Questions

1) Locate the Healthy People 2020 Framework and answer the following questions.

a) What is the vision of HP2020?

b) What are the overarching goals?

2) Locate the about page. What original accomplishment is HP2020 based on?

3) Locate the data about page. What are the three data objectives?

4) Locate the Leading Health Indicators (LHIs). There are only 12. Select one of the LHIs.

a) What LHI did you select?

b) What are the Leading Health Indicators for your LHI?

c) Select one data point from your LHI that would affect someone college aged.

5) Locate the 2020 Topics and Objectives. There should be 42. Select one of the Topics.

a) What is your topic?

b) What is the goal for your topic?

c) What is an emerging issue for your topic?

Memorandum

Write a brief Memorandum for the Food Research, Enterprise, and Sustainability Hub (FRESH) program team, responding to one of the prompts listed:

• How could/should FRESH invite stakeholders into the evaluation process? How will they identify those stakeholders?
• How could/should FRESH plan to disseminate their evaluation findings? What planning can they do now, to improve the utility of their findings?
• What could/should the FRESH team be considering in their work this year, if they want to be able to demonstrate their program's impact in year five?
• What should the FRESH team know about cultural competence? How could prioritizing cultural competence affect the program itself or its evaluation?

This memo should be written for an audience of program operations staff (not other evaluators) and is likely to include citations for sources you draw upon in your answer. Your memo doesn't need to be formal or formatted in a particular way - the key here is to speak directly to your audience

Human Trafficking Questions:

1. What does Human Trafficking entail?

2. Why is this important for the nurse to know and understand?

3. What strategies would you implement in your unit to address this situation? How should a nurse handle this situation for positive outcomes for the client?

4. Provide three (3) questions you would like to ask Homeland Security R/T Human Trafficking?

A patient presenting with which symptom of a renal calculi would likely warrant the patient needing surgical or procedural interventions to eradicate the stone , rather than the patient being able to pass the stone independently

You are a nurse caring for a hospice, bedridden, terminal cancer patient in a nursing home. Every time you move the patient, he screams in pain and has tears in his eyes. The patient's daughter has never heard her dad yell in all 60 years of her life. She has also never seen him cry. The daughter requests that the nursing staff do not turn her dad. She states, "he is going to die soon. Just leave him to die peacefully."

How do you as the nurse, form your ethical thoughts regarding this decision?

Would all nurses be comfortable not turning the patient? How would you decide?

Explain and give an example of each:

Beneficence

Nonmaleficence

Autonomy

Justice

Accountability

Identify, describe, and define the concepts, purposes, and components of a nursing model, and apply basic systems model concepts to the Roy Adaptation Model.

I. Assessment:  AB, 65-year-old African American female, who was admitted for generalized weakness and pain in her right foot.

Vital Signs: T - 38.6 oral; P- 110 apical; R- 22; BP- 165/75 LUE, manual, sitting; Sp02 – 96% on RA.

AB is awake, alert, and orientated x4. AB appears to be uncomfortable. AB denies any numbness or tingling. Her skin is appropriate for ethnicity and is warm to the touch. She is tachycardiac, rate of 110 and regular. Pedal pulses are present but unequal in bilateral lower extremities with +3 in L and +2 in R noted. She has IV access, 20 gauge, in her RAC. IV site is clean, dry, and intact. Lung sounds are diminished with expiratory wheezes noted in the bases bilaterally. Her abdomen is soft and non-tender. AB denies N/V/D. AB denies dysuria, hematuria, or frequency with voiding. AB has full and equal ROM bilaterally in all extremities; however, she complains of sharp consistent pain in R heel that increases with activity. AB rates the pain as 5/10 with rest and 8/10 with activity on a 0-10 scale. 2cm x 2cm open wound with a moderate amount of yellow purulent drainage is noted on heel of R foot. The skin surrounding the wound is erythematous and hot to the touch.

Past History: Hypertension, Type II Diabetes, Seasonal and Exercise Induced Asthma, Depression and Generalized Anxiety Disorder

Social & Economic History: AB is a widow. Her husband recently passed away from cancer. AB lives alone with her two cats in the home that she owned with her late husband in the downtown area of the city. AB is a homemaker and never worked outside of the home. She has three grown children (2 boys and 1 girl) who all live nearby; however, AB reports that “they are busy and don’t have time for me.” AB reports that she was an active member in her church until recently when her foot “started giving her trouble.” AB currently receives social security benefits for herself and from her late husband as well as her late husband’s retirement pension. AB’s health insurance in Medicare part A & B. Although AB denies trouble affording her medications; she reports difficulty accessing healthcare services due to transportation. AB never had a driver’s license.

AB is a former cigarette smoker. She admits to smoking one pack a day for 30 years. She reports that she quit smoking approximately 10 years ago. AB admits to drinking one glass of wine every night before bed. She states it helps her relax. AB denies history of drug use or abuse as well any previous drug or alcohol related treatment.

II. Meds: Daily

1) Amlodipine 10mg, qd

2) Aspirin 81mg, qd

3) Metformin 500mg, BID, with meals

4) Lantus 40 units with breakfast and at bedtime.

5) Escitalopram 20mg, qd

6) Vancomycin 1g IVPB q12 hours   

Meds: PRN-

1) Ibuprofen 200mg -3 PO as needed for mild pain

2) Morphine 1mg IVP as needed for moderate pain

3) Morphine 2mg IVP as needed for severe pain

4) Proventil HFA 2 puffs as needed

III. Lab Results:

RBC -   5.0                                  Platelets- 325                                      CL- 107

WBC- 15                                INR- 0.9                                                 Mag- 2.0

HGB-   14                                   K+ - 4.0                                                 CA- 9.0

HCT-   40                                    NA- 138                                                  

Other Pertinent Labs:

BUN - 30

Creatine- 1.28

Blood Glucose - 300

Wound Culture – positive for gram-positive bacteria, methicillin resistant Staphylococcus aureus

IV. Questions to be answered for Medication Administration: Use Unbound Medicine-Davis’s Drug Guide for Nurses

1.      Why is the client taking each daily medication? - do not list the action of the meds.

-

2.      What are the important nursing implications of each medication?

3.      Based on your assessment are there any medication(s) that the client should be taking which are not currently ordered? If so, which class of medication should be ordered and why (you do not have to give the name of a specific medication).

Are there any medications that should be held?

4.      What combination of medications ordered poses the greatest risk for the client? Explain why.

V. Questions to be answered for Lab Tests Results:

1.    Explain why the labs were performed- you may group related labs together. i.e. Hgb & Hct

Hint: Make sure to link it to the diagnosis and/or medication that the client is taking.

2.    What do the lab results indicate?

VI. List 3 areas of teaching for the client. Explain in detail what you will teach the client/ significant other concerning the diagnosis.

VII. Nursing Diagnosis:

Mrs. Baker is a 79-year old female admitted to your unit with a complaint of anorexia, fatigue, pain and swelling of the left lower extremity. She was admitted with a diagnosis of cellulitis of the right lower extremity with a wound infection on her right heel. She is on bed rest. She has a history of Diabetes, Hypertension, Afib and CAD. She is 5’5”, weighs 102 lbs.

Mrs. Baker is awake, alert, and oriented x3. Heart rate is regular at 59; lungs are decreased bilaterally in the bases; O2 sat is 90% on room air. She has positive bowel sounds, positive pedal pulses, and bilateral edema of the lower legs. She is voiding frequent small amounts of clear yellow urine in the bedpan. She has an IV of 0.9% NSS infusing at 125ml/hr in the R forearm that is intact and patent. She has a 3cm x 4cm open wound on her right heel.

Vital signs on admission were T: 39.1, HR: 84 and regular, RR: 24; BP 182/98. She c/o of pain in the right lower extremity 8/10 and was medicated with Oxycodone. Her appetite has been fair at best. The blood sugar at 0730 was 168 and she received 10 units of Novolog insulin. She ate 10% of breakfast. She was sent to Nuclear Medicine for a CAT Scan with Contrast of her right lower extremity.

Mrs. Baker tells you that she is on so much medication that she sometimes does not refill the medications because they are too expensive. She is on a fixed income and has to pay her bills and still eat.

Social History: Obtained from the Home Health Nurse- who visits Mrs. Baker weekly

Mrs. Baker is divorced. She has a 97 year old father who lives in a nursing home 400 miles away and a 59 year old estranged daughter who lives 90 miles away. Mrs. Baker also has a 23 year old granddaughter who lives in the home with her but is in and out on a consistent basis. Her granddaughter does not work and often asks Mrs. Baker for spending money. The granddaughter becomes very hostile and angry when her grandmother does not “lend her money”. Mrs. Baker has told several people that her granddaughter serves as her care giver. She owns her home in a lower middle class neighborhood but it is in very poor condition. She eats 2 meals a day, smokes 3 packs of cigarettes and drinks a pint of alcohol weekly. She rarely sees or communicates with her neighbors; occasionally will answer her telephone or doorbell. She realizes that she cannot fully maintain her home or herself independently but refuses in- home services and placement. She has a protective services case worker who has tried to arrange help, but Mrs. Baker refuses all attempts. She does not respond to her physician’s request to keep her appointments. She also refuses to discuss her finances with anyone.

Meds: Daily

Glipizide 5 mg po bid, Metformin 1000mg po bid, Novolog 10 units sq. tid with meals, Novolog sliding scale, HCTZ 12.5 mg po bid, Lisinopril 20 mg po bid, Protonix 40 mg po daily, Lovenox 40 mg SQ daily, Magnesium Oxide 400 mg po daily, Levemir 40 units SQ qhs, Potassium Chloride 20meq po daily, Digoxin 0.125 mgs po daily, Metoprolol 25 mgs.po daily, ASA 81 mgs. daily, Vascepa 2 grams po. Bid, Aricept 10 mgs. po hs, Coumadin per orders.

Meds: PRN-Oxycodone/Acetaminophen 5/325 mgs po q4h prn pain, Hydralazine 20 mg IV for SBP> 160 q6h prn

Lab Results:

RBC 4.2                                     Platelets- 106,000                                             CL- 107mEq/L-

WBC- 13.2                                 INR 2.2-                                                            Mag- 1.2 mEq-

HGB- 10g/dl                                K+ 2.9mEq/L                                                      Hgb A1C -10%

HCT- 33.4%                                NA- 140-                                                          FBS-200mg/Dl

I. Questions to be answered for Medication Administration: Use Unbound Medicine-Davis’s Drug Guide for Nurses

1.      Why is the patient taking each daily medication? - do not list the action of the meds.

Glipizide, Metformin, Novolog, Levemir-                               Lovenox-

HCTZ, Lisinopril, Metoprolol –                                                        Mag Oxide-

Potassium Chloride-

Protonix-

Digoxin

Vascepa-

2.Based on your assessment of the patient are there any medication(s) that she should be taking which are not currently ordered? If so, which class of medication should be ordered and why (you do not have to give the name of a specific medication).

Are there any medications that should be held?

3.      What combination of medications ordered for Mrs. Baker poses the greatest risk for the patient? Explain why.

4.      Which medication should be held prior to the CAT Scan? Explain why the med should be held and how long this medication should be held.

II. Questions to be answered for Lab Tests Results:

Explain why the labs were performed- you may group related labs together. i.e. Hgb & Hct

What do the lab results indicate?

NURSING DIAGNOSIS:

List 3 areas of teaching for the patient. Explain in detail what you will teach the patient/ significant other concerning her diagnosis.

Other questions to consider:

1.     Are there any ethical/moral obligations in caring for Mrs. Baker?

2.     What is your emotional response to the thought of caring for an older person who has been mistreated?

3.     Identify actions that can help relieve stress in family caregivers.

Discuss LOINC - health standard and breakdown of LOINC Message and an example of LOINC Message type. Thanks.

It is 1000 hours in the emergency department (ED) when the ambulance brings in G.G., a 35-year-old man
who is having difficulty breathing. He complains of chest pain and tightness, dizziness, palpitations, nausea,
paresthesia, and feelings of impending doom and unreality; he is having trouble thinking clearly. He
tells you, "I don't think I'm going to make it. I must be having a heart attack." He is diaphoretic and trembling.
His vital signs are 184/92, 104, 28, 98.4 ° F (36.9 ° C). This episode began at work during a meeting at
approximately 0920 and became progressively worse. A co-worker called 911 and stayed with him until
medical help arrived. The patient has no history of cardiac problems. After a full medical workup, it is determined that G.G.'s condition is stable. His shortness of breath and anxiety resolve after he is given lorazepam (Ativan) 1 mg IV push (IVP). The lab work and ECG results are all within normal parameters and there is no evidence of any physical disorder. A diagnosis of panic attack is
made. G.G. admits to having had three similar episodes in the past 2 weeks; however, they were not nearly
as severe or long-lasting. G.G. shares with the ED staff that he has been under severe stress at work and home. He tells them he
is going through a divorce, he lost a child last summer in a motor vehicle accident, and his company is
downsizing. He will probably be out of a job soon. He hasn't been sleeping well for the past couple of
months and has lost about 20 pounds. G.G.'s condition is stable and the ED physician discusses what has happened with G.G. The physician gives G.G. a prescription for a "week's worth" of medication and instructs G.G. to see his primary care physician
for further treatment and evaluation. G.G. tells you all about his worries with his job and all that has happened to him in the past year. He tells
you that he appreciates you listening to him. He expresses fear that the panic attacks will return.

Write a end of shift SBAR report.

choose a data that research interests, taking into consideration that the data consists qualitative and quantitative variables. (using the available data sources, i.e. questionnaire, records, approved electronic sites, ....etc.)

the data should be entered in a table please

Please detail the breakdown of the LOINC (Logical observation identifiers names and codes) message and also detail the example of LOINC Message type. thx.