*While talking to your mother, who is a nurse, she related an interesting story about a 14-year-old patient that she saw in the early 1980s when she worked in a gynecology office. When the young girl first presented, she vomited in the waiting room. She stated that she had been feeling ill the night before and that she had also been having an unusually heavy menstrual flow. She also complained of chills and a diffuse rash on her arms and legs, and she reported having a fever. Upon getting her to the examination room, your mother checked her temperature and blood pressure while the doctor asked her some questions. He asked her if her neck was stiff, to which she answered no; he ordered a lumbar puncture, anyway. At this point, she was starting to look dizzy, and her blood pressure was 80/55. The doctor asked her if she’d ever had sexual intercourse, to which she answered no. The patient’s mother also confirmed that she was up to date on all her immunizations. This young girl was eventually admitted into the hospital for treatment. Your mom mentioned, as an interesting aside, that several days after she was admitted, the skin on the palms on her hands began to slough off.

1. What kind of infectious diseases come to mind when a widespread rash is seen as the primary complaint? (Hint: Why had the doctor asked about her sexual history? Why did he ask about her immunizations?)

2. Her rash was diffuse, with well-separated bumps that were maculopapular. Was it likely to be chicken pox? Why or why not?

3. The cerebrospinal fluid obtained from the lumbar puncture was clear—no evidence of bacteria. This ruled out another infection. Which one?

4. The doctor then asked the patient about her menstrual history and practices. She began menstruating at the age of 12 and reported that her last period began four days ago. She reported that she mainly uses tampons during her period. What infection do you think the doctor had in mind by asking about menstruation? Briefly describe this infection and the likely pathogen that causes it.

5. Your mother says that if you see a patient with these symptoms once you start practicing as a physician’s assistant, it is less likely to be the same infection as what this young girl experienced. Why?

. As a License Practical Nurse Student .Identify potential Interview questions and how to conduct your self in an interview.

Type up several questions and responses that you may be asked in an interview. Add questions that you might ask in an interview and their relevance to the job you are seeking.

Reflect on the course using these course learning objectives:

1. Define the history and scope of public health nursing including the core competencies of the nurse in public health settings.
2. Incorporate evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan
3. Collaborate with community members, community liaisons, and members of the healthcare team to develop health promotion and prevention planning for individuals, families, and groups across the lifespan in community settings.
4. Perform a comprehensive assessment of a community in relation to its health needs, health policies, and resources.
5. Utilize technologies to inform, communicate, and enhance the health of individuals, families, and groups in public health settings.
6. Apply evaluation results to the delivery of care, allocation, and distribution of resources
7. Provide input into the development of policies to promote health and prevent disease.

1. The ICU nurse prepares to administer a dobutamine (Dobutrex) drip. The patient weighs 176 lbs. The safe dose range for this medication is 2.5-10mcg/kg/min. The medication preparation delivered by pharmacy is 250mg in 500mL of D5W.

1. What is the safe dose range for this patient? Express your answer in mg.
2. The drip is started at 60mL/hr. Would this be an acceptable action? Explain why or why not.

2. The nurse is preparing to administer a 500mL 0.9% NaCl IV fluid bolus at 250mL/hr. The IV tubing contains a Micro Drip set with a drop factor of 60gtts/mL. In order to administer the fluid bolus at the correct rate, how drops per minute must the nurse observe in the chamber?

Abdominal and Neurological Assessment

1. How long do you listen for bowel sounds in each quadrant? If there are no sounds, what might this indicate? If the sounds are hyperactive, what might this indicate?
2. Why do you assess for bruits and what may be causing this?
3. Which sounds are normally heard during percussion of the abdomen? When would these findings be abnormal?
4. When assessing pupillary response, what nerves are you assessing and what do these nerves control?
5. List five reasons for a non-reactive pupil?

Clinical Assignment

You are caring for a 68-year-old male who has been hospitalized for extreme constipation. He is having bowel movements now, but he has had a poor diet that contributed to his constipation problems. His wife died 9 months ago. He eats mostly canned soups and processed lunch meats on white bread because he does not cook much. He sometimes gets fast food, such as hamburgers or fried chicken. He likes meat but does not eat vegetables or fruits. He tells you they go bad before he can eat them all, so they are a waste of money. He mostly drinks soft drinks throughout the day.

Critical Thinking Questions:

• How will you determine the effectiveness of the current treatment for constipation?
• What nutritional concerns do you have for this patient?
• How will you help him manage this issue?
• How will you help this patient prevent rehospitalization for constipation in the future?

As a health policy analyst for the governor of one of the states that did not expand Medicaid under the Affordable Care Act (ACA), you have been tasked with exploring whether now is a good time for your state to make a policy change. The governor has heard about the impact the Medicaid expansion has had in other states. Many of the uninsured in those states have been brought into coverage. Since the federal government is bearing the majority of the cost of the expansion, this change seems like a no-brainer. In fact, your boss read an article about a candidate for governor in Georgia who asked an audience on the campaign trail “Raise your hand if you would say no to someone who said, ‘Give me a dollar and I’ll give you $9 back’” (Goodnough, 2018, para. 3). Further, this is estimated to be costing states between $6 and $8 million per year. Your boss finds these arguments compelling, needs you to investigate the expansion option further, and has requested input before she makes her decision and a possible recommendation to the legislature. Do some research on the states that have not expanded Medicaid. Pick one to focus on and prepare a proposal for the governor that addresses the following questions:

1. What does the ACA say about the Medicaid expansion in states and how it needs to work? Who and what will the expansion cover?
2. From the experience of states that have expanded, what are the pros and cons of expansion? What are the relevant political, social, and economic concerns?
3. What’s the situation in the state you picked? Why has it not already expanded?
4. What are the political, social, and economic issues for your state that the governor needs to consider? Who will be covered? How much will it cost? Is the legislature likely to go along?
5. What is your recommendation to the governor? Is expansion in your selected state feasible or not?

Cody Roberts: DOB 2/1/80, Male, 6’0”, 190 lbs, BMI 25.8, Active, Non-Smoker, Non-Vegetarian

Food Journal

• Milk, Low Fat, 1%, 8 fl. oz
• Soymilk (All Flavors), Non Fat, with Added Calcium, Vitamins A and D, 8 oz
• Sardines, Atlantic, with Bones, Canned in Oil, 5 items
• Oil, Cod Liver, 1 tbsp
• Egg, Yolk, Raw, 1 item
• GENERAL MILLS TOTAL Raisin Bran Cereal, 1 cup
• TROPICANA PURE PREMIUM 100%Juice, Orange w/ Calcium & Vitamin D, 8 fl oz

iProfile Report(s) Used

• Single Nutrient: Vitamin D (mcg)

Question

• What is the biggest contributor of vitamin D for most humans?
• Look over your Single Nutrient report and share which food contains the most Vitamin D, how much it contains, and whether it is a naturally occurring or fortified source of the vitamin.
• Why do you think vitamin D deficiency in children and the risk of rickets may be on the rise? Explain your answer referencing what you learned from the Single Nutrient report as well as other ways children could get vitamin D.

At 80, Meena had been in a nursing home for 2 years after a stroke, when her health declined, and she was no longer able to communicate her wishes. Meena's physician, Dr. Torres, told her family she was dying. She said that medical tests, physical therapy, and intravenous treatments were no longer really needed and should be stopped because they might be causing Meena discomfort.
Dr. Torres also said that checking vital signs (pulse, blood pressure, temperature, and breathing rate) was interrupting her rest and would no longer be done regularly.

1. From the above situation, develop a nursing care plan (NCP) designed to maintain the patient’s dignity
and achieve a peaceful death.

Then, Meena developed pneumonia. Her family asked about moving her to the hospital. Dr. Torres explained that Meena could get the same care in the familiar surroundings of her nursing home. Besides, the doctor said, a move could disturb and confuse her. The family agreed to leave Meena in the nursing home, and she died 2 days later surrounded by those close to her.

1,Identify nursing priorities/standards of care for these interventions

Central Line/Dressing Standards of Care:

Nursing Standards of Care:         

Rationale:

2, Identify nursing priorities/standards of care for these interventions

Insert Urinary Catheter/Standards of Care:

Nursing Standards of Care:         

Rationale

1. Develop a concept map that highlights concepts of the age-related changes of the organ systems.

2. Identify age-related changes that you see in an individual (family member or client/patient) and describe the impact these changes have had on the individual.

3. Develop a teaching module on health promotion through the life span in order to encourage healthy aging.

4. Discuss the various physiological changes of aging to which smoking contributes.

Choose a research article from a nursing/nutritional journal that explores the issue of strategies to improve health related outcomes regarding obesity/malnutrition in our society today. Below are a few suggestions you might consider.

This can include:

1. What are barriers to a healthy nutritional status?

2. Rates of obesity/malnutrition in Virginia.

3. Why do people have difficulty in maintaining a healthy lifestyle?

4. What impact can nurses have effecting changes in the health care system?

5. Does preventive care make a difference?

.

Induction of Labor Secondary to Postdates

WHAT ARE THE:

Alterations in Health (Diagnosis):

Pathophysiology Related to Client Problem:

Health Promotion and Disease Prevention:

Risk Factors:

Expected Findings:

Laboratory Tests:

Diagnostic Procedures:

Nursing Care:

Therapeutic Procedures:

Medications:

Client Education:

Interprofessional Care:

Safety Considerations:

Complications: