300 words

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Discuss how the concept of “health” has changed overtime. Discuss how the concept has evolved to include wellness, illness, and overall well-being. How has health promotion changed over time? Why is it important that nurses implement health promotion interventions based on evidence-based practice?

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Case studies

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  • MEXICAN CASE STUDY #2  Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olga’s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olga’s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables.
  • The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetable picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines. Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out “chits” to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance.  Study Questions 1. Identify three socioeconomic factors that influence the health of the Gaborra family.
  • 2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia.  3. Identify strategies to help improve communications in English for the Gaborra family.  4. Identify three health-teaching goals for the Gaborra family.  5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda. 6. Discuss three preventive maintenance–teaching activities that respect the Gaborra family’s belief in the hot and cold theory of disease management.  7. Identify strategies for obtaining health data for the Gaborra family. 8. Identify four major health problems of Mexican Americans that affect the Gaborra family. 9. If Olga were to see a folk practitioner, which one(s) would she seek?  10. Explain the concept of familism as exhibited in this family.  11. Distinguish between the two culture-bound syndromes el ataque and susto.  12. Discuss culturally conscious health-care advice consistent with the healthbelief practices of the pregnant Mexican American woman.  13. Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen.  14.
  • Identify where the majority of Mexican Americans have settled in the United States.   PUERTO RICAN CASE STUDY #2  Carmen Medina, aged 39, lives with her husband, Raúl, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, José; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medina’s job. They live in a threebedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medina’s do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosa’s and Miguel’s developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is more preoccupied with the family’s financial situation. Mrs. Medina’s parents are encouraging them to return to Puerto Rico.
  • Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medina’s last physical examination was after she had José. She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the family’s finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions  1. Explain Mrs. Medina’s attitude in her relationship with her adolescent daughter.  2. Identify strategies to ensure that Rosa seeks prenatal care.  3. Identify barriers to accessing health care for the Medina family.  4. What are the high-risk behaviors exhibited by this family?  5. What communication barriers exist in this family that affect care delivery?  6. Discuss gender and family roles in the context of traditional Puerto Rican culture.  7. Identify sociodemographic factors affecting the physical- and mentalhealth well-being for this family. 8. Identify Puerto Rican folk practices appropriate for this family. 9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why?  10. If Mrs. Medina’s parents visit a health-care provider, what might they expect?  11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina. 12. Discuss the importance of respeto and familism in the Medina family.  13. Identify culturally congruent interventions for Rosa’s pregnancy.  14. Identify health-promotion and disease-prevention interventions needed for José.

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What does a Research Hierachy looks like

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Before you get started with this assignment, please complete the Research Hierarchy Activity to provide context for the assignment.

Now that you have completed the Research Hierarchy activity, you can see how each type of research fits in a particular hierarchy. This is important because it provides information about each type of research study: its validity, rigor, soundness, reliability, and so on. With this context in mind, you will now examine the twenty articles provided here to give you practice in determining which article goes with each level of research hierarchy.

Overview

Here is a list of twenty nursing journal articles that are available to you through the Regis Library. These articles are from a wide range of study types; from randomized controlled trials (RCT) to expert opinions.

Assignment Instructions

  • Review all of the articles in preparation for this assignment. Using this Research Hierarchy Template (Word), you will list one journal article for each of the seven levels of the research hierarchy pyramid (you will not need to use all twenty articles to complete the hierarchy; you will use a total of seven of the twenty articles). Articles will not be used in more than a single hierarchy level.
  • After you have determined one journal article that corresponds with each of the levels of the hierarchy, provide a one to two sentence statement for each article to explain your rationale for selecting it and assigning it to that hierarchical level. You will write one to two sentences, justifying your selection, using the Research Hierarchy document that you submit.

Please refer to the Grading Rubric for details on how this activity will be graded.

To Submit Your Assignment:

 

Writing Assignment Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Writing Assignment Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsContent of PaperThe writer demonstrates a well-articulated understanding of the subject matter in a clear, complex, and informative manner. The paper content and theories are well developed and linked to the paper requirements and practical experience. The paper includes relevant material that fulfills all objectives of the paper.

Cites five or more references, using at least two new scholarly resources that were not provided in the course materials.

All instruction requirements noted.

30 pointsThe writer demonstrates an understanding of the subject matter, and components of the paper are accurately represented with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Course materials and scholarly resources support required concepts. The paper includes relevant material that fulfills all objectives of the paper.

Cites four references.

All instruction requirements noted.

26 pointsThe writer demonstrates a moderate understanding of the subject matter as evidenced by components of the paper being summarized with minimal application to evidence-based practice, theory, or role-development. Course content is present but missing depth and or development.

Cites three references.

Most instruction requirements are noted.

23 pointsAbsent application to evidence-based practice, theory, or role development. Use of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Content of paper is inaccurately portrayed or missing.

Cites two or fewer references.

Missing some instruction requirements.

20 points30Analysis and Synthesis of Paper Content and MeaningThrough critical analysis, the submitted paper provides an accurate, clear, concise, and complete presentation of the required content.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.

All instruction requirements noted.

30 pointsPaper is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill paper requirements. The content supports at least one viewpoint.

All instruction requirements noted.

26 pointsPaper lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. The paper’s content may be confusing or unclear, and the summary may be incomplete.

Most instruction requirements are noted.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing some instruction requirements.

Submits assignment late.

20 points30Application of KnowledgeThe summary of the paper provides information validated via scholarly resources that offer a multidisciplinary approach.

The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application is provided.

All questions posed within the assignment are answered in a well-developed manner with citations for validation.

All instruction requirements noted.

30 pointsA summary of the paper’s content, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

All instruction requirements noted.

26 pointsObjective criteria are not clearly used, allowing for a more superficial application of content between the assignment and the broader course content.

Student’s indication of how they will apply this new knowledge to their clinical practice is vague.

Most instruction requirements are noted.

23 pointsThe application of knowledge is significantly lacking.

Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.

Missing several instruction requirements.

Submits assignment late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement and supportive content and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization, and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Missing significant content. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100

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Workplace Culture and Leadership

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1. Briefly describe your identified leadership style and explain how it compares to the transformational style of leadership.

2. Explain how leaders in a healthcare organization contribute to a healthy workplace culture. Then, explain how your style of leadership could be leveraged to create a healthy workplace culture.

3. Finally, explain how leaders use transformational leadership to ensure congruency with the mission and values of the workplace environment.

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Common Illnesses and the Use of CAM

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Purpose

The Course Outcome covered this week is CO1.

CO1: Identify theories, concepts, and beliefs related to transcultural nursing. (PO1)

Discussion

We encounter patients after they have explored various avenues of self-help. At times, these avenues involve the use of complementary and alternative medicine (CAM). Our readings this week are very helpful.

  1. Select a common (or not so common) illness or condition that affects a specific ethnic group.
  2. Identify two (2) CAM therapies that patients are likely to try before seeking (or in addition to) allopathic, osteopathic, or ayurvedic medical intervention for the illness or condition.
  3. Discuss the effectiveness of each therapy you identified.

Note: Do not discuss an illness or condition about which a classmate has already posted. The diversity will lead to a more robust discussion. There are many examples you may discuss, including sickle-cell disease in African Americans, constipation in the elderly people, or the use of Reiki for mental and emotional healing by Japanese people. Think of others from your practice settings or prelicensure experiences.

professor’s comment:

Hello All,

This is one week I am really looking forward to because you are all experts in this area from all of your work with the patients and families you care for.  We all encounter patients after they have explored various avenues of self-help. At times, these avenues involve the use of complementary and alternative medicine (CAM). I look forward to your choice for an illness that affects an ethnic group that you have worked with and the CAM therapies you identify.

Example: Class and Professor,

One not so common illness discussed is depression amongst Chinese population. There are cultural differences that must not be overlooked within this population when dealing with depression. While sadness may be reported, it also may not and it was repeated in multiple studies that often other symptoms are more prominent. “In a study to differentiate somatic versus psychological symptoms as a cultural expression of depression, Chinese outpatients reported more somatic symptoms compared to Euro-Canadians, who reported more psychological symptoms” (Andrews & Boyle, 2016).  As a health care provider it is important to recognize the differences.

Unlike persons living in the general U.S. population, Chinese and Chinese Americans often do not report feeling sad when they are depressed. Depression-related signs and symptoms that are commonly reported by Chinese patients include the following: Boredom, discomfort, pain fatigue, unexplained physical abnormalities” (Smith, 2018). Frequently, signs will be down-played or ignored by the patient for fear of embarrassment of diagnosis of a mental health condition. “There is a strong social stigma and sense of shame in Chinese culture regarding depression” (Smith, 2018). Because of this seeking care may not be an option and care may be delayed.

Other than being prescribed medications as what seems last resort for depression, complementary and alternative medicine (CAM )therapies may be used. CAM therapies that are explored are Chinese herbal therapy, acupuncture, and movement therapy known as t’ai chi. As noted by Smith (2018), they are the most commonly used interventions for treatment of depression that is also known as “shenjing” in Chinese culture. There was such noted success with movement therapy, a study was formally recognized showing huge improvement of signs and symptoms among participants over a 12 week course (Smith, 2018). Movement therapy, specifically T’ai Chi should be explored as a recommendation for individuals who are capable and willing to try it before prescribing medications that often come with side effects.

-Allyson

  • Reference
  • Andrews, M. M., & Boyle, J. S. (2016). Transcultural concepts in nursing care (7th ed.). Philadelphia: PA. Wolters Kluwer.
  • Smith, N. (2018) Chinese Patients: Providing Culturally Competent Care to Patients with Depression. Ipswich, Massachusetts. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T903134&site=eds-live&scope=site

Reference: American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

Andrews, M. M., & Boyle, J. S. (2016). Transcultural concepts in nursing care (7th ed.). Philadelphia: PA: Wolters Kluwer.

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nursing theory

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 The purpose of this paper is to define, describe, and explain your own beliefs about the four concepts of the nursing metaparadigm and their inter-relationship to one another as they guide your current nursing practice. There are no right or wrong thoughts, feelings, or beliefs; these represent your own philosophical beliefs. Then you must correlate or link your current philosophy to one particular nursing theory, identify these. The reflection paper is to write in MS Word, be typed according to APA format and must be three pages in length. The article should include a title page and reference page; however, these pages are not to be included in the final count. Evaluation criteria are as follows:  Criteria for Personal Philosophy of Nursing Reflection Paper:  1. Introduction & brief description identifies the purpose of the paper and the factors influencing the development of the personal nursing philosophy. 4 points  2. Define, describe and explain your personal thoughts, feelings, and beliefs about the concepts of the 4 nursing metaparadigms: 8 points  a. Person/client  b. Environment  c. Health  d. Nursing  3. Identification and a brief description of the nursing theory found to be the most compatible with the student’s personal nursing philosophy. Discuss the core components of the theory and how it reflects the student’s personal philosophies. 3 points  4. Organization, documentation, references followed APA format. 5 points

 

Chapter 7: Dorothy Johnson’s Behavioral System Model

and its Application

Chapter 8: Dorothea Orem’s

Self-Care Deficit Nursing

Theory

Chapter 9: Imogene King’s Theory of Goal

Attainment

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The head to toe physical

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Assignment Details

The head to toe physical

You will complete a head to toe physical on a volunteer. You will need to record your assessment and then document your findings.

General survey: state findings aloud

Head

Eyes

Ears

Nose

Throat

Neck

Respiratory

Cardiac

GI/GU (do not assess their genitals)

Musculoskeletal

Neuro

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements

Before finalizing your work, you should:

  • be sure to read the Assignment description carefully (as displayed above)
  • consult the Grading Rubric to make sure you have included everything necessary; and
  • utilize spelling and grammar check to minimize errors.

Your writing Assignment should:

  • follow the conventions of Standard English (correct grammar, punctuation, etc.);
  • be well ordered, logical, and unified, as well as original and insightful;
  • display superior content, organization, style, and mechanics; and

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Nursing Leadership Action and Continuous Improvement Plan

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· Reflect on your Clifton Strengths results from the beginning of the course as well as the growth you have made in completing the course.

· Consider how you will continue to enhance your leadership behaviors after the course.

 

· Post an end-of-course assessment of your strengths and areas for improvement. Reflecting back on this course and using the literature, develop two SMART goals that you could implement to enhance your leadership behaviors and skills.

 

 

Developing SMART Goals

SMART is an acronym to help with realistic goal-setting. Use it as a tool to develop goals for yourself—

they could be goals for your career, your studies at Walden, or even your personal life.

This resource includes the SMART goal criteria, example goals, and a template for you to develop your

own academic, professional, and personal SMART goals.

SMART Goal Criteria

S is for specific.

The more specificity you bring to your goal, the clearer it is.

• Vague goal: “I want to advance in my company.” How exactly would you like to advance—in

terms of money or title? What position would you like to hold?

• More specific goal: “I want to advance to the position of senior sales manager.”

M is for measurable.

You must be able to track your progress toward the goal and understand when you have attained it.

Measurability allows for that.

• Not measurable: “Get better at public speaking.”

• Measurable and specific: “Give one class lecture without stuttering.” If you do not stutter during

the class, you know you have achieved the goal.

A is for achievable or attainable.

One tendency with goal setting is to aim too high, but that approach can set goals beyond our reach.

• Likely not achievable: “Earn my Doctor of Nursing Practice degree within 1 year of starting.”

This goal is not feasible due to workload and the established timeline of the program. Likewise,

“Become an executive chef in a three-star restaurant within 2 years” is not likely to happen if

you are currently a dishwasher with no culinary training. So… be conservative when

determining what is actually achievable.

R is for relevant.

This criterion ensures that the goal is important to you right now, at this point in your life.

• For instance, if your goal is “Start my own home health care business by the end of the year,”

consider what else is going on in your life. What other goals are you working toward? How

does this goal help or hinder those? Perhaps you have just bought a house, which has reduced

your finances; it might not make sense to invest in a business at this point as well.

T is for timely or time-bound.

Every goal must include a deadline or timeframe. Otherwise, why would you ever start it? The

procrastinator in you might just keep waiting and waiting and never take action.

• When determining an appropriate goal timeframe, ask yourself how long you need to

realistically complete the goal. This date gives you the end point, but it should also spark a

desire to achieve mini-goals along the way to attaining the larger goal.

 

 

 

Example Goals

The key to an effective goal is to combine all of these criteria, so that your goal is specific, measurable,

achievable, relevant, and timely altogether. Let’s look at two examples to see if they fit all of the

SMART criteria.

Example Goal 1

By a PhD in Public Health student: To improve my grammar, I will complete the Sentence Structure

Basics and Verbs modules in the Writing Center with a 90% score within 6 months.

• Is it specific? Yes. The student includes the names of the modules and where to find them,

rather than just “modules.”

• Is it measurable? Yes. The student needs to receive a certain score.

• Is it achievable? Yes. The student has given herself adequate time, and she is not expecting

perfection. She is giving herself some leeway in the score.

• Is it relevant? Yes. The student is working toward a PhD in Public Health degree, and she will

eventually write a dissertation. For a dissertation, proper grammar is especially important,

making the goal relevant to the student’s situation.

• Is it timely? Yes. The student has attached a timeframe of 6 months to this goal.

Example Goal 2

By an MS in Education student who is also a middle-school teacher: I will attend two professional

development workshops.

• Is it specific? No. The student has listed professional development workshops in general but

not which ones.

• Is it measurable? Yes. The student has indicated two workshops. When two have been

attended, she knows the goal is completed.

• Is it achievable? Yes. It is reasonable that the student has access to professional

development workshops as a teacher.

• Is it relevant? Sort of. Professional development is certainly relevant to the teaching

occupation, but without specificity, the relevance is unclear.

• Is it timely? No. There is no deadline or timing information within the goal to indicate when it

should take place.

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Recombinant DNA

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Recombinant DNA.

Using the maps below, answer the following questions about the gel:
  https://media.pearsoncmg.com/bc/bc_tfc_microplace_9/supplement/newimages/pAMP.gif
   

1. Identify the lane with the pAMP fragments.

2. Identifigy the lane with the pKAN fragments.

3. Which restriction fragment of pAMP contains the amp resistance gene?

4. Which restriction fragment of pKAN contains the kan resistance gene?

5. Which restriction fragment is 784 bp?

6. Why are the pKAN fragments so close together?

   https://media.pearsoncmg.com/bc/bc_tfc_microplace_9/supplement/newimages/plasmidgel.jpeg
   

Two strains of E. coli were inoculated on the media shown below. E. coli strain 1 is sensitive to ampicillin and kanamycin. E. coli strain 2 is resistant to ampicillin and kanamycin. Explain the following results:
  https://media.pearsoncmg.com/bc/bc_tfc_microplace_9/supplement/newimages/ecoli_na2.jpeg E. coli 1 on nutrient agar

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Nursing Assign Help

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A 21-year old female (A.M) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, note that her skin in warm and flushed and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn

  • She had some readings on her glucometer which were reading ‘high’
  • She vomits almost every time she takes in fluid
  • She hasn’t voided for a day but voided a great deal the day before
  • She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

 

  1. What is the pathophysiology for the condition you believe A.M. has?
  2. Relate the etiology and clinical manifestations for the condition you identified for A.M.

The practitioner at the urgent care facility makes the decision that A.M. needs to go to the hospital by ambulance. Once at the Emergency Department (ED), the ED physician orders these items:

  1. 1000 ml Lactated Ringer’s (LR) IV stat
  2. 36 units NPH (Humulin N) and 20 units regular (Humulin R) insulin SQ now
  3. CBC with differential; CMP: blood cultures X2 sites; clean-catch urine for UA and C&S; stool for ova and parasites; Clostridium difficile toxin, and C&S; serum lactate; ketone; osmolality; ABGs on room air
  4. 1800 calorie, carbohydrate controlled diet
  5. Bed rest
  6. Acetaminophen (Tylenol) 650 mg orally Q4 hrs PRN
  7. Furosemide (Lasix) 60 mg IV push now
  8. Urinary output every hour
  9. VS every shift

The orders above — which are questionable related to her condition and which are appropriate?

  1. What are the expected treatments for this condition?

Instructions:

Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition.

Use two evidence-based articles from peer-reviewed journals or scholarly sources to support your findings. Be sure to cite your sources in-text and on a References page using APA format. http://rasmussen.libanswers.com/faq/208365

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