Surgery Assignment

A 62-year old male client who has undergone a total laryngectomy for laryngeal
cancer is being cared for on the surgical unit. He has a tracheostomy tube in place. In
addition to providing tracheostomy care, the nurse is also trying to help the client
communicate his needs to the staff as he is unable to speak.

a.  By what means can the client with a tracheostomy communicate his needs to
the staff?
b. Develop a plan of care for this patient including two actual and two potential

Purpose

An effective way to engage with the topic of writing is to consider how writing matters in various communities on a daily basis. This paper provides the chance to reflect in a personal way about a writing community you successfully joined by learning how to use the language and reasoning skills of that community. By using personal experiences and anecdotes, you will trace your movement from an outsider to an insider in a particular community. Examples of writing communities include a specific workplace, a sports team, a church community, a social or college club, a different country and language, a specific discussion forum--online or in-person.

Task

Write a 3-5 page personal narrative that explores a particular writing community that you are very familiar with and that you feel comfortable discussing with your peers. This writing community should be one that you have chosen, rather than one you were born into. Pick a clear writing community, explain and analyze the writing community’s specific language practices and value system, and show readers that you have become a full member of this community by learning those language practices. Follow these specific steps:

1. Include a main point or take-away (thesis) in the beginning of your essay to clearly indicate to readers what the essay is about and what overall point you wish to make.
2. Identify the community’s specific reasoning (logos), its values and emotions (pathos) and explain how you built your credibility (ethos) as a new community member.
3. Explain some of the tensions and limitations of this writing community: do some members demand or disapprove of certain language use?
4. Use what cultural anthropologist Clifford Geertz calls “thick description” in your essay to identify a particular setting, mood, and people’s characteristics (names, ages, etc.). Show, rather than tell, by using sensory details in your own writing that cue readers to visual, auditory, olfactory, tactile, and kinesthetic aspects.
5. Highlight one or two particular incidents (anecdotes) in which the community’s language practices are nicely evident.
6. You may use quotes from individuals of this community, or from texts the community uses. Make sure to integrate such quotes into your essay.
7. Your audience are your peers and myself, your instructor. Thus, tailor the language of your essay to us, your real audience, and use a style that is distinctly your own.

Dr. Jenner's recommendation about 6th grade girls receiving the vaccine as part of their routine pediatric visits. Is it reasoning and benefiting the children?

What barriers might seem that may prohibit the implementation of a requirement for HPV vaccinations in schools?

How these barriers could be overcome?

a nurse at the family clinic triage several clients over the phone. Which of the following clients should the nurse instruct to come to the clinic?

a. a client who uses a diaphgram for contraception and has lost 30 lb in the pats 6 months dieting

b. a client who had an intrauterine device (IUC) inserted yesterday and has cramping and bleeding.

c. a client who has started taking oral contraceptives and is experiencing bright red vaginal breakthrough bleeding

d. a client who has sharp pain in her shoulder following a laparascopic tubal yesterday

Post 5 actions describing how YOU can improve global health.

Drawing on economic concepts and illustrative examples in your answers, discuss the following two statements separately and whether you agree with the statement or not.

1. A person can benefit from having health insurance coverage even if the premium paid exceeds the cost of health care received.

2. Preserving the concept of consumer sovereignty is sufficient justification for addressing moral hazard using demand-side solutions. To what extent do you agree with this statement in the context of health care?

Surgery Assignment

A 25-year-old female client is being admitted to the postanesthesia care unit (PACU)
following a thyroidectomy for hyperthyroidism. The client had undergone three
months of preoperative treatment with antithyroid medications and iodine
preparations to establish euthyroid status prior to her surgery. At the client's bedside
the nurse has set up a tracheostomy set, endotracheal tube, laryngoscope, and suction
equipment. There are ampules of calcium gluconate on hand. The nurse places the
client in a semi-Fowler's position, and is supporting her head and neck with pillows
and sandbags. The nurse frequently checks the client's vital signs, and assesses her
suture line for strain or bleeding. Once the immediate postoperative period has passed,
the client will be transferred to the surgical ward where she will recuperate and learn
about lifelong thyroid replacement therapy.
a. Why is it so important for the client to be euthyroid prior to thyroidectomy
b. Why is it mandatory to have emergency equipment and ampoules of calcium
gluconate on hand following thyroidectomy?
c. Why is it important to support the client's head and neck with sandbags and
pillows?
d. Develop a plan of care for this patient two (2) actual and two (2) potential

itial Post:

An 11-year-old boy presents to the emergency room (ER) with a 4-inch laceration on his right arm. He was with his friends doing bicycle stunts when he fell off his bike and cut his arm on a rusty nail from the ramp. In addition, his wrist is swollen, bruised, tender to touch, and warm, with limited mobility. He will most likely need stitches to close the laceration and a splint for the sprain.

In your initial post answer the following questions:

1. After treatment, as he prepares to leave, you give him last-minute care instructions for laceration and sprain. What would be important for this boy to know to prevent further health concerns with his injuries?
2. The boy concernedly asks you, “My uncle lost his foot because he got gangrene in it. Am I going to lose my arm if I get an infection in this cut?” How would you respond?

How is virtual healthcare organized through government, free market and sole provider?

Patient Profile

R.B. is a 55-year-old woman who presented to the emergency department (ED) via ambulance for acute shortness of breath. Her daughter called an ambulance after finding her mother with an increased respiratory rate and shortness of breath. Upon arrival to the ED, R.B.’s respirations were 40 and shallow with wheezing in the lower lobes and rhonchi in the upper lobes bilaterally. She had positive jugular vein distention and a heart rate of 128. After treatment with albuterol nebulizer via mask, her vital signs were temperature 96.8°F, pulse 98, respirations 28, blood pressure 148/84, and O₂ saturation 94% with 15 LPM via mask. Arterial blood gasses showed her pH 7.19, pCO₂ 90, PO₂ 92%, HCO₃ 38. R.B. was intubated for hypercapnia. After an echocardiogram showed an ejection fraction less than 50%, she had an emergency left heart catheterization done with two stent placements into the left anterior descending artery. A pulmonary artery catheter was placed, and the initial hemodynamic readings show elevated left ventricular preload. R.B. is now being transferred to the intensive care unit (ICU).

Subjective Data

• Lives with her single daughter, who cares for D.B. full time
• Daughter is not present at bedside
• Smokes 1 pack of cigarettes per day
• No longer active outside of the home because of her chronic illness
• Does not drink alcohol

Objective Data

Physical Examination

• Orally intubated #8 endotracheal (ET) tube taped at 26 cm to lip
• Ventilator settings: FIO₂ 60%, tidal volume 700, assist control (A/C), rate 16, PEEP of 5
• Height 5'5", weight 117 kg
• Alert and oriented to person, place, and time
• Fine crackles and wheezes bilateral lower lobes
• 2+ pitting edema bilateral lower extremities

Diagnostic Studies

• Chest x-ray postintubation: ET tube 4 cm from carina. Infiltrates in both bases; left base is worse than right
• 12-lead ECG: ST elevation
• Troponin: 41.94
• Lung V/Q scan negative for pulmonary embolism
• Urinalysis: dark yellow and cloudy, protein 28 mg/dL, positive for casts, positive for red blood cells and white blood cells, positive for glucose and ketones

Question 5

You obtain a set of hemodynamic monitoring values. Interpret these results.

Question 6

Describe each of R.B.’s ventilator settings and the rationale for the selection of each.

Question 7

How does PEEP lower CO?

Question 8

R.B. is started on intravenous dobutamine and sodium nitroprusside. How will these medications affect her hemodynamic status?

A 2-year-old female with spinal muscular atrophy type 1 presented to the emergency department in moderate respiratory distress. Physical assessment showed a bell-shaped configuration of thorax and ribs, and moderate intercostal and substernal retractions. The patient was receiving bilevel positive airway pressure (BiPAP) at home with the following settings: spontaneous mode, pressure 18/10 cm H2O, room air, with 4-hour sprints twice a day. BiPAP was initiated on the following settings: spontaneous/timed mode rate of 22, pressure 20/10 cm H2O, and FIO2 0.40. Albuterol and hypertonic saline were administered by jet nebulizer and an aggressive secretion clearance regimen was ordered. Chest radiograph revealed diffuse left lung opacification consistent with left lower lobe pneumonia, clear visualization of the diaphragm, and left upper lobe atelectasis. The right lung was clear. The patient was transferred to the pediatric intensive care unit (PICU). Due to increased work of breathing, the patient settings were increased to BiPAP 24/12 × 28 60% FiO2 around the clock for impending respiratory failure. Albuterol treatments were increased to Q2 hours followed by chest percussion, postural drainage, and cough assist. The patient’s respiratory status continues to deteriorate. She was intubated and mechanical ventilation initiated. A vibrating mesh nebu- lizer was used to deliver medicated aerosol therapy inline with the ventilator circuit.

1. Why was the vibrating mesh nebulizer selected when the patient was intubated and switched from a noninvasive ventilator to an ICU ventilator?

• Describe any two of the following--Ebola, HIV/AIDS, Chagas, or Schistosomiasis--from the standpoint of the relationships between (1) culture/economy and disease; (2) cities/towns and disease; (3) environmental change and disease; and (4) human ecology and disease.
• Within the above framework, how do the two diseases reflect “negative externalities” and “Karl Polanyi’s Paradox” (as defined in GPCC)?

250 word minimum; no maximum word count. Display the word count at the end of your post.

Does anyone have the answers or a guide to a case study on i-human for David Douglas? He is a 74 y/o patient, 6' 0" (183 cm), and 165.0 lb (75.0 kg). His admission diagnosis is "Day 1 Rehab for left total hip arthroplasty, post-op day 5"

Explain briefly Principles and Methods of Drug Administration :
1)RIGHT DOCUMENTATION
2)RIGHT ASSESSMENT.
3)RIGHT EVALUATION..
4)RIGHT TO REFUSE..
5)RIGHT CLIENT EDUCATION