1. What is your position as a provider or Nurse practitioner of banning unvaccinated patients from visiting clinics and why?
2. What are the logical and reasonable responses to people who refuse being vaccinated?
3. What are the pros and cons of using a revised immunization schedule?

Patient Introduction

Location: Orthopedic unit 1555

SBAR report from day shift nurse:

Situation: Mrs. Jacobson is an 85-year-old white female who was admitted last evening after falling and fracturing her hip. X-rays have been taken and show left intertrochanteric hip fracture. Mrs. Jacobson is scheduled for surgery tomorrow.

Background: Mrs. Jacobson has a 10-year history of osteoporosis, and her daughter reports that recently Mrs. Jacobson has been having dizzy spells.

Assessment: Mrs. Jacobson's vital signs are stable. Her pain is under control with morphine every 4 hours, and I medicated her at 1400. Her pain level was 2 after the morphine. The skin is intact; color and sensation around the hip area are within normal limits. A Morse Fall Scale assessment was completed on admission, and her score was 45. Fall precautions were implemented.

Recommendation: You will need to reposition Mrs. Jacobson as she needs to be turned every 2 hours. You should perform a focused musculoskeletal assessment, reinforce safety, and provide patient education on fall risk. Assess her pain level and medicate for pain if needed.

Edith Jacobson
Documentation Assignments
Document your focused musculoskeletal assessment of Edith Jacobson.
Document your focused skin assessment of Edith Jacobson.
Document the patient teaching that Edith Jacobson would need related to fall risk and prevention during her hospitalization and upon discharge.
Document the essential elements of proper body alignment for Edith Jacobson and include the specific supplies that would be needed.

patient safety and falls in the hospital environment

A hip implant failed two weeks after surgery. It was removed and the contact angle was found to have a value of 120o. A new implant that was coated with fibronectin (with a contact angle of 40o) was found to get integrated within three days! Provide an explanation for these observations.  

Summarize your understanding in computational approaches on virology. Your summary must not be more than 3000 words and less than 1000 words.

Case Study 1:

Maria Cortez is a 32-year-old client who had surgery on her left knee 2 months ago. She is obese and has had difficulty ambulating since the surgery. She also has a history of pulmonary embolus (PE). She has been taking a low molecular weight heparin, enoxaparin, since the surgery because of her history of PE and risk for the development of deep vein thrombosis (DVT).

1. Ms. Cortez calls the medical clinic and asks to speak to the nurse. She states that she has just learned that she is pregnant and is concerned that the enoxaparin will harm the baby. How should the nurse respond?
2. Ms. Cortez has a successful delivery of a baby girl. Ten months later, she is hospitalized for additional surgery on her knee. Her recovery is complicated by the development of a DVT, and she is started on warfarin. Discuss the teaching that the nurse should provide Ms. Cortez before discharging her on warfarin.

Case Study 2:

A client is being treated for a deep vein thrombosis in the left lower leg.

1. The client is being treated with heparin. Discuss potential assessments for this client.
2. The client is started on warfarin along with the heparin infusion. The client asks, “Why am I on two anticoagulants?” Discuss your possible responses and client teaching.

Case Study 3:

Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin administration.

1. Describe the occurrence of HIT in clients and how it is detected.
2. What are the risk factors for this disorder?
3. What are the potential interventions to control the outcome of HIT?

Case Study 4:

Andrew Oliver is a 45-year-old man who works as a mental health counselor. He presents to a small community emergency department with an acute anterior ST elevation myocardial infarction. Within 20 minutes of arrival, he receives alteplase by continuous intravenous (IV) infusion over 3 hours. He also simultaneously receives an IV bolus of heparin and is started on a heparin drip. You are the nurse assigned to his care.

1. To regulate the amount of heparin Mr. Oliver receives, his aPTT is measured. What is the therapeutic value for aPTT?
2. Oliver’s prescriber adds warfarin to his treatment regimen. The order is for Warfarin 5 mg PO daily and for evaluation of baseline Pt and INR. The nurse administers the warfarin and order the blood work for the next morning. What therapeutic INR value indicates that the warfarin dosage is appropriate?

Case study 5:

A 57-year-old man with a history of hypertension and unstable angina is admitted to the emergency room with severe, crushing chest pain. He was working in the yard when he began to have pain in his left arm with diaphoresis and nausea. He took three sublingual nitroglycerin tablets before asking his wife to call EMS.

1. Why is nitroglycerin indicated for the relief of chest pain caused by myocardial ischemia?
2. What instructions should be given to patients prescribed sublingual nitroglycerin?
3. The following medications are ordered. What is the purpose of these drugs, and what assessment should the nurse perform related to the administration of these drugs?

• Aspirin 81 mg chewable tablets, give 4 tablets STAT
• Intravenous morphine sulfate 2 to 4 mg every 10 minutes as needed to control pain
• Atenolol 5 mg IV
• Nitroglycerin IV drip at 10 mcg/minute

The patient undergoes a successful placement of a stent in the right coronary artery. The patient has aspirin 324 mg orally every day and metoprolol 100 mg orally twice a day prescribed.

The following medications are ordered. What is the purpose of each of these drugs and patient teaching required?

• Nifedipine 20 mg PO twice a day
• Clopidogrel 75 mg PO daily

Case Study 6:

Richard Gerald, a 72-year-old man, has a history of hypertension and coronary artery disease. He stopped smoking and began a regular exercise program after having a non-ST-segment elevation myocardial infarction 2 months ago. He was discharged on nitroglycerin- in a sublingual form and as transdermal patch (1 inch) every 4 hours while awake (off at night) – and on atenolol 50 mg orally daily.

1. Why dose Richard have to remove the nitroglycerin transdermal patch at night time?

Mr. Gerald returns to the clinic for a follow-up. His blood pressure is 130/86 mm Hg. And his heart rate is 86 beats per minute. He reports that he has been pain free since discharge. He is taking his atenolol as prescribed but reports that he is using the nitroglycerin patch four times a day around the clock because it is easier for his schedule. Given his vital signs, his provider increased the atenolol to 100 mg daily.

1. Gerald asks the nurse why he needs to take atenolol at all, when he has no pain, and why the dose has been increased. How should the nurse respond? What patient teaching needs to be reinforced?

While reviewing his medication instructions with Mr. Gerald, the nurse learns that he has a history of erectile dysfunction and has some sildenafil.

1. Which was prescribed for him before his MI. what actions should the nurse take?

we are told a newborn weights 152 ounces . How much is the weight in Grams?              Using ratio and proportion then Using dimensional analysis

• Complete an ANNOTATED bibliography in APA format (12 pt. Times New Roman, double-spaced, 1-inch margins). • Address the following assignment requirements. 1. Summarize and evaluate a minimum of 6 (six) peer-reviewed journal articles published within the past 5 years that address current research topics in public health. 2. Each annotation must be a minimum of 250 words and include the following: ▪ Summary of the resource content ▪ Evaluation of resource utility ▪ Assessment of resource credibility and reliability o Paraphrase information to demonstrate your own understanding of the topic in the context of public health research.

What are the common challenges heaIthworkers face?

Heck No, I Won’t Go! I’m Not Covering for Free!

On Thursday night Dr. Jones was at home watching television and spending time with his family. The phone rang. The South Shore General Hospital ER physician asked him to see an urgent patient. Dr. Jones replied that he was not on call for the emergency room at South Shore General Hospital, and furthermore, the hospital was paying members of a competing group to cover the emergency room. The emergency room doctor said that he was aware of the arrangement with the competing group. However, the ER could not reach the on-call physi-cian and had tried for some time. Dr. Jones, who earlier had a glass of wine with dinner, responded, “You’ll have to keep trying. I’m not coming in.” The next day Dr. Jones called the Chief of Staff and the Chief Medical Officer (CMO) of South Shore General Hospital and informed them that neither he nor any members of his group would cover the ER unless they were compensated in a similar manner to the competing group and had an appropriate contractor arrangement with the hospital. Dr. Jones asked the Chief of Staff and CMO if they worked for free. Dead silence. “While you’re thinking about that question, let me say this to both of you. Doctors are working harder and longer hours and earning less money every year. Why should we give up our free time and work for nothing when you’re willing to pay the other group?”

Discussion Questions

1. What are the facts in this situation?

2. What are the three organizational issues this case illustrates?

3. Was Dr. Jones obligated to go to the emergency room at South Shore General Hospital?

4. Is there an ethical dilemma in a doctor choosing not to go in to see a patient? What about the physicians who were on call? Do you think they violated any ethical principles? Or do you think this was just a matter of miscommunication? Provide a rationale for your responses.

5. If he had gone in and there had been an adverse patient outcome, how do you think the fact that he had consumed an alcoholic beverage that evening would play in a courtroom?

6. How should the ER physician have handled this matter? What is the best way to ensure emergency room coverage?

7. What steps should the administration of South Shore General Hospital take in the future to prevent this problem from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

Background Statement?

Major Problems and Secondary Issues?

Your Role?

Organizational Strengths and Weakness?

Alternatives and Recommended Solutions?

Evaluation?

Heck No, I Won’t Go! I’m Not Covering for Free!Dale Buchbinder

On Thursday night Dr. Jones was at home watching television and spending time with his family. The phone rang. The South Shore General Hospital ER physician asked him to see an urgent patient. Dr. Jones replied that he was not on call for the emergency room at South Shore General Hospital, and furthermore, the hospital was paying members of a competing group to cover the emergency room. The emergency room doctor said that he was aware of the arrangement with the competing group. However, the ER could not reach the on-call physi-cian and had tried for some time. Dr. Jones, who earlier had a glass of wine with dinner, responded, “You’ll have to keep trying. I’m not coming in.” The next day Dr. Jones called the Chief of Staff and the Chief Medical Officer (CMO) of South Shore General Hospital and informed them that neither he nor any members of his group would cover the ER unless they were compensated in a similar manner to the competing group and had an appropriate contractor arrangement with the hospital. Dr. Jones asked the Chief of Staff and CMO if they worked for free. Dead silence. “While you’re thinking about that question, let me say this to both of you. Doctors are working harder and longer hours and earning less money every year. Why should we give up our free time and work for nothing when you’re willing to pay the other group?”

Discussion Questions

1. What are the facts in this situation?

2. What are three organizational issues this case illustrates?

3. Was Dr. Jones obligated to go to the emergency room at South Shore General Hospital?

4. Is there an ethical dilemma in a doctor choosing not to go in to see a patient? What about the physicians who were on call? Do you think they violated any ethical principles? Or do you think this was just a matter of miscommunication? Provide a rationale for your responses.

5. If he had gone in and there had been an adverse patient outcome, how do you think the fact that he had consumed an alcoholic beverage that evening would play in a courtroom?

6. How should the ER physician have handled this matter? What is the best way to ensure emergency room coverage?

7. What steps should the administration of South Shore General Hospital take in the future to prevent this problem from occurring again? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

Background Statement?

Major Problems and Secondary Issues?

Your Role?

Organizational Strengths and Weakness?

Alternatives and Recommended Solutions?

Evaluation?