Your patient has cardiovascular disease (CVD) and has been admitted with these vitals: BP 190/90, HR 100, RR 35. When asked about symptoms, the patient states, “I have a very bad headache and feel light headed.” History reveals he has had one heart attack three years ago. He is a pack a day smoker and often drinks more than one drink per day. When doing your morning assessment, you find a dime sized wound on his lower leg. The wound is open in the center and red around it. When asked, the patient states his feet and legs are cold much of the time and he no longer walks long distances because of pain in his legs.

Question: What is the most immediate concern for this patient and why? Include in your answer specific facts, data, examples, and other information drawn from your textbook

Alice Foote is an 84-year old nursing home patient with advanced dementia who develops kidney failure and is brought into the emergency room. Ms. Foote is currently semi-comatose from the kidney failure, which, like her dementia, was caused by her hypertensive vascular disease (i.e., hypertension). The kidney failure is irreversible; that is, there is nothing that can be done to restore the functioning of the kidneys. However, dialysis can compensate for the effects of the kidney failure by serving as her artificial kidney. The emergency room physician consults the nephrologist (kidney doctor) on-call about dialysis. The two physicians peruse Ms. Foote's medical record and find that, before developing kidney failure, Ms. Foote had been withdrawn and bedridden, was not able to recognize family or friends, and needed assistance for all basic activities, including feeding and bathing. They also discover that Ms. Foote had duly executed a Florida "Living Will" several years earlier, before she developed her dementia, after a lengthy discussion about end-of-life care with her physician. The Florida Living Will states: If at any time I am incapacitated and (initial all that apply) ___AF___ I have a terminal condition, or ___AF___ I have an end-stage condition, or ___AF___ I am in a persistent vegetative state and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal. The nephrologist considers starting Ms. Foote on chronic, thrice-weekly dialysis, which will restore Ms. Foote to her pre-kidney failure level of functioning. However, the nephrologist is reluctant to do so because of Ms. Foote's dementia, the cost of dialysis (more than $45,000 per year) and the fact that Ms. Foote's life expectancy even with dialysis is no more than a couple of years. The nephrologist tells the emergency room physician that dialysis is not an option and that Ms. Foote should be returned to the nursing home with instructions about basic comfort care. If Ms. Foote went back to the nursing home without dialysis, she would die, probably in three days. The emergency room physician has called the hospital's ethics committee for advice. You are on the hospital ethics committee, and the committee has asked you to investigate and report back to the committee on the ethical and legal considerations raised by Ms. Foote's situation. What would you say?

What is the novel coronavirus and why is it called coronavirus? How are coronaviruses transmitted between people? How can I protect myself against corona viruses?

Terri is a 28-year-old woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her partner, Greg, as she is lethargic and unable to make any sense. Greg reports she has been unwell with a flu-like illness for the past week with nausea and vomiting over the past 2 days. Terri had decided not to take her usual insulin dose last night as she hadn't been eating and her blood sugar was only 8.1 mmol/L.

                On examination you find Terri has a Glasgow Coma Scale score (GCS) of 10 (eye opeming:3; verbal response :3; motor response:4); she has deep, rapid respirations, acetone smell on her breath and her skin is flushed ad dry. Greg reports she had gone to the toilet several times during the night and, when she woke up this morning, she had wet the bed. Her blood glucose level (BGL) is 42.1 mmol/L and her ketone levels are 7.1 mmol/L. Urinalysis shows large amounts of glucose and ketones with a low specific gravity. Her vital signs are:

• BP 102/54 mmHg
• Hr112 beats/minute
• Rr 36 breaths/minute, rapid and shallow
• T: 36.2 degree Celsius
• Spo2 96% with no supplemental oxygen

Medical staff suspect Terri has diabetic ketoacidosis (DKA) and order two large bore intravenous (IV) cannulae inserted for fluid resuscitation and IV insulin administration.

Phase 1

Terri has been in the emergency department for half an hour. An indwelling catheter is placed to closely monitor Terri's fluid balance while the diuresis continues. Terri is initially commenced on a rapid infusion of normal saline to replace fluid lost through the osmotic, diuresis and improve her BP. Medical staff have ordered the commencement of an IV insulin infusion to slowly decrease Terri's BGL and you access the hospital's protocol for this and prepare the infusion. Blood tests are taken to determine urea and electrolyte status as well as arterial blood gas analysis to assess the presence and extent of acidosis.

Although Terri's initial oxygen saturation levels were good, you apply a simple face mask with 6 L O2, supplemental oxygen as she is tachypnoeic and you want to optimise her FiO2. After receiving 2 L of normal saline, Terri's BP begins to improve. Her current vital signs are:

BP - 110/62 mmHg

HR - 102 beats/minute

RR - 34 breaths/minute, still rapid and shallow

T-37.2°C

Spo2 -97% with 6 LO via simple face mask

Phase 2                                                                                                                                                              

The results of the blood tests, received 30 minutes later, show Terri's potassium levels are 6.2 mmol/L. Her other electrolytes were within normal ranges. You immediately place her on a continuous electrocardiogram (ECG) monitor and take a 12-lead ECG, which shows high peaked T waves. Her ABG results are:

pH - 7.18

PaCO2 - 40 mmHg

HCO3 - 13 mmol/L

PaO2 - 125 mmHg

Base excess (BE) - 4 mEq/L

Sao2 - 95%

Twenty minutes after you take your initial ECG, Terri loses consciousness and her continuous ECG monitor shows a 6-second episode of ventricular tachycardia (VT), after which Terri regains consciousness, back to the original GCS 10 assessed on arrival. You notify medical staff and take another 12-lead ECG, which still shows peaked T waves, but no other abnormality. You monitor Terri closely for any further VT episodes. Her vital signs are:

BP - 106/62 mmHg

HR - 121 beats/minute

RR - 30 breaths/minute, still rapid and shallow

T -37.0°C

Spo2 -97% with 6 L 02 via simple face mask

Phase 3:

Terri has been treated for a total of 24 hours now. She has received IV fluid, which was switched to normal saline to Hartmann’s solution, after receiving 2 litres of normal saline, to ensure electrolytes were maintained; her IV insulin infusion continues. After 24 hours of treatment, Terri’s BGL is 31.3 mmol/L, ketones are 4.5 mmol/L and her potassium levels are now 3.2 mmol/L.

                ABG tests weretaken every hour for the first 6 hours, until her pH began to normalise, then every 2 hours. Her ABG is showing significant improvement and is currently:

-pH-7.34

-PaCO2-36 mmHg

-HCO2 -15 mmol/L

-PaO2- 105 mmHg

-BE- 3mEq/L

-SaO2-98%

A strict fluid balance chart was recorded and the indwelling catheter remained in place, for accurate urine output measurements, for 3 days until her condition stabilised. Her vital signs at present are:

-BP- 112/62 mmHg

-HR- 87 beats/min

-RR-22 breaths/min

-T- 37.1 °C

-SpO2-97% with 6 L O2 via simple face mask

Directions: Answer the following questions and cite references. Create a Nursing Care plan based on the case presented.

1. What condition explains the patient’s hypotension and diuresis? Discuss your answer.

2. What intravenous fluid/s is appropriate to treat this patient’s dehydration? Justify.

3. Discuss what has activated the renin– angiotensin– aldosterone mechanism?

4. Explain the physiology that triggered the patient to exhibit tachypnea.

5. Kindly interpret the patient’s ABG results. Explain your answers using up and down arrows, followed by a short narrative.

6. Justify the cause of the patient’s dysrhythmia.

7. Explain what should be monitored all throughout the patient’s stay.

8. Why is it important to maintain an accurate fluid balance record for this patient?

9. Please prepare a nursing care plan for Terri’s condition.

A client is diagnosed with Ménière disease and asks the nurse to describe the disorder. The nurse provides the client with which information? (Select all that apply.)

1.     Ringing in the ears occurs.

2.     It is characterized by vertigo.

3.     Bilateral sensorineural hearing loss occurs.

4.     Permanent hearing loss develops as the attacks increase.

5.     Cigarette smoking needs to be avoided because of the blood vessel- constricting effect.

6.     Salt and fluid restrictions that reduce the amount of fluid in the ear may be helpful.

Read the following assessment task. Pay careful attention to the exact requirements of the task. Then look at the student’s response. For this task you should :

a.Write a couple of sentences assessing how well the student has carried out the task. b.Write the student some feedback based on whether they have completed the task well or whether they have omitted parts of it.

Use supportive language while you are providing advice on how they can improve in future assessment tasks. (about 200 words for a and b)

Choose a course you have studied. For this course, write two paragraphs about it. The first paragraph should be a summary of the course, in your own words. The second paragraph should include your own comments on what you liked or disliked about the course, and what was most interesting. Include some advice you might give another student thinking of studying this. Write about 200 words for each course summary (the first and second paragraphs together should add up to about 200 words).

Here is the student’s answer: I studied a course about identifying trees. It explained the different types and families of trees. It described how you can look at features of the trees such as bark, leaves, trunks etc. and use that to work out which family of tree it is and maybe even find out what species. It says which trees are native in the UK and which trees are brought in from abroad. It also had a print-out field guide to help you in the field when you are walking around and see some trees you can’t identify. I really liked this course. I am not very good at identifying trees, but my children are growing up and asking me what they are, but I can’t always tell them. This should really help me be able to work out what kind of tree it is when I am out and about.

who are the pioneers of epidemiology in public health and what did they do?

What does "health literacy" mean? How is this term defined by the Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs of the AMA? Do you agree that an individual's health literacy is likely to be worse than their general literacy? Why or why not?

How do you determine if the data/information you are using for an analysis is reliable and valid? (You'll have to consider the definitions of reliability and validity.)
- How critical is this type of concern for the Health Services Area?

1. Article: Ethical Challenges in the Era Of Health Care Reform by: Vicki D. Lachman

• What did you learn?

Artclie: Ethical Issues in the DisruptiveBehaviors of Incivility, Bullying, andHorizontal/Lateral Violence by: Vicki D. Lachman

What did you learn?

The relationship between human resources and healthcare is very complex. If we only see human resources as doing the hiring and firing for an organization, we are selling their impact short. How does human resource build and maintain a quality healthcare organization?

Your response must be at least one complete paragraph.

1. What is the name of the connective tissue that surrounds each individual muscle fiber?

Select one:

a. Perimysium

b. Endomysium

c. Sarcolemma

d. Epimysium

2. Which of the following statements is TRUE?

Select one:

a. Large motor units are recruited for fine/precise movements and innervate ~1000-2000 muscle fibers

b. Large motor units are recruited for coarse movements and innervate ~1000-2000 muscle fibers

c. Small motor units are recruited for coarse movements and innervate as few as 10 muscle fibers

d. Small motor units are recruited for coarse movements and innervate ~1000-2000 muscle fibers

3. What is the definition of a motor unit?

Select one:

a. A motor neuron and all the muscle fibers it innervates

b. A motor neuron and all the motor units it innervates

c. A motor fiber and all the muscle neurons it innervates

d. A muscle unit and all the motor fibers it innervates

4.What is the name of the specific neurotransmitter secreted at the axon terminal of a motor neuron into the synapse of the neuromuscular junction?

Select one:

a. Acetylcholine

b. Adenosine Triphosphate

c. Testosterone

d. Acetyl CoA

5. _____________ is the thin contractile protein that contains the regulatory protein ______________ which calcium ions bind to, initiating muscular contraction.

Select one:

a. myosin, troponin

b. actin, troponin

c. actin, tropomyosin

d. myosin, tropomyosin

6. Which of the following is one of the training adaptions specific to strength "resistance" training?

Select one:

a. Increased oxygen extraction from the blood by active muscles

b. Increased glycolytic enzyme activity

c. Increased number and size of mitochondria

d. Increased motor units recruited

7. Strength training results in increased size of myofibrilar proteins

Select one:

True

False

8. Water composition in skeletal muscles account for nearly _____ percent of muscle weight

Select one:

a. 75

b. 55

c. 65

d. 85

9. Which of the following has been scientifically proven to reduce muscle cramps?

Select one:

a. Injecting calcium gluconate or magnesium sulfate into the localized area

b. Taking a spoonful of mustard

c. Drinking pickle juice

d. Eating bananas

10. Which of the following is currently the accepted theory as to why muscles feel tight when stretched?

Select one:

a. Weak tendons stimulate a contraction response

b. Titin molecules being stretched

c. Actin and myosin filaments become overlapped

d. Increased tension in the connective tissues surrounding the muscles

11. Two individuals starting at the same strength and fitness characteristics begin a training program. These individuals are also both highly motivated. They will end up with the same training adaptations as long as they both make sure they are fully rested, hydrated, maintain a healthy diet, and have nothing wrong with their nervous, endocrine or immune systems.

Select one:

True

False

12. What is one of the main reasons why fit people who detrain get back into shape faster compared to inexperienced exercisers?

Select one:

a. Increased content of contractile proteins in muscle cells

b. Proliferation of satellite cells causes increase mitochondrial content in the muscles

c. Increased plasma volume initially in the first 2 weeks of a training program

d. Increased number of nuclei remain after training

13. Which of the following is a reason why Type II fibers are better suited for fast, powerful movements?

Select one:

a. Sarcoplasmic reticulum is better at cycling calcium

b. More mitochondrial content

c. Slower myosin ATPase activity

d. Increased blood vessel quantity around the area

14. Research has shown that up to _____ percent of aerobic performance may be determined by genetics

Select one:

a. 50

b. 17

c. 10

d. 6

15. In general, muscles need to be damaged in order for them to get bigger (hypertrophy)

Select one:

True

False