Case Studies

Ginny, 4 years old, has been transported to the local children’s hospital with a fever and abdominal pain. Her physician suspects that it is appendicitis. After reviewing the appropriate diagnostic tests and consulting a pediatric surgeon, the diagnosis of appendicitis is confirmed. Ginny is scheduled for an appendectomy as soon as possible. Ginny’s parents are at her bedside and are having trouble processing the recent turn of events as they occurred very suddenly and progressed quickly. Ginny has two older siblings, who are currently staying with a neighbor.

1. What do you think would be some of Ginny’s reactions to hospitalization?

2. What are the factors affecting Ginny’s reaction to her hospitalization? (think about stages of development)

3. What are some of the reactions Ginny’s family may experience regarding Ginny’s hospitalization?

The nurse has reviewed the surgeon’s orders and is beginning to prepare Ginny for her appendectomy (see above). Ginny is notably upset and her parents are equally anxious about the surgery. The nurse prepares Ginny for the operation and then focuses her attention on addressing the needs of Ginny and her parents.

4. What is the nurse’s role in caring for Ginny during her hospitalization?

5. What are some of the things the nurse can do to prepare Ginny for surgery?

6. What are some of the steps the nurse will do to prepare Ginny and her family for discharge?

ELECTROLYTE IMBALANCES:

Several patients were admitted in the medical ward. Answer the following questions pertinent to the patients’ conditions.

PATIENT A–Presented in the emergency department with severe headache, irritability, and tremors after finishing a full marathon. Laboratory values reveal Serum sodium level of 130 mEq/L.

PATIENT B–Presented in the emergency department with severe body malaise, diminished bowel sounds, and ECG reveals an extra U-wave in the tracing after 8 bouts of watery diarrhea. Laboratory values further reveal a Serum potassium level of 3.0 mEq/L.

PATIENT C–A post thyroidectomy patient presented with severe muscle cramps and prolongation of QT-interval in the ECG and was referred to the medical consultant for co-management. Serum calcium level is 4.0 mEq/L.

PATIENT D–A patient receiving magnesium for the management of seizure disorder suddenly presented with depressed deep tendon reflex and becomes stuporous. Laboratory values reveal a Serum Magnesium level of 2.6 mg/dL.

1. Given the Patient B’s presentation, trace the pathophysiological cause of the decrease in serum potassium level.
2. What will be the emergency medication that should be readily available in managing the disorder apparent for Patient D?
3. Explain the relationship of thyroid surgery and the development of hypocalcemia in Patient C.
4. Explain the relationship of Patient A’s prior activity and the development of hyponatremia.
5. Explain the mechanism behind the development of prolonged QT –interval for Patient C.
6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.

ACID-BASE IMBALANCES:

Multitude of patient’s conditions can predispose them to different acid-base imbalances. Several patients were admitted in the medical-surgical ward and are put under your care. Answer the following questions pertinent to the patients’ conditions.

PATIENT A–admitted in the medical ward 30 minutes ago with chief complaint of severe dizziness and vertigo accompanied by frequent vomiting. As the patient moves, vomiting follows which is now recorded to be 7-8 times from the time of admission. Diphenhydramine 1 ampule TIV and metoclopramide 1 ampule TIV as stat doses were given to the patient.

PATIENT B–a dialysis patient who have stopped attending his dialysis session was admitted in the ward due to changes in sensorium. Serum creatinine level is elevated as well as the Blood Urea Nitrogen (BUN). Shallow respiration is noted upon the assessment of the patient.

PATIENT C–a patient was rushed to the emergency department and later was admitted to the ward with chief complaint of shortness of breath, numbness and tingling around mouth and fingers, and lightheadedness after taking a major examination in school. The patient was offered a brown bag by the admitting nurse.

PATIENT D–A patient with emphysema as admitted in the ward due to difficulty of breathing. The patient appears reddish and is complaining of lightheadedness. The patient was immediately hooked to oxygen therapy at 2 Lpm. Choose from the following ABG results which will be consistent with the patient’s condition:

A.pH 7.50 PaC02 31 HCO3 17

B.pH 7.30 PaC02 30 HCO3 18

C.pH 7.48 PaC02 49HCO3 30

D.pH 7.32 PaC02 50 HCO3 28

1. Patient A: __
2. Patient B: __
3. Patient C: __
4. Patient D: __
5. Explain why Patient B presented with shallow respiration in relation to the patient’s condition.
6. Explain why Patient D experiences lightheadedness and why the patientappears reddish in relation to the patient’s condition.
7. Explain the purpose of offering brown bag to Patient C as an emergency management for the patient’s condition.
8. Create a drug study for the medication: METOCLOPROMIDE specifying the following:

• Drug classification
• Mechanism of action
• Indication (*for the case of the patient mentioned above)
• Contraindication
• Side effects
• Nursing Considerations

Summarize RA 5527 according to Article/section numbers and its corresponding content of each of the Sections.

Jimbo, a 30-year old male, has a BMI of 31 kg/m2 , hypercholesterolaemia, and glaucoma. After a series of concerning episodes of mood disturbances, his psychiatrist diagnoses him with schizophrenia. He decides to prescribe an appropriate antipsychotic. Although the treatment is ultimately effective, he initially complained of several side effects with little therapeutic improvement.

a. Suggest an appropriate antipsychotic to prescribe to him. Justify your selection by referring to pharmacodynamic and toxicodynamic responses.

b. Explain why Jimbo experienced side effects and therapeutic effects at different stages in the pharmacotherapy .

Treatment proceeds well for the next few months, though one evening Jimbo is rushed to the emergency room by his brother. The emergency room team observes severe muscle spasms, hyperpyrexia, a brown discolouration of the urine, and a blood pressure of 180/115 mmHg. His brother informs the medical team that Jimbo had taken more than the required dosage that day.

c. Discuss the underlying pathogenesis of the observed clinical manifestations, and a drug you could use to treat the condition. Explain the rationale for selecting the drug for treatment.

After the birth of her son, Ilona maintains a healthy lifestyle. Given the change of circumstances, she and her husband decide to work towards a second child. She discusses the situation with her doctor, and they decide to switch her to another anti-epileptic medication as monotherapy. Her doctor warns her though that any rash should be report immediately after prescribing her the new monotherapy.

d. Explain how you would switch her to another drug, and which drug was prescribed. Justify your selection of the drug.

Kiara is a 53-year-old female with severe chronic persistent asthma. She also has a history of osteoporosis, diabetes, and hypertension. Her daily treatment regimen for the control of her asthma is comprised of high-dose inhaled beclomethasone, inhaled salmeterol, slow-release theophylline, and monteleukast. She has complained to her specialist that she is still having frequent exacerbations and night-time symptoms. He then decides to put her on a short course of oral prednisone for 14 days.

a. How would prescribing additional glucocorticosteriods such as prednisone help in the treatment of the major symptoms of asthma? State two of these symptoms and the mechanism by which prednisone will treat them.

b. Considering her medical history, which factors should be taken into consideration by her specialist before prescribing oral prednisone? Substantiate your answer by referring to the mechanism by which prednisone would aggravate these conditions.

c. After two weeks of frequent asthma attacks, Kiara decides to double the dose of her theophylline. Comment on the appropriateness of her decision to double the dosage, and discuss the implications thereof. Justify your answer.

d. Which drug class should be used if she experiences an asthma attack? Justify your answer.

e. Following a thorough investigation, Kiara’s specialist establishes that her exacerbations are most likely due to improper inhaler technique. Too much of the drug is deposited in her mouth and as a result is not reaching the lungs. What can be done to overcome this issue? Justify your answer.

f. If Kiara had hepatic dysfunction, what would the implication be of prescribing the short course of oral prednisone? Justify your answer.

Description:

In this activity, you will participate in a discussion about cover letters.

Objectives:

• Create a resume and cover letter.

Instructions:

Step 1: Respond to the following:

Find and post a job posting you are interested in applying for, either now or in the future, and write a cover letter for that position. Post the cover letter for feedback from your peers.

Please help me with this assignment. I have no idea.

Note: Everything is in APA style.

Answer the following question

Alexandria general hospital has 4 departments;

Allocate the support department costs using the direct method ?

1. What does a "Multidisciplinary/Interdisciplinary" environment mean to you? - Multidisciplinary is when people from different disciplines work together, each drawing on their disciplinary knowledge. Interdisciplinary is when integrating knowledge and methods from different disciplines, using a real synthesis of approaches. 2. How can this environment be achieved in the academic setting? 3. Would this type of environment help you in your academic learning? Why or why not? 4. Would this environment in school help you in any way to become a better clinical professional? Why or why not? 5. How can this environment be better achieved or promoted in the clinical setting? 6. Anything else that you find important.

Help with 2-6 please

Piagetian theory, as applied to music instruction, involves
Select one:
a. Progressive stages of musical development and a sound-before-symbol approach.  Age eight is a watershed year in a child's cognitive development. At this time, children are capable of identifying timbres, discriminating among random melodies, and perceiving structure in simple melodies, although they are less successful in perceiving the sound of more than one simultaneous musical line (or harmony).
b. Learning I occurs without effort, as music within the environment is absorbed by the learner. Learning II, thinking is combined with experience when the child learner strives to become a competent performer through lessons or classroom instruction. The final phase
takes the performer past technical skills to music as a personal expression of joy and even religious faith.
c. Cultural signs—such as verbal comments, facial expressions, or indicatory gestures—that direct the child's attention to specific elements of an experience provide the means for drawing children into knowing their culture (in this case, musical culture) while also shaping and coloring their perceptions and eventual understanding of the cultural object (the music).
d. Three teaching and learning strategies: enactive, learning through a set of actions; iconic, learning through images and graphs; and symbolic, learning by going beyond what is immediately perceptible in the environment

Read The Following Article:

Baig, M., Gazzaz, Z. J., & Farouq, M. (2020). Blended Learning: The impact of blackboard formative assessment on the final marks and students’ perception of its effectiveness. Pakistan Journal of Medical Sciences, 36(3), 327.

And provide a detailed evaluation (critique) the value of the article, stating whether you agree or disagree with the author, with supporting evidence including at least 5 points of each of the following (Analyze with details): 1- Article strengths 2- Weaknesses 3- recommendations to enhance the article or future research.

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the followin

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
5. Discuss what additional aspects managers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

"The Supreme Court's 2012 ruling that states could decide whether to participate in the health law's Medicaid expansion program was controversial." Write a response to the statement given describing the Medicaid expansion program and why some states did NOT participate. Include how the decision to participate in the expansion program affects access, quality, and healthcare costs for providers. Don't forget to describe the pros and cons.