CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both college educated and worked full-time while they were in their native country. In addition, Mr. Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real estate. Their daughter came to the United States as a registered nurse and met her husband, a drug company representative. The older couple moved to the United States when their daughter became a U.S. citizen and petitioned them as immigrants. Since the couple was facing retirement, they welcomed the opportunity to come to the United States. The Arahans found life in the United States different from that in their home country, but their adjustment was not as difficult because both were healthy and spoke English fluently. Most of their time was spent taking care of their two grandchildren and the house. As the grandchildren grew older, the older couple found that they had more spare time. The daughter and her husband advanced in their careers and spent a great deal more time at their jobs. There were few family dinners during the week. On weekends, the daughter, her husband, and their children socialized with their own friends. The couple began to feel isolated and longed for a more active life. Mr. and Mrs. Arahan began to think that perhaps they should return to the home country, where they still had relatives and friends. However, political and economic issues would have made it difficult for them to live there. Besides, they had become accustomed to the way of life in the United States with all the modern conveniences and abundance of goods that were difficult to obtain in their country. However, they also became concerned that they might not be able to tolerate the winter months and that minor health problems might worsen as they aged. They wondered who would take care of them if they became very frail and where they would live, knowing that their daughter had only saved money for their grandchildren’s college education. They expressed their sentiments to their daughter, who became very concerned about how her parents were feeling. This older couple had been attending church on a regular basis, but had never been active in other church-related activities. The church bulletin announced the establishment of parish nursing with two retired registered nurses as volunteers. The couple attended the first opening of the parish clinic. Here, they met one of the registered nurses, who had a short discussion with them about the services offered. The registered nurse had spent a great deal of her working years as a community health  nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-related issues. Reflective Questions 1. What strategies could be suggested for this older adult couple to enhance their quality of life? 2. What community resources can they utilize? 3. What can the daughter and her family do to address the feelings of isolation of the older couple? 4. What health promotion activities can ensure a healthy lifestyle for them? 

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted.  

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

 Case Study 1 

Mr. JS presents today to your office for a follow up appointment after a BP reading at home of 166/95 last week. He is a 52 y/o male with a PMH of HTN and Angina secondary to CAD, which is well controlled, experiencing less than 1 attack per month. On today examination, MR JS’s vital signs are as follows: Temperature: 96.8º Heart Rate: 68 bpm Blood Pressure: 168/92 Respiration: 14 Ox Sat: 95% at room air Pain: denies pain. Labs: Last LDL on records (6 months ago): 189 Current Medications: Atorvastatin 40 mg/day Metoprolol tartrate 10 mg/twice/day 

CASE STUDY QUESTIONS: 

1) According to the recently released American Heart Association guidelines on hypertension, what should be the BP goal for a patient with chronic stable angina and hypertension? 

2) In addition to diet and lifestyle modifications, what is the medication of choice to control the BP of a patient with chronic stable angina? Provide rationale 

3) Provide at least 3 (questions) you would ask your patient RELATED to the case presented and provide rationale. 

4) Please explain whether you would request any laboratory or screening tests for this patient and why (if any) 

5) How would you achieve the B/P goal recommended for this patient according to the guidelines provided above? 

6) Provide References in APA style 

 Testicular Cancer 

Case Studies A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. Studies Results Routine laboratory studies Within normal limits (WNL) Ultrasound the testicle Solid mass, right testicle associated with calcifications HCG (human chorionic gonadotropin) 550mIU/mL (normal: <5) CT scan of the abdomen Enlarged retroperitoneal lymph nodes CT scan of the chest Multiple pulmonary nodules Diagnostic Analysis At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes. 

Critical Thinking Questions 

1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer? 

2. What might be the side effects of cytotoxic chemotherapy? 

3. What was the purpose of preserving his sperm before chemotherapy? 

4. Is this young man’s age typical for the development of testicular carcinoma? 

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

                                                             USE  ANY 4 FROM  THESE STUDIES 

Kampiatu, P., & Cozean, J. (2015). A controlled, crossover study of a  persistent antiseptic to reduce hospital-acquired infection. African journal of infectious diseases, 9(1),69. https://doi.org/10.4314/ajid.  v9i1.2.

  Ho, H. J., Poh, B. F., Choudhury, S., Krishnan, P., Ang, B., & Chow, A. (2015).  Alcohol handrubbing and chlorhexidine handwashing are equally effective in removing methicillin-resistant Staphylococcus aureus from  health care workers’ hands: A randomized controlled trial. American journal of infection control, 43(11), 1246–1248. https://doi.org/10.1016/j.ajic  .2015.06.005.

  Saito, H., Inoue, K., Ditai, J., Wanume, B., Abeso, J., Balyejussa, J., & Weeks,  A. (2017). Alcohol-based hand rub and incidence of healthcare-associated infections in a rural regional referral and teaching hospital in  Uganda (‘WardGel’ study). Antimicrobial resistance and infection control, 6, 129. https://doi.org/10.1186/s13756-017-0287-8.

 Kritsotakis, E. I., Kontopidou, F., Astrinaki, E., Roumbelaki, M., Ioannidou,  E., & Gikas, A. (2017). Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance:  a national prevalent cohort study in acute care hospitals in  Greece. Infection and drug resistance, 10, 317–328.https://doi.org/10.  2147/IDR. S147459 

  Sadule-Rios, N., & Aguilera, G. (2017). Nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance. Intensive & critical care nursing, 42, 17–21. https://doi.org/10.1016/j.iccn.2017.02.005

After reading chapter 5, 6, 7, and 8, please answer this question.

Discuss the topic you are planning to use for the clinical practice experience. Create a PICOT research question that will guide the practice experience.

See the attachment for a PICOT selection guidelines