Mr. Morgan is a client who has been coming to the clinic for several years for management of coronary artery disease (CAD) and hypertension (HTN). A cardiac catherization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a chest x-ray (CXR) showed cardiomegaly, and a 12 lead electrocardiogram (ECG) showed sinus tachycardia. You review his morning labs and initial assessment.

1. As you review these results, which ones are of possible concern, and why? (5 points)

2. Knowing his history and seeing his condition this morning, what further questions are you going to ask Mr. Morgan and his daughter? (5 points)

Mr. Morgan tells you he becomes exhausted and has shortness of breath climbing the stairs to his bedroom and has to lie down and rest (“Put my feet up”) at least an hour twice a day. He has been sleeping on two pillows for the past 2 weeks. He has not salted his food since the physician told his not to because of his high blood pressure, but he admits having had ham and a whole bag of salted peanuts 3 days ago. He denies having palpitations but has a constant, irritating nonproductive cough lately.

3. You think it’s likely that Mr. Morgan has heart failure (HF). From his history, what do you identify as probable causes for his HF? What risk factors does he have for heart failure? (5 points)

4. You are ready to do your physical assessment. For each potential assessment finding for HR, indicate whether the finding indicates left-sided (L) or right -sided heart failure (R). (5 points)

__1. Fatigue, weakness, especially with activity

__2. Jugular (neck vein distention)

__3. Dependent edema (legs and sacrum)

__4. Hacking cough, worse at night

__5. Enlarged liver and spleen

__6. Exertional dyspnea

__7. Distended abdomen

__8. Weight gain

__9. S3/S4 gallop

__10. Crackles/wheezes in lungs

5. What diagnostic tests will be ordered and provide a rationale for the test? (5 points)

Chart view/Medication Orders

The physician confirms your suspicions and indicates that Mr. Morgan is experiencing symptoms of early left-sided heart failure. Medication orders are listed above.

6. For each medication listed, identify its class, and describe its purpose for the treatment of HF. (10 points)

7. As you remove the digoxin tablet from the automated medication dispensing machine, you note that the dosage on the table label is 250mcg. What will you do? How much will be given? (5 points)

8. Based on the medication orders, which blood test or tests should be monitored carefully? Explain your answer. (7 points)

9. When you give him his medications, he looks at the potassium tablet, wrinkle his nose, and tells you he “hates those horse pills.” He tells you a friend of his said he could eat bananas instead. He says he would rather eat a banana every day than take one of those pills. How will you respond? (3 points)

10. This is Mr. Morgan’s first episode of significant HF. Before he leaves the clinic, you want to teach him about lifestyle modifications he can make and monitoring techniques he can use to prevent or minimize future problems or hospital admissions. List five suggestions you might make and the rationale for each. (10 points)

11. You tell Mr. Morgan the combination of high sodium foods he had during the past several days might have contributed to his present episode of HF. He looks surprised and says, “But I didn’t add any salt to them!” What specific diet teaching can be done with Mr. Morgan? (5 points)

12. You also include teaching about digoxin toxicity. When teaching Mrs. Morgan about the signs and symptoms of digoxin toxicity, which should be included? (Select all that apply.) (3 points)

1. Dizziness when standing up
2. Visual changes
3. Loss of appetite or nausea
4. Increased urine output
5. Diarrhea

13. What is the action of digoxin? Digoxin: (2 points)

        a. causes systemic vasodilation.

        b. promotes the excretion of sodium and water in the renal tubules.

        c. increases cardiac contractility and cardiac output.

        d. blocks sympathetic nervous system stimulation to the heart.

14. Which findings would indicate an increased possibility of digoxin toxicity? Explain your answer. (5 points)

          a. Serum potassium level of 2.2mEq/L

            b. Serum sodium level of 139mEq/L

            c. Apical heart rate of 64 beats/minute

            d. Digoxin level of 1.6ng/mL

15. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, work to reduce heart failure? (Select all that apply) ACE inhibitors: (5 points)

            a. prevent the conversion of angiotensin I to angiotensin II

            b. cause systemic vasodilation.

            c. promote the excretion of sodium and water in the renal tubules.

            d. reduce preload and afterload.

            e. increase cardiac contractility.

            f. block sympathetic nervous system stimulation to the heart.

16. What patient teaching should be included for a patient on an ACE inhibitor? (5 points)

17. What are three parameters you would assess before/after administration of Furosemide? (3 points)

18. What patient teaching should be included for a client on Furosemide? (5 points)

19. What is the purpose of the beta blocker carvedilol? It is given to: (2 points)

            a. increase the contractility of the heart.

            b. cause peripheral vasodilation.

            c. increase urine output.

            d. reduce cardiac stimulation by catecholamines.

20. What patient teaching should be included for a client on a beta blocker? (5 points)

Why should food policy analysis be performed?

nurse's role in supporting your client through the dying experience.

what are the benefits and issues with groupthink? Give an example of groupthink that you have witnessed or been part of. why is this an example of groupthink?

discuss personal experience of caring for a dying patient or doing a post mortem care

1. Explain the importance of balancing intake with insulin. Consider how the person’s level of exercise is related to this.

List the pharmacological interventions for Acute inflammatory demyelinating polyradiculopathy, and state the category the drug belongs as well as the actions and side effects of the drugs

You have just been accepted to nursing school. As a requirement, you have to have a tuberculosis (TB) test as well as a hepatitis B recombinant vaccine. The nurse who administers the TB skin test explains that if significant swelling occurs around the injection site, you will need to have chest x-rays to determine if you are infected with Mycobacterium tuberculosis. On the morning of the second day after the skin test, you awake to find your arm red and swollen in an area about the size of a quarter around the site of the test. It is also tender to the touch. Now you are really worried. Could you have TB?

1. Why does the reaction to the skin test take 36-48 hours to show up? Explain. 2. If you have a tuberculosis infection, why doesn’t the whole body, or at least the respiratory tract, react when the antigen is injected during this diagnostic test?

Establishing a good foundation before a new program of study is introduced is very important. The Ghana College of Nursing and Midwifery therefore ensured this step in developing a curriculum before introducing a postgraduate degree or masters in Advance Midwifery program. The college also adopted progressive ideology (pragmatism) as its philosophy.
A. (i) Explain philosophy of Education
     (ii) Explain what it means to establish a foundation in developing the curriculum for this program.

B. Briefly explain how the chosen philosophy of education will influence the following:
(i) selection of courses
(ii) teaching methods /strategies to use
(iii) involvement of students in the classroom.

C. Discuss 4 benefits of philosophy of education in curriculum development and school administration

D. Write 4 program outcomes for the masters program

Write about the epidopmology of smoking and using a sober tool app successfully for people who are ready to quit smoking

Begin to gather information and materials to design a thorough plan to communicate the educational program including marketing strategies. Layout an outline of the plan and materials you will develop.

1. You are a student nurse providing care for patients in a hospital setting. Your nursing informaticist specialist is holding a meeting with all staff to explore alternate methods of documenting patient data. The hospital currently uses hand written records.
   1. What are the advantages of having the technology available to institute electronic health records?
   2. What is the role of the nursing informaticist specialists in this process?
   3. What are the basic steps the staff will follow when using the system development lifecycle (SDLC) process to ensure successful implementation of a new electronic health record?
   4. Discuss use of the core terms basic to informatics.