Sauron is an HIV-positive patient who also suffers from herpes and rheumatoid arthritis. He was diagnosed with HIV in the late 90s and was prescribed a combination of three antiretroviral (ARV) drugs comprising two nucleotide reverse-transcriptase inhibitors (NRTI) and one non-nucleotide reverse-transcriptase inhibitor (NNRTI). Quite recently, his ARV treatment was changed to a fixed-dose combination (FDC) of the same drugs. His doctor also prescribed fluconazole as prophylaxis for candida suppression.
a. If Sauron is taking interferon-α to treat the herpes, explain i) how it will exert a therapeutic effect and ii) how the frequency of its dosage can be reduced. (1½)
b. Describe how fluconazole would prevent growth of fungi such as Candida albicans. (2½)
c. Explain why it would be inadvisable for him to take cyclosporine for the treatment of rheumatoid arthritis while taking fluconazole. (1)
d. Describe how NRTIs would exert a therapeutic effect as a component of ARV treatment and provide two advantages of prescribing the ARVs as an FDC. (3½)
e. If Sauron had to be prescribed lopinavir due to resistance to the NNRTI in the FDC, what can he do to increase the bioavailability of lopinavir? (½)
f. Sauron was non-compliant to his antifungal prophylaxis and as such, he developed oral thrush which progressed to systemic candidiasis. He was hospitalised and administered a slow intravenous infusion of amphotericin B. After an hour of infusion, he started experiencing fever, chills, headache, muscle pain and nausea. What could be the cause of Sauron’s symptoms and how could this have been prevented? (1)
g. After recovery, Sauron develops influenza and uses oseltamivir for treatment. He notices that the antiviral is ineffective, which shocks him since he has used it the previous year with no problem. What could have caused this drug ineffectiveness?
In: Nursing
Aragorn and Arwen are newlyweds who have just returned from honeymoon in Mozambique. They spent most of their afternoons walking on the beach sand, though have noticed a fungal infection of their toenails. Their doctor confirms their suspicions, and they are put on griseofulvin therapy.
a. What would the implication be of the prescription if they were trying to get pregnant?
b. The couple manages to conceive and a healthy baby is born. While Arwen is breastfeeding she develops cytomegalovirus retinitis and a second nail fungal infection. Her doctor prescribes butenafine for the fungal infection and a DNA polymerase inhibitor for the retinitis. Comment on the appropriateness of this prescription and justify your rationale.
c. Arwen notices that on both times she was on antifungal therapy she developed gastrointestinal disturbance. What do you think could have been the cause of this?
In: Nursing
The subject is nursing fundamental 101 at transition Career Institute. The questions on ATI testing . and nursing leadership
In: Nursing
Case Study 1: Lisa Luther
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Age: 90 |
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This is Lisa Luther. Lisa has been a resident in Lotus Compassionate Care for two years. Lisa moved to the centre after being diagnosed with early-stage Alzheimer. She loves staying in the centre as all the staff and care workers are very supportive in helping her cope with the difficulties brought about by the disease. Lisa is also suffering from hearing and vision loss; Her left hear is completely deaf, while her right ear has moderate hearing loss. Lisa wears a hearing aid on her right ear. Both her eyes have cataracts that render her eyes with moderate visual impairment. Lisa is a vegan and has been a vegan for the most of her life. |
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Scenario 1
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While assisting another client eat lunch in the centre’s common dining area, you noticed that the care worker attending to Lisa is serving her meat. Having cared for Lisa in the past, you know that Lisa is vegan and does not eat or use meat products. You informed the care worker that Lisa follows a vegan diet. The care worker told you that Lisa is not lucid and will not even know what she had lunch. |
Guidance: in your explanation, provide an example of such cultural needs and what you can do to ensure it is accepted and upheld. |
In: Nursing
In: Nursing
1. List 3 Positive Ways Nurses Use Social Media
2. Negative 3 Ways Nurses Use Social Media
3. How to Avoid Disclosing Confidential Information
Case 1Nurse Fatma recently saw that the patient, who was having a difficult time due to the death of her mother and brother, had sent her a friend request from Facebook after her discharge. Nurse Fatma approved the friendship request and gave her friend support in the grieving process she was experiencing due to her loss.In: Nursing
Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.
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Mr. B Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation. The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily). A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist, but hold the medication until seen by them. As recommended, Mr. B visits his primary care physician for a
follow-up. During the visit, Mr. B's blood pressure is found to be
elevated (160/90), so his physician tells Mr. B to restart taking
his blood pressure medication. |
Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.
In: Nursing
Case 2. Understanding how bacteria in the gut shape allergy and asthma risk.
The microbes that naturally colonise the digestive tract of very young infants may affect their risk of developing childhood allergies and asthma. Recently, scientists identified several patterns of microbial communities in the stool of infants aged 16 to 137 days old. Every pattern of organisms potentially results in a different metabolic environment in the gut based on what the organisms produce as they grow. One particular pattern of microbes in these infants appeared to influence immune cell populations and promote the development of allergy and asthma. Newborns at highest risk for allergies and asthma had an increased abundance of specific fungi and had a lower abundance of certain bacteria compared to those at lower risk. Exposing healthy immune cells to a bacterial metabolite called 12,13-DiHOME (present in higher amounts in the stool of the infants who were at high risk to develop allergies and asthma) caused a decrease in allergy-protective cells and an increase in allergy-promoting cells. Translocation of microbial products (metabolites) through permeable brush borders of the intestine is linked with altered inflammatory responses that may drive pathways for allergic asthma.
Please help with question 1 and 2
1. How would you use a potential biomarker to determine allergy/asthma risk associated with gut bacteria?
2. Write up a SOP for your biomarker assay.
In: Nursing
Complete drug card-
Generic /brand name
Category class
expected Pharmacological Action
Complications
Contraindications/Precautions
Interactions
Medication Administration
Evaluation of Medication Effectiveness
Therapeutic Use
Nursing Interventions
Client Education
1. Lanoxin
2. Furosemide
In: Nursing
1)patient has low serum albumin with dependent edema. he is to receive 2 units of seeum albumin iv. the reason for this is given to
a)decrease bp
b)improve nutrition
c)lower hydrostatic pressure
d)pull water back into the vascular bed
a) after receiving the albumin will the patients urine output
increase or decrease??
b) after receiving the albumin what will happen to the colloid osmotic pressure??
In: Nursing
In: Nursing
Using outside research sources, describe the similarity and differences between telehealth and telemedicine in the health care provider workplace. What are the positive and negative aspects of telehealth nursing? What impact is telehealth reimbursement in the current environment having on the long term development and implementation of telehealth initiative within a physician provider or health care or hospital setting? What is your outlook for continued usage and success/failure of telehealth after the current pandemic slows? Support your theory with financial analysis and data.
In: Nursing
Draft a list of Structured interview questions based on a clinical trail as a topic.
This is towards understanding for structured vs. unstructured interview types.
Draft about 10 questions for a structure interview please. The questions should be things that an interviewer to ask a participant (who will be a patient that want to be a participant in a clinical trail).
In: Nursing
Draft a list of Unstructured interview questions based on a clinical trail as a topic.
This is towards understanding for structured vs. unstructured interview types.
Draft about 10 questions for a Unstructured interview please. The questions should be things that an interviewer to ask a participant (who will be a patient that want to be a participant in a clinical trail).
In: Nursing
Julia Morales, age 65, and Lucy Grey, age 73, are
partners who have been together for more than 25 years. They are
retired and have spent the past several years traveling together.
Julia has lung cancer, which has been treated with chemotherapy and
radiation, and now she wishes to stop treatment. Lucy is supportive
and feels she will be able to care for Julia in their home. Lucy's
past medical history includes a knee replacement. Their support
system includes Julia's son, Neil, and Lucy's niece, Nora.
The introductory monologue takes place in Julia's home prior to an
initial home health nurse visit. In the monologue, Julia discusses
her life, including raising a son to adulthood, then meeting Lucy.
She reviews her history with cancer and relates her understanding
of home hospice care and her desire to die at home. She expresses
concern about leaving Lucy alone.
The scenarios begin with the home health nurse evaluating Julia
after she has decided to stop treatment for her lung cancer. Her
partner Lucy wishes to care for her in their home. In the second
scenario the end of Julia's life is near and she is surrounded by
her loved ones and the hospice nurses. Julia dies during this
scenario. The learners are introduced to supportive measures for
both the patient and the family during this process. The final
scenario concentrates on Lucy and the difficulties she has
adjusting to her new life after Julia is gone. The objectives focus
on the students' assessment of Lucy's grieving process, how well
she is coping, and the physical changes that she has experienced
over the past few months.
Scenario 1 involves a visit by the home health agency nurse.
Learners are expected to complete a physical and functional
assessment of Julia and her nursing care needs, as well as an
assessment of the home with a focus on safety. Julia inquires about
hospice services, but her son, Neil, urges her to try one more
round of chemotherapy. Lucy is supportive of Julia's decision and
tries to comfort Neil. Learners will assess Lucy's caregiver
strain, and articulate what hospice care means for the patient and
family. The assessment tools recommended for this scenario include
SPICES: An Overall Assessment Tool of Older Adults, the Katz Index
in Activities of Daily Living, and Informal Caregivers of Older
Adults at Home: Let's PREPARE!
Scenario 2 takes place in the home two months later. Julia is
barely responsive and has Fentanyl patches for pain. Nursing care
consists primarily of performing an appropriate patient assessment
and ensuring patient comfort. Julia dies during this scenario and
the learner provides support for the family. During debriefing,
discussions may include how nurses manage their own emotions and
self-care after the death of a patient.
A second monologue occurs three months after Julia's death. Lucy is
in the emergency room. She is grieving and wants to talk about
Julia and their life together. She feels very lonely, but has had
some contact with her neighbor, Adele, and her niece, Nora. There
have been other instances where she has become anxious, dizzy, and
slightly confused, stating that her heart was pounding and she felt
like she "can't walk or do anything." Lucy thinks she has called
911 "about once a month since Julia died" and was transported by
ambulance to the emergency department.
Scenario 3 takes place in the emergency department. Lucy called 911
once again after another fall at home. Her blood pressure is
slightly elevated. Otherwise, Lucy is found to be in good health.
Objectives relate to assessing her safety, her fears, the grieving
process, and her need for assistance at home. The assessment tools
recommended for this scenario include SPICES, The Hendrich II Fall
Risk Model, the Geriatric Depression Scale, and the Generalized
Anxiety Disorder 7 (GAD-7).
Finish the Story:
Learners have now seen Lucy at four snapshots in time. What do they
think her life will be like three months from now?
In: Nursing