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?

In your own words, describe the primary difference between consequentialist and non-consequentialist approaches to ethics. Choose one of the major theories associated with consequentialism: what objections might be made to this theory? Choose one of the major theories associated with non-consequentialism: what objections might be made to this theory?

In this course wrap-up discussion, please reflect on your experience in the course and address the following items:

• Identify one of your major takeaways from this course.
• What aspect of the course helped you achieve this?
• How will you apply this knowledge to your practice and career?

provide an example of considerations the disability support provider must have when working with a client relating to client's culture

• Identify harmful stereotypes used to marginalize groups of people.
• Examine the impact of inequality among groups of people.
• Analyze historical and contemporary cultural texts related to "othering."

identify the change politics surrounding support service or services relating to disability that would have impacted the clients. describe the change can be identified and why it impacted the vlient

The client is an elderly man admitted for a COPD exacerbation. He appears cachectic and is having difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. His vital signs are: T 102 F, P 124, RR 36, BP 162/84, SpO2 88% on room air.

• Identify the primary nursing goal at this time and discuss 3 priorities for nursing care and explain the rationale for each.
• Develop a teaching plan for the use of a metered dose inhaler (MDI) and a small volume nebulizer.
• Identify 2 methods to administer oxygen to the client, including the nursing considerations for each. Which method of delivery is appropriate for a COPD client and why?
• Compare and contrast the manifestations and treatment for an asthma exacerbation versus a COPD exacerbation.
• The client is ordered Azithromycin 500 mg IVPB to be given over 45 mins. Pharmacy supplies Azithromycin 500 mg in 250 mL of D5W. The IV tubing has a drop factor of 15 gtt/mL. At what rate will the nurse set the pump?  

The client has been brought to the Emergency Room with a pleural effusion, complaining of shortness of breath, a dry irritating cough and chest wall pain 6/10. His vital signs are T 102.1 F, P 118, RR 32 and shallow, BP 142/82, SaO2 90% on RA. The provider has ordered a chest tube to be placed due to fluid collection in the pleural space.

• Compare and contrast spontaneous, iatrogenic and tension pneumothoraxes, including their etiologies, manifestations, and treatments.
• Describe 2 nursing interventions that could be provided to help maintain the chest tube and chest drainage system and provide rationale for each.
• The client calls out with shortness of breath. The chest tube has become disconnected from the drainage system and is now contaminated. Write a nurse’s note to describe the situation and what actions were taken to correct it.
• The provider orders Zosyn 3.375 gm to be infused every 6 hours. The pharmacy sends the ordered dose up in a 250 mL bag of NS. The provider orders the dose to be infused over 3 hours. What is the rate to be set on the IV pump? How many grams of Zosyn will the clientreceive each day?