A 7-year-old female weighing 26 kg presents to the emergency department with an asthma exacerbation. Her mother reports she has had an upper respiratory tract infection for the last 2 days and has been using her albuterol inhaler more frequently. Today she has received treatments every 2 to 3 hours but still complains of shortness of breath and has frequent coughing. She reports taking her controller medication, Flovent 44 mcg 2 puffs bid as prescribed. Her mother states that the patient uses her controller medication every day. Your assessment reveals the following: an alert yet anxious 7-year-old, sitting on the edge of the bed leaning forward. She has moderate inter- costal retractions. You ask her to tell you her name and favorite activity at school, but she must stop and take a breath after four words. At this time, vitals are as follows: heart rate of 140 beats per minute, respiratory rate of 42 breaths per minute, SpO2 at 93% on room air, blood pressure of 90/60 mm Hg, temperature of 37.5°C. Upon auscultation, breath sounds are diminished with very faint expiratory wheezes throughout all lung fields.

1. You are called to the room.

   Your reassessment after an hour reveals the following: heart rate of 156 beats per minute, respiratory rate of 36 breaths per minute, SpO2 at 95% on room air. Mild intercostal retractions persist. Breath sounds reveal increased expiratory wheezes throughout all lung fields. The patient status has improved after an additional hour of observation (heart rate of 140 beats per minute, respiratory rate of 28 breaths per minute, SpO2 at 98%, blood pressure of 88/60 mm Hg). Intercostal retractions are no longer present. Breath sounds show improved air entry throughout all lung fields, and few expiratory wheezes persist. The patient is discharged home with follow up with her primary care physician in 2 days.

2. Are there other recommendations that you might make for this patient at this time?

educating a parent on the importance of vision screening

1) explanation on why it is important for vision screening for infant (you are making this for a parent to understand, not another healthcare provider)

2) minimum os 3 behaviors or observations a parent may see that may indicate a vision problem.

3) who will the child see for this exam? Explaining how first discuss with pediatrician, referral to ophthalmologist, and lastly explain what an ophthalmologist is.

4) Explain what follow up care they may need

5) if they are school age, explain the importance of informing the child's teacher or school

1. What is the difference between Child abuse or neglect and describe the symptoms.

2. If you found or suspect a youth is being abused or neglected, would you let the parent know you are reporting the incident? Why or Why Not?

In your own words, explain the pathophysiology of COPD and how it affects Jim. This is a good definition but we need pathophysiology of  whats happening to the alveoli ? why does it make breathing difficult?

i need reference with this question aswell

A patient with pneumonia is admitted to the intensive care unit with a diagnosis of septic shock. She is confused. Her extremities are cool to touch. A central line catheter is inserted. The patient’s blood pressure is 76/40 with a heart rate of 100 beats/min.

1. What pharmacological treatment will the nurse expect to administer first? What assessment findings would indicate that the treatment is effective?

2. The patient's blood pressure has increased to 78/50. What medication does the nurse anticipate to be ordered now? What assessment findings would indicate that the treatment is effective?

3. Three hours later, the patient's blood pressure is 76/50 with a heart rate of 88 beats/min. The patient has now had the diagnosis of myocardial infarction confirmed. The nurse receives an order to start a dopamine infusion at 12 mcg/kg/min. Why was this medication added? What are the adverse effects of this medication?

4. *******PLEASE INCLUDE SOURCES************

Form a Coalition for national insurance coverage

Your organization just opened a new service line: outpatient spinal fusions. The first cervical spinal fusions were done last week, and your coders have coded 10 of them. Unfortunately, several weeks and another 25 procedures later, you get a memo from the business office stating that there are denials on Medicare fusions (17 to date). The billing manager states that it is something about a status indicator “C”. She would like you to review the CPT code assignments and help determine what the problem is and how it can be resolved because the charges for these procedures exceed $35,000 per case.

After reviewing the cases, the CPT codes are assigned are correct.

2251-arthodesis cervical

*22845-anterior instrumentation

22851-use of biomechanical device (cage)

*20936-autograft of bone from same site

*denotes a status indicator of C for that CPT code

3. Brainstorm at least three possible solutions to the problem.

Research the CMS website/internet for the proposed changes.

Review the proposed changes. Do you agree(yes or no) that the proposed change is good for the facility? Why?

Site your reference resource.

Discuss the measures for creating an environment that will provide physiological and psychological comfort during the female and the male genitalia examination.

I. Read Chapters 29 to 30

II. Pain Assessment and management in children.

a) Write a description and interpretation of the several pain assessment scales

FLACC

CHEOPS

TPPPS, PPPRS, PPPM

COMFORT

FACES ( FPS-R and Wong-Baker)

OUCHER

Numerical rating scale (NRS)

Visual analog scale(VAS)

NCCPC-PV

NIPS

CRIES

PIPP

NPASS

I. Read Chapters 29 to 30 for Quiz # 7 ( Next Week) II. Pain Assessment and management in children. a) Write a description and interpretation of the several pain assessment scales FLACC CHEOPS TPPPS, PPPRS, PPPM COMFORT FACES ( FPS-R and Wong-Baker) OUCHER Numerical rating scale (NRS) Visual analog scale(VAS) NCCPC-PV NIPS CRIES PIPP NPASS

Place the following patients in order for which you would see first as they come in through the emergency department. Explain why you would see them in this order. A. A patient with myasthenia gravis experiencing eye droop B. A 65 year old man with a blood pressure of 140/80 C. A 30 year old type II diabetic with a BS of 250

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to "Communicable Disease Chain," "Chain of Infection," and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

1. Chickenpox
2. Tuberculosis
3. Influenza
4. Mononucleosis
5. Hepatitis B
6. HIV
7. Ebola
8. Measles
9. Polio
10. Influenza

Epidemiology Paper Requirements

1. Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
2. Describe the social determinants of health and explain how those factors contribute to the development of this disease.
3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
4. Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
   note the communicable disease I am looking for is tuberculosis. Please cover all aspects of questions from 1-6

1. You are a nurse working in a labor and delivery unit in a small town near a Native American reservation. Charity, your patient, is about to give birth to her sixth child. Her family does not have health insurance. Normally she would give birth at home; however, her blood pressure is high. Her family is doing a dance to scare away the evil spirits that brought about this medical condition. She is in a lot of pain but refuses an epidural. She believes that pain is something that should be tolerated. There are also about 20 family members present to watch the birth, including all of her children. After the baby is born, she hand-expresses colostrum from her breasts and disposes of it. Additional family members arrive with all sorts of food to celebrate the birth of the baby. (Learning Objectives 5 and 6)

A. What are the cultural traits with Charity and her baby that are specific to her Native American culture?

B. How would you provide culturally sensitive nursing care to Charity and her baby?