CLINICAL SCENARIO:A. Patient’s ProfileName:Patient AndengBirthday: April 24,1931Age: 89 y/oSex:Female

Nationality:FilipinoReligion:Roman CatholicAddress:MalabonDate of Admission: Aug. 2,2020Time of Admission:11:30 PMChief Complaint: multiple vague physical and shortness of breathAdmitting Diagnosis: AnemiaHistory of Present IllnessPatient A's chief complaint is of feeling tired and short of breath at times. She also complains of arthritic pains in her neck and hands. Review of systems is notable for hearing loss, dentures, glasses, and dyspnea, mostly with exertion. She has occasional palpitations of the heart and orthopnea at times. Her bowel movements are regular, and she has not noticed any blood in the stool. She has 1+ chronic edema of the legs, which is about usual for her.Past Medical HistoryHer medical history is positive for congestive heart failure, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and osteoarthritis.During her last hospitalization, one year ago for pneumonia, the nephrologist and pulmonologist told Patient A there was not much else that could be done for her. Despite the poor prognosis, her multiple medical conditions stabilized and she completed a rehabilitation program. She enjoys participating in activities and has developed friendships with some other residents. Over the past year, she has been treated for multiple infections, including bronchitis and multiple urinary tract infections.Family History(+) HPN(+) Diabetes(-) Asthma(-) CancerAdmission OrderPatient A's chief complaint is of feeling tired and short of breath at times. She also complains of arthritic pains in her neck and hands. Review of systems is notable for hearing loss, dentures, glasses, and dyspnea, mostly with exertion. She has occasional palpitations of the heart and orthopnea at times. Her bowel movements are regular, and she has not noticed any blood in the stool. She has 1+ chronic edema of the legs, which is about usual for her. She has not had a mammogram for five years, and she has not had a dual energy x-ray absorptiometry scan, colonoscopy, or other preventive care recently.

Patient A's record indicates an allergy to sulfa drugs and penicillin. She also has completed advance directives (a do not resuscitate order and a living will). She is taking the following medications:Amlodipine besylate (Norvasc): 5 mg/dayCalcium carbonate (OsCal) with vitamin D twice dailyPolyethylene glycol powder (Miralax): 17 g in 8 oz liquid dailyFurosemide (Lasix): 40 mg/dayEscitalopram (Lexapro): 20 mg/dayPrednisone: 10 mg/dayOmeprazole (Prilosec): 20 mg/dayCinacalcet (Sensipar): 30 mg/daySimvastatin (Zocor): 20 mg at bedtimeTiotropium oral inhalation (Spiriva): 1 cap per inhalation device dailyVitamin B12: 1,000 mcg twice dailyEnteric-coated aspirin: 81 g/dayUpon physical examination, Patient A appears well-nourished and groomed. She is mildly short of breath at rest but in no apparent pain or distress. She is 5 feet 6 inches tall and weighs 156 pounds. Her vital signs indicate a blood pressure of 132/84 mm Hg; pulse 72 beats/minute; temperature 97.4 degrees F; respirations 20 breaths/minute; and oxygen saturation 94% on 2 L/minute. Her oropharynx is clear, and her neck is supple. There is no lymphadenopathy. The patient is hard of hearing and wears glasses for distance and reading.Patient A's heart rate is slightly irregular, with a soft systolic ejection murmur. Evaluation of her lungs indicates diminished breath sounds in the bases with no adventitious sounds. Abdomen palpation finds it to be soft and non-tender, with active bowel sounds and no signs of hepatosplenomegaly. As noted, Patient A has 1+ pitting chronic edema and vascular changes to lower extremities. There are no active skin lesions. Neurologic assessment shows no focal deficit. Extremity strength is rated 4 out of 5. A mini-mental status exam is administered, and the patient scores 22/30, indicating mild cognitive impairment.Blood is drawn and sent to the laboratory for CBC and a basic metabolic panel. The results are:Leukocytes: 5,700 cells/mcLRBC: 3.02 million cells/mcLHgb: 8.1 g/dLHCT: 25.2%MCV: 83 fLMCH: 26.5 Hgb/cellMCHC: 32%RDW-CV: 15.8%Platelets: 150,000 cells/mcLGlucose: 82 mg/dLBlood urea nitrogen (BUN): 34 mg/dLCreatinine: 1.4 mg/dL

GFR: 38 mL/minute/1.73 m2Patient A is in no apparent distress at present, but she appears to have anemia, as evidenced by the low Hgb. She has chronic kidney disease (stage 3), which may be contributing to the anemia. Further laboratory evaluation is necessary to determine the etiology of the anemia and to determine if specialty referral to gastroenterologist or hematologist is necessary. The clinician orders an iron profile, vitamin B12 and folate levels, reticulocyte count, and stool for occult blood. The resultsof this testing are:Vitamin B12: 1,996 pg/mLFolate: 9.9 mcMFerritin: 20 ng/mLSerum iron: 26 mcg/dLUnsaturated iron binding capacity: 216 mcg/dLTotal iron binding capacity: 242 mcg/dLTransferrin saturation: 11%Reticulocyte count: 1%Stool for occult blood: Negative (three samples)Vitamin B12 is a water-soluble vitamin that is excreted in urine, so a high level is generally not significant. The folate level is sufficient, while the ferritin level is considered low-to-normal. The iron profile shows a low level of iron in the blood; this may be caused by gastrointestinal bleeding or by inadequate absorption of iron by the body. Patient A has medical conditions that can cause elevated cytokines, which would interfere with iron absorption. If her ferritin level was high, which it is not, it would suggest AI/ACD. Therefore, the patient appears to have anemia secondary to chronic kidney disease.Prior to initiating treatment with an ESA, the patient is evaluated for a history of cancer, as these agentsmay cause progression/recurrence of cancer. Before writing the prescription for darbepoetin alfa, the clinician signs the ESA APPRISE Oncology Patient and Healthcare Professional Acknowledgement Form to document discussing the risks associated with darbepoetin alfa with the patient. The lowest dose that will prevent blood transfusion is prescribed.The multidisciplinary team works with Patient H to develop a treatment plan. It is determined that treating the anemia will improve the patient's quality of life. The patient is prescribed ferrous sulfate 325 mg twice daily. Because vitamin C facilitates iron absorption, the iron can be given with a glass of orange juice or other citrus juice (not grapefruit). Iron must not be given with calcium, milk products, and certain medications as they can interfere with absorption. The patient should be monitored for the development of constipation and the need for stool softeners. In addition, darbepoetin alfa 40 mcg is prescribed, to be administered subcutaneously every week. This requires significant monitoring. Hgb and HCT should be measured on the day patient is to receive the injection, and the drug should be held if the Hgb is greater than 11.5 g/dL. If a current Hgb level is unavailable, the drug should not be given.Blood pressure should be measured twice daily after treatment with darbepoetin alfa is initiated. Staff must also monitor for symptoms of a deep vein thrombosis and pulmonary embolus (e.g., unilateral edema, cough, and/or hemoptysis). Daily exercise is encouraged to help reduce the risk of a blood clot.

After one month, Patient A has received darbepoetin alfa weekly for four weeks. She is also taking the ferrous sulfate and a stool softener. The review of systems is unchanged from the previous evaluation.The physical examination is also unchanged aside from a 1-pound weight loss. No new complaints or problems are reported. A review of the patient's vital signs shows a blood pressure of 130/80 mm Hg; pulse 78 beats/minute; temperature 97.8 degrees F; and oxygen saturation 97 on 2 L/minute. Her Hgb levels over the last month have improved:Week 1: 8.4 g/dLWeek 2: 9.2 g/dLWeek 3: 9.6 g/dLWeek 4: 10.1 g/dLNo side effects as a result of the darbepoetin alfa are observed. Patient H's blood pressure remains stable, with no signs or symptoms of a blood clot.The clinician orders the weekly monitoring of Hgb and HCT to continue with the darbepoetin alfa held if the Hgb is greater than 11.5 g/dL. If the medication is held more than once, the clinician will re-evaluate the dosage and frequency. The patient may only need the injection once or twice a month after the anemia is stabilized. The clinician also reduces the patient's vitamin B12 supplement to daily (rather than twice daily) and reduces her prednisone dose to 5 mg/day.

PATHOPHYSIOLOGY OF ANEMIA SECONDARY TO CHRONIC KIDNEY DISEASE OR PATHOPHYSIOLOGY OF THIS CASE SCENARIO

In 500 words, describe the concept of family care giving in the context of what type of families provide care, key issues for carers, and strategies and/or resources that might be required.

infant Care Center Director Qualifications and Duties...................................................................101415

Assistant Infant Care Center Director Qualifications and Duties................................................101415.

1Infant Care Teacher Qualifications and Duties............................................................................101416.2

Infant Care Aide Qualifications and Duties.................................................................................101416.3

Staff-Infant Ratio.........................................................................................................................101416.5

Staffing for Infant Water Activities.............................................................................................101416.8

Toddler Component in an Infant Care Center.................................................................................101417

Infant Needs and Services Plan....................................................................................................101419.2

Modifications to Infant Needs and Services Plan........................................................................101419.3

Infant Care Discipline..................................................................................................................101423.1

Infant Care Transportation..............................................................................................................101425

Infant Care Isolation for Illness...................................................................................................101426.2

Infant Care Food Service................................................................................................................101427

Infant Care Personal Services.........................................................................................................101428

Responsibility for Providing Care and Supervision for Infants......................................................101429

Infant Care Activities......................................................................................................................101430

nfant Care General Sanitation.....................................................................................................101438.1

Outdoor Activity Space for Infants..............................................................................................101438.2

Indoor Activity Space for Infants.................................................................................................101438.3

Infant Care Center Fixtures, Furniture, Equipment, and Supplies..................................................101439I

nfant Care Center SleepingEquipment......................................................................................101439.1

can you fiil this table using the information above

Jessie is the carer of James, her 25-year-old son with intellectual and physical disabilities and mental health issues. Jessie worked for 15 years as a social worker, but gave up her career when James was born and has been caring for him ever since. James is an outgoing young man, but he needs daily assistance with personal care, dressing, medication, meal preparation, transport, attendance at appointments, and financial management issues. Up until one year ago Jessie provided all the care for James, but Jessie’s health deteriorated and she needed the assistance of support workers on a daily basis. Jessie has painful arthritis which is restricting her movements and she has recently been diagnosed with a benign brain tumour which will require intensive treatment over a period of months during which time Jessie will be unable to care for James at all. While Jessie has been ill, James’ behaviour has become quite demanding which has increased Jessie’s stress.

In a short paragraph for each, answer the questions.

• Identify key changes that might include a risk of the care relationship breaking down.

• Having confirmed with a supervisor the risks that might lead to relationship breakdown, how might James’ individualised plan be reassessed or reviewed?

1) Sacha’s mother has brought him to the doctor's office because he has been misbehaving at home and at school and never seems to listen to anything the adults say to him. His mother noticed that he does not respond when she calls his name, and he often seems to live in his own world. Now that he has entered kindergarten, his teacher also reports that Sacha does not seem to respond quickly and has limited vocabulary. How should the medical assistant respond?

2) Alicia, who is 62 years old, comes to the office for a routine eye examination. When you ask her when her last eye exam was, she tells you that she hasn’t had her vision checked in about 7 years, because the exams make her nervous. What should you tell Alicia to help her feel more comfortable and to help her understand the importance of her eye examination?

3) Tom brings his 6-year-old daughter Jane to the office. The physician diagnoses her with conjunctivitis and prescribes eye drops. How should you advise Tom to help Jane avoid spreading the disease to her siblings and classmates?

Peter is a 50-year-old truck driver working at a transportation company since he was 30 years old. He lives with his wife and his son aged 16 who is a form-four
student. He has had hypertension for 15 years. He is taking Lasix and Zestril. However, due to his working schedule, Peter is not able to strictly follow the
medication regimen. Two years ago, he was diagnosed with heart failure and had been repeatedly admitted due to acute pulmonary edema (APO). Since then,
he also needs to take Digoxin and use home oxygen every day. He was admitted to your medical ward due to APO. He had severe shortness of breath. He
appeared very frightened and asked if he would die this time. The doctor prescribed IV Lasix stat.

one PHYSICAL problem and ONE PSYCHOLOGICAL problem

This all what I have. Summarizing the three reasons why the food industry needs immigrants. please do it because the due date in November 1st.

Summary Paragraph Assignment

Date Due: Sunday, November 1st

The purpose of this assignment is to test your summarizing skills and your ability to use sources appropriately in your writing. This assignment is worth 25 points.

Requirements of the Assignment:

Write a one-paragraph summary of the article, “3 Big Reasons the Food Industry Needs Immigrants”. The paragraph should contain 10-15 sentences and include the following:

• A summary sentence
• The author’s full name
• The full title in quotations and capitalized correctly
• The author’s main point(s) and supporting points
• When it was written
• Where it was originally published (this is not a geographical location!)

Three Big Reasons the Food Industry Needs Immigrants

In response to the new administration’s moves to control entry to the USA and follow through with deportation plans as well as construction of a border wall, the February 16th nationwide strike “A Day Without Immigrants” inspired many businesses to close restaurants, not go to work, keep children home from school, to not buy gas, not go to restaurants or shop online or in stores. While it might take a few months to actually calculate the true impact of the actual impact this movement may have had on the country’s economy or on the perception of Americans when it comes to immigrants, as a food industry, there are profound considerations when it comes to immigrants supporting our food system. Supporters of immigrants' rights march in downtown Washington during an immigration protest pay close attention to. There are three important reasons that the food industry needs to the administration's planned changes to immigration

REASON #1: Agriculture - According to the U.S. Department of Labor, 57% of the country’s agricultural workforce is undocumented. And this workforce is employed mostly with low wages that help keep farms in business and domestic food prices down. Labor shortages have been reported by farm owners as a major concern, and while this affects large farms, less availability for labor also becomes an issue for small, family-owned farms, school food programs, restaurants, manufacturers, and the communities and families where workers have for a long-time built their financial sustainability on these jobs.

     REASON #2: Street Food - In major cities with large immigrant populations, street food vending is a major way for these families to support themselves financially. In Los Angeles, the mayor is attempting to fast-track changes to a law that makes street food sales legal - an important move to protect these immigrants that could face criminal charges making them more vulnerable to Trump’s deportation efforts. So why do we need street food as a food industry? Street food plays an important role in ethnic food trends, the ever-evolving palates of the US population, and the inspiration for food flavor innovations in CPG and in restaurants. According to PricewaterhouseCoopers, surveys indicate that 88% of households are consuming at least two ethnic foods per month with annual food sales at $6.5 billion for Hispanic foods and $2 billion for Asian foods. And it also deserves mentioning that Nielsen reported last year that Halal food sales reached $2 billion in the grocery and c-store channels

     REASON #3: Restaurants - BLS statistics show that an estimated 1.4 million of restaurant industry workers are foreign born, working as chefs, dishwashers, busboys, etc. To some, this may not seem significant enough for alarm as it adds up to about 10% of the restaurant industry’s workforce. However, a 2008 study from the Pew Hispanic Center suggests higher numbers citing that nearly 20% of restaurant cooks and 30% of dishwashers are undocumented immigrants.   These are low paying and perhaps to most, unappealing jobs, but obviously still necessary to keep the restaurant industry in business.

     While we face a highly volatile political climate, it is important that close attention be paid to our food system’s dependency on immigrants as well as the cultural knowledge and innovation they bring to support consumer desires Beyond the appetite for ethnic foods and economic benefits, the food industry also finds itself in a time when consumers are paying close attention to corporate positioning when it comes to human welfare. Last month, a CBS poll showed that 61% of Americans feel that illegal immigrants should be allowed to stay and apply for citizenship, and 13% said they should be allowed to stay, but not allowed to apply for citizenship. Time will tell how President Trump’s policies play out for our food system as well as our shoppers’ needs and concerns.

Identify at least three regulatory bodies or industry regulations that specify certification, licensure requirements, or scope of practice for your specialty. Discuss the way these bodies or regulations influence the educational requirements and experiences for your specialty. Advanced practice registered nurses must incorporate the APRN consensus model in their response.

When monitoring blood product administration, there are hemolytic and nonhemolytic reactions that may occur. Discuss the monitoring parameters for one of these two reactions and what action the nurse should take when a reaction occurs.

An elderly client with mild dementia and confusion has sustained an unwitnessed fall. The nurse is performing hourly neuro check as ordered by the provider. Which of these findings should be reported to the charge nurse immediately?

1. A change in BP 125/75 to 118/86

2. A glasgow coma scale of 14

3. A New onset of lethargy

4. Pupil size of 4 mm in both eyes