Ponion Boy Inc. (PB) has a total market value of $400 million, consisting of 12 million shares of common stock selling for $25 per share and $100 million of 8 percent perpetual bonds currently selling at par. PB pays out all earnings as dividends, and its marginal tax rate is 35 percent. The firm’s earnings before interest and taxes (EBIT) are $45 million. Management is considering increasing PB’s debt until its capital structure has 65 percent debt, based on market values. The additional funds will be used to repurchase stock at the new equilibrium price. At the new capital structure, PB’s cost of debt is estimated at 13.5 percent and its cost of equity is estimated to be 14.85 percent.

What is PB’s weighted average cost of capital at its current debt level of $100 million?

      a. 7.32%      

      b. 9.51%      

      c. 10.52%     

      d. 8.75%      

      e. 12.25%

What is PB’s weighted average cost of capital at its new capital structure?

      a. 8.25%      

      b. 8.553%     

      c. 9.89%      

      d. 9.25%      

      e. 10.90%

Based on the WACC calculated in Problem 6, what is the new total corporate value of PB?

      a. $190,209,133

      b. $198,087,774

      c. $268,348,623

      d. $220,570,098

Based on the UBI’s new total corporate value calculated in 7, what is the value of the debt that PB has in its new capital structure?

      a. $86,359,128.26

      b. $99,321,167.25

      c. $118,852,664.85

      d. $138,439,097.50

      e. $174,426,605.50

Based on PBs new total corporate value in problem 7 and its new value of debt in problem 8, how many shares remain outstanding after the recapitalization?

      a. 1,215,400 shares      

      b. 1,200,000 shares      

      c. 1,872,341 shares      

      d. 9,320,451 shares      

      e. 6,694,371 shares`

Mary is a 32-year-old G2 P2 who delivered a baby boy by repeat cesarean section at 1200. She received epidural morphine for pain management. Mary returned to the mother-baby unit at 1530. She had an IV of LR infusing, but the nurse discontinued it at 2000 after Mary tolerated sips of clear liquids and then a regular diet at dinner. It is now 0800. When the nurse enters the room, she finds Mary unresponsive with a respiratory rate of 8 breaths/min.

1. Who sets the nursing standards of practice for perinatal and women’s health nursing?

2. How are these standards reflected in the hospital setting?

3. How is negligence determined?

4. The risk management department reviews the nurse chart and finds that vital signs were taken q 8 hours. The unit policy on epidural morphine states that vital signs are assessed q 4 hours x 24 hours, and the respiratory rate is assessed q 2 hours. The policy also states that an IV must be in place for 24 hours. Which of the standards of professional performance that delineate roles and behaviors for the professional nurse apply in this situation?

5. Did the nurse fulfill her legal responsibilities as a nurse?

6. A code blue is called, but Mary does not regain consciousness. She is intubated and transferred to the intensive care unit and placed on a ventilator. In a court of law, could the nurse’s care be considered negligent?

A young boy, age 2 years, pulled a pot of boiling water over his head, arms, and chest, resulting in a mixed burn to the anterior surface of his head and arms, chest, and feet.

Discuss the factors that determine the classification of the types of burns and determine what type(s) this victim probably has. (See Classification of Burns.)

Discuss how the physicians in the emergency room will determine the percentage of the body that may be burned and what special considerations may be involved when evaluating a child. (See Percentage of BSA Burned.)

Discuss the additional effects associated with burns and the treatments involved, which include shock, pain, electrolyte and fluid imbalances, respiratory complications, infection, metabolic problems, and anemia. (See Effects of Burn Injury.)

Discuss the actions to promote the healing of burns. Specifically address the problems that may be associated with scarring and the effects of growth that this 2-year-old may experience. (See Healing of Burns.)

Client 1: Ethan Sky

Ethan is 8 years old boy and is recently recovering from car accident where he lost his right lower limb. His emotional and physical well-being is a concern for his parents and they are bringing him to the centre to work with you to build his confidence. He has anxiety about travelling in a car and returning to school. His mum and dad are struggling to manage his feelings and outburst of anger. He does have two siblings and he is distancing himself from them has he is frustrated he cannot run around with them.

Client 2: Linda Pearson

Linda is 55 year old women who had a stroke that caused partial blindness to her left eye. She is currently undergoing treatment plan to train her visual stretch and exercise to help her improve her vision. She has been referred to your centre for support with hazard perception (e.g. how she moves around the environment). You are also supporting the family to help them understand where Linda comes from and how they can help around her living environment.

1. you need to describe the personal care to your client’s relations such as parents, sibling and children. To support you consider the following factors;

- Caring
- Empathy
- Gentleness
- Respectful
- Empowering
- Reliable
- Sensitive
- Non-Judgemental

2.Identify procedures which relate to personal care in a chosen health and social care setting
you need to consider the procedures that will support the two clients in different setting. To support you consider the following factors;

- Moving and lifting
- Hand washing
- Disposal of waste
- Child Protection and Adult Protection and Safeguarding
- Self-protection
- Cleaning equipment
- Food handing
- Confidentially
- Risk Assessment

3. you need to explain why it is important to follow these procedure in relation to personal care. To support you consider the following;

- Health and safety of clients (risk assessment)
- Health and safety of carers
- Infection control
- Efficiency
- Insurance/ litigation
- Regulations (e.g. Care Standards Act 2000, National Minimum Standards in relation to personal care)

Using the following case, describe how you would set up a program for young boy Jonathon who is watching too much T.V. and not getting his homework done, by using principles from operant conditioning (behavior modification). Be sure to include all of he tasks you would use before getting started. Determine the target behavior you would seek to change. include techniques that both increase and decrease the target behavior and those behaviors closely associated with the target behavior.

Jonathon is an eight-year-old boy. He is in the third grade and Bonneville Elementary School in Salt Lake County. He is the middle of three children. His older brother is age l l and his younger sister is age four. All three children live with their biological mother. Their parents divorced a year ago.

The children's father, Marquis, has a new partner and they live in an apartment approximately 15 miles from Jonathon, his mom, and his siblings. His mother is not seeing anyone at this time, so her evenings are spent at home with the children. She is, however, employed outside of the home and works as a clerk at a local convenience store.

Once a week, and every other weekend, the kids go to their father's house. Jonathon has begun complaining about being there as he reports it is not much fun because his father is "never there". He indicated that his dad's girlfriend isn't very friendly and that she orders Jonathon and siblings around all of the time.    

Jonathon did well is school, until his parents began to have relationship problems. His mom especially noticed a change in his grades after his father moved out of the house, just over a year ago. Prior to that, he was earning A and B grades and seemed to enjoy his teachers and classmates.

He has been assessed and does not have any neurological problems or learning disorders. As the school social worker, you have been asked to help Jonathon by setting up a behavioral program that will improve his grades.   Your assignment is to set up a program that addresses his study habits. He has been watching TV excessively, according to his mother, and he his neglecting to do his homework. As a result, he is getting D and F grades in his classes

Robert "Bubba" Breaux, 32, owns and operates a po boy shop in New Orleans, called Ya Mama's Po Boys. It is a family business that sells authentic New Orleans fare, just like "ya mama would serve" assuming she was from New Orleans. Bubba wants to establish a retirement plan so he can save for his retirement and the retirement of his employees on a tax-deferred basis. He has recruited you to assist in making a plan selection

Bubba only wants to contribute in years that he makes a profit and does not want to incur much if anything on administrative expenses. Since the employees of Ya Mama's are all family members, Bubba is happy to contribute on behalf of the employees when the restaurant is doing well

A. Based on Bubba's objectives, what type of retirement plan is most suited for his needs?

B. Why might you recommend that Bubba utilize a qualified profit sharing plan with a CODA in lieu of the suggestion in question 1? (if you suggested a profit sharing plan with a CODA for question 1, reconsider)

C. Bubba employs the following individuals. Which employee may he exclude if the plan was SIMPLE, SEP or 401(k) profit sharing plan?

Thank You!

Case Studies Tasks:

Susan and Joe had a wonderful little boy named Daniel, but he had been having an awful lot of bacterial infections and he was barely a year old. It seemed that the antibiotics cleared up one bacterial respiratory infection only to have another follow shortly. The scary thing was that Daniel had just fought off a case of pneumonia caused by Pneumocystis carnii, a fungal infection that was usually found in people with HIV. Waiting for the test results of an HIV test for their little boy was one of the worst experiences ever. Thank goodness it came back negative. However, it seemed that their troubles were just beginning. After this last lung infection, the fungal one, and a negative HIV test, their doctor had ordered a number of other blood tests, including a genetic test that Susan didn’t fully understand. Apparently the doctor was worried about Daniel’s immune system functions. Susan had also met with a genetic counselor who collected a family history of any immune disorders. The details were vague, but Susan’s mother, Helen, knew that one of her three brothers had died young from an unexplained lung infection. Unfortunately, Grandma Ruth had passed away a few years ago, leaving them with numerous unanswered questions. Susan and Joe had an appointment with their doctor that afternoon to go over the results. When they arrived Dr. Dresdner led them into an office where Ms. Henchey, the genetic counselor, waited. This can’t be good, thought Susan. The doctor began by explaining that they had analyzed Daniel’s blood and found that while he had normal levels of B cells and T cells, his antibody levels were anything but normal. The levels of IgG, IgA, and IgE were very low, almost undetectable, and Daniel had abnormally high levels of IgM and IgD. It appears that his immune system failed to undergo immunoglobulin isotype switching due to a CD40 ligand mutation in Daniel's DNA.

1.Diagram an antibody response graph for a normal 1st and 2nd exposure with the antibodies correctly labeled for each exposure. Then diagram what Daniel's graph would look like, based on his situation.

2.Diagram and/or explain why IgG is low and what CD40's role is? Why is a mutation in that gene a problem? (There is no specific diagram I am looking for here, either diagram it or explain it, depending on which you prefer.)

Charlotte: A 60-year-old woman was fit and well until late in the summer she was out tending to her lovely tulip garden when she was stung on the back of her right hand by a pesky wasp. This was nothing new, unfortunately as she had been stung a couple times in the last two weeks. With in minutes after this sting Charlotte fell to the ground and looked as though she was becoming pale/grayish and was gasping for air. After five minutes it was getting worse, but likely a neighbor doctor rushed over and administered an epinephrine shot, which provided support until the ambulance could arrive.

1.Which antibodies and cells are involved in this allergic reaction and how does it lead to anaphylaxis?

2.Why didn't this happen on the first stings? How does anaphylaxis impact the body and how did the epinephrine help?

Jessalyn: Jessalyn regularly goes in for blood transfusions. Jessalyn's blood type is A-. Normally her blood transfusions go well and her nurse, Traci, does a great job of double checking the blood type she is receiving. This time Traci is out of town and she gets a nurse who was able to skate through school doing the bare minimum and doesn't really care that much about his job. He doesn't double check the blood type for her transfusion and . . . The blood type was incorrect.

1.Diagram and/or explain what happened.

2.Which blood types could Jessalyn receive, why?

Jack is a 4-year-old boy with a known peanut allergy. On September 15, 2016, Jack’s parents took him to the nearby, but small, Maplewood Community Hospital emergency department for evaluation of a suspected allergic reaction. Jack’s parents reported that he developed facial swelling, tongue swelling, and a diffuse red rash over his entire body immediately after eating what was “labeled” as an almond butter cookie. Before arriving at the ED, Jack’s mother administered oral diphenhydramine at the onset of his symptoms, without any apparent improvement. At the Maplewood ED, initial physical examination was significant for diffuse facial edema including the lips, tongue edema, and a diffuse urticarial rash on the chest, back, arms, and legs. Jack was treated with epinephrine intramuscularly, methylprednisolone intravenously, diphenhydramine IV, and ranitidine IV. Rash and tongue edema were unchanged, and facial edema improved. While Jack was being examined and treated at the ED in the presence of his father, his mother was waiting in the Maplewood Community Hospital cafeteria. During this time, Jack’s mother became dizzy and unsteady on her feet. She made her way back to the ED. There, staff noted that she was slurring her speech and exhibiting left facial droop, both signs of a stroke. Triage nurses and physicians performed standard diagnostic tests which included stroke assessments, an electrocardiogram, and a computed tomography (CT) scan. None of these tests indicated evidence of stroke (like intracranial hemorrhage). So, the staff diagnosed her with Bell’s palsy, a form a temporary facial paralysis unrelated to stroke. Jack’s mother was discharged. Jack’s mother is somewhat of a celebrity in Maplewood Community. She is a well-known video blogger and Instagram celebrity. When some of the staff at Maplewood Community Hospital heard she was in the hospital they wanted to know why since there had been rumors for a long time that she was a “speed freak”. Several nurses and physicians not on her treatment team accessed her chart and one physician sold the information he obtained from her record to TMZ.

Meanwhile, after her initial examination of Jack, the Maplewood ED attending physician telephoned the ED attending physician at Saint Paul Children’s Hospital to discuss transfer for specialized pediatric care (unavailable at Maplewood Community Hospital) for a presumed allergic reaction. The Saint Paul Children's Hospital physician agreed to accept the patient transfer request. Maplewood then contacted a private ambulance service for patient transport. Copies of the medical records were made and handed to the ambulance crew at the time of transport. But the private ambulance service then transported Jack to Edina Children’s Hospital instead of Saint Paul Children’s Hospital. On arrival at Edina Children’s Hospital, Jack was evaluated and noted to have obvious facial edema and a generalized urticarial rash. No intraoral edema or respiratory distress was present at the time of arrival. The medical team at Edina Children’s Hospital recommended admission to the hospital for further evaluation, monitoring, and treatment. After determining that Jack had been transferred from Maplewood Community Hospital, the Edina Children’s Hospital ED charge nurse telephoned Maplewood Community Hospital to inquire about the transfer, including why no advance communication about the transport had occurred. The Maplewood Community Hospital charge nurse explained that the transfer had been intended for Saint Paul Children's Hospital. She then alleged that Edina Children’s Hospital had committed an EMTALA violation by treating Jack rather than immediately transferring Jack to the intended destination at Saint Paul Children’s Hospital. The Edina Children’s Hospital ED attending physician then arranged for Jack’s transfer to Saint Paul Children’s Hospital. A subsequent review revealed that the private ambulance service had dispatched its personnel with incorrect destination information. But none of the three hospitals led any formal complaint about each other or about the ambulance company. Jack was soon discharged from Saint Paul Children’s Hospital and is now doing fine.

Unfortunately, Jack’s mother did not fare as well. She died from a stroke on October 3, 2016. The coroner determined that her right carotid artery must have been so seriously occluded on the date of her visit to Maplewood Community Hospital, that she suffered a first stroke at that time. Therefore, ED clinicians there should have been administered the appropriate therapy (tissue plasminogen activator) to dissolve blood clots.

You are a Healthcare Administrator at a local hospital and Jack’s father comes to you for help because he knows you are a healthcare expert. He wants to know whether he has a wrongful death claim against Maplewood Community Hospital and whether you think any of the hospitals committed EMTALA violations. He also wants to know if you think a privacy violation occurred and if one did occur who he should file a complaint with. Moreover, he doesn’t like the way the malpractice system works in his State and would like to lobby the State legislature to make changes. Since you are a healthcare expert he would like your opinion on what changes should be made to the current malpractice system in the United States. He feels that he shouldn’t have to file a lawsuit against Maplewood for them to take ownership of misdiagnosing his wife. Finally, while he is down lobbying for malpractice reform he also wants to discuss changes to the privacy rule with the state legislature and wants your opinion on what might be changed so his wife’s privacy might have been better protected while she was in the hospital. He asks that you prepare a memo with all the requested information in it so he can evaluate his next steps.

Jesse is a 3-year-old boy who was diagnosed with Osteogenesis Imperfecta (Page 1699-1700) – A congenital life-long condition that impacts the strength of the bones. Jesse will be pre-disposed to multiple broken bones throughout his life. He is being seen today in the emergency room setting related to a broken right arm. Jesse’s parents have been struggling with the diagnosis but have slowly been adapting their lives to support Jesse. Jesse’s mother quit her job and decided to remain home to provide care for Jesse and his older siblings. Jesse’s father as a computer analyst has allowed Jesse’s mother to be a stay-at-home mother, but the finances are tight at times.

1. What are the effects of special needs on Jesse?
   • How will the nurse address and assess Jesse based on his developmental age?
   • What vital signs would the nurse document and what method would they use to obtain these values?
2. What are the effects of special needs on Jesse’s family?
3. What is involved in the nursing management of a medically fragile child?
   • How would the nurse assess Jesse’s pain?
     • What tool would the nurse use to assess Jesse’s pain?
4. Ibuprofen is the preferred NSAID for pain management for fractures. Based on the order below, how many mLs would the nurse administer to the patient?
   • ORDER: Ibuprofen - 115 mg (10 mg/kg/dose) PO every 6 - 8 hours (Max daily dose 40 mg/kg/day)
   • On hand: 100 mg / 5 mL
   • Child weight: 11.5 kg
   • (Round to the tenth's place)
5. What teaching would the nurse provide to the family to promote safety going home related to pain management?
   • What additional discharge teaching might the nurse provide to the family?