You are the public health nurse working in a clinic, caring for underserved populations (Domestic violence) answer these questions

*1- Identify the population underserved

*2 Risk factors: what are the health concerns for this population

*3 Screening: what are the barriers to health care for this population

*4- Prevention Include level of prevention (primary, secondary, tertiary). what are the barriers and what nursing interventions will the nurse implement

*5 Patient Education/ resources

Joanne Duffy was inspired to create the quality -caring model by what she saw as:

A) the marginalization of caring behaviors as greater emphasis began placed on procedures,tasks,technology ,and cost containment

B) a measurable drop in quality of patient outcomes as nurses focused more on caring on clinical competency

C)the complete disconnect between caring behaviors and the quality of patient outcomes

D) the lack of a one- size fits-all approach to caring for patients of all types.

Respiratory Disorders

Mr Suliasi, a 53-year-old male retired FMF baker, is admitted to the TB ward at the Toomey Hospital because of productive cough of more than 2 weeks, hemoptysis, anorexia, and weight loss. His temperature is slightly elevated every afternoon. After performing a Mantoux skin test, he is considered as a patient suspected with pulmonary tuberculosis.

Using the information about Mr Suliasi,

-discuss your management of the patient with evidence to support your management.

-Describe at least 5 signs and symptoms and the rationale.

-Identify 3 common investigations (Labs) and special investigations (Radiology) that will be carried out in this situation and the result (evidence-based)

-Describe the treatment (trade and generic names), identify the indication for use, route (Intravenous/oral), and its side effects in a tabular form.

-Identify 5 therapeutic interventions and rationale (nursing/medical/surgical) that you will carry out in the ward for this patient in order of priority.

How is the “product” of health care and the “business” of health care different from other commodities? Do consumers follow the same principles for health care as they do for other purchases? Do normal market forces apply to health care?

1. A patient is more at risk to aspirate into the right or left lung? Explain your answer.

2. The distal tip of an oral endotracheal tube (CEll) once appropriately placed sits in what structure

What is the difference between electronic health records (EHR) and electronic medical records (EMR)? What are the advantages and disadvantages of EHR? How do electronic records improve workflow processes and reduce costs? Explain. Cite at least one reference in your response.

Please assign these patients to staff, being mindful of the scope of practice and ability levels of staff members? The staff for the next shift includes: • Raul; an experienced RN. • Tara; an RN orientee assigned with Raul for the shift. It is her third day on the unit. • Monique; a supplemental RN. The last assignment in this unit was three weeks ago. • Dorothy; an experienced LPN. • Timmy; an experienced nursing assistant. • Val; unit secretary, split between your unit and the one next door as your secretary called in sick. Patients currently on unit: #2201: PP, a 51-year-old female with T1DM (type one diabetes) who has ESKD (end-stage kidney disease). She was admitted for a revision of her A-V fistula. She has a temporary Hemodialysis catheter in place. She’s scheduled for hemodialysis this morning. #2202: RP, a 72-year-old male patient with a CBI (continuous bladder irrigation) who is post-op from a TURP yesterday. He has had many clots passed through the CBI and has needed the catheter manually irrigated three times during the past shift. #2203: empty bed. #2204: MG, an 88-year-old female patient admitted two days ago with urosepsis. She’s currently getting IV antibiotics through a peripheral IV every eight hours. She has been incontinent of urine twice during the past shift. She is currently complaining about pain at the site of her IV. #2205: MW, a 44-year-old female patient who had a cystoscopy yesterday for a biopsy of her bladder. Cancer is suspected. She is currently waiting for the provider to write her discharge orders so she can go home today. #2206: JS, a 69-year-old male patient with uncontrolled hypertension and chronic kidney disease admitted last evening. He has a history of non-adherence to his medications at home and comes into the hospital every four to five months with chest pain, high BP readings, and weight gain. He’s been prescribed Lasix, Lisinopril, and metoprolol. His provider would like to send him home tomorrow. He has not been evaluated by the case-manager on your unit yet. #2207: AM, a 21-year-old female patient with an acute kidney infection. She was admitted during the night. The patient currently has IV of NSS infusing at 100 ml/hr via peripheral IV and is complaining of 9 out of 10 back pain. Is febrile with a temp of 100.6 F #2208: MS, a 60-year-old male patient with a renal calculi diagnosed by CT scan. Being medicated with IV Fentanyl every three hours for 10 out of 10 pain reported by the patient. Receiving IV fluids and needs assistance to the bathroom. Urine must be strained each time the patient voids. #2209: SS a 72-year-old male admitted with hematuria. He is having diagnostic testing completed for renal carcinoma. The patient has a history of leukemia as a 40-year-old. This patient and his family are very upset by the diagnosis and the patient is intermittently tearful. #2210: CT, a 55-year-old female admitted with community-acquired pneumonia. She is currently on 4 L NC and has a 02 saturation of 92% at rest. She is short of breath and has been ringing for the nurse frequently as she is frightened of dying when she gets SOB. She is receiving Levaquin IV every 24 hours for her pneumonia. This patient also has an ileal conduit with a drainage bag attached. She had her bladder removed ten years ago due to cancer. #2211: RM, a 76-year-old male patient with cellulitis on his left shin. He’s on contact precautions for MRSA. He has been receiving continuous peritoneal dialysis at night, he’s assigned to your unit, as your staff has the training to use the PD equipment. #2212: AF, a 40-year-old female patient with an intellectual disability from a group home setting. She was admitted with pyelonephritis during the night. She is scheduled for discharge today. She will need her IV discontinued and discharge instructions will need to be given to the patient and her caregiver.

1. What are the signs and symptoms of pneumonia

2. what are the causes of pneumonia

3. How is a dichotomous key used to identify sources of infection

4. How is Bordetella Bronchieptica transmitted

Considering your facility’s risk management policies and procedures, what would be your role (as a Nurse leader)  in ensuring compliance with these procedures and policies? How are these policies evaluated and what role can a nurse leader play in supporting such policies?

What are two possible physical environment and neighborhood factors that may make people more likely to contract and develop complications from COVID-19?

Identify 2 traits of an ethical leader. Why are these traits important for the DNP leader?

The surgical suite is designed in a way that facilitates good patient care. Discuss the layout of the operating room and how it can reduce surgical site infections

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)