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Case Study: Chronic Hypertension

Female was admitted to inpatient care with a diagnosis of chronic hypertension with severe features and started on Labetalol 200 mg po q 8 hours. She was monitored for 3 days and her BP stabilized at 130/78. Fetal testing was reassuring. She was discharged home on hospital day 3 on Labetalol and was to be seen twice weekly for BP checks, and was instructed to take her BP at home twice daily. Safety of medications was discussed in-depth with her. Signs/symptoms of PIH were reviewed with her. Two weeks later she had po nifedipine added. She subsequently delivered a healthy baby girl at 39 weeks gestation. She was discharged home on above medications (as she was breastfeeding) and continued meds for hypertension past her 6-week postpartum appointment. She was referred to her primary care provider for continuing care. 

Purpose of this case study is to address the significantly different standards of labs and vital signs for pregnant patients. 

· Based on the case study above, complete a comprehensive well-woman exam 

· What is your primary diagnosis? Explain. 

· What are two other differential diagnoses? Explain.

· What additional questions you would ask the patient? Explain your reasons for asking the additional questions

· Then, what types of symptoms you would ask for? Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.)

· Lastly, explain which treatment options and diagnostic tests you might recommend

1) Minimum 8 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

              Part 8: minimum 1 page

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 3 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: 

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. 

1. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. 

2. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. 

3. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. 

Part 2: 

The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. 

Review the following topic materials

“About the Affordable Care Act”

“Health Care Transformation: The Affordable Care Act and More”

1. What are the most important elements of the Affordable Care Act in relation to community and public health? 

2. What is the role of the nurse in implementing this law?

Part 3: ( INFECTION CONTROL AND PREVENTION )

1. Discuss one personal strength and one weakness you have regarding professional presentations (project capstone about  INFECTION CONTROL AND PREVENTION  ). 

2. Name one method for improvement for each of these 

3. Discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

Part 4:  ( INFECTION CONTROL AND PREVENTION)

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. 

1. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Part 5:

Fifty-four-year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery.

1. How is the concept of “disorders of brain function” related to Fred’s presenting symptoms?

2. What aspects of cerebral circulation would come into play in Fred’s case?

Part 6:

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.    Does he need medication(s) given his history of MI?

3.   Considering that you have a case study, you only need 2 posts for this discussion board, 1 initial and 1 reply. As usual, all posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited.

Part 7: Community Nursing

There is a planned community health project to decrease the incidence of human papilloma virus (HPV).

1.  Who is/are the target population? Why?

2. What are some key factors to consider when planning an HPV prevention program?

Part 8:

 1. What is meditation? 

      a. Discuss the benefits of meditation? (mention at least 3).

2. Indicate any research study that support the benefits  of meditation 

3. Have you ever practiced meditation? (Yes)

      a . Discuss your experience? 

 Title: qualitative article critique

Paper type Dissertation Chapter – Literature Review

Paper format APA

Course level Master

Subject Area Nursing

# pages 2   ( or 600 words Minimum)

Spacing Double Spacing

# sources 1

Paper Details

Assignment Content

Conduct a search of the literature for qualitative studies on your problem utilizing the search plan submitted Week 3. You may revise the plan as you conduct the search.

Locate a minimum of four academic research studies. Each member should read all of the articles selected using the reading plan developed in Week 3. Selection of final articles should reflect a group process and not simply each team member selecting an article and submitting.

Use the Literature Search Activities in Bibliographic Databases Log to document your search process. You will add to the form in future weeks as you continue the search.

Write a 350-word summary of your search process and explain why you selected the articles you chose.

Include a reference page identifying the articles you selected using APA guidelines.

Submit the Literature Search Activities in Bibliographic Databases Log and your summary.

Resources

Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
Learning Team Toolkit

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Discussion: Pharmacokinetics and Pharmacodynamics

Teaching Plan Sickle Cell Anemia 10 Year Old- due 4 hours from now – Apply if only you can meet the deadline 

You  only need to work on number 3. Because the other things are objectives  that you must meet in the writing. Basically what you are doing its teaching a child  of 10 years about sickle cell anemia and you need to use what number 3  is asking you to do

you must follow grading rubric

Give quality work and I will work with you always in my 3 classes which have just began

Check the attachment for the assignment 

1- Discussion question: The nurse is completing a physical examination on a patient complaining of breast pain. Discuss important information to document during a physical examination of the breast.

2- 3 paragraphs of 3 sentences each

3- 2 references not older than 2015

4- APA style

Where Did Theory Come From

The purpose of this Assignment is to explore how a theorist explicates his or her philosophy and thoughts behind a theoretical field. As in other fields of study, nursing has a plethora of theorists and theories. These theorists have developed their paradigm over time enriching it with research and dialogue with other theorists.

Directions

In this assignment, you are going to explore how a nurse theorist of your choice created his or her theory.

You will become the theorist immersing yourself in the writings from the earliest mentioned to the most current literature.

Writing in the voice of the theorist (taking on the persona of the theorist) create the theory through the following four stages.

In the first stage, theorizing occurs. This is where you, as the theorist, identify the concepts of what nursing is and is not. Perhaps you questioned what concepts were guiding those in nursing practice and then started to question your role. You started asking yourself, “Where am I in nursing, and where the profession is going? Is there some overarching concept that guides the professional in his or her practice?” This is where you recognize that a theory is needed.

In the second stage, syntax is developed. This is where you will define the terms. Look for changing definitions of terms. Consider, for example, Jean Watson. She starts by defining the word “caring.” Within the last ten years she has refined her terminology changing the term caring to caritas. This demonstrates a growth and maturation from decades of research she and other scholars did to produce the theory of caring.

The third stage is theory testing. Defined as the phenomena behind the theory that are exposed through research. The definitions of terms are refined. The theorists and other researchers consider whether this theory helps answer questions that arise in practice. This is where your theory is used in by a widening group of researchers. For example, graduate nursing students request the tool you developed while testing your theory.

The fourth and last stage is evaluation. This is where philosophical debate occurs as the concepts are applied through evidenced based practice in the act of providing nursing care.

Assignment Details

For this Assignment, you will write on how you developed your theory through the four stages (theorizing, syntax, theory testing, and evaluation). Your paper must be 3 to 5 pages, not including the title and reference pages.

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:

• Minimum requirement of at least five sources of support
• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under the Course Resources) 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
• use APA 6th Edition

Answer all questions 

FILE ATTACHED BELOW

Questions:

How would you explain what an Explanation of Benefits form is?

How would you explain the difference between the amount submitted and the amount allowed?

After you explain the amount allowed to her, she gets irate and exclaims, “How dare Dr. Simmons overcharge me by $8.00!” She then said that she was going to call his office and give them a piece of her mind.

How will you respond to this?

The Title (Family Caregiving and Social Policy) is the policy that I’m going to use in my project

Answer the following questions: 

•     What are the sources of pediatric primary care in the United States? Are these sources sufficient for providing health-care services to the pediatric population? Why or why not?
•     Are there certain pediatric populations that lack access to health-care services? Why?
•     What are the barriers to children in accessing health-care services in the United States? Why do these barriers exist?

Do 1 page

Provide references in APA format.