Case Study

Michael O’Malley, age 49, lives in Staten Island, New York, with his wife, Sharon. He has been a New York City police office for 25 years. The O’Malleys have two sons, 20 and 16 years of age, and a daughter, 18 years of age. Mr. O’Malley has always taken pride in the fact that he is athletic, working out 3 days a week at the gym and playing softball in the police league. Overall, Mr. O’Malley is physically fit. However, despite his exercise routine, he continues to smoke two packs of cigarettes a day and drinks several beers on the weekends when he is off duty. He weighs 220 pounds, is 72 inches tall, and has a BMI of 29.8. Mr. O’Malley thrives while working the midnight shift; in fact, he prefers it. For many years while his children were small, working the night shift made it possible for him to attend school plays, baseball games, and other activities in which his children were involved. He adapted to working this shift, and even now, when his children are nearly grown, he continues to work the midnight shift. He typically relies on fast food for lunch during his work hours.

His wife, a nurse at a hospital near their home, works on the orthopedic unit. She enjoys her work and often works extra shifts to help defray the costs of college for their oldest son. Mr. O’Malley also frequently works overtime, leaving very little time for the two of them as a couple. As an officer with the NYPD, Mr. O’Malley was an emergency responder to the World Trade Center on September 11, 2001. He quickly sprinted up several floors of the north tower before being called to evacuate because the south tower had collapsed. He developed a chronic cough from dust exposure during the collapse, but over the course of several years, the cough dissipated. Happy to be alive when many of his fellow officers had perished, he did not complain about his cough and never sought medical treatment.

Mr. O’Malley is called to the scene of a domestic dispute. On arrival at the scene, he notices that the wife had several fresh bruises to her face and what appear to be fingerprints around her neck.She states that her husband has just left but said he would be back.Out of the corner of his eye, Mr. O’Malley notices an adult male running from the scene, and he gives chase. He runs after the subject for several blocks, finally catching up to him in a dead-end alley. Although trapped, the man fights with Mr. O’Malley, who has called for backup. After several minutes of intense wrestling, Mr. O’Malley finally succeeds in restraining the subject just as backup arrives.

About 30 minutes later, while filling out paperwork, Mr. O’Malley begins to feel a fullness in his chest, followed by pressure and tightness. He gets dizzy, stands up, and falls to the ground. Another officer present in the office feels for a pulse, but there is none. CPR is started, and when the paramedics arrive, Mr. O’Malley is defibrillated, and sinus rhythm is restored. He is taken to the emergency department and then the cardiac catheterization lab. A stent is placed in his left anterior descending artery. A pulmonary artery catheter is placed, after which the cardiac output is 3.5 and the cardiac index is 1.5. An intra-aortic balloon pump is placed, and milrinone, a phosphodiesterase 3 inhibitor used to treat HF, is started.

Over the course of the next several days, Mr. O’Malley’s condition stabilizes. The balloon pump is weaned and removed. An echocardiogram reveals an EF of 25%, and lisinopril, which is an ACE inhibitor, and carvedilol, which is a beta blocker, are started. Mr. O’Malley is eventually weaned off the milrinone. His EF remains low, less than 30%. An implantable cardioverter-defibrillator is placed for primary prevention of sudden cardiac death. Mr. O’Malley is discharged home after 7 days.

Mr. O’Malley elects to retire on medical disability from his job, which has been his identity for many years. At first, many of his fellow officers come by frequently to visit, but after a few months, the visits become few and far between. Mr. O’Malley stops smoking and no longer drinks alcohol on weekends. He attends a cardiac rehabilitation program for 3 months and then begins a self-directed exercise program. He learns his medications and monitors his weight, blood pressure, and pulse rate. Mrs. O’Malley continues to work full time and continues to pick up extra shifts, since Mr. O’Malley’s retirement and disability benefits do not cover the loss of his salary. Mr. O’Malley soon begins to experience depression and isolation, and after not smoking for several months, he begins smoking again. He gradually stops exercising and begins to gain weight.

A year later, Mr. O’Malley notices that his pants are getting tighter and tighter and his shoes no longer fit as well as they did. He complains to his wife that he has no energy and wonders whether he is coming down with a cold or the flu. Then he begins to wake up in the middle of the night gasping for breath. He develops lower extremity edema and progressively more fatigue. He goes to see his cardiologist, who performs an echocardiogram.

Mr. O’Malley’s EF is now 15%. Mr. O’Malley is admitted to the hospital for diuresis and medication titration. A pulmonary artery catheter is inserted. His pulmonary artery pressures are elevated, and his CO is decreased. He is again placed on milrinone, and aggressive diuresis is begun.

Mrs. O’Malley is worried. She requests family medical leave from her employer and calls their oldest son home from college. She spends a lot of time at the hospital and feels a sense of impending doom about the future, with good reason. The reports from Mr. O’Malley’s doctors are not good, and every day seems to bring another obstacle to be overcome. Mr. O’Malley suffers some kidney failure following diuresis. His milrinone is increased, and his renal function stabilizes. Once his fluid status has improved, attempts to wean the balloon pump are unsuccessful. The injury to his lungs suffered during the September 11 attacks is now apparent, and a pulmonary workup is performed. Ultimately, it is decided that he requires placement of a left ventricular assist device (LVAD).

The LVAD surgery is successful, and Mr. O’Malley recuperates quickly. Still unable to work, he begins to cook and help more with the housework. He volunteers at the local library, reading to preschool-age children. He suffers a few complications related to the LVAD, including a driveline infection. He has regular visits with the LVAD team, and things are going well for a change. After 6 months, his care team decides that Mr. O’Malley is now a candidate for heart transplantation. His pulmonary function has improved, and he has stopped smoking. He is listed for a donor heart and receives his transplant 2 months later.

Answer the following questions in 2-3 sentences.

1. What was the initial cardiac injury that Mr. O’Malley suffered?

2. What are three habits that Mr. O’Malley has that can negatively affect his heart?

3. What type of HF is Mr. O’Malley experiencing, and what can cause it?

4. What are some of the factors that may have caused Mr. O’Malley to experience systolic HF?

5. Mr. O’Malley was started on a medication regimen and had what surgical intervention to prevent sudden cardiac death?

6. What are a few self-care activities that Mr. O’Malley did to decrease exacerbations?

7. What is one complication that Mr. O’Malley faced after receiving the LVAD?

8. What two events occurred that allowed Mr. O’Malley to be placed on a donor list for a heart transplant?

• Current hospital practice after the birth of a child is to place it with the mother and/or father for a reasonable amount of time. But it wasn't always that way. For a while, babies were whisked away moments after birth and put in the incubator room where they could be kept "safe" and monitored. This unfortunately affected maternal bonding with infants and decreased maternal commitment to the infant's care in some cases. Use principles of evolutionary psychology to explain why this might be predicted. (Hint: consider parallels with male vs female post-natal investment in children)       

• Menopause seems like it violates evolutionary theory. If we are supposed to maximize reproduction, how would cutting off the ability to reproduce accomplish that? Use the concept of inclusive fitness as a way out of that apparent paradox. Why would menopause become more likely the older a woman becomes (assuming reproductive life histories that would have been the norm over most of human evolutionary history)?  

• In many species, males have excess reproductive capacity relative to females (if we consider investment per offspring by each sex). Competition between males for access to female reproduction is often given as a reason why the males of many species also tend to be bigger (or more colourful, or more ornate singers) than females. So what's up with phalaropes? Explain in terms of evolutionary principles.

• Milly, Molly, and Mandy are identical triplets in their 60s who experienced complicated births and had neurological problems shortly afterward. One of them underwent surgery that severed her corpus callosum. Another had a hemispherectomy; one side of her cortex was removed. The third recovered without treatment. They would like to know who had what operation, but their mother refuses to tell them and the hospital records have been lost. They have heard that you know something about psychology, but all you have is the ability to perform some basic tests and to use a simple EEG unit from your meditation practice (sensors on the forehead and just behind the ears). Devise some tests to figure out who had what procedure.  

• You recently had your corpus callosum severed in an attempt to control epilepsy (sorry). If I show an image of a parrot in your left visual field, how might you be able to respond in a way that would show that you recognize it as a clarinet? How would you likely not be able to respond? How might it be different if I showed an image of a pen? Explain. How might it be different if you had the operation when you were 2 years old? Explain.  

What is the Epidemiology of Hep A?

What is the treatment, control, and prevention for Hep A?

Medication templates, epinephrine, expected pharmacological action, therapeutic use, complications, medication administration, contraindications,nursing interventions, interaction, client education, and evaluation of medication effectiveness

A five-year-old male patient was admitted to the hospital with a severe acute infection of the ethmoid sinuses. The patient has had a history of sinus infections. At three years of age, the patient had been diagnosed with a pneumonia infection, but did not have an increased level of white blood cells. Presently, the patient was treated with antibiotics and his antibodies against streptolysin O, an antigen from streptococci, were measured. The patient had no antibodies against SLO, and his IgG levels were low, IgA were undetectable, and his IgM levels were elevated. A biopsy was done of a lymph node and no secondary follicles or germinal centers were found. The patient was given a DPT vaccination, and no antibodies against the tetanus toxoid were generated as a result. When the patient’s cells were analyzed by flow cytometry, his CD19+ B cells stained positive for surface IgM and IgD, but not IgA or IgG. His T cells were isolated and stimulated in the lab with phorbol ester and ionomycin, but they did not bind CD40. There was no family history of susceptibility to infection. What deficiency does this patient suffer from?

Self Care:

What does self-care mean to you? What do you do for self-care? What do you think you could do better? How do boundaries play a part in self-care?

For this task, you are to write a report about a time you have provided individualized support to a client in the community services industry. If you have not provided individualized support for a client in the community services industry, please complete this in conjunction with your observation task. Your report must include details on the following: a. How you provided support services for the client, including: i. What you did to prepare for the support activities, include information regarding assembling and required equipment ii. How you developed and maintained trust with the client iii. What methods you used to show respect to all involved throughout the process iv. If you sought any assistance throughout delivering the support

Lack of places to sit and relax has been a problem in Ibri College of Technology for many students. They find it difficult to choose a place in their breaks where they can sit after a class or while waiting for their next class. Write a recommendation report to Dr Hamdan Al Manthari based on the problem given. Your report should have a heading, introduction, discussion of recommendations and a conclusion. Give your report a title.

(Nutrition/Diet).We live in an environment where it is easy to consume too many unhealthy Kcals while being sedentary. What specific, practical, simple strategies for managing this obesogenic environment could one suggest to clients?

1. What is Myasthenia Gravis?

2.What body parts does Myasthenia Gravis affect most?

3. What neurotransmitter is blocked and how?

4. Describe the symptoms of Myasthenia Gravis

5. What is the treatment for Myasthenia Gravis?

6. Describe the nurse interventions for Myasthenia Gravis1. What is Myasthenia Gravis?

2.What body parts does Myasthenia Gravis affect most?

3. What neurotransmitter is blocked and how?

4. Describe the symptoms of Myasthenia Gravis

5. What is the treatment for Myasthenia Gravis?

6. Describe the nurse interventions for Myasthenia Gravis