A term neonate (4 kg) was born with thick meconium following a prolonged and arduous labor. Apgar scores were 1 at 1 minute and 4 at 5 minutes of life. The neonate required full resuscitation measures at birth, was intubated and mechanically ventilated by t-piece resuscitator in the delivery suite, and transferred to the neonatal intensive care unit. He was ventilated in the SIMV mode on the following settings: PIP 26 cm H2O, PEEP 5 cm H2O, I-time 0.4 seconds, and a respiratory rate of 45 breaths per minute FI O2 0.80. The ABG revealed the following: pH 7.09, CO2 74 mm Hg, PaO2 35 mm Hg, bicarbonate 16 mEq/L, and base excess 8. The PIP was increased to 30 cm H2O, and 5 minutes after the increase to the PIP, the following was observed: SpO2 90% to 95% and the measured tidal volume 3 ml/kg. The measured MAP on the ventilator was 16 cm H2O, and tidal volume was 12 mL (3 mL/kg). The mode of ventilation was switched to HFOV. The initial oscillator settings were MAP 18 cm H2O, amplitude 38, frequency 10 Hz, and FiO2 75%. This continued for 8 hours, during which time the clinical condition and blood gases started to improve. The chest X-ray showed good lung expansion. The amplitude was reduced as chest wiggle was pronounced and CO2 started to decrease. Oxygenation also started to improve, so FiO2 was reduced to 40% on day 2. Over the next 48 hours, the MAP was slowly reduced by increments of 1 to 2 cm H2O until a MAP of 14 cm H2O. The oxygen requirement was only 35%. On day 6 of life, the neonate was to be extubated to nasal CPAP at 4 cm H2O and an FI O2 of 0.28.

1. What was the rationale for transitioning from conventional ventilation to HFOV?

2. How do you approach setting the mean airway pressure when transitioning from conventional ventilation to HFOV?

3. What ventilator parameters are used to increase or decrease CO2 on the HFOV?

4. What is an important aspect of setting the amplitude when transitioning to HFOV?

EHP Model Strengths and Weaknesses

What does James Baldwin say about " the experience of a Black writer in America"?

Who is James Baldwin's audience?

Nomenclatures undergo periodic evaluation and update. Investigate how the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) impacted coding for hoarding in 2017. As part of your investigation, determine if the DSM-5 and the code set are fully aligned with this code and support your opinion.

There are many factors that can influence such decision for cloud server and client server. security, cost, training and more. which would you choose and why ?

there are many factors that influenced the decision on a cloud server or client server such as cost, security, training and more. which one would you choose, cost, security,training etc.

and why ?

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ETHICAL PRINCIPLES APPLICATION

Before making the final decision the doctor must consider the principles of health care ethics, which will help the physician make the choice that will have the best possible benefits for both the patient and society. Analyze the case scenario to be able to identify the 7 principles.

Mrs. De Leon, a patient who has an ovarian cyst, left untreated, will result in kidney failure. An operation to remove the cyst is the best treatment, but the patient is frightened of needles and is against the surgery that would require a needle to give her anesthesia. The doctor must work with the patient to respect the fact that she dislikes needles and doesn’t want the operation, and needs to find a solution that would prevent her from going into kidney failure, which is in her best interest. Although the surgery is the best choice, forcing the patient to accept the needle would be harmful to her . Finally, the doctor needs to consider the impact that the patient’s choices might have on others if she starts to go into preventable kidney failure, she’ll need dialysis, which affects other people who need the same treatment. The doctor also asked the patient that she will sign a consent form before the procedure and the nurse will ask her information, data, past and present medical history. The physician is committed to his roles and responsibilities as the attending physician of Mrs. De Leon.  

Write the statement from the given case that applied the ethical principles.  

Autonomy-

Confidentiality-

Veracity-

Fidelity-

Justice/ Fairness-

Beneficence-

Non- maleficence-

Describe the most important deficits related to temporal lobe injury. Explain in detail and give examples.

Allisson Russo is a 15 year old girl admitted to the Emergency Room with Right , lower quadrant pain. She is eventually diagnosed with appendicitis and scheduled for an appendectomy. After visiting Allison in the Er, the surgeon Alerts the Operating Room nurse, Ms. Wendy Harnes that the surgery will take place in an hour. Allison is HIV positive from emergency medical acre and blood transfusions that she received six years ago, following an auto accident. Allison does not know that she is positive, at the request of her parents, who are born high-powered attorneys. Allison tells Ms. Harnes that she used to to be involved in sports but has dropped these activities in school because of feeling more tired than usual. She thinks that her academic studies are simply requiring more of her attention , but her mother has suggested that perhaps she would be seeing a new doctor soon. Allison asks the nurse “ Do you think being tired at my age is a serious concern? I thought all teenagers feel like this. I feel that I have a serious health problem.” How should Ms. Hayes respond to Allison?

3 possible diagnoses for patients with hyperactive bowel sound, lower lew quadrant pain with slight fever?

1. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality has identified seven Portfolios of Research. The full list can be viewed at http://www.ahrq.gov/cpi/portfolios/index.html

2. Two of the Portfolios of Research that are of key importance to this week's learning are

(1) Health Information Technology and (2) Patient Safety.

Describe how these two Portfolios of Research relate to the ONC's Health Information Technology Patient Safety Action and Surveillance Plan: June 2013 (Washington, DC: Office of the National Coordinator for Health Information Technology, 2013).

please include references

1. What edits would you make to the General Hospital’s disclosure policy, if any, to improve the clarity of the requirements to both the patient and hospital staff?
2. If General Hospital implemented a new online patient portal that allowed patients to request disclosure of their medical information online, what changes would need to be made to their release of information policy?
3. In the scenario in question 8 above, could General Hospital mandate all release of information requests be submitted through the online patient portal to help streamline the process internally and mitigate access and disclosure risks? Why or why not?