Post an explanation of the differential diagnosis for the patient in the case study you selected
In clinical settings, pediatric patients often present with hematologic and metabolic disorders such as anemia and diabetes. Many of these disorders are manageable with drug therapy and lifestyle changes, but they can pose serious complications for patients if left untreated. In your role as the advanced practice nurse, you must identify patients at risk of hematologic and metabolic disorders and provide the appropriate education for them and their families. Consider potential treatment, management, and education strategies for the patients in the following case studies.
Case Study 1
You see a 1-week-old Asian infant for a weight check. The infant is back to his birth weight and is breastfeeding for 10 minutes every 2 hours with one 3-hour stretch a day. He is alert, has bowel movements with each feeding, and wets 810 diapers a day. His blood type is A+ and his mothers blood type is A+. Coombs testing at birth was negative. You note slight scleral and skin jaundice.
Case Study 2
Jimmy is a 3-year-old picky eater according to his mother. He refuses to eat anything but waffles for breakfast and macaroni and cheese or chicken nuggets for lunch and dinner. He will eat apples and bananas but refuses all vegetables except corn. After a normal physical examination, you obtained blood testing that revealed the hemoglobin is 11.4 mg/dl and his hematocrit is 30% (both obtained by venipuncture). The CBC revealed microcytic hypochromic RBCs.
Case Study 3
Melissa is a 13-year-old who presents to your office for a well-child check. Physical examination reveals a thin child who is short of stature. Breast Tanner stage is II and pubic hair development is Tanner I. Neurologic, skin, heart, lung, abdominal, and HEENT examinations are normal.
To prepare:
Review Endocrine and Metabolic Disorders and Hematologic Disorders in the Burns et al. text.
Review and select one of the three 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 hematologic or metabolic 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 hematologic or metabolic disorder.
Explain how your proposal will directly and indirectly impact each of the aspects.
After discussion with your preceptor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account for developing the evidence-based change proposal. Explain how your proposal will directly and indirectly impact each of the aspects.
Discussion 2
Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction
Describe the quality improvement process and the Quality model that will be used as a basis for the practice problem.
Describe the quality improvement process and the Quality model that will be used as a basis for the practice problem. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
For the Week 3 Assignment, you will combine your Week 1, 2 and 3 assignments and submit a 3-4-page paper that addresses the following:
Practice Problem (Completed in Week 1)=
In hospice, one of the goals is to have skilled nurse visits at least 3 days prior to death and at least 3-6 days prior to death. If we track ESAS it is supposed to help indicate who we can expect to pass away based on changes reported and then be able to increase nursing visits-however to be effective the data has to be accurate. Are we asking the patient or caregivers the 10 symptoms or just guessing based on our assessment
Please include information from discussions and everything below. In the literature review, you dont have to worry about the bottom 5 that are not relatated to the ESAS but my help and can use it.
State the practice problem in measurable terms.
State the data that suggests a practice problem exists
Include a purpose statement.
Analysis of the Existing Evidence (Completed in Week 2)
Summarize the findings from the evidence analysis that support your practice problem. Include minimum of at least 5 evidence-based practice sources that support your practice problem. Identify research, clinical guidelines, expert opinions, and other relevant information. You must include two-three research studies in your analysis. Using your own words synthesize the evidence that supports your identified practice problem. There should be no quotes or personal opinions included in this section.
Quality Improvement Process (Completed this Week) (Approximately 2-3 paragraphs)
Describe the quality improvement process and the quality model that will be used as a basis for the practice problem. This is not your entire quality improvement plan, only a description of the quality improvement process and the quality model you chose. You will develop your specific quality improvement plan in week 4. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
Conclusion
As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
Instructions: Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format.
CASE STUDY: Active Labor: Susan Wong
Mrs. Wong, a first-time mother, is admitted to the birthing suite in early labor after spontaneous rupture of membranes at home. She is at 38 weeks of gestation with a history of abnormal alpha-fetoprotein levels at 16 weeks of pregnancy. She was scheduled for ultrasonography to visualize the fetus to rule out an open spinal defect or Down syndrome, but never followed through. Mrs. Wong and her husband disagreed about what to do (keep or terminate the pregnancy) if the ultrasonography indicated a spinal problem, so they felt they did not want this information.
Reflective Questions
1. As the nurse, what priority data would you collect from this couple to help define relevant interventions to meet their needs?
2. How can you help this couple if they experience a negative outcome in the birthing suite? What are your personal views on terminating or continuing a pregnancy with a risk of a potential anomaly? What factors may influence your views?
3. With the influence of the recent Human Genome Project and the possibility of predicting open spinal defects earlier in pregnancy, how will maternity care change in the future?
Based on the video, describe two key reform factors that you believe will need to be addressed by future health care workers or leaders and explain why.
Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards. View the video located in the study materials entitled College of Nursing and Health Care Professions: Do We Know What Our Future Is? for insight into the challenges of health care reform.
Based on the video, describe two key reform factors that you believe will need to be addressed by future health care workers or leaders and explain why. (Note: You can download slides from this video for ease of review in developing your forum response). Additionally, what role does adherence to MCO standards play in your future health care vision?
Identify and describe the five stages of a constructive conflict process.
Applying the Stages of Constructive Conflict Management
In Chapter 1 of the text, Managing Conflict Through Communication, the five stages in a constructive conflict process are explained. Write a paper in which you identify a conflict that you or someone you know has had and has already been resolved. Identify and describe the five stages of a constructive conflict process. Then, apply each of the five stages of a constructive conflict process to your example. Your paper should clearly identify each stage and provide details or examples for each stage. You can review Examples 1 and 2 on pages 15-16 of the text for ideas on how to organize this assignment.
The paper must be one to two pages in length (excluding title and reference pages) and formatted according to APA style. You must use at least two scholarly resources (at least one of which can be found in the Ashford Online Library) other than the textbook to support your claims and sub claims. Cite your resources in text and on the reference page. For information regarding APA samples and tutorials, visit the Ashford Writing Center.
What evidence suggests that Anna does not have an acute severe infection?
Discussion Prompt
Case Study
Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a tickling cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent colds every spring and fall.
Physical Examination
Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat:Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)
Lungs: Clear to auscultation and percussion
Initial Post: Answer the following questions about Anna Sanchez and her condition.
What evidence suggests that Anna does not have an acute severe infection?
If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
A skin test indicates that Anna is allergic to cat dander. Two months ago, Annas roommate brought home a cat. Why didnt Annas symptoms start when the cat entered the household, rather than 3 weeks later?
What class of antibodies bind to the mast cells?
What physiological mechanisms caused the redness of Annas nasal mucosa?
What mechanisms caused Annas clear postnasal drainage?
Response # 1: Carefully read the initial posts made by the other students in your small group.
Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.
Response #2: Go back into your own initial post.
Identify what diagnostic testing or additional information you might need to establish a diagnosis.
Identify what you believe is the correct diagnosis for the patient in the case study with the rationale for your response.
Identify why the differential diagnoses left by your peers are or are not the correct diagnosis and support this with evidence from research and from the case posted by your peers.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is running away.
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.s situation. Include the following:
Describe the clinical manifestations present in Mrs. J.
Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients transition to independence.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Discuss the impact on blockchain finance and how these functions will accelerate basic functions.
Prepare a 4-5 page paper on the implications for voting, lotteries, certificate issuance, security auditing and enterprise. Discuss the impact on blockchain finance and how these functions will accelerate basic functions.
Your paper should be 4-5 pages long (excluding the title and reference pages) and formatted according to APA.
Compose your essay in APA format, including the introduction and conclusion, and in-text citations for all sources used.
Create short- and long-term goals for achieving the companys strategic plan.
Throughout this course, you have been using different analysis strategies to determine best practices for developing your business plan. Its time to develop a strategic plan that will help you determine where your business is now, where you want to take it, and how you will get there. Your strategic plan will help you implement and manage the strategic direction of your company. Additionally, you will communicate the direction of your company to stakeholders.
Develop a strategic plan for the company you selected at the beginning of your MBA program and share it with stakeholders.
Create a 10- to 15-slide presentation for key stakeholders to solicit their approval of your strategic plan. Address the following in your presentation:
An introduction with mission and vision statements
Core values, ethics, and social responsibility principles
Analysis of the companys:
Internal environment (e.g. strengths and weaknesses related to resources, trademarks, patents, copyrights, or current processes)
External environment (e.g. opportunities and threats related to market trends, economic trends, demographics, or regulations)
An evaluation of the internal and external environments impact on achieving the company strategy
Create a strategic objective for the company.
Create short- and long-term goals for achieving the companys strategic plan.
Determine methods for collecting data and measuring the success of the strategic plan.
Include APA-formatted in-text citations and a reference page.
Cite at least 3 peer-reviewed documents. Note: You may include your textbook as 1 of the sources
