A complex, multi-system disease process is defined as a condition or disorder that either affects the whole body or involves multiple organs. Your textbook uses diabetes as an example of a complex, multi-system disease process; while fundamentally a disease of dysfunctional glucose regulation, it affects nearly every system in the body and leads to altered elimination, altered perfusion, and so on.

You may select any complex, multi-system disease process that interests you except diabetes--the text has covered this disease in great detail. Some examples of disease process which may be explored include chronic kidney disease, systemic lupus erythematosus, Sjögren's syndrome, or vasculitis. There are, of course, many other diseases which would be appropriate to explore as nearly every disease process in the human body affects more than one physiologic system. If you have concerns about the appropriateness of your selected disease process, please contact the instructor early in the process of your project to review. The essay should include four major sections.

1. First, you should describe the altered physiology that leads to the disease state you have chosen. This may include more than one specific alteration.

2. Second, you should describe the clinical manifestations present in the disease, and explain why these manifestations present using pathophysiologic concepts to form your explanation.

3. Third, you should explain how the physiologic alteration causes multi-system alterations in function.

4. Finally, you should describe the treatment modalities used to restore normal function and give a simple explanation as to how the normal function is restored. Your must follow APA format with appropriate citations.

A 74-year-old man was admitted to a nursing home for the first time following hospitalization for an exacerbation from heart failure, which is being controlled with Lasix 120 mg a day at this time. While the patient was in the hospital, he fell on the way to the bathroom and sustained a fractured hip, which required an ORIF. He had spinal anesthesia for the fractured hip.

He lives alone at home and has three grown children who live in the same town. He would like to return home. He has been widowed for 9 months. He had been married for 50 years and worked outside the home as a banker. His wife prepared all his meals for him.

During hospitalization, his dietary intake was 10 to 20% of the food provided. He did not receive any food from family or friends to offset his hospital meals. Since admission to the nursing home two days ago, he has eaten only 10% of his diet, which was a low-NA diet, mechanical soft (due to improperly fitting dentures). He was a 20-year smoker, one pack a day. He reports minimum alcohol intake.

He states that since his wife died, he has been leading a sedentary lifestyle, not going out very often. He reports no “real exercise” activities.

The Medications Discharge from Hospital:

• Digoxin 0.125 mg oral every morning
• Lasix 40 mg tid
• Nu-Iron 150 mg oral daily
• Hydrocodone and acetaminophen tablets, 5 mg/500 mg for pain

Answer these questions:

1. What additional subjective information will you be asking for?
2. What objective findings will you be looking for?
3. What laboratory tests do you think you want to order and why?
4. What factors are affecting this patient’s current nutritional and hydration status?
5. What recommendations would you make to alter his nutritional status?

Exercise: Anthropometrics Assessment

Instructions: Complete the following measurements with your partner.

1. Calculate the BMI of a female who is 66 inches (5 foot 6 inches) and 170 lb. What is the BMI classification? (BMI = weight in kg/height in meters squared (m²); weight in kg = weight in lb./2.2; height in meters = height in inches x 2.54 cm; height in meters = height in cm/100). *Remember to square the meters value in the denominator.

Example: Height = 60 inches (5 ft 1) and 110 lb.

Weight in kg = 110/2.2 = 50 kg; Height (m²) = 60 inches x 2.54 = 152.4 = 152.4/100 = 1.524 meters = 2.32 m²; BMI = 50 kg/2.32 = 21.5 (Classification: normal)

2. Calculate the waist-to-hip and waist-to-height ratios of this female with a waist circumference of 30 inches and hip circumference of 35 inches. How well do both calculations compare?

3. Explain whether her health risk status based on BMI standards aligns with her risk status based on waist/hip and waist/height ratios.

4. What are the procedures, advantages and disadvantages of four methods for body composition assessment?

5. Calculate her estimated energy needs using an appropriate formula from the Body Composition handout.

6. View the posted video “Korr: Indirect Calorimetry and Energy Expenditure” at https://www.youtube.com/watch?v=zUrkHqgeiyg. How do these results compare to what your needs might be based on the gold standard (indirect calorimetry)?

How does the State of New York rank in health care quality? What does your New York do well? What can New York do better and how?

What are the differences in treatment for bacterial, fungal, and viral infections on the skin?

George Garcia, a 23-year-old construction worker, and his wife, Anita, age 20, bring their 4-month-old daughter to the emergency room of a small community hospital. They speak broken English. They have another small child with them, as well as two older women. They are very worried about the infant, who they say has been unable to retain feedings of diluted cow's milk. Now, because of poor sucking and increased sleeping, the infant has not had anything by mouth for the last 24 hours. When asked, the parents say the infant has been sick for 3 or 4 days. The infant is listless, and her eyes are sunken. Anita is newly pregnant with her third child.

The Garcia family lives together in a small house 2 miles from the Mexican border in a predominantly Mexican American neighborhood.. The padrinosor compadres (godparents) live next door to the Garcias. The family is Catholic, and a medal of Our Lady of Guadalupe is on a chain around the older child's neck. The baby has a bracelet with a seed in it around her wrist. The 2 older women with the Garcias are the mothers of George and Anita. George's mother is a curandero, and has been treating the baby with weak specially brewed teas.

1. How would the health care practitioner approach the family to demonstrate respect, compassion, and understanding?

2. Describe family roles and common living arrangements in a family of Mexican-American heritage.

   If the doctor's recommendation is that the infant should be hospitalized, who in the family would make the decision?

3. What is a curandero? Name 2 other kinds of folk practitioners, and describe what they do.

4. Discuss spirituality and the meaning of life for persons of Mexican-American heritage.

5. The infant could have mal de ojo. What is this, and how is it treated? Should the health care professional touch the infant?

In the 1990’s HIV/AIDS was a topic of great concern to people in the U.S. As information was disseminated, fears about HIV/AIDS decreased. Many people in the U.S. no longer consider HIV/AIDS a serious health threat. What do current statistics reveal? Has HIV/AIDS been eradicated in the U.S.? Are those with HIV/AIDS in the U.S. today only those considered marginalized? What would health care in the U.S. today be like if HIV/AIDS had become the pandemic it is in other countries? ( answer in approx 250 words)

How are risk management and quality management used in health care?

Discuss why documentation is important in nursing.

Discuss what nurses, acting as change agents and/or a political body, can do to improve knowledge of and access to palliative care in developing countries. ( Answer in Approx 250 words).

Long-Term Care Reimbursement The federal and state governments are the largest payers of health care services in the United States. The largest federal programs are the Medicare and Medicaid services. Using the information from the textbooks, lectures, and Internet resources, provide a brief summary of Medicare and Medicaid services in a Microsoft Word document. To get up-to-date information on the programs, review the information shared on the following websites: The Centers for Medicare and Medicaid Services The Social Security Administration In your summary, include the following points: An overview of the different Medicare and Medicaid services The population covered under Medicare and Medicaid services The services of long-term care covered under Medicare and Medicaid, including the restrictions placed on them

REFERENCE: Title:Long-Term Care: Managing Across the Continuum Author: John Pratt Edition/Year: 4th Ed./2016 Publisher: Jones & Bartlett ISBN: 978-1-284-05459-0

Get up-to-date information on the programs, review the information shared on the following websites:

- The Centers for Medicare and Medicaid Services

- The Social Security Administration

Please answer all discussion questions and answer the case study questions.

1. Discussion Topic: Are the cognitive skills of a child affected by their nutrition?
2. Discussion Topic: What is the primary cause of fatal ingestions in children younger than 5 years of age? Discuss button battery ingestion.
3. Case Study: Sally is a 3-year-old girl in the primary care physician’s office. Sally’s mother states that she is having “temper tantrums.”

Subjective Data

Mother states Sally eats well.

Sally sleeps 11 to 12 hours a day.

Sally speaks in four- to five-word sentences.

Objective Data

Birth weight: 3 kg

Today’s weight: 13 kg

Height: 90 cm

Sally speaks in three- to four-word sentences with a 300-word vocabulary.

Questions: Please only provide short answers for the case study section. No more than 2 sentence response for the case study section. Follow the guidelines below for the discussion section.

1. Is Sally’s vocabulary appropriate for her age?
2. Are Sally’s height and weight appropriate for her age?
3. What information can Sally’s nurse give about her temper tantrums?
4. What is the goal of discipline for a preschooler?

. Describe two marketing challenges and two marketing opportunities that particularly impact public health organizations.

Gender-neutral parenting is a form of raising a child without letting others around the child know his or her sex. Proponents of gender-neutral parenting point out that a child can choose clothes, toys, and behaviors freely, without the constraints imposed by society. Opponents of this type of rearing are concerned with isolation, bullying, or other social concerns among peers, as well as confusion for the child in other organized settings. Is gender-neutral parenting beneficial or detrimental to a child and why?