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CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm.

I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack

QUESTION 1
1.       CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack”
HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”.

He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.

Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

1 of 2 Questions:
Why is HDL considered the “good” cholesterol?

2 of 2 Questions:
Explain the role inflammation has in the development of atherosclerosis.

QUESTION 3

1.       A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question:

What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

QUESTION 4
1.       A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work.

States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).

Question:

Explain how a positive strep test has caused the patient’s symptoms.

QUESTION 5

1.       The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question:
Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT.

QUESTION 6
1.       A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.

Question:

Explain why a large pulmonary embolus interferes with oxygenation.

QUESTION 7

1.       A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.

Question:

Explain why a large pulmonary embolism causes right ventricular strain.

QUESTION 8
1.       A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home.

The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

Question 1 of 2:
Explain early asthmatic responses and the cells responsible for the responses.

Question 2 of 2:
Explain late asthmatic responses and the cells responsible for the responses.

QUESTION 10

1.       A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.

Question 1 of 2:
Explain the pathophysiology of emphysema and how it relates to COPD.

Question 2 of 2:
Explain the pathophysiology of chronic bronchitis and how it relates to COPD.

QUESTION 12
1.       Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler.

Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).

Question:
 
Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.
 
QUESTION 13
1.       A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.
 
Question:
 
The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition.
 

Two months ago, you saw Josie, a 34-year-old nurse, to whom you prescribed escitalopram 10 mg daily and alprazolam 0.5 mg, three times a day as needed for anxiety.

You saw Josie a 34-year-old nurse to whom you prescribed escitalopram 10 mg daily

Two months ago, you saw Josie, a 34-year-old nurse, to whom you prescribed escitalopram 10 mg daily and alprazolam 0.5 mg, three times a day as needed for anxiety.

Today, Josie, her mom, and her boyfriend, Robs, present for a follow up visit. Josie reports, “My anxiety isn’t really any better. I haven’t been able to come in to work for the past three days. I ran out of my alprazolam and I cannot even think about going to work without it. Tell her, Robs, what it’s like.”

“Yesterday,” Robs says, “Josie couldn’t get through the day, so um, yeah, she took some of my mom’s alprazolam yesterday.”

Josie’s mom interrupts to ask, “But why did you even give her that drug? With her history of alcohol addiction! She’s been alcoholic since she was in her early 20s. And did she tell you her dad also had problems with addiction?”

“Addiction?” Robs asks Josie’s mom. “Are you worried about addiction to this drug?”

He turns to you, agitated. “Did you know Josie’s sometimes taking up to seven pills a day? At least that I know of. Is that overusing or addiction?”

Josie starts crying. “But I can’t function without alprazolam. Robs, you know how hard nursing has been ever since orientation ended. I love my job but I just want to feel normal. And the alprazolam makes me feel that way. Please….” she pleads.

From your perspective as Josie’s psychiatric nurse practitioner, address the following in your initial post.

1-How does alprazolam work? What makes the medication so addictive?
2-Are there any special considerations for Josie because she is a registered nurse? What are the rules and regulations in your state for impaired nurses? Include the link to online information.

Design nursing care strategies which incorporate genetic and genomic risk factors. You are feeling passionate about developing information to share with your clients and families that have positive genetic testing results.

Design nursing care strategies which incorporate genetic and genomic risk factors

Scenario
You are feeling passionate about developing information to share with your clients and families that have positive genetic testing results. A young couple approaches you concerned that they may have a child with Down syndrome as both the male and female in the relationship have siblings with Down syndrome. You decide to create an educational document that supports the family in their search for more information.

Instructions
Describe educational information that a couple may need to know before the birth of their baby. What testing can be recommended? How is this testing done and when in the gestation?
Additionally, After birth, what resources can be offered to this couple to care for their newborn with Down syndrome?
Finally, List and describe resources this family may access now and into the future to support care for their child with Down Syndrome into adulthood.

More details;

Mr White is a new patient (aged 75) to the practice and during his initial appointment he will require full bitewing x-rays to be taken.

Mr White is a new patient aged 75 to the practice

Case Study
Please read through the following case study.  Reflect on your learning and your own research within this unit.
Prepare a response that responds to each of the issues presented below.  Your responses must reflect your knowledge, skills, and application for this unit.

Case Study 1

Mr White is a new patient (aged 75) to the practice and during his initial appointment he will require full bitewing x-rays to be taken.He has most of his permanent dentition however wears a partial denture which contains both upper laterals and upper left first molar.

1.      Explain how you would prepare Mr White for his x-rays, any safety precautions you take, your choice of x-ray equipment, accessories such as locating devices or guides, and technique for the x-rays including positioning of film or film plate or sensors. (Min 500 words)
2.      What precautions do you take to ensure quality x-rays and how do you label, mount and store the x-rays correctly?
Case Study 2

Your 10-year-old patient is requiring an OPG to assess the eruption pattern of her permanent dentition.

1.      Explain how you operate the necessary equipment for this exposure.
2.      Once the image has been produced you notice it is blurred.  How do you prevent blurred images occurring?

Quality outcomes

Ensure the following for your submission:
i)       Firstly, It is grammatically correct.
ii)      Secondly, It is error-free.
iii)     Thirdly, It is in simple English.
iv)    Fourthly,  It comprises of an average of 15 words for each sentence.
v)      Lastly, There are separate paragraphs for each new content/topic or discussions.  Include references to relevant legislation, which must be defined.
Attach any models, tools, or resources that could be used in an organisation to improve the case study situations presented.
Tip: Read all text aloud in order to identify any gaps and correct them.  Ask another person to proof read your work in order to check for accuracy before you submit.

Writing strategies and actions for future improvements
A case study is designed for you to demonstrate your skills in reading, accurately interpreting and providing workable responses and strategies.
Check that your responses provide:
1.      Identification and clarification of the key issues.  Discuss and provide some suggestions as to what has caused these.
2.      Key facts and information that is relevant and demonstrates your ability to provide solutions.
3.      Templates and resources that could assist managers in the future when managing their teams.
4.      Recommendations, both short term and long term, to improve the current situation.
Also ensure the appropriate use of headings and formats so as to reflect a professional presentation.

This is a paper that is focusing on the future of nursing practice IOM report discussion. The paper also provides several questions to use in writing the assignment paper in detail.

The future of nursing practice IOM report discussion

Review the Institute of Medicine’s 2010 report “The Future of Nursing: Leading Change, Advancing Health.” Write a 750-1,000 word paper discussing the influence of the IOM report on nursing practice. Include the following:
1.Summarize the four messages outlined in the IOM report and explain why these are significant to nursing practice.
2.Discuss the direct influence the IOM report has on nursing education and nursing leadership. Describe the benefits and opportunities for BSN-prepared nurses.
3.Explain why it is important that a nurse’s role and education evolve to meet the needs of an aging and increasingly diverse population.
4.Discuss the significance of professional development, or lifelong learning, and its relevance in caring for diverse populations across the life span and within the health-illness continuum.
5.Discuss how nurses can assist in effectively managing patient care within an evolving health care system.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center

Note, ensure  that the paper is at least three pages exclusive of the cover and the reference pages. Also, ensure that you include all the references you use in finding research for this assignment paper. References should be at least three for the paper. All references, citation, and writing should follow the APA formatting and styling guidelines. Finally, ensure you focus on the assignment topic in detail.