Scenario: A doctor has ordered a test or treatment that is, based on the best practices of your profession, incorrect or medically inappropriate.

1. What should you do when faced with this problem?

2. What policies and support mechanisms do you have in this situation?

3. What preparation do you need to make prior to taking action?

4. Think of one specific treatment/test from your discipline and tell us what you would say when you approach the physician to discuss it with him or her.

An IV containing heparin in 250 mL of NS is infusing at 40 drops per minute. The infusion set is a microdrop. What is the infusion time? ( 1 drop = 4 microdrops, 1 mL = 15 drops = 60 microdrops)

The Spirit Catches You and You Fall Down

"When you fail one Hmong patient, you fail the whole community" (p. 253). How does this perspective differ from your cultural perspective on health care? How does knowing this put pressure on the healthcare system to adequately treat those from a clan-based culture, in your view?

How do diseases of the urinary system affect other body systems?

D.G., a 72-year-old man whose wife died 6 months ago, is brought to the health care provider by his daughter because he is not eating much and has been lethargic and sleeping a lot. He has a history of hyperlipidemia for which he takes niacin–lovastatin 500/20 mg PO daily at bedtime. Subjective Data Has been unusually tired for the past couple of months Is frequently short of breath and sometimes feels like his “heart is pounding” Has lost weight because his wife always used to cook for him, and he doesn’t cook for himself Describes a typical daily meal as coffee and a donut for breakfast, a hot dog and lemonade for lunch, and a jelly sandwich on white bread and coffee for supper Objective Data Physical Examination Blood pressure 118/72, pulse 98, temperature 98.2°F, respirations 16 Oxygen saturation 92% on room air Height 5'6", weight 135 lb, BMI 21.7 kg/m² S1 and S2 auscultated and regular Bilateral radial pulses +3 and regular Lungs clear bilaterally Diagnostic Studies * RBC 3,300,000/µL * Hemoglobin 8.3 g/dL * Hematocrit 24% * MCV 73 fL * MCH 23 pg * WBC 9100/µL * Platelets 250,000/µL * Iron 28 mcg/dL * Ferritin 14 ng/mL * Cobalamin 600 pg/mL * Folate 10 ng/mL D.G. is diagnosed with iron-deficiency anemia

5. With D.G.’s loss of his wife who cooked meals for him, and based on his present living situation, what are a couple of ways or things that could be done to assists in his intaking of better rich ironed foods? List at least two:

6. The health care provider (HCP) has prescribed an iron supplement for D.G. What would

you teach D.G. about taking iron supplements? List at least four:

7. Evaluate D.G’s readiness to learn. What is one positive and one negative factor that might affect the chances of learning success?
   1. One positive factor:

2. One negative factor:

Reference(s):

Pick a character from movies, television, or books. Identify and explain a social determinant of health that influences the character's health.

what is the advantage of having a physician and a nurse? Is there not a lot of overlap in knowledge, why would you want both?

Mrs. Fatima is 65 years old , celebrating her birthday . She is widow , lost her husband 6 month back . She lives alone but she has grandchildren who sometimes visit her She works as a school teacher . Everyone in the school was thanking her for her good work . Ali is a teacher working in the same school , he commented telling her that you are supposed to be at home by this age , you don't have enough strength to continue your career . Mrs. Fatma has changes in her health condition as now she becomes fatigued easily , she also experience shortness of breath when she walked a blocks , sometimes she experience gastritis

1. What do you think the major role changes Mrs. Fatma is experiencing? As a nurse how you can help her to cope with her new role?

2. As a nurse how you can prepare her for retirement?

A 24-year-old Caucasian female client presents for her 36 weeks prenatal appointment. She is a G1 P0. She is single and lives with her mom. She is currently working as a certified nurse aid in a nursing home and works 40 hours/week. Her pregnancy was unexpected but making the most of her situation. Her boyfriend lives out if state. She had limited prenatal care since not know she was pregnant until 16 weeks gestation. She has attended prenatal classes at the hospital recently. She is up to date on her vaccinations and thus far her prenatal labs as are as expected. She has a history of irregular menses because of her passion for long-distance running. Prior to her knowledge of this pregnancy she was running 30 miles/week and her BMI prior to pregnancy was 17. Her weight gain at this point has been 15lbs. She plans to attend college after the baby is born. She has hopes to attend nursing school. Her current medications are Tylenol and prenatal vitamins with folic acid.

1. Does the client have any risk factors for preterm labor? If this client calls the clinic and reports vaginal discharge or any leakage of fluid, what questions should the nurse ask?
2. This client inquires about labor, discuss the difference between true labor vs false labor?
3. Considering her history, what other items are of concern?
4. Discuss the expected feelings/behaviors that the nurse should discuss with this client.
5. Develop a plan of care with the utilization of the nursing process regarding one of the items of concern identified.

QUESTION THREE The social and economic importance of work receives substantial attention because a primary function of work in any society is to produce and distribute goods and services. Often times, less attention is paid to the importance of work to the individual.

i. Explain the two way interaction between work and health.

ii. Describe, using the cycle of neglect, the occupational health and safety in developing countries.

iii. List and describe the characteristics of occupational diseases (give necessary examples)

Arwen, a 40-year old female, has been newly diagnosed with constipation-predominant irritable bowel syndrome. She complains of severe pain, constipation, and often vomiting. Her doctor has prescribed lubiprostone and fluoxetine.

a. Explain how lubiprostone would help treat her symptoms.

b. Rationalise the use of fluoxetine in her treatment regimen.

c. Would ondansetron be appropriate as an anti-emetic? Justify your reason

A 53-year-old newly married male had just returned from Mozambique where he spent his honeymoon. Two weeks later, he developed nausea and vomiting, abdominal pain, high fever and chills. He was admitted to hospital where thrombocytopenia and spleen enlargement were observed. When a diagnostic test was done, it revealed positive results indicating an infection with Plasmodium falciparum, and he was immediately treated with IV chloroquine.

a. Which disease can be caused by P. falciparum?

b. Discuss the plasmodium lifecycle in human host.

c. At which stage of the plasmodium life cycle does an infected person present with clinical manifestations of malaria?

d. Describe the mechanism of action of chloroquine.

e. Describe one chemoprophylactic drug that the patient could have taken prior to visiting Mozambique and the duration thereof.

Discuss adverse drug reaction of Losartan, and Losartan with Furosemide, Albuterol, Digoxin in this case study

Jackie Kindling is a 70-year-old female who presents to the ER with shortness of breath and lower extremity edema. She is short of breath with minimal exertion. Jackie sees her doctor regularly for management of diastolic heart failure [AHA Stage C] and chronic asthma. Her last office visit was three weeks ago. Medication changes were made at that time due to her fluid overload and elevated blood pressure. In the ER, Jackie is being assessed and treated for possible diastolic heart failure exacerbation [AHA Stage D]. She is allergic to Sulfa.

Prescribed drugs listed for the treatment: Furosemide 80 MG Oral Tablet; Losartan 50 mg (Cozaar); Albuterol 0.09 MG/ACTUAT Metered Dose Inhaler [Ventolin]' Digoxin 0.0625 MG Oral Tablet.  

Frodo, a 32-year-old mineworker, has developed a persistent cough over the last two weeks accompanied with fever and night sweats. Her doctor is suspecting a tuberculosis (TB) infection.

a. List the detection methods that can be used to confirm TB diagnosis.

b. Name two drugs to be included in the first-line treatment regimen and discuss their mechanism of action in treating TB.

c. What is the purpose of the intensive and continuous phases of TB treatment?

d. While on first-line therapy, Frodo discovers that his contact lenses are starting to turn orange. Which drug is most likely responsible for this effect and why?

Due to his busy schedule, he has neglected to take his medication properly and has now developed a multidrug-resistant TB. The doctor has decided to add streptomycin to his treatment regimen.

e. Since starting his new treatment regimen, Frodo has been experiencing frequent bouts of vertigo. Discuss the most likely reason for this.

f. A few weeks later, Frodo develops an anaerobic bacterial infection in his GIT. He thinks that because he is already taking streptomycin, it should eradicate the infection. Discuss why this assumption is incorrect.