1. Read HealthyPeople's overview of Environmental Health and review its OBJECTIVES.

2. Choose 1 EH Objective. Why is this objective important to you? Give an example of an environmental health project of an organization that you think can help HealthyPeople reach the objective you have chosen.

You are working in a college health clinic when a client comes to you complaining of a variety of problems, including constipation, stomachache, and frequent colds. You find out that the client follows a vegan lifestyle but has done very little research into this type of lifestyle. In addition, she primarily eats in the dorm cafeteria, which seldom serves vegan dishes. Therefore, most days, she ends up eating dry cereal for breakfast and French fries for lunch and dinner.

Calculate the amount of daily protein that your client needs (she is within a healthy weight range for her age and height at 128 pounds).

a. 10 grams b. 15.9 grams c. 22 milligrams d. 46.5 grams e. 83 grams

Which of the following could be added to your client's daily breakfast cereal in order to add protein?

a. soy milk b. marine algae c. orange juice d. flax seed meal e. dried fruit

What is most problematic about your client's current diet?

a. It is too low in carbohydrates. b. It is too high in fiber. c. It lacks the variety that provides necessary nutrients. d. It cannot be sustained over time. e. It lacks meat and dairy products.

Which of the following would provide the greatest amount of protein for someone following a vegan diet plan?

a. 1 slice of whole wheat bread b. 1 tofu burger c. ½ cup cooked brown rice d. ½ cup cooked green beans e. 1 tablespoon peanut butter

Which of the following food pairs could be included in your client's diet to yield complementary proteins?
a. bagel with peanut butter b. tofu sautéed with peppers c. celery with almond butter d. black beans and rice e. soy yogurt with sliced peaches

Which of the following foods could your client add to her diet to ensure adequate levels of zinc?

a. flaxseed b. orange juice c. spinach d. eggs e. pumpkin seeds

11. List and explain three real nursing diagnoses and one at risk,
that can be used with the client-family facing the process of
loss and grief.

12. Indicate at least 5 nursing interventions for each of the
diagnoses listed in the previous question

Patient Profile

Z.Q., 74-year-old Hispanic man, came to the emergency department (ED) 7 days ago with shortness of breath. His wife stated that he had a history of hypertension, depression, and chronic obstructive pulmonary disease (COPD). The admission chest x-ray examination revealed dense consolidation of the left lower lobe. An arterial blood gas (ABG) at that time showed: pH 7.60, PaCO₂ 29mm/Hg, HC0₃ 32mmol/L, and PaO₂ 75mm/Hg. Z.Q. quickly deteriorated and subsequently was intubated. He has been in the intensive care unit for 3 days.

Subjective Data

• Z.Q. and wife have been married 45 years and live with a daughter and two grandchildren.
• They speak both English and Spanish.

Objective Data

Physical Examination

• Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%
• Height 5'6", weight 75 kg
• Patient localizes to endotracheal (ET) tube and is intermittently aroused, making several attempts to pull ET tube
• Orally intubated #7.5 ET tube, taped at 27 cm to lip
• Volume cycled ventilator at FIO₂ - 60%, in assist control mode of 14 breaths per minute, tidal volume 450, positive end-expiratory pressure PEEP 5 cm H₂O
• Breath sounds decreased in bases with bilateral crackles that do not clear after suctioning
• Brown-yellow secretions returned with suctioning
• Peripheral pulses weak at 1/4 with capillary refill greater than 4 seconds
• 2+ pitting edema in the bilateral lower extremities

Newly Obtained Diagnostic Study Results

• Arterial blood gas (ABG) pH 7.31, PaCO₂ 58mm/Hg, HCO₃ 28mmol/L, PaO₂ 54mm/Hg, EtCO₂ 38 mm/Hg
• Chest x-ray examination reveals diffuse white out in middle and lower lobes; endotracheal tube present with tip well above the carina; left subclavian central venous catheter is in the superior vena cava
• Computed tomography scan reveals alveolar opacities with increasing effusions in the gravity-dependent areas of the lungs

Case Study Questions:

1. You have read the patient’s profile and physical assessment data. What clinical data from this information is relevant and must be recognized as significant to you as the nurse? Student Must List at Least 7 answers
   1. Blood pressure 167/98,
   2. pulse 112,
   3. temperature 102.0°F,
   4. respirations 14,
   5. oxygen saturation 72%
   6. Peripheral pulses weak at 1/4 with
   7. capillary refill greater than 4 seconds
   8. 2+ pitting edema in the bilateral lower extremities

2. Blood pressure 167/98, pulse 112, temperature 102.0°F, respirations 14, oxygen saturation 72%

What are your nursing interpretations of the client’s presenting vital signs? What would be your initial assumption from your already learned knowledge – Student’s are to apply their own assumption/thinking, faculty want you to think on your own; see what you come up with. Student Must Address All Vital Signs:

• Temp = high- which might indicate infection, fever
• BP = High- hypertension
• Pulse á = high- tachycardia
• RR =   tachypnea
• O2 Sat â = hypoxemia

3. What would be your initial nursing priority that will guide the plan of care for Z.Q.?

The initial nursing priority are maintaining the airway, providing sufficient oxygenation (Breathing)and circulation. This process are often refer to as ABC. In Z.Q. case, maintain the airway, providing oxygenation and supporting hemodynamic function are prioritize.

4. What would be two prioritized nursing diagnoses for Z.Q. prior to providing client care? Include all 3 parts of nursing diagnosis. Student Must List at Least 2

5. Although Z.Q. speaks both Spanish and English, what would be two cultural aspects to consider in caring for the client? Student Must List at Least 2

6. What 5 prioritized nursing interventions will be initiated by you as the nurse based on your listed initial nursing priority in question 3? Student Must List at Least 5

7. Once treatment has been initiated, what relevant clinical assessment data would you need to closely monitor in detecting a possible change in status or complications? Student Must List at Least 4

How would you as the nurse, evaluate the effectiveness of your nursing interventions for Z.Q.? Student Must List at Least 4

R.B. is a 65-year-old female who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8˚ F, pulse 98, respirations 18, blood pressure 148/84, and O₂ saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO₂ 90, PO₂ 92%, HCO₃ 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with two stent placements into the left anterior descending artery. A pulmonary artery catheter was placed and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the ICU.

• 12 Lead ECG:ST elevation
• Troponin:41.94
• Lung V/Q scan negative for pulmonary embolis
• Urinalysis: Dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones

5.   You obtain a set of hemodynamic monitoring values. Interpret these results.

6. Describe each of R.B.'s ventilator settings and the rationale for the selection of each.

7. How does PEEP lower cardiac output?

8. R.B. is started on intravenous dobutamine and sodium nitroprusside. How will these medications affect her hemodynamic status?

Read the Chapter 8 Nutrition Debate, “Antioxidants: From Foods or Supplements?” answer the questions below and post your responses to the Week 4 Discussion Questions thread on Canvas: -With everything you’ve learned in this chapter, how do you plan to ensure that you regularly consume appropriate levels of antioxidants?

-If a friend or family member decided to take antioxidant supplements as “health insurance,” what advice might you give them about this decision?

-Go to your local drugstore and research various brands of vitamin C, vitamin E, and beta-carotene supplements, recording the amount of each nutrient in the recommended dose. Estimate if, and how much, the recommended dose exceeds the RDA for each nutrient and list some potential long-term outcomes of taking exceeding amounts of these supplements.

A 52 year old African American female presents to your clinic. She is complaining of weakness, numbness and tingling in her feet as well as an itchy rash to her groin area. She states she was diagnosed with "sugar diabetes" (Type 2 diabetes) 6 years ago but she did not follow up with the recommendations for care from her previous provider. She states she doesn't like to go to the doctor because her dad had "a lot of health problems. He was always in the doctors office and it brings up bad memories." Her father died at age 60 from chronic kidney disease.

Additional history:

• Numbness and weakness present for one month
• Rash has been intermittent for years. Worse in the warm weather
• States her eyes are "tired" in the evening which makes it difficult watch television
• She denies chest pain, shortness of breath, edema, change in bowel habits, skin ulcers, difficulty walking, syncope or seizure
• 1. How would you describe the similarities and differences between type 1 and type 2 diabetes to this patient?

• 2.You tell to your patient her current symptoms may be present due to her diagnosis of diabetes which is not being adequately managed. How would you explain to her that her diabetes is contributing to her visual complaints, rash, and numbness to extremities?

  3. What treatment recommendations would you make for this patient? Consider pharmacologic (you do not have to be specific with the doses) and nonpharmacologic interventions, lifestyle recommendations and referrals.

• 4.Please list at least two scholarly references utilized in this assignment:

WHAT IS THE IMPACT OF MALPRACTICE ON THE RELATIONSHIP BETWEEN PATIENT AND PROVIDER?​

Location: Skilled Nursing Home Care Facility 0800

Report from charge nurse:

Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday's labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

Recommendation: You should complete a basic assessment, review the labs, perform a wound assessment and dressing change, and then reposition the patient to optimize venous return. Please provide patient education on improving venous return to prevent further stasis ulcers, and continue compression therapy with the use of elastic bandage and an antiembolism stocking.

Josephine Morrow

Documentation Assignments

1. Document the findings of a focused skin assessment of Ms. Morrow, including any findings that identify the presence of chronic venous insufficiency.
2. Document any abnormal laboratory results that are associated with the presence or status of Ms. Morrow's stasis ulcer.
3. Record the results of Ms. Morrow's Braden Scale assessment.
4. Document the characteristics of Ms. Morrow's venous stasis ulcer.
5. Document the dressing change and irrigation of Ms. Morrow’s wound.
6. Record patient education on ways to promote venous return.
7. Prepare 3 Nursing Diagnosis and their defining characteristics for Ms. Morrow's diagnosis.

Nursing shortages are a source of feared for many health care administrators. Describe what the nursing workforce is like where you live. (Your state board of nursing website is a good place to gain information.) Next, discuss what aspects are leading to an overall nursing shortage, and what steps are being done to counteract this shortage.

Give the possible ABO groups for the children of the following matings. Give all possibilities.

Father group O, mother group O ______________________________________________

Father group A, mother group O ______________________________________________

Father group B, mother group O ______________________________________________

Father group AB, mother group O _____________________________________________

Father group AB, mother group AB ____________________________________________

Father group A, mother group A ______________________________________________

Father group AB, mother group AB ____________________________________________

Father group A, mother group A

Define amorph and give an ABO example.

The location of the surgery department is usually such that it is easily accessible to and from the various surgical patient support departments, such as the intensive care unit (ICU), emergency Department (ED), Labor and delivery (L&D), and other various departments. Several design types are used in surgical services departments, depending on the facility. Please respond to the following question with a minimum of 300 words for your responses.

1. Which OR design plan features a clean central core surrounded by a series of ORs? Why is this plan favored? How does it facilitate traffic control and the prevention of surgical site infection (SSI)?
2. Name four ancillary departments in the hospital that directly support the operating room. Describe their function in relation to the operating room.

Name a at risk population group and relate two foundational Healthy people 2020 health measure to their health status? Describe how nurses could be better utilized within the community to support the health of this risk community members. Discuss specific roles for the BSN RN in the community setting related to the specific identified health issues in community of at risk population. Identify both advantages and challenges.