You are making an IV infusion that is to have a final concentration of 0.5 mg/mL. You are making 1000 mL of the total solution and the vial of medication is a concentration of 25 mg/mL. How many mL of the medication should you place into the IV fluid?

Julie is 45 year old mother and lives on a cropping farm, run as a family business, with her husband and his brother. Julie has three children same, aged 14; Katie, aged 12 and James aged 8.The two older children attend boarding school and return home for holidays. James is at home and attends the local primary school 50 km away.
Both Julie's boys have type 1 diabetes that she manages.
Julie has lived with her diabetes for 37 years and has many comorbidities due her both her diabetes and celiac disease. which she developed as a teenager. Julie has stage 3 chronic kidney disease, poor eyesight and osteoporosis. She is currently tryinģ to give up smoking after having smoked since of 16.
Julie currently sees her endocrinologist in large metropolitan hospital every three-month at outpatient clinic. It take her five hours to drive by car to the appointment in the city a journey that she takes with her husband. Her nephrologist is based at the regional hospital about 2 hours drive from home.Julie engages with a diabetes educator via phone and face to face monthly . The local hospital is 50 km away and is small, rural hospital. with a locum doctor and regular nursing staff, who cover the acute inpatient ward, and community registered nurse. She attends a community chronic diseases self management program at the local church hall run by the community registered nurse once a week in town and does her weekly groceries. Julie has expressed to the diabetes educator that she need more assistance with managing her own condition. She is concerned that her son who have type 1 diabetes, may end up with the same comorbidities as her because she has an autoimmune chronic condition

Question

Collaboration between interdisciplinary team members is a dynamic process reliant on effective communication and shared-decision making. Students must recognise and understand that individuals with chronic and complex conditions require interdisciplinary management to ensure quality patient outcomes.

1.Using the case study provided , you are required to verbally execute a clinical handover to a relevant interdisciplinary health professional using the ISBAR (Identify, Situation, Background, Assessment and Recommendations) format.

2.You are required to provide written rationale for your chosen interdisciplinary healthcare professional. This rationale must demonstrate your understanding of the importance of collaborative care in relation to the patient.

legal clarification in impossible dilemma for nurse working in hospital

John Miller, a 65-year-old male, arrives at the clinic complaining of his shoes not fitting and feeling like he cannot take a deep breath. During the patient interview, he also states that he is having intermittent pain in his chest. He is taking glyburide 2.5 mg daily, captopril 25 mg twice a day, and HCTZ 25 mg daily. He has not taken the HCTZ for 2 weeks and is hoping to get this medication refilled. The physician wants to evaluate his congestive heart failure. He orders an ECG and a stress echocardiogram. The patient has not previously had a stress echocardiogram and you need to explain it to him before the test begins.

Discussion Questions:

1. Explain to John the difference between an ECG and an echocardiogram.
2. John expresses concern about having a heart attack during the procedure. How can you alleviate his fear?
3. You must perform an ECG on this patient. Describe the steps in the procedure.

1. What is an ointment base?

2. What is an ointment?

3. What is the name of a commercial product (made by Cheesebrough-Pond's) consisting of white petrolatum?

1. Have I had personal experiences with health inequities or social injustices such as oppression? Have these inequities or social injustices influenced my well-being or the well-being of a close friend or loved one? How did the experiences make me feel? How did I deal with that situation?

2. Do I see health inequities and social injustices in my daily nursing practice? For example, do I see the oppression of vulnerable groups?

3. Are the human rights of my patients/clients being compromised or violated?

4. When I consider a practice situation in which I was concerned about the health inequities experienced by a patient/client related to their basic human rights, what did I think? What did I believe? How did I act? What might that situation have been like for the individual, family or group I was working with?

5. Do my colleagues and I talk about our experiences of health inequities or social injustices? How might our understanding of health inequities and social justice influence our nursing practice in the future?

1. Social justice is important for every nurse to consider in their daily nursing practice. Do I agree with that statement? What does it mean to my current nursing practice?

2. Do I know how I might further incorporate knowledge of the social determinants of health into my everyday practice?

3. When I think about making practice changes based on my new understanding of the social determinants of health, I feel...

4. When I tried to apply knowledge in social determinants not known among my colleagues, was it challenging for me? What did I think at the time? Did I feel supported by colleagues? Did applying the new knowledge improve my patient’s outcome?

5. How has my practice approach been framed thus far? Do I need to shift my approach on the basis of what I have learned about the social determinants of health? Will reframing questions in my practice approach radically change my practice? (if, for example, I began asking “What broader social, economic, political conditions are making it more or less likely for this person (or group) to smoke or live a sedentary lifestyle?” instead of “Why is this person (or group) engaging in unhealthy behaviours such as smoking or living a sedentary lifestyle?”).

6. When I reflect on where I see myself on the continuum of action, what barriers and supports influence my ability to take action? How does interprofessional and cross-sectoral collaboration factor into this ability?

Ms. Glessner is a 35-year-old executive secretary. She has been divorced for 3 years and has two sons, 11 and 13 years of age. She is brought into the emergency department (ED) by her neighbor. She has some slashes on her wrists and is bleeding. The neighbor states that both of Ms. Glessner’s sons are visiting their father for the summer. Ms. Glessner has become more despondent since terminating a 2-year relationship with a married man 4 weeks previously. According to the neighbor, for 3 years after her divorce, Ms. Glessner talked constantly about not being pretty or good enough and doubted that anyone could really love her. The neighbor states that Ms. Glessner has been withdrawn for at least 3 years. After the relationship with her boyfriend ended, she became even more withdrawn and sullen. Ms. Glessner is about 20 pounds overweight, and her neighbor states that Ms. Glessner often stays awake late into the night, drinking by herself and watching television. She sleeps through most of the day on the weekends.

After receiving treatment in the ED, Ms. Glessner is seen by a psychiatrist. The initial diagnosis is dysthymic disorder with suicidal ideation. A decision is made to hospitalize her briefly for suicide observation and evaluation for appropriate treatment.

The nurse, Ms. Ward, admits Ms. Glessner to the unit from the ED.

Nurse: Hello, Ms. Glessner, I’m Marcia Ward. I will be your primary nurse.

Ms. Glessner: Yeah… I don’t need a nurse, a doctor, or anyone else. I just want to get away from this pain.

Nurse: You want to get away from your pain?

Ms. Glessner: I just said that, didn’t I? Oh, what’s the use? No one understands.

Nurse: I would like to understand, Ms. Glessner.

Ms. Glessner: Look at me. I’m fat, ugly, and no good to anyone. No one wants me.

Nurse: Who doesn’t want you?

Ms. Glessner: My husband didn’t want me, and now Jerry left me to go back to his wife.

Nurse: You think because Jerry went back to his wife that no one else could care for you?

Ms. Glessner: Well… he doesn’t anyway.

Nurse: Because he doesn’t care, you believe that no one else cares about you?

Ms. Glessner: Yes.

Nurse: Who do you care about?

Ms. Glessner: No one… except my sons… I do love my sons, even though I don’t often show it.

Nurse: Tell me more about your sons.

Ms. Ward continues to speak with Ms. Glessner. Ms. Glessner talks about her sons with apparent affection; however, she continues to state that she does not think of herself as worthwhile.

1. Assessment: What does the case study reveal about the client?
2. What is the Objective Data?
3. What is the Subjective Data?
4. Concentrate on two initial nursing diagnoses that seem to have the highest priority.

1. There are about 10 stages in the Life Cycle Management of Medical Device. Can you name 4 points and briefly explain each point?

2. The management of medical equipment is a risk-based management program. Please start with the manufacturer’s design to meet intended use, risk assessment, acceptance testing, use, maintenance to the stages of post-market surveillance, and reporting to equipment condemnation. Briefly describe the features of the safety management mechanism at each stage.

Question 5: You are caring for a new mother with her newborn. She is of Hispanic descent. Please discuss what transcultural nursing care is. Discuss the difference between cultural competence, awareness and diversity when providing nursing care to this mother. Please do not just copy definitions.

1. Compare and contrast the social organization of Songhai and the Mali empire. You answer should include a description of the social structures of each civilization and where they overlapped or not

• The roles different people played in society
• General social relations
• The effects the social organization had on the political structure of each of the two empires

Medication Assisted Therapy (MAT) Case Presentation

A 21-year-old Caucasian male presents to the outpatient detoxification and rehabilitation facility, for opioid detoxification. For the past two weeks, this patient has being using 15 bags of heroin intravenously. According to the patient, the main reason for his seeking medical attention is to avoid going to jail. The patient has a history of law violations and has been monitored by a probation officer once a week. The probation officer worked with the patient and his family to arrange the probation treatment program instead of jail. The patient voluntarily agreed to be evaluated for admission to the outpatient treatment facility.

History

Mr. W is a 21-year-old single male who was referred for treatment by his probation officer. Mr. W is currently unemployed, and lives with his friends in a different location each day because his relationship with his family deteriorated due to addiction, he is no longer welcomed in the family house. According to Mr. W, he is not homeless “I always find a place to crash for a night”. Mr. W states that he has been using marijuana from age 15 but it is not his drug of choice any longer. He was introduced to heroin by his best friend about five year’s age during very stressful times in his undergraduate school. He states that his parents and two sisters are aware of his addiction problems and do not support him at all. However, his grandmother understands him more than anyone, and supports him financially in order to prevent him from stealing. Mr. W states that “If you do not admit me today, I will go and get high, and I do not care what happens to me after.”

History of present illness

Mr. W presents for opioid detoxification and rehabilitation. He has no past medical history or any hospitalizations for medical conditions. However, he states that he was found unconscious by his mother in August 2016, and was hospitalized at Hospital due to a heroin overdose. He left the hospital against medical advice after two days of admission. He denies any history of head injury, trauma, asthma, hypertension, diabetes mellitus, or seizures. He is not on any prescribed medications. In addition, he denies any history of food, drug or latex allergies. Mr. W also denies any surgical history.

Psychiatric history

Mr. reports that he has struggled with severe anxiety and mild depression from an early adolescent age. He stated that he cannot remember the time when he was free of anxiety without using some kind of drugs. According to the patient, he was never hospitalized for anxiety or depression. However, he states that he did have suicidal ideations in the past, but not suicidal attempts. He denies any history of self-inflicted cuts or injuries. He has been prescribed benzodiazepine (Xanax) a medication for anxiety and seroquel, antipsychotic (an atypical type for depression, but stopped taking both medications two years ago. “I am not crazy and don’t want to be hooked on it.” Currently he is not under either a psychologist’s or psychiatrist’s care and does not take any psychiatric medication.

Review of systems

Mr. W reports that he was not feeling well, because he took his last bag of heroin at five in the morning. He denied recent visual changes, eye pain, discharge or inflammation. Denies a history of shortness of breath, wheezing, chest pain, or chest palpitations or arrhythmia. Mr. W states that he is very nauseous and had diarrhea in the morning, but denies abdominal pain. Mr. W is very restless, states that he has pain in his back, rated five out of 10 and just feels uncomfortable sitting in the chair although he denies a history of joint disease. Denies skin rash, moles, or changes in skin pigmentation. Denies any urinary incontinence, urgency or frequency. However, he states that his appetite has decreased during the past year and has been constipated for the past week. Denies use of any over-the-counter medications for his constipation.

Physical Assessment

Well-developed and nourished, slightly disheveled White male. Patient is alert and oriented to person, place, time and situation. Easily irritable, angry and very talkative. Vital signs are: BP 130/88 (left arm, sitting position) HR 104 RR 22 Temp. 98.8 Fahrenheit. Normocephalic, atraumatic, short hair and symmetric flushed face. Eyes: pupils are constricted bilateral, round, reactive to light and accommodation, sclera is red and teary. Ears with normal ear canal and tympanic membrane. Runny nose no erythema of nostrils and normal septum. Dry oral mucous membranes, poor dentations, and missing back tooth. Neck supple with midline trachea and no lymphadenopathy or jugular vein distention. Heart rate is regular but mild tachycardia (104), no murmurs, rubs or gallops, bilateral dorsalis pedis pulses 2+. Anterior and posterior lungs sounds are clear to auscultation bilateral, no wheezing, crackles or rhonchi. Bilateral upper extremities with multiple tattoos and fresh needle track marks in the antecubital area and popliteal space in the lower extremities. Bilateral hand tremors with extended arms, no edema noted on upper or lower extremities. Bilateral feet with dry, cracking and peeling skin, patient states that it is very itch at times. Bilateral toenails and fingernails with in normal limits, no cyanosis or clubbing of nails noted. In general, Mr. W is able to make his needs clear, however his speech is very rapid, and his pupils are constricted/pinpoint (1 mm).

Assignment

1. What diagnostic tests would you order? Provide rationale.

2. What diagnosis will you give this patient? Differentials?

3. Assuming MAT with Suboxone to be the treatment modality, describe the sequence of treatment for this patient.

4. What are the concerns with initiating Suboxone treatment for this patient?

5. How will you address his psychiatric care along with the MAT? What medications might you consider for any psychiatric conditions? Provide rationale.

What complementary and alternative approaches to health have you tried? What influenced your decision to use those approaches?

Question 1 (5 marks, 1 each)

Therapeutic communication includes five levels: interpersonal communication, transpersonal communication, small-group communication, intrapersonal communication and public communication.

Define these levels.

Question 2 (5 marks, 0.5 each)

The HCP might employ different techniques to establish a relationship with the patient. The selection of the technique depends heavily on the purpose of collaboration and the ability of the patient to communicate verbally. Therapeutic communication helps patients to trust and relax, while non-therapeutic communication causes patients to feel uncomfortable and untrusting and builds walls barring communication between caregiver and patient.

Classify the following techniques into therapeutic or non-therapeutic communication techniques.

• Paraphrasing.

•Asking personal questions.

• Giving personal opinions.

• Providing information.

• Focusing.

• Asking relevant questions.

• Defensive responses.

• Self disclosing.

• Passive or aggressive responses.

• Arguing.

Question 3 (5 marks, 1 each)

Alberto Mendez, a 46 year old man with a family history of heart disease, has shown up 30 minutes late for a routine physical examination. Mr. Mendez does not speak English, but he has brought his 15 year old daughter with him to serve as interpreter. After his arrival in the office and before his being shown into the examination room, the front desk receptionist explains to you that he is late because his car was rear-ended by another car. When you walk to the examination room to interview and prepare Mr. Mendez for his visit with his physician, you sense immediately that he is upset. Your responsibilities are to take his signs, pulse, temperature, blood pressure, respiratory rate.

Based on this scenario, discuss five factors that may act as barriers and impair the communication process.

Question 5 (5 marks, 1 each)

Describe the interpersonal skills that are essential for successful healthcare professional.

How can you improve patient outcomes with evidence-based practice?. Describe at least one situation in which you applied evidence-based nursing practice. Identify how and where you found the evidence-based guidelines. Explain how your behavior in the situation is different than it would have been without your additional education from this RN to BSN program