1. What is the calculated LDL level as calculated using the Friedewald calculation?

2. Which patient, if any, should have his or her LDL measured, rather than calculated? Explain your answer.

3. How many known CHD risk factors does each patient have?

4. Based on what is known, are these patients recommended for lipid therapy (diet or drug?) and, if so, on what basis?

Case scenario:

Maria, a 55 year-old patient, was recently diagnosed with bronchial asthma. Her mother and three brothers also have asthma. In the past year, Maria has had three asthmatic attacks that were treated with prednisone and an albuterol inhaler. At a clinic visit today, prednisone is prescribed for 4 weeks and the order is written as follows:

Day 1: 1 tablet four times a day

Day 2: 1 tablet three times a day

Day 3: 1 tablet two times a day

Day 4: 1 tablet in the morning

Day 5: ½ tablet in the morning

To minimize the frequency of Maria’s asthmatic attacks, the doctor prescribes aminophylline 1200 mg/day in divided doses. The albuterol inhalation is to be taken as needed. Nursing interventions include patient history of asthmatic attacks and physical assessment.

5. When taking the patient’s history, what should the nurse include concerning asthmatic attacks? What physical assessment would suggest an asthmatic attack?

6. What type of drug is aminophylline? Why should the nurse asks Maria if she smokes?

7. What are the side effects, adverse reaction, and drug interactions related to aminophylline?

8. What nonpharmacologic measures can the nurse suggest that may decrease the frequency of asthmatic attacks?

9. Which are appropriate rescue medications used for acute asthmatic attack? Which drugs are used as preventive medications?

How could you incorporate the updated information on colorectal cancer screening into your client health promotion teaching?

what safety precautions need to be initiated for the baby

Screening for early detection of lung cancer is a new concept. How do you feel about performing this screening for clients who are current or former smokers?

What would you advise a man over 50 who is reluctant to be screened for prostate cancer?

possible nursing diagnosis for newborns from the first 2 hours of age

The Patient Bill of Rights is a list of what patients have as rights when it comes to being under the medical field and knowing what personal medical information will be exposed to healthcare workers. It is the rights of the patient when the patient gives out medical information and to keep that information safe. The patient must sign an informed consent that is a document signed by them that is accepting the medical or surgical intervention. The nurse’s role when it comes to consent is, “to have safe, considerate and respectful care, provided in a manner consistent with your beliefs”, (National Institutes of Health, 2019). Yes, the nurse can provide the consent, but the patient’s beliefs override what the nurse thinks that patient should do with their medical information. The patient is aware of what situations need to be done but they are wise enough to make their own decisions. The nurse has told them the pros and cons to inform the patient about the informed consent and the patient makes their decisions based on that.

Please read the passages and give a response for the thought

If the patient refuses to sign, that is it. The nurse may add more information of why it is necessary to have an informed consent to inform the patient but never to persuade the patient. “To refuse to participate in research, to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of these actions, including possible dismissal from the study and discharge from the Clinical Center. If discharge would jeopardize your health, you have the right to remain under Clinical Center care until discharge or transfer is medically advisable”, (National Institutes of Health, 2019). This alone provides that the patient is not to be forced to sign any informed consent if the patient chooses not to and if it needs to be sign then the nurse needs to let the patient’s primary care provider know. The nurse can only do so much in their scope of practice and all they can do is ask the patient for their signature based on the evidence provided for the informed consent. The only ways to manage the issue is either informing the patient of why the informed consent is right in front of them without persuading. Or contacting higher up management and/or the primary care provider to let them know that the informed consent is not going to be signed. It is never right to force the informed consent on a patient and that is what the patient chooses to do regardless on what the nurse believes the patient should do.

Patient presents to the clinic with a four-month history of generalized joint pain, stiffness, and swelling, especially in her hands. She states that these symptoms have made it difficult to grasp objects and has made caring for her 6 and 4-year-old children problematic. Physical exam remarkable for bilateral ulnar deviation of her hands as well as soft, boggy proximal interphalangeal joints. The metatarsals of both of her feet also exhibited swelling and warmth. .why patients with rheumatoid arthritis exhibit these symptoms and how does it differ from osteoarthritis?

what are some examples of debate in the story of Didache?

A clinical documentation improvement program has been up and running for six months. Initial training of the CDI staff covered the following:

• Overview of CDI program and goals

• MS-DRGs including CCs and MCCs and their impact on MS-DRG assignment

• The top 10 MS-DRGs for the organization

• What documentation is used for code assignment and where to find in the paper and electronic medical record

• Review of clinical indicators for specific diagnosis such as respiratory failure and protein-calorie malnutrition

1. After reviewing the training program, recommend 4 additional topics that should be covered.

2. Why are these topics important to the CDI program

C. A., a 63 year old Filipino male with hormone-refractory prostate cancer is your clinic patient. C. A. was diagnosed with benign prostatic hypertrophy (BPH) several years ago and was taking alpha blockers for this condition.

A year ago, his BPH symptoms worsened despite maximal therapy. At that time, his primary physician performed a digital rectal examination and noted that he had a new hard nodule (1cm x 1cm) in the right lobe of his prostate and a PSA of 2.4 (PSA in the year prior to that was 2.2). A prostate biopsy revealed high-grade adenocarcinoma. A bone scan showed a small focal abnormality in the lumbar spine at the level of the L2 vertebra. The prostate cancer was staged as T2b.

1. What are the risk factors of prostate cancer?
2. How is prostate cancer diagnosed?

C. A.’s past medical history includes the following:

• Hormone-refractory metastatic prostate cancer per HPI (history of present illness)
• Severe Gastroesophageal Reflux Disease
• Coronary artery disease status post myocardial infarction two years ago with a history of left circumflex percutaneous transluminal coronary angioplasty
• Pulmonary nodules 2 mm , stable per CT for the last 5 years
• Hypertension
• History of depression
• Current tobacco abuse
• Hyperlipidemia

At the time of diagnosis, the patient was seen by the oncologist and then by radiation oncologist. Their recommendation was for the patient to undergo radiation therapy (external beam Intensity Modulated Radiation Therapy) followed by hormonal therapy and possible Taxotere trial.

1. Based on this information, what aspect of C. A.’s history do you think will have an implication in his nursing care?

Six months post-cancer diagnosis, C. A. was treated with radiation therapy (external beam Intensity Modulated Radiation Therapy) to his prostate and pelvic lymph nodes and placed on hormonal therapy and a Taxotere trial. He complained of increasing low back pain. An MRI scan showed bony metastasis to the L2 and L3 spine. The PSA was increasing at 18.6. He received radiation therapy to the spine.

1. What will be your priority concern at this time?
2. What changes in the plan of care will you recommend?

Eleven months post-cancer diagnosis, C. A. is here with his wife to see this physician for routine follow-up. He reports moderate pain control on his current pain regimen. He also states that his appetite is poor and that he tires easily. He is independent in his ADLs and IADLs, and even working occasionally on his good days. You note that he has lost 2 pounds since his last clinic visit 2 months ago. (BMI= 25.6).He is alert and oriented. His recent labs show a PSA = 70.7

1. You assisted C. A. for an interval history (wt loss, fatigue, Taxotere, etc). He lies down on the examination table for the physician to do a routine examination. What questions will you ask C. A.?
2. C. A. is looking anxious and asks: “How much time do I have?” What will be your response?

The physician’s progress notes read: C. A. is a 63 year old male with hormone refractory prostate cancer, KPS = 70%, anorexia, weight loss, increasing pain and fatigue. His PSA is increasing despite multi-modal therapy. He is alert and oriented. He has no other reported symptoms.

1. Which of these findings is your priority concern at this time? Why?

You researched that patients with hormone refractory prostate cancer who have indices similar to C. A. (age 63, PSA 70.8, Albumin 2.6, Alkaline Phosphatase 219, Hgb 11.5, LDH 680), who are tracked through the database at Memorial Sloan Kettering Cancer Center. They show a median survival of 3 months at a Karnofsky Performance Scale (KPS) of 70 (which is C. A.’s KPS score at the present time) and a 1yr survival probability of 2% with 2-yr survival probability of < 1%. (These estimates don’t directly consider presence or extent of metastases, PSA doubling time or patient ethnicity).

As for the patient’s health care goals, his primary objective is to remain pain free. He realizes that despite his young age, metastatic prostate cancer is an uncurable disease with treatments being primarily palliative with rather modest survival benefit at the current stage.

1. With this new development, what changes will you expect in C. A.’s plan of care?
2. What recommendations will you include for C. A.’s benefit?

Though his wishes are to continue considering available chemotherapy/radiation, C. A.’s primary goal is to be pain free, and to be able to spend quality time with his family, and to stay active. Though he would prefer to have CPR and intubation as treatments for acute issues, he would not like prolonged life support and would wish to have them withdrawn if they only served to prolong his life artificially.

1. What are the available resources that you can recommend for C. A. so he can achieve these goals?

She (Patricia Keely, 1963-2017 )was a 21-year-old undergraduate at the University of Minnesota when she discovered a lump near her neck. It was Hodgkin's lymphoma, a cancer of the lymphatic system. She underwent radiation therapy and later also chemotherapy.

Despite a cancer recurrence in grad school, she earned a doctorate in cell biology from Minnesota and embarked on the research career that brought her to Madison after stints at Washington University in St. Louis and the University of North Carolina.

Doctors aren't sure what causes Hodgkin's lymphoma. But it begins when an infection-fighting cell called a lymphocyte develops a genetic mutation.

Prior infection with Epstein-Barr virus is associated with increased risk of getting cancer later on.


The mutated cells to multiply rapidly, causing a large number of oversized, abnormal lymphocytes to accumulate in the lymphatic system, where they crowd out healthy cells and cause the signs and symptoms of Hodgkin's lymphoma.

Symptoms are vague:
•Painless swelling of lymph nodes in your neck, armpits or groin
•Persistent fatigue
•Fever
•Night sweats
•Unexplained weight loss
•Severe itching

The main treatments for Hodgkin lymphoma are chemotherapy alone, or chemotherapy followed by radiotherapy.

Dr. Patricia Keely first became a group leader at the University of Wisconsin-Madison and later became the Chair of the Department of Cell and Developmental Biology. She studied the mechanisms driving breast cancer development and metastasis. She was particularly interested in how the microenvironment in the vicinity of tumor cells influences cancer development

In 2006, Dr. Patricia Keely was diagnosed with esophageal cancer, probably caused by the radiation that cured her lymphoma. She underwent surgery in January 2006. Doctors removed two-thirds of her esophagus and the top of her stomach.
After surgery, "my prognosis for being without disease was only 50-50," Dr. Keely said. If the cancer came back, it would mean it has spread and there would be no cure.

She got different opinions from doctors. She was told that chemotherapy would be effective only if accompanied by radiation, but she could not have any more radiation therapy because of her earlier treatment.

She plunged into medical literature and found a clinical trial at the Mayo Clinic for an experimental drug called Iressa intended to prevent a recurrence of esophageal cancer.

"I understand the mechanism" of the drug, she said. "It made intellectual sense to me. It blocks a signaling pathway that is found to be increased in metastatic esophageal cancer."
Question 1:
Dr. Keely chose to enter a clinical trial where cancer patients were treated with IRESSA. IRESSA is a targeted EGF receptor drug. What type of mutation involving the EGFR might thus have been present in Dr. Keely’s metastatic tumor? List 2 possible oncogenic EGFR alterations.





Question 2:
How does the EGF receptor inhibitor IRESSA act (What domain in EGFR does IRESSA target?). What alternative anti-EGFR drugs would be available that would act differently than chemical inhibitors?






Question 3:
How might IRESSA have helped Dr. Keely to increase her survival chances once diagnosed with esophageal cancer? What would IRESSA do in terms of pathway effect and cellular processes affected?







Question 4:
IRESSA needs to be taken continuously by patients undergoing treatment. Often, tumor cells develop resistance after a while. What type of resistance mutants are frequently observed in the EGF receptor?












Question 5:
IRESSA (Geftinib) is one approved drug that targets the EGFR. Tarzeva (Erlotinib) and Gilotriv (Afatinib) are others. Are these targeting the same EGFRs? How about their mechanism? And what about Erbitux (Cetuximab)?









Question 6. Particular receptor tyrosine kinases (RTKs) that promote excessive cell division are found at high levels on various cancer cells. A protein called Her2 is a version of EGFR involved in tumor development. Choose the best statement about Her2 action.

A. Activation of Her2 causes cells to undergo apoptosis.
B. Activation of Her2 promotes progression through the cell cycle.
C. Activation of Her2 has no effect on the cell cycle.
D. Activation of Her2 causes cells to enter the G0 (quiescent) phase of the cell cycle.
E. All of the above



Question 7. Knowing how receptor tyrosine kinase signaling through the EGF type family of receptors works, what additional pathway molecule would you target for effective anti-cancer therapy to eliminate cancer cells that acquired resistance to IRESSA? Choose the most effective way to target.

A. Drugs that inhibit Raf kinase
B. Agents that inhibit EGFR activation, such as the monoclonal antibody drug herceptin
C. Drugs that inhibit mTOR
D. Drugs that inhibit Ral-GDS
E. Drugs that inhibit both, Raf and PI 3-kinase activity

Why do you think this is the most promising approach? Explain inn 1-2 sentences

answer only first 3 questions please according to the text