Discussion: Using the Walden Library

Where can you find evidence to inform your thoughts and scholarly writing? Throughout your degree program, you will use research literature to explore ideas, guide your thinking, and gain new insights. As you search the research literature, it is important to use resources that are peer-reviewed and from scholarly journals. You may already have some favorite online resources and databases that you use or have found useful in the past. For this Discussion, you explore databases available through the Walden Library.

To Prepare:

• Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
• Begin searching for a peer-reviewed article that pertains to your practice area and interests you.

By Day 3 of Week 6

 An 89-year-old female complains of a “stabbing chest pain” and points to the area just below her scapula at the right mid-clavicular line. She states that she had an upper respiratory infection last week that “just seems to hang on.” She has no other complaints. 

• Which lab or imaging tests would you order for this patient? Why?

this is an individual written assignment , , about the pandemic of this century: the covid-19 its causative agent; as you know is : sars-cov-2, you should review the statistic facts, the clinical presentation of covid-19, and mainly the pharmacological management of this pandemic.

elaborate a 3 pages Assignment, APA, 5 references .

This assignment will help prepare you for conversations with clients with a mental health condition.

Course Competency

Describe the foundations of mental health nursing.

Transferable Skill

Communication: Displaying capability in writing, reading, and oral communication; understanding of non-verbal language.

Instructions

It will be carried out with two students working together. This is a “role play exercise,” in which one student is the student nurse, and the other will role play as a client. In this assignment, the nursing student will be demonstrating the therapeutic nurse-client relationship and analyzing the therapeutic and nontherapeutic techniques used. You will take turns in the roles.

This is not about always having therapeutic responses. It is about learning from practice and review. It is expected that you will think of other ways to respond or interact with the client that may be more therapeutic after the interaction is terminated. After the conversation is over, you will complete in IPR form.

The client roles are:

1. Mr. Jones is a 69-year-old retired engineer. He was admitted to the in-patient psychiatric unit the previous day. His daughter had called the police when he locked himself in his bathroom and refused to come out. She thought he was suicidal. He was brought to the hospital by the police and was admitted on involuntary status. He has been reticent since admission but told his daughter he had no reason to live since his wife died.
   Diagnosis: MajorDepressive Disorder
   Nursing Diagnosis: Risk for suicide.
2. Mrs. Alvarez is a 34-year-old female who has lived in this country for the past 10 yrs. She is a stay at home mom with three small children. Her husband works two jobs to support the family. Lately, she has been extremely anxious and fears that her children will become ill or injured. This seems to be an unrealistic concern, but she has been unable to sleep well and has lost 15 lbs. in the past month. She is a voluntary admission and states she knows she needs help.
   Diagnosis: Generalized Anxiety Disorder
   Nursing Diagnosis: Ineffective coping

You will select the role you wish as a client and take turns switching roles. After the conversation, you will document the interactions using the form provided and following the guidelines instructions for each column.

IPR Form Explanation

The IPR is completed with the form to guide you, and the rubric to explain the grading process for content.

The IPR Form is linked here.

• The first column is for you, the nursing student’s, comments/ questions, and responses. You may want to include the introduction process. It is understandable if the initial conversation is more superficial to establish rapport. You may not want to include all of this but move on to the more focused interaction. Your nonverbal communication is included here.
• Then, the conversation will move to a focus on the client’s feelings, concerns, issues as he/she has identified them. After the introduction, it may be beneficial to establish with the client a short- term goal for the interaction.
• The second column is for the client’s comments, questions, responses. Also, the nonverbal reactions of the client are included in this column.
• The middle column is for you to write what you are thinking or feeling.
• The last two columns are for you to document the technique that you used in that portion of the conversation. If it is a nontherapeutic response, you are to write the response and think of how you could revise to more therapeutic response. You can change any response if you think of how you could have responded differently but, identify and change all nontherapeutic responses.

Remember, this is an assignment that will assist you in all communication with others.

Explanation of the Rubric Criteria for Interpersonal Process Recording (IPR)

• Communication (20 verbal entries, ten nonverbal, ten techniques)
• Criteria 1 Nursing Interaction (verbal and nonverbal)
  Nursing statements and questions demonstrate a positive, caring approach and show insight into the client needs. These interchanges will include the introduction process, but not the more superficial interchanges. Nonverbal communication techniques are also recognized. Thoughts and feelings are identified and documented.
• Criteria 2
  The client verbal statements and questions are documented. Nonverbal communication is also observed and interpreted. You may also identify defense mechanism(s) used by the client.
• Criteria 3
  All communication techniques used are identified (using titles previously reviewed).
• Criteria 4
  All non-therapeutic techniques to be identified and changed to a therapeutic method. If in the review of the interaction, a more appropriate or therapeutic approach (verbal or nonverbal) is identified, document how this response/ statement would be changed

The following post is from another student. Please react adding other extra imformation relate to the post. 

Short answer

Less than 10 % similarity

References APA

Question 1

           At my care facility, we have had a system to monitor errors, and this is in alliance with the Patient Safety regulations set by the state and the World Health Organization (WHO). These system, however, consists mostly of complying with rules and filing of incident reports after an error was found. This reactive system lives little room for being proactive and catching errors before they happened. Therefore, as of last year, our facility has implemented guidelines that are more proactive in nature. Some of the priority areas as outlined by the World Health Organization’s World Alliance for Patient Safety and the Collaborating Centre are to do quarterly training in identifying and reporting medical errors, implement reporting guidelines that are not punitive in nature, but rather informative; this way no one is afraid to speak up, and lastly, identify the events that are “near misses” and develop a plan to make these less frequent (Grawn, Thom & Walters, 2015).

Question 2

           The Institute of Medicine and Joint Commission published a study, “To Err Is Human”, which discuss in part that healthcare teams who fail to collaborate have increased mortality and failure-to-rescue (deaths within 30 days of admission among patients who experienced specific complications) rate” (Grawn, Thom & Walters, 2015). Nowadays there are partnership recommendations in position for healthcare facilities demanding implementation of “interdisciplinary practice plans” for accreditation by Joint Commission (Fewster-Thuente & Velsor-Friedrich, 2008). Effective communication is crucial to reducing medical errors and improving patient outcomes. The opportunity to act as a healthcare team is essential for improved patient care and the opportunity to provide care that’s “patient-centered and valued” (Ezziane et al., 2014).

Question 3

           The Institute of Medicine’s four-pronged approach to reducing medical mistakes are: “(1) an analysis of errors at your practice site that have caused some degree of patient harm, and (2) an analysis of your aggregate medication-error data. The other 2 prongs, of equal importance, are both proactive in nature and include (3) an analysis of “near misses” (errors that have the potential to reach the patient or cause patient harm) and (4) an analysis of errors that have occurred in other organizations” (Westrick & Dempski, 2009, p. 117).

           These elements entail being reactive, being proactive, analyze the mistakes, and correct them. All of these are reportable and should be taken into consideration at organizational evaluations consistently.

References

Grawn, S., Thom, F. & Walters, I. (2015). Building efficient medical teams in professional medical care. Journal of Organizational Management, 16(9), 28-36. doi:10.1108/14777261211251508

Fewster-Thuente, L., & Velsor-Friedrich, B. (2008). Interdisciplinary collaboration for healthcare professionals. Nursing Administration Quarterly, 32(1), 40-48. doi:10.1097/01.NAQ.0000305946.31193.61

Westrick, S. J., & Dempski, K. (2009). Essentials of nursing law and ethics. Sudbury, MA: Jones and Bartlett.

Directions

1. Please review the infographic as way to guide you in getting started with your assignment: Developing an Assignment with Integrity (Links to an external site.)
2. View a short tutorial with tips for completing this assignment: iCARE Paper Tutorial (Links to an external site.)
3. Getting Started: Interprofessional teams are part of practice trends we see developing in all aspects of care delivery. Consider you own work environment (or recent clinical setting).
   • For this assignment, consider the concept of interprofessional teamwork and patient outcomes.
   • Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.)
   • Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)
   • iCARE components are:
     • C ompassion
     • A dvocacy
     • R esilience
     • E vidence-Based Practice (EBP)
   • How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?
4. Select one scholarly nursing article from CINAHL as a resource for your paper.
   • Additional scholarly sources can be used but are optional.
   • When searching in the CINAHL database, please limit your search word to one component of the paper you wish to emphasize, such as ‘Resilience’.  Searching for the term iCARE will not produce the results you need.
5. Elements of iCARE paper
   • Title page
   • Below are the headings to be used for this assignment.
     • Introduction: (No heading needed here in APA) Explain the type of work setting you are discussing and whether interprofessional teams are currently present. If interprofessional teams are present, indicate a team function that could be improved. If interprofessional teams are NOT present, indicate what type of team you think might be possible in the setting.
     • Describe a nursing action item for each component below that could contribute to: interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.
       • Compassion
       • Advocacy
       • Resilience
       • Evidence-Based Practice
     • Summary: Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes. Address how you may be able to influence this process of support for interprofessional teams overall in your unit or organization.
     • References: List any references used in APA format.

Templates

The prepared paper template is RECOMMENDED for this assignment.

iCare Assignment Template (Links to an external site.) – APA 6th edition

iCare Assignment Template – APA 7th edition

  nursing process assignment.docx 

1)  Minimum 20 slides with  speaker notes

              Part 1: Minimum 8 slides with  speaker notes (All slides)

              Part 2: minimum 12 slides with  speaker notes (All slides) 

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 6 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:  Type II Diabetes

In the presentation of your chosen topic, be sure to examine the pathophysiological factors that influence the incidence and manifestations of acute, episodic, and chronic diseases in populations across the lifespan

 1. Pathophysiology

2. Risk factors and causes

3. Possible consequences

4. Prevention Strategies

5. Treatment Modalities

Part 2: 

Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.

Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.

PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.

Medications:
Metformin 1000mg ER one tab daily – Type II Diabetes controlled

Coumadin 5 mg. daily – Hx of DVT – Controlled

Kava Kava 50 mg. tid – Self-medication for anxiety

CoQ10 – 200 mg. daily. – Self-medication for unknown reason

Assignment Directions:

1. Provide a diagnosis for the patient and and and justify your reasons for the diagnosis based on scientific articles

2. Provide a treatment plan specifically for this patient

   (a) Pharmacologic 

   (b) Non-pharmacologic.

3. Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. 

   (a) Include drug-drug interactions and side effect profiles.

4. Provide an education plan for Mr. X

1. A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.  

   Question 1 of 2:

   What is ALL?  — 

QUESTION 2

1. A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.  
   Question 2 of 2:

   How does renal failure occur in some patients with ALL? 

QUESTION 3

1. A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.  

   Question 1 of 2:

   What is the pathophysiology of acute SCD crisis and why is pain the predominate feature of acute crises?  

     

QUESTION 4

1. A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.  

   Discuss the genetic basis for SCD.
     

QUESTION 5

1. The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.    

   Explain the genetics of hemophilia.

     

QUESTION 6

1. The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.    
   Question 2 of 2:
   Briefly describe the pathophysiology of Hemophilia.

QUESTION 7

1. During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.  

   What is the underlying pathophysiology of myelomeningocele? 

QUESTION 8

1. During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.  
   Question 2 of 2:

   Describe the pathophysiology of hydrocephalus in infants with myelomeningocele. 

QUESTION 9

1. A preterm infant was delivered at 32 weeks gestation and was taken to the NICU for critical care management. Physical assessment of the chest and heart remarkable for a continuous-machinery type murmur best heard at the left upper sternal border through systole and diastole. The infant had bounding pulses, an active precordium, and a palpable thrill. The infant was diagnosed with a patent ductus arteriosus (PDA).  

   Discuss the hemodynamic consequences of a PDA. 

QUESTION 10

1. A 7-year-old male was referred to the school psychologist for disruptive behavior in the classroom. The parents told the psychologist that the boy has been difficult to manage at home as well. His scholastic work has gotten worse over the last 6 months and he is not meeting educational benchmarks. His parents are also worried that he isn’t growing like the other kids in the neighborhood. He has been bullied by other children which is contributing to his behaviors. The psychologist suggests that the parents have some blood work done to check for any abnormalities. The complete blood count (CBC) revealed a hypochromic microcytic anemia. Further testing revealed the child had a venous lead level of 21 mcg/dl (normal is < 10 mcg/dl). The child was diagnosed with lead poisoning and it was discovered he lived in public housing that had not finished stripping lead paint from the walls and woodwork.  
   Question:

   How does lead poisoning account for the child’s symptoms? 

QUESTION 11

1. Emergency Medical Services (EMS) was dispatched to a home to evaluate the report of an unresponsive 3-month-old infant. Upon arrival, the EMS found a frantic attempt by the presumed father to resuscitate an infant. The EMS took over and attempted CPR but was unable to restore pulse or respiration. The infant was transported to the Emergency Room where the physician pronounced the child dead of Sudden Infant Death Syndrome (SIDS). The distraught parents were questioned as to the events surrounding the discovery of the baby. Parents state the child was in good health, had taken a full 6-ounce bottle of formula prior to being put down for the evening. The child had been sleeping through the night prior to this. Parents stated the baby had had some “sniffles” a few days before and was taken to the pediatrician who diagnosed the child with a mild upper respiratory tract viral syndrome. No other pertinent history. 

   Question:

   What is thought to be the underlying pathophysiology of SIDS? 

QUESTION 12

1. A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease. 

   Question 1 of 2:

   What is Kawasaki Disease and what is the pathophysiology? 

QUESTION 13

1. A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease. 
   Question 2 of 2:

   How does Kawasaki Disease cause coronary aneurysms? 

QUESTION 14

1. A 9-year-old boy was brought to the Urgent Care Center by his parents who state that the child had a sudden onset of difficulty catching his breath, has a new cough and is making a “funny sound” when he breathes.  The parents state there is no prior history of this, and the child had not been ill prior to the start of the symptoms. Past medical history noncontributory. No family history of respiratory problems. No known allergies to drugs or food. Physical exam positive for respiratory rate of 26, use of accessory muscles, with suprasternal retractions, heart rate of 132 beats per minute, an audible inspiratory and expiratory wheeze noted, and the pulse oximetry is 89% on room air. After the APRN institutes appropriate urgent treatment, the child’s breathing slowly returned to normal, vital signs normalize, and the pulse oximetry increases to 97%. The APRN suspects the child has asthma and tells the parents that they need to bring the child to a pulmonologist for further evaluation and care.  

   What is the underlying pathophysiology of asthma? 

QUESTION 15

1. A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.  

   Question 1 of 2:

   What is cystic fibrosis and discuss the pathophysiology.

QUESTION 16

1. A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.  
   Question 2 of 2:

   What is the reason people with CF are often malnourished? —

QUESTION 17

1. A 14-year old girl who was trying out for cheerleading underwent a physical examination by the APRN who notices that the girl had uneven hip height, asymmetry of the shoulder height, shoulder and scapular prominence and rib prominence. The rest of the physical exam was normal and the APRN referred the girl to an orthopaedist for evaluation for possible scoliosis. Radiographs in the orthopaedic office confirms the diagnosis of idiopathic scoliosis. The spinal curve was measured at 26 degrees and it was recommended that the girl be fit for a low-profile back brace.  

   Question:

   What is thought to be the pathophysiology of idiopathic scoliosis? — 

QUESTION 18

1. A 2-year-old boy was brought to Urgent Care by his parents who state the boy has been having large amounts of diarrhea, been very irritable and very pale. The parents noticed there was blood in the diarrhea and when the boy’s legs became swollen, they sought care. Past medical history noncontributory and all immunizations up to date.  Social history noncontributory and the child is in day care 5 days a week. No known exposure to other sick children and the only new event the parents could think of is the day care workers took the children to a local petting zoo about a week ago. Physical exam revealed a pale, ill appearing child with swollen legs, tender abdomen, and petechia on the legs and abdomen. The APRN suspects the child may have been exposed to a bacterium at the petting zoo and arranges for the patient to be transferred to the Emergency Room. There the child was found to be in renal failure, have hypertension and was diagnosed with hemolytic uremic syndrome (HUS).  

   Question:

   What is the pathophysiology of HUS?  — 

QUESTION 19

1. The parents of a 3-year-old boy bring the child to the pediatrician with concerns that their child seems “small for his age”. The parents state that the boy has always been small but did not worry until the child went to day care and they noticed other children of the same age were much bigger. They also note that his teeth were very late in coming in. Normal prenatal, perinatal and postnatal history and no medical history on either side of family regarding issues with growth and development. Physical exam is normal except for short limbs and small teeth. The pediatrician suspects the child has pituitary dwarfism. A complete laboratory and radiographic work up confirmed the diagnosis.  
   Question:

   What is the pathophysiology of pituitary dwarfism? 

QUESTION 20

1. A 4-year-old boy was brought to the Emergency Room by his parents with a suspected femur fracture. The parents state the child was playing on the couch when he rolled off and cried out in pain. There were no other injuries noted. Review of the child’s chart revealed this was the 4th Emergency Room visit in the last 15 months for fractures after low impact injury. The parents were suspected of child abuse and Child and Protective Services were consulted. The APRN assessing the child noted that the child had unusually thin and translucent skin, poor dentition, and blue sclera. The APRN suspects the child may have osteogenesis imperfecta (OI). Laboratory results revealed an elevated serum alkaline phosphatase and the diagnosis OI was made based on the clinical picture and elevated alkaline phosphatase.  

   Question:

   What is the pathophysiology of OI? — 

3 critique  and  1 concept anlysis

 for theorist DOROTHEA E. OREM “‘SELF CARE DEFICIT NURSING THEORY'”