When Saul Garlick was a young boy, he traveled with his family to Delani, a rural community in Mpumalanga, South Africa, and was shocked by the antiquated conditions and lack of schools in which the residents of the small village lived. He pledged to do something to help. When he was 18, Garlick launched a nonprofit organization, Student Movement for Real Change (SMRC), and raised $10,000 to build a school in Delani. Over the next few years, Garlick’s vision for the nonprofit expanded, and SMRC began to focus on sending college students to live with local families in South Africa and build entrepreneurial ventures with them. While attending graduate school at Johns Hopkins School of Advanced International Studies, Garlick took 18 undergraduate students on a five-week trip to Mpumalanga. He was dismayed when he saw that the school he had built years before was shuttered and in total disrepair.

It was then that Garlick realized that simply throwing money at a problem would not fix it.

He committed himself to finding a scalable, sustainable solution based on a social entrepreneurship model. Garlick began to reimagine SMRC. What if, he thought, he could take bright, enthusiastic college students from around the world to Africa and have them work with local people to develop new ideas and solutions to the most pressing local problems? He changed SMRC’s name to ThinkImpact and began raising money to fund its mission. By 2009, Garlick was raising $400,000 annually to support ThinkImpact; unfortunately, costs were running higher. Like leaders of most other nonprofit organizations, he was frustrated because raising money is an ongoing process that demands a great deal of time and takes away from the time they spend on achieving their mission. Still, he was encouraged because ThinkImpact had gained traction and was beginning to make a difference in local communities in South Africa and Kenya. After missing a couple of payrolls for ThinkImpact’s small staff, however, Garlick began to consider other ways that he could accomplish the organization’s mission.

After attending a workshop with other social entrepreneurs, Garlick identified three options:

• Option 1. Remain a nonprofit organization. ThinkImpact has contracts with two universities that generate $50,000 annually. In addition, Garlick expects that grants and donations will bring in up to $100,000 per year. However, if Garlick wants to realize ThinkImpact’s mission, he estimates that he will need an additional $200,000 to $250,000. As he has learned, raising money for a nonprofit is never-ending and takes valuable time away from achieving the organization’s mission.

• Option 2: Shut down the nonprofit and start a for-profit company. Under this scenario, the for-profit company would purchase ThinkImpact’s assets and pay off its debts, essentially giving Garlick and his employees a fresh start. To finance the new company, he could borrow money and approach family members and friends who have indicated that they would invest in a for-profit company if there is a chance of earning a return on their money. The for-profit business would generate revenue by charging colleges and universities a fee to provide students with meaningful, immersive international experiences that focus on social enterprise. Garlick estimates that the for-profit company would hit its breakeven point in three years. His primary concern is whether colleges and universities would be as open to working with a for-profit company as they are with a nonprofit such as ThinkImpact.

• Option 3: Keep the nonprofit organization but start a for-profit business as a subsidiary.This hybrid model incorporates the advantages of the first two options. The nonprofit could still pursue grants and donations, and the for-profit operation could utilize traditional sources of financing, including debt, which would make ThinkImpact less dependent on somewhat unpredictable grants and donations. One concern that Garlick has is the potential for a conflict of interest if he is a stockholder in the for-profit subsidiary and the executive director of the nonprofit parent company.

2. If Garlick chooses to create a for-profit entity, either to replace the current nonprofit organization or as a subsidiary, what potential sources of funding might he be able to tap?

Juan is a 2 year old boy who was admitted via the ER for difficulty breathing. He and his parents do not speak English. You immediately begin a focused assessment on Juan and your findings include:

• Juan is sitting upright with his hands on the bed, chin and tongue out, drooling excessively.
• Breath sounds in all lung fields are severely diminished.
• Stridor is present.
• His color is dusky blue, O2 Sats 60%
• HR 122, RR 24, BP 100/60
• Juan’s parents are crying and screaming, but you cannot understand them.

Considering this scenario, answer the following questions:

1. What assessment findings are abnormal and are concerning to you?
2. What condition is this patient presenting with?
3. You notify the physician of the abnormal findings. What orders will you anticipate from the physician? Include rationales.
4. Provide a PRIORITY NURSING diagnosis:
5. List three nursing interventions you will perform for this patient. Include rationales.
6. List any immunizations that could have prevented the development of this illness.

In Pediatrics, the family essential to the emotional security and development of the child. What will you do for this family who is frightened and does not speak English?

Jordan is a 9 year old boy who is a direct admission for observation. He has a hx of vomiting and diarrhea for 48hrs.

Subjective Data:

N/V/D x 48hrs

reports haven’t voided today

unable to tolerate oral fluids

Obj Data:

VS: T 37.8 C (100 F) HR 120 RR 24bpm BP 110/60

wt: 34.2 kg

BS hyperactive x 4 quads

lethargic, poor skin turgor

What assessment data is most concerning to the RN? What other assessment data would be useful? Describe the 3 phases of parenteral rehydration associated with moderate dehydration. What are the priority outcomes? What interventions/rationale should the nurse implement? What is the best way to approach Jordan regarding the ordered IVF? What would be good diversional activities for him? When should the discharge teaching begin and what should be included?

Timothy is a seven year old boy, his mother takes him to the pediatrician for review. Its weight is 31 kg and corresponds to the 95th percentile; their height is 127 cm and they are between the 75th and 90th percentiles for their age. His body mass index is 19.25 kg / m2, which is just above the 95th percentile for his age. Their growth percentiles have increased in recent years. Timothy's mother expresses her concern to the pediatrician about the weight of her son; his brothers, one older and one younger than him, are slimmer. Timothy's mother is obese, but her father is a normal weight for height. Timothy is in his second year of elementary school and takes the school bus both to go to school and to return. She participates in her school's school breakfast program, but her parents give her extra money to buy, if she wants, some of the food sold in the cafeteria or the vending machines. After school, Timothy and his siblings stay at home with a babysitter until one of their parents returns from work. Timothy usually watches television or entertains himself with video games after school; Their parents leave treats (chips, cookies, and soft drinks) at home for their children to eat after school. The mother usually prepares the evening meal, which consists of meat, starch, vegetables and a dessert. After dinner, Timothy does his homework and then watches more television with his parents. He often has ice cream before going to the cabin.

Apply nutritional assessment,

nutritional diagnosis,

nutritional intervention

and nutritional surveillance

Jaron Baker is a 10-year-old boy who is admitted to the health care facility with a fractured tibia after falling from his bicycle on the way home from a friend’s house. He is scheduled for surgery to repair the fracture. During the interview, Jaron offers little information, allowing his parents to answer most of the questions. When the nurse asks Jaron questions, he uses few words, often limiting the answers to yes, no, or I don’t know. (Learning Objectives 14, 15)

a. What factors may be contributing to Jaron’s participation in the interview?

b. How might the nurse approach Jaron to gather additional information?

c. Based on Jaron’s developmental level, which interventions in preparation for surgery would be most appropriate?

A boy falls off his bike and skins his knee. In thinking about the structure of the lower leg and specifically the knee, it quickly becomes apparent that the knee is a good example of a location in the body where many types of tissues work together to perform a function – in this case movement. Identify at least four different types of tissues that are present in the lower leg and knee area. You must include at least 3 of the 4 categories (i.e. connective, epithelial, nervous, muscle) of the tissues you select. For each tissue you identify include the following information: name of tissue tissue category function of that tissue in the lower leg and knee region

You just got off the phone with your boss, and boy was he mad. The final numbers just came in for the year, and you went over your budget by over 6%. As Director of Operations, you oversee most of the production departments at the Whispering Phone Book. Your budget covers production, distribution, and operations. Your boss wouldn’t listen when you tried to explain that the overage was not all your fault, and in fact, was not all bad. You decide that the only way to convince him was by showing him the numbers, since he is the CFO and all. Since your staff is so busy with year- end closings, you decide to hire a consultant. to prepare all the information you will need for the meeting with your boss on Friday.

Your job is to save the Director’s skin with his boss. Prepare a report, utilizing your knowledge of Managerial Accounting, that provides explanations for what caused the budget overage. Your report MUST include the creation of a flexible budget, the calculation of activity and performance variances, and a memo explaining the analysis to your boss.

Following is pertinent information for your analysis:

·        When you built the budget last August, you made the following assumptions:

o   Whispering phone book would produce 100,000 phone books across the country.

o   Production costs were $1.00 per book

o   Planned distribution costs were .25 per book.

o   Paper prices would amount to 3.50 per book.

o   You estimated 1.50 per book for printing costs.

·        Actual production was 110,000 books

·        You employed 40 production workers.

·        Phone, supplies, administrative costs, and maintenance do not vary with volume.

Case 1

Presentation: A five year old boy who was referred to a neurologist by his pediatrician because of an abnormal gait. He was adopted from another country about a year ago, and his adopting parents have noticed that he is clumsy when he runs where he falls often. He runs on his tiptoes, which has occurred since they started taking care of him. Otherwise, he has no other problems. He is doing well in kindergarten despite his language difficulty. His teacher notes that he has trouble getting up from a sitting position at school. His parents deny that he has chronic fevers, leg pain, weight loss, seizures, skin rash, urinary or bowel incontinence, or frequent colds.

History: His past medical, developmental, family, and birth histories are unknown. His immunizations are up-to-date and his PPD this year has been negative.

Physical : His vital signs are normal. His height, weight and head circumference are at the 50th percentile. He is alert, active, shy, well-nourished and slim in no distress. His skin shows no neurocutaneous stigmata. His head is normocephalic and atraumatic. His pupils are equal, round, reactive to light. No nystagmus is evident. His fundi are normal with sharp disk margins. His TMs are clear. His throat is normal with a uvula midline. His lungs, heart, and abdomen are normal. His back shows no sacral dimples.

Neurological : A standard cranial nerve e*am reveals no deficits. His strength is +4/5 in his deltoids, knee flexors and extensors; +5/5 in his biceps and triceps. His calves are visibly enlarged with a firm, rubbery feeling. He gets up to a standing position using a Gowers' maneuver. No dysdiadochokinesia. Negative Romberg sign. Sensation to light touch is intact. His reflexes are +2/4 in his biceps, triceps, brachioradialis, patella and ankle. His plantar reflex is down going (negative Babinski sign). No clonus is elicited. Normal anocutaneous and abdominal reflexes are present. His gait is best described as a wide based waddling. When running, he tends to run on his toes. He is unable to jump.

Diagnosis? and what medication or treatment?