· Explain why the items you included in the privileged note would not be included

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Part 2: Privileged Note

 

Based on this week’s readings, prepare a privileged psychotherapy note that you would use to document your impressions of therapeutic progress/therapy sessions for your client from the Week 3 Practicum Assignment. (THE WEEK 3 ASSIGNMENT IS ATTACHED)

 

· The privileged note should include items that you would not typically include in a

note as part of the clinical record.

· Explain why the items you included in the privileged note would not be included

in the client’s progress note.

· Explain whether your preceptor uses privileged notes, and if so, describe the

type of information he or she might include. If not, explain why.

 

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 5, “Supportive and Psychodynamic Psychotherapy” (pp. 238–242)
Chapter 9, “Interpersonal Psychotherapy” (pp. 347–368)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

 

Abeles, N., & Koocher, G. P. (2011). Ethics in psychotherapy. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, J. C. Norcross, G. R. VandenBos, & D. K. Freedheim (Eds.), History of psychotherapy: Continuity and change (pp. 723–740). Washington, DC: American Psychological Association. doi:10.1037/12353-048

 

Cameron, S., & Turtle-Song, I. (2002). Learning to write case notes using the SOAP format. Journal of Counseling and Development, 80(3), 286–292. Retrieved from the Academic Search Complete database. (Accession No. 7164780)

 

Nicholson, R. (2002). The dilemma of psychotherapy notes and HIPAA. Journal of AHIMA, 73(2), 38–39. Retrieved from http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4http://library.ahima.org/doc?oid=58162#.V5J0__krLZ4

 

U.S. Department of Health & Human Services. (n.d.). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/

 

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practice [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Stuart, S. (2010). Interpersonal psychotherapy: A case of postpartum depression [Video file]. Mill Valley, CA: Psychotherapy.net.

Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.

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Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

  1. Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
  2. Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
  3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
  4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

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.

ESSENTIALS OF EVIDENCE-BASED PRACTICE

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Course Project: Part 3—Translating Evidence Into Practice

 

In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.

 

(Link for part 1 – https://www.homeworkmarket.com/content/nurs-5052nurs-6052-essentials-evidence-based-practice-course-project-part-1-grading-rubic-an)

 

(Link for part 2 – https://www.homeworkmarket.com/content/nurs-5052nurs-6052-essentials-evidence-based-practice-course-project-part-2-grading-rubic-an)

 

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.

 

To prepare:

 

Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?

With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.

Explore possible consequences of failing to adopt the evidence-based practice that you identified.

Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

 

To complete:

 

In a 3- to 4-page paper:

 

Restate your PICOT question and its significance to nursing practice.

Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.

Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.

Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

 

This part of the Course Project is due. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.

Note: In addition, include a 1-page summary of your project.

You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8 respectively) into one cohesive and cogent paper.

 

For this final iteration, you will need to:

Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

 

 

Please follow the belo link for Templates:

 

http://academicguides.waldenu.edu/writingcenter/templates

 

Required Readings

 

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 12, “Sampling in Quantitative Research”

This chapter introduces key concepts concerning sampling in quantitative research. This includes such concepts as a description of populations, different types of sampling and their uses, and how to determine a manageable, yet sufficient number to be included in a sample. The chapter also includes suggestions for implementing a sampling plan.

 

Chapter 13, “Data Collection in Quantitative Research”

Once a sampling design is complete, the next step is to collect the data, and this is the focus of Chapter 13. The chapter describes how to develop a data collection plan, and provides information about the different types of instruments that can be used, such as structured observation and biophysiologic measures.

 

Chapter 22, “Sampling in Qualitative Research”

The focus of this chapter is on the sampling process in qualitative research. The chapter describes the different types of sampling and when they are commonly used. Sampling techniques in the three main qualitative traditions (ethnography, phenomenological studies and grounded theory studies) are highlighted.

 

Chapter 23, “Data Collection in Qualitative Research”

This chapter examines the process of data collection in qualitative research as well as key issues surrounding data collection. This includes such methods as self-reporting, surveys, interviews, and personal journal keeping. The chapter also highlights important considerations when utilizing unstructured observations to gather data and how to record field notes.

Keough, V. A., & Tanabe, P. (2011). Survey research: An effective design for conducting nursing research. Journal of Nursing Regulation, 1(4), 37–44. Copyright 2011 by Elsevier Science & Technology Journals. Used with permission of Elsevier  Science & Technology Journals via the Copyright Clearance Center.

 

This text emphasizes the advantages of survey research. The authors describe the nuances of survey research projects, including their design, methods, analysis, and limitations.

Walden University. (n.d.a.). Paper templates. Retrieved July 23, 2012, from http://writingcenter.waldenu.edu/57.htm

 

This resource provides you access to the School of Nursing Sample Paper, which will serve as a template for formatting your papers.

Media

Laureate Education (Producer). (2012b). Data collection. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 4 minutes.

 

Dr. Kristen Mauk discusses how she collected data for her DNP project in this video. She describes the details of her pre- and post-tests used to track nurses’ knowledge in a rehabilitation unit.

 

Optional Resources

Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. (2009). Evidence-based practice challenge: teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.

 

This text emphasizes the advantages of survey research. The authors describe the nuances of survey research projects, including their design, methods, analysis, and limitations.

Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews (Online), 11, Art. No.: CD001270.

Melnyk, B., Fineout-Overholt, E., & Mays, M. (2009). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments. Worldviews on Evidence-Based Nursing, 6(1), 49.

Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing. Philadelphia, PA: F.A. David Company.

Chapter 9, “Evaluation of Research Instruments and Experimental Conditions”

Structure and Function of the Musculoskeletal System

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Case Study: Topic

Case Study Posting Requirements

Make sure all of the topics in the case study have been addressed.
Cite at least three sources—journal articles, textbooks or evidenced-based websites to support the content.
All sources must be within five years.
Do not use .com, Wikipedia, or up-to-date, etc., for your sources.
Case Study 1

Structure and Function of the Musculoskeletal System

Jennifer belongs to a women’s rugby team. At 23 years old, she has been playing for five years and trains daily to keep up her strength and stamina. During one game, she was injured. Unable to walk, she was carried off the field supported by her coach and an athletic therapist. At the hospital, after an examination and MRI of her right knee, she was given her diagnosis. Jennifer suffered what is often termed the “O’Donoghue triad”: a ruptured medial collateral ligament, a ruptured anterior cruciate ligament, and tear of the medial meniscus.

Jennifer’s injury involved the complete tearing of two ligaments. What are the similarities and differences between the anatomy and function of ligaments and tendons?
Jennifer’s rehabilitation will include techniques that will increase her joint proprioception. What is proprioception, and what will occur if this neural function is not restored?
The knee joint exemplifies a diarthrodial joint. What are the anatomy of the synovial membrane and the importance of synovial fluid in such a joint?
Case Study 2

Disorders of Musculoskeletal Function: Trauma, Infection, Neoplasms

Marvin is a healthy, active 36-year-old who belongs to a martial arts club. Once a week he takes lessons in Judo, and on the weekends, he participates in local competitions. At his last competition, Marvin was paired with a skilled participant from another club. His rival threw him to the mats, and as Marvin struggled, came down hard to pin him down. Marvin heard a snap, followed by instant pain in his left forearm. Radiographs at the local hospital confirmed he suffered a transverse fracture of the distal aspect of his left ulna.

What are the typical signs and symptoms of a fracture? Why shortly after the injury does the pain temporarily subside?
How does a hematoma form, and what function does it serve in the process of healing a fracture?
Marvin was told he would be seeing a physiotherapist as his healing progressed. What are the muscular and joint changes that occur during immobilization and the ways Marvin and his physiotherapist can work to address these changes?
Case Study 3

Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders

Mandy is a 16-year-old competitive figure skater who practices several hours a day with her coach at the skating arena. Because of her extremely active lifestyle and restricted diet to maintain her athletic physique, she experiences ongoing amenorrhea. One day during practice, she landed a jump and fell to the ice in pain. Her left foot swelled up almost immediately, making it difficult for her coach to remove the skate. At the hospital, radiographs revealed a fracture of the fifth metatarsal bone and general radiolucency of all the bones in her foot. A follow-up DXA revealed a bone mass of 2.7 standard deviations below mean.

What is the etiology of Mandy’s premature osteoporosis, and how her condition is thought to contribute to a decrease in bone density?
Knowing what you do about bone mineralization, why does a deficiency of estrogen in women lead to osteoporotic change?
Osteoporosis and osteomalacia both involve abnormal bone mineralization. What are the general macroscopic differences of these two conditions?
Case Study 4

Disorders of Musculoskeletal Function: Rheumatic Disorders

Rick is a 27-year-old who works in an accounting firm. He had started to experience lower back pain and stiffness that he thought were a result of the long hours he spent at his desk. More recently, however, he began to have sleep difficulties. He found that he often woke up during the night feeling hot and sometimes sweaty. Furthermore, his back pain disrupted his sleep, particularly when it radiated around his pelvis and into his thighs. When his lack of sleep began to interfere with his work, he went to an osteopath to see what was wrong. She listened to his case history carefully. Upon physical examination, she noted a slight decrease in his lumbar lordosis and a reduced range of movement in his lumbar spine. His blood tests revealed the presence of HLA-B27, an elevated ESR, and absence of RH. His radiograph showed evidence of sacroiliitis.

What is the likely diagnosis Rick received? What are the common clinical presentation and manifestations of the disease?
Why is osteoarthritis of the hips a potential secondary complication of this disease? What are the structural changes that occur in the articular cartilage of an osteoarthritic joint?
What is the effect of advanced ankylosing spondylitis on lung function?
Case Study 5

Structure and Function of the Skin

Yael is an 18-year-old college student who is bothered by excessive perspiration. She knew she sweat a lot under her arms and kept antiperspirant in her schoolbag to use throughout the day. Yael’s problem was not limited to under her arms, however. Her hands and feet also perspired heavily, and it embarrassed her. She did not like holding her boyfriend’s hand if her hands were particularly sweaty, and she had problems grasping her pen while in class because her palm became slippery. Yael suffered from a condition called primary focal hyperhidrosis, a condition involving hyperactive sweat glands in certain areas of the body.

What are the anatomical and functional differences between eccrine and apocrine glands?
What autonomic nervous system controls the function of thermoregulation of the skin? How do goosebumpsgoose bumps contribute to heat conservation?
Describe the location of the blood plexuses in the skin. How is blood circulation to the skin involved in thermoregulation?
Case Study 6

Disorders of Skin Integrity and Function

Leonard works in the agriculture industry and raises beef cattle. At 60 years of age, he has spent most of his life working outdoors harvesting hay and tending to his herds. His wife was the first to notice a change in his skin. One day, after taking off his shirt, she noticed a significant change in the mole he had on his right shoulder. It not only was darker but was moist and appeared to have been bleeding at one point. Surrounding the mole, his skin was red. His wife remembered hearing stories of Leonard working on his father’s farm, spending long hours out in the hot sun even though his father had gone into the barn to work during the hottest part of the day. She insisted him go to the family physician to have it examined.

Leonard’s physician performed a biopsy on the lesion and told Leonard he suspected the growth may be malignant melanoma. What cells are affected in this form of skin cancer? How might his childhood exposures to the sun predispose him to this form of cancer?
How do UVA and UVB rays contribute to the process of oncogenesis in skin cells?
The mole on Leonard’s shoulder was a nevocellular nevus. What are the cellular composition and appearance of this type of mole before it underwent malignant change?
To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home.

 

How the Appalachian and Arab heritage view the process of death and explain if there is any similarity in any of them?

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Read chapter 8 and 9 of the class textbook and review the attached Power Point presentation.  Once done, answer the following questions;

1.  Give an overview of the Appalachian and Arab heritage related to their healthcare beliefs and mention if there is any similarity in both cultures.  Give an example.

2.  How the Appalachian and Arab heritage view the process of death and explain if there is any similarity in any of them?

3.  Explain is there is any similarity in the healthcare beliefs of the Appalachian and Arab heritage with the evidence based nursing care that is provide.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard title “Week 4 discussion questions”.  A minimum of two evidence based references no older than 5 years old  besides the class textbook are required.   500 words are required.

The word document is a example that I need .

Discuss how you will use your current leadership skill set to advocate for change in your workplace.

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Details:

 

Rate yourself using the results from the “Nurse Manager Skills Inventory”:

http://www.aone.org/resources/nurse-manager-skills-inventory.pdf

Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:

Personal and professional accountability
Career planning
Personal journey disciplines
Reflective practice reference behaviors/tenets
Discuss how you will use your current leadership skill set to advocate for change in your workplace.

Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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 Turnitin. Please refer to the directions in the Student Success Center.

Identify and discuss the duties and responsibilities of a pharmacist toward a patient.

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After reading the article in the required reading: “The medicine shoppe v. Loretta lynch, et al.: Pharmacists and prescribing physicians are equally liable.” Discuss the following:

  1. Identify and discuss the duties and responsibilities of a pharmacist toward a patient.
  2. Based upon your research and assessment of the case, did the pharmacist perform the required duties and uphold patient rights?
  3. Is the pharmacy at fault? Why or why not?
  4. What is the impact of the pharmacist’s actions on the patient and community?
  5. What precautions can be taken to ensure these types of incidents by allied professionals don’t happen to others? Should there be more regulations in place?

Length: Submit a 3-page paper.

Discuss how Mr. Davis’s loss of sight is affecting the way he treats others and is treated by them.

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DIS 11

Read the Critical Thinking story on page 367 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1 Discuss how Mr. Davis’s loss of sight is affecting the way he treats others and is treated by them.

Topic 2  Mr. Davis is a patient at the clinic where you work. Discuss the ways you would adjust your usual routine to accommodate his needs.

Topic 3  Discuss why cataract surgery would be scary to Mr. Davis and what Dr. Hsing and his staff could do to ease his apprehension.

Topic 4  If Mr. Davis does not go ahead with the surgery, what help might he receive from an agency for the visually impaired? What other services might be available to help him deal with his grief and depression?

DIS 12

Read the Critical Thinking story on page 398 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Discuss why the school wants Michael to have completed treatment before he returns to class.

Topic 2  You work in Dr. Gaines’s office and you know that the Boulay’s appointment today is about a potential contagious rash. What precautions should you take when the family arrives?

Topic 3  Discuss how you might explain to Shaylene what impetigo is, how it spreads, and what she can do to prevent her other children from getting it.

Topic 4  Shaylene is in a very difficult, and all too common situation. Discuss possible answers to her question “What am I gonna do?”

DIS 13

Read the Critical Thinking story on page 425 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  Why is it more difficult for Jacob to maintain his injection routine in middle school than it was in elementary school?

Topic 2  Knowing that missing an insulin injection could cause a diabetic coma and possibly death, why do you think Jacob is not more conscientious in his self-care?

Topic 3  Do you think Jacob’s schoolmates talk about him, or does he just think they do? Discuss the possibilities. What steps can Jacob take to help his classmates understand his condition?

Topic 4  Consider the cost of managing Jacob’s diabetes for 1 year, for 10 years, for his lifetime. What if Jacob did not have insurance? What would happen if his mismanagement of his condition resulted in a hospital stay?

DIS 14

Read the Critical Thinking story on page 461 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  In a sexual relationship, which partner is responsible for birth control and why?

Topic 2  If a couple cannot agree about family size or birth control methods, what options are available to them?

Topic 3  Discuss how cultural differences and religious beliefs influence choices like family size and birth control.

Topic 4  Some cultures value male children over female children. Discuss why you think this is so and how the changing cultural role of women may affect these values.

DIS 15

Read the Critical Thinking story on page 498 of your textbook. Submit 1 entry in response to the Topics listed. You may answer a topic or reply to another student’s answer to a topic.

Topic 1  What precaution had James taken in case the pharmacist asked questions?

Topic 2  Suppose Terrance was suspicious about allowing James pick up the prescription. Discuss the steps Terrance might have taken, including involving his supervisor.

Topic 3  Terrance appears to blame himself for what happened with the MS Contin prescription. What might the pharmacy have done to ensure that medicine is always given to the right person, no matter who is on duty?

Topic 4  Ms. Tirendale is obviously suspicious of her son’s actions regarding the prescription. Discuss the steps she might take to help him if she thinks he is abusing drugs.

Case study discussion

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NR 507 Week 1 Discussion:

PART 1: 

John is a 19-year-old college football player who presents with sneezing, itchy eyes, and nasal congestion that worsens at night. He states that he has a history of asthma, eczema and allergies to pollen. There is also one other person on the football team that has similar symptoms. His vitals are BP 110/70, P 84, R 18, T 100 F.

Write a differential of at least three (3) possible items from the most likely to less likely. For each disease include information about the epidemiology, pathophysiology and briefly argue why this disease fits the presentation and why it might not fit the presentation.

PART 2:

A patient has been admitted into the emergency room that was in the passenger side of a car that collided with another car head on. The patient is pale, barely conscious and has a weak and thready pulse. An IV is started. The vitals are BP 80/50, P 140, T 96.0 and R 26. As the team fights to keep the patient alive they have to remove the spleen. Blood is given but it has been mistyped. A transfusion reaction occurs.

Describe the type of hypersensitivity reaction that has occurred and discuss the molecular pathophysiology of the specific type of hypersensitive reaction you have chosen.

In the event that this patient survived the car accident and the transfusion reaction which organs are most likely to be damaged and why?

PART 3:

A 44-year-old patient presents with lump in the chest of approximately 2 cm in diameter. There is a slight dimple over the location of the lump and when the lump is manipulated it seems to be attached to the surrounding tissue. A lumpectomy is performed and the mass is sent to pathology. The pathology report comes back and the mass is confirmed to be an estrogen receptor negative, a progesterone receptor negative and a her2/neu receptor positive breast cancer.

• What are some of the risk factors for breast cancer?

• What tumor suppressor genes are associated with breast cancer?

• What tumor oncogenes are associated with breast cancer?

• Compare and contrast tumor suppressor genes from oncogenes?

NR 507 Week No. 1 Quiz:

1. Which statement about vaccines is true? (Points : 2)

2. Which statement is true about fungal infections? (Points : 2)

3. What is the role of reverse transcriptase in HIV infection? (Points : 2)

4. What of the following remains a significant cause of morbidity and mortality worldwide? (Points : 2)

5. Once they have penetrated the first line of defense, which microorganisms do neutrophils actively attack, engulf, and destroy by phagocytosis? (Points : 2)

6. After sexual transmission of HIV, a person can be infected yet seronegative for _____ months. (Points : 2)

7. Deficiencies in which element can produce depression of both B- and T-cell function? (Points : 2)

8. Hypersensitivity is best defined as a(n) (Points : 2)

9. A person with type O blood is likely to have high titers of anti-___ antibodies. (Points : 2)

10. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction? (Points : 2)

11. During an IgE-mediated hypersensitivity reaction, what causes bronchospasm? (Points : 2)

12. In a type II hypersensitivity reaction, when soluble antigens from infectious agents enter circulation, tissue damage is a result of (Points : 2)

13. In which primary immune deficiency is there a partial to complete absence of T-cell immunity? (Points : 2)

14. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? (Points : 2)

15. What effect does estrogen have on lymphocytes? (Points : 2)

16. Which hormone increases the formation of glucose from amino

17. During a stress response, increased anxiety, vigilance, and arousal is prompted by (Points : 2)

18. Which cytokine is involved in producing cachexia syndrome? (Points : 2)

19. Which of the viruses below are oncogenic DNA viruses? (Points : 2)

20. By what process does the ras gene convert from a proto-oncogene to an oncogene? (Points : 2)

21. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-) in cell metastasis? (Points : 2)

22. Many cancers create a mutation of ras. What is ras? (Points : 2)

23. In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes? (Points : 2)

24. Tobacco smoking is associated with cancers of all of the following except (Points : 2)

25. What percentage of children with cancer can be cured? (Points : 2)

Discussion: Diagnosis And Management Of Respiratory, Cardiovascular, And Genetic Disorders

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Case Studies 1–3

Respiratory disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.

Case Study 1:

A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive.

Case Study 2:

Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using a short-acting beta agonist every 3 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid, but the prescription ran out, and he forgot to get it refilled. He says he came today because he woke up at 2 a.m. coughing and couldn’t stop, thus preventing him from going back to sleep. Over-the-counter cough suppressants don’t help. He denies cigarette smoking, but his clothing smells like smoke. His respiratory rate is 18 and he has prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea. All other exam findings are normal.

Case Study 3:

A father presents his 9-year-old with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment. Physical examination reveals the following: respiratory rate is 18, lungs are clear to auscultation, patient is able to take deep breaths without coughing, there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.

Case Studies 4–6

Assessing, diagnosing, and treating pediatric patients for many cardiovascular and genetic disorders can be challenging. As an advanced practice nurse who facilitates care for patients presenting with these types of disorders, you must be familiar with current evidence-based clinical guidelines. Because of the clinical implications, you have to know when to treat patients with these disorders and when to refer them for specialized care. In this Discussion, you examine the following case studies and consider appropriate treatment and management plans.

Case Study 4:

Miguel is a 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball. He is 6 feet 5 inches tall and weighs 198 pounds. You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.

Case Study 5:

Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.

Case Study 6:

You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week. Physical examination reveals the following: HEENT exam is benign, lung sounds are clear, a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist, and abdominal exam is benign.

To prepare:

  • Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
  • Review and select one of the six provided case studies. Analyze the patient information.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
  • Consider strategies for educating patients and families on the treatment and management of the respiratory disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.