Case Study – Systemic Lupus Erythematosus

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Case Study – Systemic Lupus Erythematosus

Michelle is a 40-year-old teacher who was recently diagnosed with Lupus Erythematosus.

The disease has attached her GI tract. One week ago she endured a bowel resection and ostomy placement after high doses of steroids failed to control her autoimmune response. She is presently crying because she hates the ostomy, hates the steroid effects, is afraid of losing her job, and she just doesn’t feel well. She is nauseated and has cold symptoms. This morning her glucose level was 324, her white count was 15,000, her temperature is 100.8, and her incision is “red and sore.” Her medications include: • Solu-Medrol IV 40mg BID • Hydroxychloroquine PO 150 mg twice a day • Vicodin ES PO 1 tablet every six hours for moderate pain PRN • Acetaminophen PO 650mg every 4 hours PRN for mild pain or temp > 100.5 Assignment: 1. Name three nursing priorities, and why? 2. List a short-term (during shift) and a long-term (within one week) SMART goal for the patient? 3. What are the classification, action, and therapeutic effects (reason) for solu-medrol, hydroxychloroquine, and acetaminophen? 4. List drug interactions or contraindications to be concerned about for solu-medrol, hydroxychloroquine, and acetaminophen? 5. What adverse effects/side effects does the nurse need to monitor for solu-medrol, hydroxychloroquine, and acetaminophen? 6. Because of the temperature of 100.8, you administer 650mg of acetaminophen. Two hours later Michelle asks for a Vicodin, how would you respond? 7. Michelle asks if you can stop giving her the solu-medrol, why is this not an ideal course of action?

The Blum Model

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Description

The Blum Model

After completing the lecture and reading assignments, compose a well- written response paper to the following question: The Blum Model points to four key determinants of health. Select at least one of these determinants and discuss the implications for the Christian health administrator. o Requirements: Do not use the question in the response. Papers must include a substantive elaboration on the topic as well as support from scripture.

Explain how health care reform has helped shift the focus from a disease-oriented health care system to one of wellness and prevention

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Explain how health care reform has helped shift the focus from a disease-oriented health care system to one of wellness and prevention. Discuss ways in which health care will continue this trend and explain the role of nursing in supporting and facilitating this shift. In replies to peers, provide three example of wellness and prevention initiatives your organization or specialty area has in place.

Matching Theory to Client Intervention Paper

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Matching Theory to Client Intervention Paper:

Paper details Matching Theory Case Study Unsettling Transition Mrs. Elizabeth Cuthbert is an 81 year old Caucasian woman. She has been diagnosed with syncope (fainting spells), hypertension, and chronic obstructive pulmonary disease. For the last four months she has resided in a nursing facility and receives skilled nursing services. Mrs. Cuthbert’s move to the facility occurred as a result of repeated syncope and falls. Her condition has been exacerbated by the recent development of a foot drop, a weakening of the structures in her ankle that allows the foot to dangle when walking. This ailment has increased her risk of falling. Mrs.Cuthbert has been fitted with an ankle foot orthosis (AFO) and provided with a walker, but she claims these aids make her feel “weak.” Mrs. Cuthburt receives physical therapy for her balance and occupational therapy for her tasks of daily living. Her discharge plan involves placement in an assisted living apartment once she has developed the safety and ambulation skills that will allow her to live without constant monitoring. Mrs.Cuthbert’s medications for the last six months include therapeutic aspirin, blood pressure medication,and Tylenol for pain relief from her fall and osteoarthritis.

She is compliant with her medications. Mrs.Cuthbert was widowed 20 years ago and has lived alone in her home of 35 years since that time. Her immediate family includes two adult children, who live in the area, and three grandchildren, who visit and send her letters. Family members visit frequently, at least twice a week. Mrs.Cuthbert Expresses a negative attitude toward the aged in comments during unrelated discussions. For instance, when the social worker intern first met her, she cast aspersions on an“old dog” who lived in the unit, and then went on to make negative comments about her own appearance, saying she looked like “an old hag.” She received the social workers supportive comments positively, but the change in attitude appears transitory. The results of a mini-mental status examination conducted on Mrs.Cuthbert indicated that she was aware of person, time, and place. Mrs.Cuthbert was also evaluated using a mood scale to determine her risk for depression. She scored 7 out of 15 (a score higher than 5 is indicative of depression). Her response to the mood-scale questions revealed feelings of worthlessness, low energy, insomnia, and diminished interest in pleasurable activities. Mrs. Cuthbert evidences no symptoms of mania. Mrs.Cuthbert is undergoing significant change in her social support system as a result of her move to the nursing facility. She no longer has the neighbors whom she visited each day as she went about retrieving her newspaper, checking on her garden, and watering her outdoor plants. She has lost the use of her car and feels that she should give up driving permanently to prevent possible accidents. She also no longer has the option of walking to her place of worship because of her current condition. An additional problem for Mrs.Cuthbert is her reluctance to make safety changes that will allow her to move to an assisted living apartment in a nearby community where several lifelong friends reside. She has been very reluctant to adopt the walker or the AFO and has been refusing the majority of her physical and occupational therapy treatments because she is “tired.” During her care plan meeting, Mrs. Cuthbert expressed surprise that the entire interdisciplinary team had gathered to discuss her case with her and her family. She asked, “Why are all of you interested in me?” She stated that she wanted to move to assisted living because she would be able to visit with her friends there once she did so. When told that she could not move until she addressed the safety and ambulation deficits she is experiencing, she expressed interest in cooperating with the various therapists and counselors. According to Mrs. Cuthbert’s daughter, Barbara, until her current health problems and the move to the nursing facility, her mother was a relatively contented person. She crocheted,enjoyed crossword puzzles, called on friends, assisted two shut-ins whom she has known for years, and had her grandchildren over for weekend visits. Since her admission to the nursing home, it has become difficult for Mrs. Cuthbert to accomplish several of her old activities, and simply not feasible to continue others. However, she has also discontinued the activities that were appropriate for her while at the nursing home, except for doing crossword puzzles. Barbara noted that her mother was not interested in going out for meals as she had been before fall. Her daughter speculated that her mother might not want to be seen in public with the AFO and walker, but noted that she also refused take-out meals offered as well. When asked, Barbara was unaware of any history of mood disorders or other mental illness in her mother’s background, but said that her mother wouldn’t typically speak of such things anyway. Mrs. Cuthbert financial situation is sound. She owns her own house and collects pensions from both her own employment as a secretary and her husband’s work.

PICOT Question In hospitalized adult patients is hand washing with soap and water

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PICOT Question In hospitalized adult patients is hand washing with soap and water
Topic: PICOT question: In hospitalized adult patients is hand washing with soap and water or the use of alcohol-based hand sanitizer more effective in preventing Hospital Acquired Infection HAI compared to no hand washing at all during their course of hospital

 

Paper details:

Critically appraise a minimum of 14 peer-reviewed articles meeting your PICOT question search strategy. Complete the appraisal using an appropriate critical appraisal checklist. Submit your completed checklists to Canvas’ assignment manager. Sources should be between 2015-2019

Treat Montresor of A Cask of Amontillado from a psychoanalytical perspective

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Treat Montresor of “A Cask of Amontillado” from a psychoanalytical perspective and at least 750 words. Discuss what a psychoanalyst might find wrong with him. What treatment methods might be used to improve his condition. The sources cant be anonymous. They must have authors who are qualified to analyze literature. Refrain from using a three-point thesis. Make your thesis statement original and forceful, but do not offer your main essay points in it.

 

Treat Montresor of “A Cask of Amontillado” from a psychoanalytical perspective and at least 750 words. Discuss what a psychoanalyst might find wrong with him. What treatment methods might be used to improve his condition.

 

Use parenthetical documentation to cite the sources in your essay and create a “Sources Cited” section following the essay. In other words, use MLA style.

All4You! PROGRAM EVALUATION

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Description According to the U.S. Health and Human Services, their program All4You! “is designed to reduce the number of students who have unprotected sexual intercourse, which is associated with increased risk of HIV, other sexually transmitted infections (STIs), and unplanned pregnancy.

The program also aims to change key determinants related to sexual risk taking, such as attitudes, beliefs, and perceived norms. The All4You! program has two primary instructional components—a skills-based HIV, other STD and pregnancy prevention curriculum and service- learning visits in the community—that are integrated and delivered as a 14-session program (about 26 hours total).

The target audience for All4You! includes students in alternative high school settings, who are ages 14 to 18.” In this Application assignment, you should review the general resources on program evaluation in this week’s Assignment folder and All4You! Reports. ALL4YOU! A RANDOMIZED TRIAL OF AN HIV, OTHER STDs, AND PREGNANCY PREVENTION INTERVENTION FOR ALTERNATIVE SCHOOL STUDENTS Karin K. Coyle, Douglas B. Kirby, Leah E. Robin, Stephen W. Banspach, Elizabeth Baumler, and Jill R. Glassman. PREGNANCY PREVENTION INTERVENTION IMPLEMENTATION REPORT Program Name: All4You! Developers: Karin K. Coyle, PhD; Douglas B. Kirby, PhD; Leah E. Robin, PhD; Stephen W. Banspach, PhD; Elizabeth Baumler, PhD; and Jill R. Glassman, PhD Then please answer each of the questions below using complete sentences with evidence and arguments – not just one or two short phrases.

1. Which type(s) of program evaluation models were used in assessing the program? Explain your choice, referring to the guides provided this week. a. Begin by defining what a program evaluation model is and what types you have seen in the week’s readings. After that, make an argument for which program evaluation model was used in the All4You program evaluation included in the week’s readings.

2. The evaluators made the decision to incorporate self-report questionnaires as important data collection tools. Why do you think they selected this approach? What are specific advantages and disadvantages of this strategy?

3. What are some of the strengths of the evaluation? What do you see as some of the limitations? Why? 4. Evaluate the part of the evaluation that was conducted as a research project. This requires reading the file Report2_All4You_Evaluation_Study.pdf which is included in the assignment materials. How confident can you be of the results reported?

Policy/Regulation Fact Sheet

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Description Assignment:

Policy/Regulation Fact Sheet

Policy/Regulation Fact Sheet As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise. With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.

In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.

To Prepare: Review the Resources on healthcare policy and regulatory/legislative topics related to health and nursing informatics. Consider the role of the nurse informaticist in relation to a healthcare organization’s compliance with various policies and regulations, such as the Medicare Access and CHIP Reauthorization Act (MACRA). Research and select one health or nursing informatics policy (within the past 5 years) or regulation for further study. The Assignment: (1 page) Create a 1-page fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following: Briefly and generally explain the policy or regulation you selected. Address the impact of the policy or regulation you selected on system implementation. Address the impact of the policy or regulation you selected on clinical care, patient/provider interactions, and workflow. Highlight organizational policies and procedures that are/will be in place at your healthcare organization to address the policy or regulation you selected. Be specific.

Events that have contributed or will continue to contribute to the nursing shortage

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Discuss the events that have contributed (or will continue to contribute) to the nursing shortage, or that contribute to a shortage in a region or specialty. Discuss at least one way that the nursing profession is currently working toward a resolution of this problem. In replies to peers, offer three different examples of how the nursing shortage has been addressed in your state, community, or specialty area.

T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial

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Scientific Article Review Summaries and critiques are two ways to write a review of a scientific journal article. Both types of writing ask you first to read and understand an article from the primary literature about your topic. The summary involves briefly but accurately stating the key points of the article for a reader who has not read the original article. The critique begins by summarizing the article and then analyzes and evaluates the author’s research. Summaries and critiques help you learn to synthesize information from different sources and are usually limited to two pages maximum. Actions to Take 1. Skim the article without taking notes:  Read the abstract. The abstract will tell you the major findings of the article and why they matter.  Read first for the “big picture.”  Note any terms or techniques you need to define.  Jot down any questions or parts you don’t understand.  If you are unfamiliar with any of the key concepts in the article, look them up in a textbook. 2. Re-read the article more carefully:  Pay close attention to the “Materials and Methods” (please note that in some journals this section is at the very end of the paper) and “Results” sections.  Ask yourself questions about the study, such as: o Was the study repeated? o What was the sample size? Is this representative of the larger population? o What variables were held constant? Was there a control? o What factors might affect the outcome? 3. Read the “Materials and Methods” and “Results” sections multiple times:  Carefully examine the graphs, tables, and diagrams.  Try to interpret the data first before reading the captions and details.  Make sure you understand the article fully. 4. Before you begin the first draft of your summary:  Try to describe the article in your own words first.  Try to distill the article down to its “scientific essence.”  Include all the key points and be accurate.  A reader who has not read the original article should be able to understand your summary.  Example of a well-written summary: The egg capsules of the marine snails Nucella lamellosa and N. lima protect developing embryos against low-salinity stress, even though the solute concentration within the capsules falls to near that of the surrounding water within about 1 h. 5. Write a draft of your summary:  Don’t look at the article while writing, to make it easier to put the information in your own words and avoid unintentional plagiarism.  Refer back to the article later for details and facts.  Ask yourself questions as you write: o What is the purpose of the study? What questions were asked? o How did the study address these questions? o What assumptions did the author make? o What were the major findings? o What surprised you or struck you as interesting? o What questions are still unanswered? Format  A complete citation of the article goes at the top of the page, below your heading.  Don’t skip a line between the citation and the start of the essay.  Indent the first line of the essay.  Be concise and eliminate superfluous information. Organization  The introductory paragraph summarizes the background information and purpose of the research (specific questions the study researched).  Then, explain the methods that were used to investigate the research questions (use past tense).  Mention the major results of the study (use past tense).  State what the author of the study learned. Critique: A Critical Review and Assessment of the Article  Include a summary as well as your own analysis and evaluation of the article.  Know the article thoroughly.  Do not include personal opinions. 2  Be sure to distinguish your thoughts from the author’s words.  Focus on the positive aspects and what the author(s) of the study learned.  Note limitations of the study at the end of the essay: o Do the data and conclusions contradict each other? o Is there sufficient data to support the author’s generalizations? o What questions remain unanswered? o How could future studies be improved?