Case Study: You are working as a clinician in a clinic that serves the indigent population. Many of the patients are 50 years old and older,  and have chronic congestive heart failure ( CHF). Your manager asked you for evidence-based resources to identify strategies to reduce frequent hospital readmissions. Answer each of the following:  1. Find an evidence-based article that focuses on strategies to reduce frequent hospital readmissions among patients 50 years and older, with chronic congestive heart failure. Reference your article at the end of your initial post. On time post.  .2.  From your article, what is your PICO ( PICOT,PICOTT) question? Identify your P-I-C-O-T.

At least 250-300 words

Balancing School and Life - My Quality of Life Self-Care Plan. The purpose of developing this Plan is to set a framework and a plan to maintain wellness and to stay motivated and engaged throughout your Program. Doing this will help you achieve success during your coursework and as a professional nurse.

The goal of the Project is to help you become self-aware and reflective as a means of identifying personal self-care strategies that will increase your energy and help you manage your stress. The Project will give you a chance to learn how this is accomplished as you will be doing similar work with clients during the Program and as a professional nurse to assist them in the same way.

Use the Quality of Life Self-Care Wheel to assess your current state. After you determine your scores, in a 2-3 page paper complete the following:

• Discuss those areas that are strengths (higher scores) and those areas that need further development (lower scores).
• Identify two strategies you can use to maintain or maximize each identified strength.
• Identify two strategies you can use to strengthen each area needing development. Explain how you will put these strategies into action. Be specific. For example, instead of stating, "I need to exercise," your action should state "I will begin to walk 20 minutes a day, 3 days a week." The action should be SMART- Specific, Measurable, Attainable, Realistic, Timeframe
• Also attach your completed form
• Minimum length 2-3 pages not including cover or referencing. APA formatting

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the '.docx' extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Instructions

Read the case study details below then answer the questions.

Dave is a five-year-old sedentary male who was referred to a pediatric dietitian due to his pediatrician’s concerns with his weight gain over the past year. His parents recently divorced and both parents have equal custody. Prior to the divorce Dave was physically active and on a regular schedule of meals and snacks. Now Dave has unlimited access to snacks at both parents’ homes and his favorite pastimes include watching cartoons and playing video games with his brothers. Dave often snacks while dinner is being made and frequently drinks juice and soda. He often eats meals and sacks while watching TV with or without his mom or dad. He usually refuses to sit down and eat at the dinner table.

1. At 3 years old Dave weighed 32 pounds and was 37 inches tall. At 4 years old Dave weighed 40 pounds and was 40 inches tall. At 5 years old Dave weighed 45 pounds and was 41 inches tall. What is Dave's weight for age %, height for age %, BMI, and BMI for age % at ages 3, 4, and 5? (see http://www.cdc.gov/growthcharts/ (Links to an external site.) for growth charts; 5 Points).
2. Use one word to correctly interpret the current status of Dave’s weight according to his BMI for age percentile (1 point)?
3. Do you have any other concerns about Dave’s growth based on the data in the above table (2 points)?
4. What suggestions do you have for helping Dave’s parents decrease his risk of illness related to his weight (2 points)?
5. Calculate the energy and protein requirements for a Dave at five years old (4 points). The EER for Boys 3 through 8 years is:

• EER = 88.5 − (61.9 × age [y]) + PA × (26.7 × weight [kg] + 903 × height [m]) + 20 kcal
• PA = 1.00 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)
• PA = 1.13 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)
• PA = 1.26 if PAL is estimated to be ≥ 1.6 < 1.9 (active)
• PA = 1.42 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

6. Describe the issues surrounding Dave’s mealtime behaviors (3 points).
7. What concerns do you have about giving Dave unlimited access to snacks, juice, and soda (4 points)?
8. How can healthy eating behaviors be developed in Dave?

Discuss a contemporary challenge in healthcare and strategies you would implement to address the issue as a healthcare administrator?

explain the Benefits of electronic health records that supports quality outcomes

Mr. C., age 68 with a history of COPD, presented in the emergency department 2 days ago febrile with a productive cough of large amounts of purulent sputum and in acute respiratory failure. He was diagnosed with community-acquired pneumonia and treated with antibiotics, hydration, aggressive pulmonary hygiene, and supplemental oxygen therapy. Although his oxygenation improved, he continued to be diaphoretic, using accessory muscles of respiration and complaining, "I am exhausted" and "I can't get enough air." Arterial blood gas revealed: pH 7.31, PaCO₂ 59 mm Hg, PaO₂ 89 mm Hg, SaO₂ 91%, HCO₃ 29 mEq/L. The decision was made to intubate and place him on mechanical ventilation with the following settings: assist control (AC) mode, tidal volume (V_T) 625 mL, respiratory rate 16 breaths/min, FiO₂ 0.70, and 5 cm H₂O of positive end-expiratory pressure (PEEP). He was transferred to the critical care unit.

Two days later, his presentation at 0500 is as follows:

• Ventilator settings: Mode AC, V_T625 mL, respiratory rate 12, FiO₂35, 5 cm H2O PEEP
• Total RR 16, peak inspiratory pressure (PIP) 22 mm Hg
• Moderate amounts sputum, rhonchi that clear with coughing, chest x-ray shows clearing pneumonia
• Negative inspiratory force ­-37 cm H₂O, spontaneous tidal volume 5 mL/kg, vital capacity (VC) 10 mL/kg, minute ventilation 10 L/min, rapid shallow breathing index of 37
• Temperature 99.0° F oral, heart rate 86 beats/min, blood pressure 132/84 mm Hg
• No vasopressor or inotropic agents, urinary output is good, NPO since admission.
• Alert and oriented to person, place and situation, hypervigilant and restless, has not slept well since admission

The team decides to perform a ventilator weaning trial. At 0620 Mr. C. is placed on 10 cm H₂O of pressure support with an FiO₂ 0.40.
Assessment at 0720 is as follows:

• Heart rate 108 beats/min
• Blood pressure 157/90 mm Hg
• Respiratory rate 36 breaths/min and labored
• SpO₂90%

He is diaphoretic and alternates between picking at his gown and falling asleep and needing to be aroused to stimulate breathing. He is placed back on the ventilator at the previous settings.
Late that morning, during rounds, Mr. C. is started on nutritional support via tube feeding and given trazodone at night for sleep. He is allowed a morning nap and has physical therapy that afternoon.

The following day he passes the pre-wean screening and is again placed on PS 5 above 5 cm H₂O PEEP. Assessment findings 30 minutes into the weaning trial are as follows:

• Heart rate of 84 beats/min
• Blood pressure 120/76 mm Hg
• Respiratory rate 18 breaths/min, unlabored
• SpO₂96%

Mr. C. is calm, cooperative, and oriented, so the weaning trial is continued for 90 minutes. Arterial blood gas results were pH 7.34, PaCO₂ 48 mm Hg, PaO₂ 74 mm Hg, HCO₃ 24 mEq/L, and SaO₂ 95%. The decision was made to extubate, and the patient was discharged from the critical care unit the following day.

Please answer the following questions concerning Mr. C,

1. What were the results of Mr. C.'s first arterial blood gas analysis? What factors contribute to these results?
2. What do the measures of negative inspiratory force, spontaneous tidal volume, vital capacity, minute ventilation, and rapid shallow breathing index assess?
3. What other parameters should/could be assessed as part of the initial wean screen?
4. Why is pressure support the mode used for the weaning trial?
5. How long does weaning the trial last?
6. Is Mr. C. tolerating weaning, and how do you know?
7. What interventions are indicated?

What are some barriers to using incident reporting systems for QI and how can those barriers be overcome?

A 16-year-old female consulted with her family practitioner because of tiredness and weight loss. On questioning, she admitted to feeling thirsty and had noticed that she had been passing more urine than normal. The doctor tested her urine and found glycosuria. He arranged for her to be seen at the hospital's diabetic clinic the next day. By then, however, she felt too ill to get out of bed, developed vomiting, and became very drowsy. Her father brought her to the emergency room when he was not able to wake her. On examination, she was found to have a blood pressure of 95/60 mmHg with a pulse rate of 112/min and cold extremities. She had deep, sighing respiration (Kussmaul's respiration) and her breath had a “fruity odor”. The following laboratory results were determined:

•Glu 450 mg/dL

•Na 130 mmol/L

•K 5.8 mmol/L

•Cl 98 mmol/L

•TCO2 5 mmol/L

•BUN 60 mg/dL

•Crea 1.5 mg/dL

Ketones Positive

•1) What diagnosis fits these biochemical features? Account for all laboratory values.
•2) Calculate the anion gap and serum osmolality.

•3) Which of the results indicate some renal impairment?
•4) Why is the BUN disproportionately increased compared to the creatinine? Is this the result of something other than renal impairment?