COPD WK is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea. She does report difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that is new onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath. There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies. Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy.

1.What short term and long term goal is expected for WK?

2.What diagnostic test do you expect the physician to order for WK?

3.What medications do you expect the physician to order for WK?

Ashley White, an 18-year-old college freshman, visits the campus health clinic today for complaint of a headache that she has had for 4 days. Ashley lives in the dorm and is majoring in English. She has recently been dating a junior named Tyler who she met through her roommate. Ashley is an only child and is a little homesick. Beth Mitchell is the RN who is assisting Ashley today in the clinic. Beth is 32 years old and has been working at the campus health clinic for 3 years. During the visit, Ashley tells her that she is concerned that she might have a sexually transmitted infection (STI) because she has started being intimate with Tyler.

• How would you approach this situation?
• When you are completing your nursing assessment, what types of questions would be relevant and important to obtain for the doctor in this scenario?
• What type of model provides an approach that nurses can use to assess sexuality in patients?
• Once ordered, what labs could be obtained to determine infection?

What are two common learning, physical, psychiatric, or neurological disabilities. How can teachers adapt instruction to support a student who has these disabilities?

Q1. Make a list comparing characteristics of skelet vs cardiac muscle; what characteristics are found in BOTH

Q2. A short (2 page at MOST) – presentation on aortic stenosis - - text and pictures & flowcharts allowed; should include:      

Prevalence in population ; Anatomy; Pathophysiology; Treatment possibilities and Outcomes.

Q3. The definition of a HR is the number of times the heart beats in 1 minute. The true HR for this patient was taken for one whole minute and was found to be ~ 70bpm, which of the 3 methods would offer then the most accurate HR measurement on this strip. Explain your answer.

what are some specific ways early childhood teachers plan lessons and units and assess student learning?

Locate one Clinical Best Practice Guideline or recent research article (within the past five years) related to sexuality, medications, or a psychosocial aspect of aging that aligns with your practice area or an area of interest. Apply one of the BSN Core Competencies that fit the article/guideline and state your rationale for using it.

1. Why is it essential that the OT practitioner be proactive in not spreading infection?

2. What are the possible ramifications to a patient if the patient contracts a serious infection while in care?

3. What are the possible ramifications to the OT practitioner if the practitioner contracts an infection due to poor infection control?

4. What part of the OT code of ethics might a practitioner be violating if the OT practitioner is lax in infection control procedures?

DISCUSSION WEEK 2

Please write 1 paragraph for each question (total 3 paragraphs) and each paragraph shall be no less than 5 sentences and no more than 10 sentences. Points will be deducted for answers with fewer than 4 sentences or extra long posting (0.5 points per each answer). Give only the essential information. Writing long, run-on sentences will be considered as multiple sentences.

Answer ALL PARTS of each question to earn full points.

Discussion Topic:

1.   Why is responsibility retained by nurses when tasks are delegated?
2.   What are the five individual power sources? Provide an example of each. Why is positive reinforcement such a powerful motivator?
3.   How does leadership differ from power? Can a leader be effective without power?

The client’s medication list includes: 1) donepezil (Aricept) 5 mg PO daily 2) Sinemet 10/100 PO TID 3) aspirin 325 mg PO daily 4) warfarin (Coumadin) 5 mg PO qHS 5) tolterodine (Detrol) 2 mg PO BID 6) atorvastatin (Lipitor) 40 mg PO qHS 7) insulin (long-acting and sliding scale) 8) gabapentin (Neurontin) 300 mg PO TID 9) iron sulfate 325 mg PO TID 10) trazodone 50 mg PO qHS 11) levothyroxine 50 mcg PO daily 12) furosemide (Lasix) 60 mg PO BID 13) potassium chloride 20 mEq PO daily 14) metoprolol 100 mg PO BID 15) lisinopril 20 mg PO daily 16) amlodipine 10 mg PO daily 17) acetaminophen 1,000 mg PO TID 18) docusate sodium 100 mg PO BID 19) polyethylene glycol powder (Miralax) 17 g PO daily 20) tiotropium (Spiriva) 18 mcg inhaled daily 21) montelukast (Singulair) 10 mg PO daily 22) fluticasone/salmeterol (Advair) 100/50 inhaled BID 23) Albuterol/Atrovent nebulizers PRN for wheezing 24) multivitamin one PO daily 25) vitamin E 400 IU PO daily 26) calcium carbonate 500 mg PO TID 27) vitamin D 800 units PO daily 28) kava root 100 mg PO QID 29) nitrofurantoin (Macrobid) 100 mg PO qHS

1)Explain which of these medications you would have concerns in administering to an elderly client and why. 2) Discuss what alternatives you might recommend to either the client or provider. 3) Describe the teaching you would provide and/or information you would need to ensure that the client understands related to the medication regimen prior to discharge.

Congestive Heart Failure

Activity One:

1)            Define preload, afterload, contractility, Frank Starling mechanism.

2)            Identify three factors that can change preload. Identify three factors that can change afterload.

3)            Describe what happens as filling volume increases, and how that affects pressure.

Activity Two:

1)            Describe reduced vs. preserved ejection fraction heart failure. Which gender is more likely to experience symptoms of CHF with exercise? Which gender is more likely to experience isolated systolic blood pressure increase? Support your answers with citation to either the course material or from online search for evidence-based practice.

2)            Compare left and right sided heart failure. What are the effects of each type of heart failure? Which type is a patient likely to experience first? Why? Which type can result in pitting edema? Which type can result in pulmonary edema?

Activity Three:

Consider this patient below. Identify the patients’ characteristics that put the patient at risk for congestive heart failure.

Sarah Freidan: 48 year old office worker, 5 feet 4 inches tall, weighs 190 lbs. Waist circumference 36 inches. Nonsmoker. No ETOH. Fasting blood glucose 155 mgt/dL. Triglycerides 200mg/dL. HDL-C 46 mg/dL. Blood pressure 148/80. Currently takes no medications.

Activity Four:

Identify pharmacologic agents for diuresis to reduce preload. Identify positive inotropes.   Identify phosphodiesterase inhibitors. Describe the mechanism of action of ACE inhibitors. Describe the mechanism of action of Human B-type natriuretic peptide. Describe the mechanism of action of Angiotensin II-receptor blockers.   Which of these agents is the most commonly used for left sided heart failure? Right sided heart failure?   You may use narrative writing or a table to answer these questions.  

Discuss the acute stress response. What nursing interventions can the nurse implement in the care plan to reduce stress and promote a healing environment? How can the nurse involve the family in the care of the critically ill patient?

Discussion Topic: Minimum 250 words

Griffin is proud of his accomplishments as a college football player.

“I’ve worked for a long time to make it this far. I did all the hard work. In addition to training hard with my team when I was in high school, spending my summers at football camp, and working out in general in the weight room, I also kept my grades up and look what it got me—a college scholarship! Next step? The NFL!”

However, college football is also taking its toll.

“I’m up at 7 every morning, bacon and eggs and biscuits and gravy and a big glass of orange juice for breakfast, followed by morning classes. Then I lift weights and practice all afternoon, eat two foot-long subs, one for my first lunch, and one for my second lunch, ending with a study hall just for the team.”

When asked if he varies his menu, Griffin tilts his head and wrinkles his nose, looking up at the ceiling. “Well, breakfast varies, depending on whether they’ve got waffles or not. I like a stack of waffles; but lunch is generally the same. Sometimes I add chips or a big cookie. Dinner’s always different. Last night I had spaghetti.”

Griffin faced some challenges last season, including a knee injury.

“But that’s all done with now. My knee is fine. The coach lectured me about something called ‘stress fractures,’” he says, “but nothing has happened. He didn’t have to worry about me.”

The nutritionist’s nurse asks the big question: What brings Griffin here today?

“Playing college football has been a big shock,” Griffin says. “I push myself harder than I have ever done in my life. My body’s just under a lot of stress. I mean, in high school, you’re player number one. You get drafted to a good college team, though, and boy, you find you’re struggling not to be on the bottom. Here, everyone was the best player in his high school. So pressure and competition and training are extra tough.”

“Eating is different too. At home, my mom let me eat what I wanted when I wanted, as long as I took my turn doing the dishes,” he laughs. “But here, some of our senior teammates have been teaching us how to load carbs. Recently some weird stuff has been happening to me, so my coach said I should talk to a dietitian.”

1. “We eat a lot,” Griffin says, “so we can bulk up; but recently, I’ve been kind of worried that I was going to get fat. My mom saw how much more I was eating and said, ‘Honey, be careful. You don’t want to get fat. What happens if you ever stop working out?’ That made sense to me. So I kept up the high carb intake but reduced my daily intake to 1600 kcal to avoid looking fat. I want to look bulked up, yeah, but not fat, for NFL recruiters. Coach got on me last time I did that, so this time I just didn’t tell him. I do all right. It’s not like I’m starving myself. This week, though, I got weak and kind of, I don’t know, I didn’t have any energy. How many calories is enough, and what’s too much?” How would you answer Griffin?
   2. Griffin mentions that some senior teammates are teaching the newer players how to “load carbs.” What advice might you give Griffin about this practice? How many carbs are good for players such as Griffin?