Mrs. Anna Temple, A 40-year-old African American woman, arrives at the emergency room, with her husband Joe. According to Mr. Temple, his wife woke up at 7 am to get ready for work. Mrs. Temple was unable to get out of bed due to weakness in her left arm and left leg. Mr. Temple also noticed the left side of his wife’s face was drooping. Upon arrival at the ED, Anna Temple had a left facial droop, left-sided hemiparesis, expressive aphasia, and mild dysphagia.

Anna’s past medical history includes atrial fibrillation (afib), hypertension, hyperlipidemia, and Type 2 Diabetes (NIDDM), anxiety, and depression. Anna’s past surgical history includes: hysterectomy, cholecystectomy, right knee arthroscopy, and incision and debridement of a left groin abscess.

Anna is awake, alert, and oriented x 3. Anna is unable to verbalize answers to questions due to expressive aphasia but is able to nod yes/no to staff. Heart rate is 101, and irregular. Lungs are clear bilaterally. O2 sat is 98% on RA. She has positive bowel sounds, positive +2 pedal pulses, and +1 bilateral edema of her lower legs. Anna’s husband reports that Anna has been complaining of numbness and tingling to her feet. Anna has also been c/o nausea and loss of appetite, and loose stools for 3 days. Anna is straight catheterized for a urine specimen. 300 cc of dark amber malodorous urine. Anna is quickly taken for a CT scan of the brain.

Vital signs, T: 37, HR, 101 irreg, RR 24, BP 188/98. Anna denies pain. Her blood sugar on admission was 242. #18 gauge IPID RFA.

Social History: Obtained from Mr. Temple. (while Anna was in CT scan).

Anna and Joe Temple have been married for 20 years. They have twin daughters, age 19, and a son, age 16. Their daughters are both freshmen in college, and their son is a sophomore in high school. Last year, Anna’s mother, who has early onset dementia, came to live with them after Anna’s father passed away from a heart attack. Joe’s parents live next door, and both have many medical appointments which Joe and Anna help take them to. Anna works full time as an administrative assistant for an insurance company. Anna often confides in Joe that her job is very stressful and rarely is able to get away from her desk for lunch or a break. Joe also says that Anna is always taking care of everyone else and is not consistent with her medications or her own doctor’s appointments. Anna has smoked 1 ppd for the last 20 years.

MEDS: Daily/PRN: Glucophage 500 mg po BID, Lopressor 25 mg po BID, Lipitor 20 mg po QD, Xarelto 20 mg po QD, Neurontin 300 mg po TID, Multivitamin 1 po QD, Premarin 0.3 mg po QD, Zoloft 100 mg po QD

Lab Results:

RBC 4.1                      Platelets- 450,000                  CL 110

WBC 16.2                   INR 1.0                                   Mag 1.4

HGB 11g/dl                K 2.8                                       Hbg A1C 12 %

HCT 32.3%               Na 148                                    Glucose 259

·Urinalysis: +2 bacteria, +3 leukocytes, +2 protein, trace RBCs,

·Diagnostic tests: non contrast CT scan: thrombolytic CVA.

·CXR: bilat bibasilar atelectasis, EKG: afib,

Mrs. Temple has returned from CT scan and tPA is administered per protocol.

In addition to tPA, the physician enters the following orders:

IV 0.9 NSS 125 cc/o, Vital signs & Neuro checks q 15 min x 4, then Q 30 min x2, then Q 1 hr. NPO until swallowing evaluation. 1 GM Rocephin IV, novolog per sliding scale, BGM ac and hs.

After Mrs. Temple’s vital signs stabilized, she was transferred to the neuro medical surgical unit with admission diagnoses of CVA, LSW, uncontrolled DM, HTN, and +UTI

STROKE:

1.      What is tPA, and why was it appropriate for Mrs. Temple?

2.      Why is Mrs. Temple NPO?

3.      What were Mrs.Temple’s risk factors for stroke?

4.      Explain how knowing the type of CVA is an important factor in treatment.

5.      What is the NIH stroke scale?

6.      Why would it be important to continue neuro checks in the hours following a CVA?

MEDICATIONS:

7.      Why do you think Anna Temple was prescribed each of these medications (look at home medications)

8.      Which of these medications may be contraindicated for Anna Temple based on her medical and surgical history?

SOCIAL HX:

9.      What additional risk factors are noted in the social hx information? How do these risk factors affect other aspects of Mrs. Temple’s health…..DM, HTN, Anxiety, Depression….

It is now 3 days post CVA for Mrs. Anna Temple, Anna’s deficits continue to improve, she is ambulating with a walker and standby assist. She is tolerating a LFLC consistent carb diet regular consistency with honey thick liquids. Anna is pleasant but with a very flat affect, very tearful at times. Anna’s vital signs and blood sugars are now within normal range. Anna will likely be discharged to acute inpatient rehab prior to transitioning to home.

10.  What diagnostic test was likely done by the speech therapist to determine that Anna needed honey thick liquids for safe swallowing?

11.  Identify actions to help Mr. and Mrs. Temple as they learn to cope with Mrs. Temple’s recovery and the other responsibilities of their busy lives.

CASE STUDY DETAILS

Case Scenario:

A 30-year-old female patient was brought by her husband to Accident & Emergency in Nizwa Hospital. Upon interview, the patient stated, “I am experiencing difficulty in breathing this past 2 days”. Upon assessment you noted the following: patient is restless with productive cough, crackles heard during auscultation, presence of nasal flaring and chest retractions with the following vital signs: BP 110/80, PR 110 bpm, RR 25 bpm, Temp. 37.1 ⁰C and SPO2 88.

1. Based from the above scenario identify ASSESSMENT DATA relevant to the care of the patient. Group the data gathered either subjective or objective data.
2. Applying the concepts learned about the nursing process and based on your assessment of the patient, what PRIORITY NURSING DIAGNOSIS?
3. Based on the given nursing diagnosis, identify the PLAN OF CARE applicable for the patient. Indicate the Goal and 3 outcome criteria.

Advanced Scenario 5:

Fran Emerson Interview Notes • Fran’s husband died in March 2017. Fran filed a joint return with her husband for 2017. She has not remarried. • Fran provided the entire cost of maintaining the household and all the support for her children, Meredith and Oliver, in 2018. • Fran’s older brother, Howard, lives with her and is permanently and totally disabled. He received disability income which he used to provide more than half of his own support. • Oliver attended day care while Fran worked. • In September 2018, Fran’s daughter, Meredith, enrolled in college to pursue a bachelor’s degree. She had no previous post-secondary education. Yuma College is a qualified educational institution. • Meredith does not have a felony drug conviction. • Fran brought a Form 1098-T and an account statement from the college. Meredith’s purchases at the college bookstore were for course-related books. • The terms of Meredith’s scholarship require that it be used to pay for tuition. • Fran took a distribution from her IRA and used all of the distribution to pay for some of Meredith’s education expenses. All her IRA contributions were deductible in the year she made them. • Fran received a Form 1099-C for cancelled credit card debt. Using the insolvency determination worksheet in Publication 4012, you helped Fran determine the value of her assets exceeded her liabilities and that she was solvent at the time the credit card debt was cancelled. • Fran did not have minimum essential healthcare coverage (MEC) all year and does not qualify for any exemption. Meredith, Oliver, and Howard each had MEC all year.

Advanced Scenario 5: Test

Questions 10. Which allowable filing status is most advantageous to Fran? a. Qualifying Widow b. Single c. Married Filing Separately d. Head of Household

11. Howard qualifies Fran for which of the following: a. Credit for other dependents b. Child tax credit c. Earned income credit d. All of the above

12. What is the amount of Fran’s child and dependent care credit shown on Form 2441, Child and Dependent Care Expenses? a. $1,591 b. $720 c. $660 d. $690

13. What is the total amount of qualified educational expenses used in the calculation of Fran’s American opportunity credit? $__________.

14. What is the amount of Fran’s individual shared responsibility payment? a. $0 b. $695 c. $1,295 d. $1,390

15. How much is Fran’s federal withholding? a. $0 b. $320 c. $2,200 d. $2,520

16. Cancelled debt from Form 1099-C, Cancellation of Debt, is reported on Fran’s tax return as: a. Wages b. Other income c. Capital gain d. It is not reported on the return

17. Which exception can Fran use to avoid the 10% additional tax on the early distribution from her IRA on Form 5329, Additional Taxes on Qualified Plans (including IRAs) and Other Tax-Favored Accounts? a. She does not qualify for an exception. b. Distribution made for higher education expenses. c. Distribution made for purchase of a first home. d. Distribution due to total and permanent disability.

A 34-year-old pregnant female discovered that her husband tested positive for HIV. She was never screened for HIV infection earlier. She shares this information to her physician during delivery. Immediate screening of the infant with molecular methods such as qPCR yielded positive results.

a. Explain the algorithm for laboratory diagnosis for screening and determination of true positive for the newborns?

b. If the results are true positives, how should the infant be monitored?

c. If the initial screening at birth yielded negative results for the infant, should the testing be concluded? Explain your reasoning.

Problem 6-5 Julia Baker died, leaving to her husband Morgan an insurance policy contract that provides that the beneficiary (Morgan) can choose any one of the following four options. Money is worth 2.50% per quarter, compounded quarterly. Compute Present value if: Click here to view factor tables (a) $56,790 immediate cash. (Round factor values to 5 decimal places, e.g. 1.25124 and final answer to 0 decimal places, e.g. 458,581.) Present value $ Link to Text Link to Text (b) $4,020 every 3 months payable at the end of each quarter for 5 years. (Round factor values to 5 decimal places, e.g. 1.25124 and final answer to 0 decimal places, e.g. 458,581.) Present value $ Link to Text Link to Text (c) $19,080 immediate cash and $1,908 every 3 months for 10 years, payable at the beginning of each 3-month period. (Round factor values to 5 decimal places, e.g. 1.25124 and final answer to 0 decimal places, e.g. 458,581.) Present value $ Link to Text Link to Text (d) $4,020 every 3 months for 3 years and $1,630 each quarter for the following 25 quarters, all payments payable at the end of each quarter. (Round factor values to 5 decimal places, e.g. 1.25124 and final answer to 0 decimal places, e.g. 458,581.) Present value $ Link to Text Link to Text Which option would you recommend that Morgan exercise? Click if you would like to Show Work for this question: Open Show Work

Catherine (wife) and Peter (husband) Mallen had lived together unmarried for some four years when Catherine got pregnant and a marriage was arranged. Peter asked Catherine to sign a prenuptial agreement. Although his financial statement attached to the agreement did not state his income at $560,000 per year, it showed he was wealthy, and she had lived with him for four years and knew from their standard of living that he had significant income. Catherine contends that failure to disclose Peter’s income was a nondisclosure of a material fact when the agreement was drawn up and that accordingly the agreement is not valid. Peter contends that he fully disclosed his net worth and that Catherine was well aware of his significant income. Further, he contends that disparities in the parties’ financial status and business experience did not make the agreement unconscionable.

Please answer ALL of the following questions in your discussion:

Was the agreement obtained through fraud?

Was the agreement obtained through duress?

Was the agreement obtained through nondisclosure of material facts?

Was the agreement unconscionable?

Case Study

Allyson is a 43-year-old female who has been married to her husband, Roy, for 12 years and have a 10-year-
old daughter, Rose, between them. Allyson claims that she has been feeling depressed and is seeking a

treatment due to a fear that she would lose everything. She claims she is always sad, tired, and angry and
feels hopeless. For her, everything seems gray. She reports that she lost interest in activities which she was
interested in before, and upset about the fact that she lost interest in raising Rose. According to Allyson, she
first started feeling depressed after she gave birth to Rose. Allyson claims that her doctor did not diagnose
her as experiencing postpartum depression. About 3 weeks later, her mood up lifted again but her symptoms
worsened past year or so. In addition, she claims she experiences abnormal sleep pattern which causes her
to over sleep about 12 hours and 14 hours. She alluded that the onset of the condition was about 7 month
ago and which is considered to be concurrent with depression. Allyson grew up in the family who
experienced and according to her, her mother also experienced depression. She reports that she
has experienced feeling depressed as early as she was 13. However, according to Allyson, her family does
not admit weakness and does not believe in therapy, she did not get proper treatment which may have
worsened her symptoms. Allyson was not a good student at high school and college. She did not go through
any significant traumatizing events such as loss of close people, abuse, bullying and so on. Allison worked
for a telecommunications company for eight years before her marriage to Roy and their moving to New York.
She now works as a consultant while raising Rose. She is financially very stable due to her husband who is a
medical doctor and herself working as a consultant. From her report, though she has been depressed, she
has never been prescribed with medication. In addition, she has never been on any drug or severe
substance use.
• Give a proper diagnostic criterion of this case according to DSM-V
• Write etiology of this case in the light of Psychodynamic Perspective?
• Design a treatment plan for this case according to Psychodynamic Therapeutic techniques?

The demand for gizmos is given by Q=2,000-100P and the supply of gizmos is given by Q=-100 + 200P. There is a $2/unit sales tax on gizmos. Who pays the tax? Who bears the economic burden of the tax? On a supply and demand graph, label the price that buyers pay, the price sellers receive, the tax incidence borne by buyers and sellers, and the deadweight loss associated with the tax.

Cassiopeia inc. is currently trading at $100 per share. After examining the stock of Cassiopeia, you have determined that in each 3 month period its price will either increase to 25% or decrease by 20%. The interest rate is 3% every 3 months. A six month European call option on Cassiopeia has an exercise price of $90. What is the value of this call option?

The price of a zero-coupon bond (ZCB) that matures at time t=10 and that has face value 100 is $61.62

Build an n = 10 binomial model lattice model with the following parameters to compute the price of a forward contract on the same ZCB where the forward contract matures at time t = 4

r_0,0 = 5%

u = 1.1

d = 0.9

q = 1 - q = ½