthritis and is on 25mg oral prednisolone to manage this chronic inflammatory disease.

Your assessment of Mr Smith reveals the following information.

General appearance: pale, diaphoretic, lying against the raised back of the bed (high Fowler’s).

Vital signs: temperature 38.6°C, RR 26 bpm, HR 115bpm, BP 94/65 mmHg, SpO2 92% on RA,

Neurological: lethargic and drowsy, GCS 14. (eye opening to speech, oriented to time, place & person, obeys commands).

Respiratory: Obvious use of accessory muscles. Difficulty speaking to answer questions. Bronchial breath sounds in both bases & course crackles to mid-zones bilaterally. Productive cough (thick, green sputum).

Laboratory and other investigations: CXR shows consolidation in bilateral lower lobes. Blood culture results sent by his GP are positive for pneumococcal. His serum lactate results have come back as 3.4 mmol/L (normal < 1mmol/L), and his WBC is 16.0 x 109/L (normal 4.5-11 x 109/L). C-reactive protein (CRP) 57mg/l

Medical orders: John is diagnosed with sepsis and acute respiratory failure. He is ordered an IV fluid resuscitation bolus, broad spectrum IV antibiotics, 2L O2 via NP to maintain SpO2 > 95%, close monitoring of vital observations and urine output.

Question:

Describe how each of these aspects of the information presented above has led to the diagnosis of sepsis and acute respiratory failure.

Presentation history (2):

Nursing Assessment (3):

• Physical appearance:

• Vital signs:

• Diagnostic tests (2): Blood tests:

Question 2

After reading the case study, you are required to identify three (3) priority nursing problems and provide your rationale for making each of these a priority.

Question 3

After identifying three (3) priority nursing problems in the previous question, you are required to formulate a goal to address each priority nursing problem.

Question 4

After formulating the goal for each priority nursing problem in Question 3, you are required to describe three (3) nursing interventions with rationale that you will implement to achieve each goal.   

Consider the criteria of causality described by Hill. How would you use these criteria to determine whether the experience of racism causes higher rates of chronic illnesses?

6. You can expect most children in the 5-year-old class to exhibit very similar abilities in their language and physical development (T/F)

8. Objectives and procedures should be aligned with one another (T/F)

14. In a brainstorming group time, the children identify what they know, what they want to know, and how they would like to find out (T/F)

15. Activities within the body of the group time should vary from one day to the next (T/F)

18. One way to assist children in developing self-discipline is to encourage them to make some of the rules themselves (T/F)

care for this patient. Two (2) actual problems and One (1) potential
problem.
DUE: 16 th OCTOBER 2020

Orthopedic Nursing
Patient Scenario
Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining
of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive
motion was painful, and active movement was impossible secondary to pain. The patient has
several chronic medical problems including as DM, Hypertension and Ischemic Heart
Disease. Treatment in the Accident and Emergency Department was centered around her
diagnosis of a fractured right femur. She lives in a nursing home, although she was
independently ambulant. She has now been admitted to your Orthopedic Unit for further
management.
Chief Concern:
 Severe, sharp pain on movement 9/10
 Inability to bear weight, sit-up or ambulate
PHH (Past Health History):

 appendectomy age 15, fractured clavicle age 19.
 laminectomy (L4‐5) 17 years ago due to a work related injury.
Medications History:
 acetaminophen 500 mg PO q6h
 Insulin 70/30 12units SC, AM and PM
 Enalapril 10mg PO BD
 Atenolol 25mg PO OD
 Aspirin 81mg PO OD
 Calcium 600mg PO OD
Physical Exam:
 BP 160/94 P 103 regular R 24 T 37.2
 Conscious and alert but appears anxious, GCS 13/15
 Height 188 cm, weight 118 kg
 IVF in progress, 0.9% Nacl to left anti-cubital fossa
 Skeletal Traction to right leg with 15 pounds weights in place
 Urinary catheter in situ, on free drainage
 TED stocking

in place to left lower limb
Labs:

XRay:

X-ray shows a transverse fracture
of the femur. The break is a
straight horizontal line across the
shaft.

Social History:
 Trinidadian born, graduated form 5 high school
 worked on an assembly line in manufacturing company; is physically demanding
 smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
 recently lost a long‐time friend at the nursing home to cancer
 spouse died 8 years ago (MI)
 no children, 1 sister alive she lives abroad
Family History
 Mother died of heart disease
 Father died of prostate cancer
Assignment
1. What are the patient priorities?
2. Identify and involve an inter-professional team that will be required to provide
holistic care for Mrs. Jane.
3. Briefly explain how a femur fracture is diagnosed.

1,Provide an explanation as to how severe dehydration can cause Acute Kidney Injury (AKI)

2, Describe four (4) nursing interventions in the direct post-angiogram period for a patient who had an angiogram via the right radial artery.  

3,Outline the three (3) actions of insulin on the metabolism of glucose.

Orthopedic Nursing
Patient Scenario
Mary Jane is an 81-year-old woman was admitted to hospital after a simple fall, complaining
of hip pain and inability to walk. The affected right leg appeared internally rotated. Passive
motion was painful, and active movement was impossible secondary to pain. The patient has
several chronic medical problems including as DM, Hypertension and Ischemic Heart
Disease. Treatment in the Accident and Emergency Department was centered around her
diagnosis of a fractured right femur. She lives in a nursing home, although she was
independently ambulant. She has now been admitted to your Orthopedic Unit for further
management.
Chief Concern:
 Severe, sharp pain on movement 9/10
 Inability to bear weight, sit-up or ambulate
PHH (Past Health History):

 appendectomy age 15, fractured clavicle age 19.
 laminectomy (L4‐5) 17 years ago due to a work related injury.
Medications History:
 acetaminophen 500 mg PO q6h
 Insulin 70/30 12units SC, AM and PM
 Enalapril 10mg PO BD
 Atenolol 25mg PO OD
 Aspirin 81mg PO OD
 Calcium 600mg PO OD
Physical Exam:
 BP 160/94 P 103 regular R 24 T 37.2
 Conscious and alert but appears anxious, GCS 13/15
 Height 188 cm, weight 118 kg
 IVF in progress, 0.9% Nacl to left anti-cubital fossa
 Skeletal Traction to right leg with 15 pounds weights in place
 Urinary catheter in situ, on free drainage
 TED stocking in place to left lower limb
Labs:

XRay:

X-ray shows a transverse fracture
of the femur. The break is a
straight horizontal line across the
shaft.

Social History:
 Trinidadian born, graduated form 5 high school
 worked on an assembly line in manufacturing company; is physically demanding
 smokes 1pk/day x 18 years, occasional marijuana use; drinks beer ~ 2/week.
 recently lost a long‐time friend at the nursing home to cancer
 spouse died 8 years ago (MI)
 no children, 1 sister alive she lives abroad
Family History
 Mother died of heart disease
 Father died of prostate cancer
Assignment instruction;
1. Briefly describe three (3) classes of medications used in the treatment of patients with femur fracture:  Pain relief  Antibiotic  Anti-inflammatory

2. What is the nursing considerations/management for this patient?

3. Develop a plan of care for Mrs. Jane, (utilize 2 actual and 1 potential nursing diagnosis, short and long term goals, nursing intervention, evaluation).

Choose one of the following categories of violence described in your text and describe it; include key risk factors and prevention strategies in your answer: ● assault and homicide ● gang-related violence ● hate crimes ● school violence ● workplace violence

23. Close contact with families leads to family identification with the program and appreciation of teacher efforts (T/F)

24. Young children who enter school with high self-esteem are unlikely to lose it when overly challenges with academic tasks or racial bias (T/F)

25. Children in the primary grades automatically are more difficult because of their increasing wish for independence (T/F)

27. Since academic learning is so important in the primary grades, teachers should strictly limit time spent in primary physical activity (T/F)

30. Collaborative teaching means one teacher plans the lesson and gathers the materials and the other teacher teaches the lesson (T/F)

31.Themes should be addressed once per year (T/F)

35.Themes should last about one week each (T/F)

39. Teachers should give reasons for why some behaviors are acceptable and others are not every time they talk to children about behaviors (T/F)

Select the type of prevention the following activity/action best represents. Washing your hands often:

Select the type of prevention the following activity/action best represents. Thyroid screening test in a 50 year old woman at her annual exam.

Select the type of prevention the following activity/action best represents. Insulin injections used daily in a person diagnosed with diabetes: