Part 1.
Write a Reflection Paper about "Fluid Imbalances".

Part 2.
Make plan of care or interventions to address the following possible nursing diagnoses associated with AKI and ESRD.

a. Fluid volume excess
b. Decreased cardiac output
c. Impaired tissue integrity: renal

Test 1.
Direction: Choose the correct answer and give the rationale.

1. The purpose of research question is to generate new knowledge, while the purpose of EBP questions is to make decision about patient care.
a. True
b. False
c. Maybe
RATIONALE: _________________________________________________

2. Evidence-based practice includes which of the following?
a. Best available evidence
b. Individual clinical experience
c. Patient values
d. All of the above
RATIONALE: _________________________________________________

3. What is the first step in applying EBP concepts to answer a clinical question?
a. Ask the question
b. Acquire the evidence
c. Appraise the evidence
d. Assess the whole process
RATIONALE: _________________________________________________

4. Evidence-based practice can be said to be a quality improvement process because?
a. You have critically analyzed many research articles
b. You have learned how to skim read many research articles
c Trial and error is still important in clinical practice
d. Evidence-based practice is a key factor contributing to accountability and benchmarking

RATIONALE: _________________________________________________

5. Evidence-based nurses ask whether there is a scientific basis for the care they deliver in order to:
a. Make certain they can evaluate findings correctly
b. Convince their colleague to change practice
c Change their practice regularly
d. Provide the most effective care for their patients.

RATIONALE: _________________________________________________

L-Phynelalanine

Case Scenario:

Ruba is a 39 years old, pregnant woman at 8 weeks gestation, and her husband, Ali, is 50 years old, arrives at antenatal clinic for follow-up. The couples have been married for 12 years. Ruba completes the initial paperwork, and the nurse notes the following obstetric history: G6 T0 P0 A5 L0 M0. Ruba and Ali asked the nurse many questions regarding Down syndrome as Ali’s sister, recently, has a boy with Down syndrome.

Q1: As Ruba has many questions regarding her pregnancy, including the physiological and psychological changes, labor process and postpartum period. The nurse advice Ruba and Ali to attend antenatal classes. List six topics should be covered in the childbirth preparation program that may help to answer Ruba’s inquiries.

Q2: After 7 months, Ruba is approximately 37 weeks gestation. She comes for antenatal follow-up visit complaining of backache, leg cramps, heartburn, constipation, and difficulty sleeping at night. Describe three nursing management for each Ruba’s complain (minor discomfort).   

A. Backache :

B. Leg cramps :

C. Heartburn:

D. Constipation:

E. Difficulty sleeping at night      

Which physiologic actions result from normal insulin secretion? Select all that apply.
A. Increased liver storage of glucose as glycogen

B. Increased gluconeogenesis

C. Increased cellular uptake of blood glucose

D. Increased breakdown of lipids (fats) for fuel

E. Increased production and release of epinephrine

F. Decreased storage of free fatty acids in fat cells

G. Decreased blood glucose levels

H. Decreased blood cholesterol levels

A woman from rural area reported to the local hospital with high fever (102^oF), light sensitivity, joint pain, and muscle pain. Her examination showed mild jaundice, and pain in the right upper quadrant of the abdomen. She also had swollen cervical lymph nodes, on both sides of her neck. Her physical revealed temperature of 102.4^oF, pulse of 90 beats/min, respiratory rate of 26/min, and BP of 110/70 mm Hg. Laboratory findings gave erythrocytes a little low, leukocytes normal, platelets low, alkaline phosphatase high, aspartate aminotransferase high, and alanine aminotransferase high. Dermatologic examination showed no rashes, petechiae, or ulcerations. She was not around any rodent manifestations.

What etiologic agent could cause this?

Case Study: Bill is 4 years old, and his mother is worried about his eating habits. He absolutely refuses to eat vegetables, meat, and most meals in general. Some days he eats very little food. He wants to eat snacks most of the time. But, his mother wants him to eat a sit-down lunch and dinner to make sure he gets all the nutrients he needs. Bill likes to eat breakfast cereal, fruit, and cheese and regularly requests these foods for snacks. However, his mother tries to deny his requests, so that he will have an appetite for dinner. Instead, he drinks 5 or 6 glass of whole milk throughout the day because it tastes good and keeps his tummy from growling.

Mealtime is a battle because Bill says he isn’t hungry, but his mother wants him to eat everything served on his plate. When his mother prepares dinner, she makes plenty of vegetables, boiling them until they are soft, hoping this will appeal to Bill. She serves casseroles and stews regularly because they are convenient. Bill’s dad waits to eat his vegetables last, regularly telling the family that he eats them only because he has to. He also regularly complains about how dinner has been prepared.
Bill saves his vegetables until last and usually gags when his mother orders him to eat them. Bill has been known to sit at the dinner table for an hour until the war of wills ends.

At preschool, Bill is often fidgety, and has difficulty remaining in his seat. The teacher finds he will not stay focused on any tasks like his classmates do. Bill’s mother asks you what she should do.

Step 2: Write an Initial Post

Create a new thread and write/submit an initial posting using facts from your book. The original post should be focused on one topic (if there are multiple examples, limit your discussion to 1-2 examples that you explain in more detail with facts from the book). Please do NOT answer every question in one post. The reason I do not want every question answered is because it either becomes too long, or it lacks depth of understanding (listing instead of explaining). It also makes it less conversational and doesn't leave as much for others to talk about. The idea behind this discussion is that collectively as a class you will answer all of the questions thoroughly using the book to back it up. If you talk about everything in one post, what will others have to say in the reply? So, I want you to show depth in your answer, but keep it focused on one idea. Provide details and/or examples in your explanations.

• What mistakes might Bill’s parents be making that contributes to Bill’s poor eating habits. (limit to 1-2 mistakes, explained in depth using facts from the book)
• What nutrient deficiency might Bill be exhibiting and how do you know based on his behavior symptoms and food intakes?
• How might Bill's/his parents’ current behaviors lead to obesity?
• How might eating breakfast be helpful to Bill?
• What strategies might Bill’s parents try to promote good eating habits for Bill? (limit to 1-2 strategies that are explained in depth with examples - foods/solutions to the food related problems)

nothing is missing .

Anna is a 45-year-old female that presented to her physician’s office for her annual check-up. Anna has a history of diabetes, obesity, and noncompliance with diet and medications to control her diabetes. She a single mother of three teenagers and smokes regularly. During the history review, Anna shares with you that she has not been feeling like herself for the past six months, she has been unusually tired and thought that she felt a lump in her right breast during a self-breast around that same time. She stated, “I am very busy with my children; I haven’t had time to get it checked out.” She has recently been experiencing right nipple pain. Anna has a positive family history of breast cancer; both her mother and grandmother have been treated for breast cancer. Anna has never had a mammogram. During the breast , the practitioner palpated a lump in Anna’s right breast. No discharge from the nipple was observed. Anna’s right breast was tender upon palpation. No abnormalities were found in the left breast. Based on the physical findings Anna will undergo a diagnostic mammogram.

Instructions

In a 2-page paper, describe the care that Anna would require and address the questions below.

1. What risk factors does Anna have that could predispose her to the development of cancer?
2. What signs and symptoms could indicate that Anna has developed cancer?
3. Based on Anna’s risk factors and presenting problems, identify three care strategies that you would use to provide quality care to Anna. Provide rationale to explain why you chose these strategies.
4. 2 pages please no less

Draw three-dimensional representations of the following amino acids. Explain their
structures.
(a) L-phenylalanine
(b) L-histidine
(c) D-serine
(d) L-tryptophan

2. The common naturally occurring form of cysteine has a chirality center that is named (R), however;

(a) What is the relationship between (R)-cysteine and (S)-alanine?
(b) Do they have the opposite three-dimensional configuration (as the names might suggest) or the same configuration?
(c) Is (R)-cysteine a D-amino acid or an L-amino acid?

Although tryptophan contains a heterocyclic amine, it is considered a neutral amino acid.

(a) Explain why the indole nitrogen of tryptophan is more weakly basic than one of the imidazole nitrogens of histidine.