Mrs. Smith is a 50 year old Caucasian woman who has 4 children ages 17, 15, 13, and 10. She was 33 with the birth of her first child. Her BMI is 25. She has no personal or family history of breast cancer. She lives with her husband in a suburban community. She is an elementary school teacher who is working part-time as a substitute so she can be home with her children. She has been healthy with no previous medical history. One year ago she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her health insurance would be expiring in the next month so she reluctantly decided to have a mammogram. She called for an appointment and they were unable to see her for another 2 months.

After waiting 2 months, her mammogram confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

1. What are the primary concerns for the patient right now?
2. What is the rationale for these concerns?
3. What are some of the expected medical surgical interventions?
4. What is the worst possible complication to anticipate?
5. What further assessment will be needed if complications develop?
6. What pharmaceutical drugs are approved treatments for breast cancer patients?
7. Discuss the advantages and disadvantages of the selected drugs, and include safety issues.

How does data become knowledge and finally wisdom? Explain the relationship between knowledge acquisition, knowledge processing, knowledge generation, knowledge dissemination, and wisdom. Then provide examples from your clinical practice (or past work experiences) according to the following:

1. Examples of knowledge acquisition
2. Examples of knowledge generation
3. Examples of knowledge processing
4. Examples of knowledge dissemination
5. Examples of the use of feedback

what are the disadvantages of Community pharmacy profession ?

What is the difference between research studies and quality improvement studies? Explain which has the stronger level of evidence and why.

The Beall Family: Crissy and John Beall are a childless couple who thought they could have a genetic child until they heard about surrogate motherhood. Mrs. Crissy Beall was diagnosed with Cancer of the uterus while in her mid 20’s and had a total hysterectomy. They have asked Dr. Ellis if he would artificially inseminate her widowed Mother (Nancy Hoffman), 51 years old with his husband’s (Mr. John Beall) sperm, so they can have a child that is genetically linked to both of them. Mrs. Hoffman is willing to undergo the procedure and has no health reasons that would prohibit her from carrying the child to term. Crissy is her only daughter and she views her role in this arrangement as an act of love. Make a reaction to this case scenario.

is it morally right?
if yes, State your reasons.
If no, State your reasons too.

What do you think, the most important quality a behavioral health nurse must possess in both behavioral health and medical settings?  Please explain why you chose the quality you identified.

Explain the concept of full disclosure and the consequences of a lack of full disclosure.

Is it ever appropriate for a physician not to tell a patient his or her full diagnosis and the potential outcome of the disease? Explain your answer.

What laws and ethics guide physicians in making the decision to disclose information fully?

What consequences or risks might the physician face for not fully disclosing information?

If you knew that full disclosure would harm a patient, would you choose to disclose the information to the patient? Explain your answer.

Application to Practice Scenario

A 13-year-old boy presented to the clinic complaining of a sore throat that persisted for 2 days. After those 2 days, he developed fever, nausea, and malaise. A throat culture revealed the presence of Group A beta hemolytic streptococci, and the child was started on antibiotic therapy. The child’s symptoms gradually improved, but approximately 2 weeks later, he returned to the clinic because the fever, nausea, and malaise returned. He became tachypneic and short of breath.

The mother noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy. On examination, the child’s blood pressure was 148/100 mm Hg, his pulse was 122 beats/min, and his respirations were 35/min. Orbital and ankle edema were present. Rales (abnormal breath sounds) were auscultated bilaterally in the chest, but no heart murmurs were found. Slight tenderness to percussion over the flank areas was noted.

A chest X-ray showed evidence of congestion and edema in the lungs.

The patient’s hematocrit was 37% and his WBC was 11,200/mm3. Blood urea nitrogen was 48 mg/dL (normal is less than 20 mg/dL). Urinalysis results showed that the patient’s protein was 2+ (24-hour excretion was 0.8 g), specific gravity was 1.012, and there were moderate amounts of RBCs and WBCs in the urine. Serum albumin was 4.1 g/dL (normal is 3.5–4.5).

1.Which evidence supports the conclusion that this patient has a kidney disease?

2.Which clinical pattern of kidney disease does this patient have? Can you explain the symptoms?

3.Which morphologic changes would you expect in the kidney?

4.What is the prognosis? What are the possible short- and long-term complications of this disease? Is it necessary to hospitalize the patient?

BEFORE AND AFTER NURSING RESPONSIBILITIES FOR SKIN SCRAPINGS

BEFORE AND AFTER NURSING RESPONSIBILITIES FOR THE PROCEDURE TZANCK SMEAR

1. Which social determinant of health applies to healthcare and immigrants?

Illegal immigrants must first transfer overall assets before coming Medicaid eligible

Helping immigrants, all individuals are immediately open to join health programs

Individuals are not Medicaid eligible until 5 years following officials citizenship

Legal citizenship is not necessary to participate in Medicaid.

What is the etiology of John Nash’s illness in "a beautiful mind" film? How were Nash’s delusions of paranoia and conspiracy affected by the realities of his job working for the government?

1. The head nurse sends the student nurse to evaluate a patient’s postoperative pain. After entering the patient’s room, the student observes the patient conversing and joking with her friends. The student decides not to investigate the question of postoperative pain further. Evaluate the correctness of the student’s decision and give an underlying rationale for the views expressed.

2. Research the medications needed to treat respiratory depression during the administration of an epidural analgesic. Obtain a copy of the monitoring guidelines used in the clinical site where assigned and discuss the importance of collecting these data on a regularly scheduled basis throughout epidural analgesic use.

Mary who is a 21 year old female comes into the Family Planning clinic today for a PAP test, which is her first.

1) Mary wants to know how the PAP test is preformed and if it will hurt?

2) Mary inquires if she should be preforming SBE? Please teach Mary how and when to preform SBE for a premenopausal women.

3) Mary states her mother is a breast cancer survivor and want to know when she should get her first mammogram?