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After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
• A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
• A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
• A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

 Question 1

Identify the full name of guideline you have identified. This will be your choice from the three options above: A pending bill, a current policy, or the development of a new bill. Include in your response a direct link to the bill or policy you are referring to or a copy of the health policy. If you are recommending a new bill, please include a one-page draft of your recommendation.

 Question 2

Identify the level at which you will advocate for your bill or policy.

• If its legislation, please let us know whether it falls into the scope of the House or Senate and if it’s at the Federal or State level
• If you chose a healthcare policy, please identify the scope as the community, a facility, an insurance agency etc.

Question 3

Provide a detailed explanation with a minimum of two reasons why this healthcare policy or bill is important. Scholarly support and citations are required.

 Question 5Using this link with your current address, please identify your US legislators. https://www.congress.gov/members/find-your-memberLinks to an external site..  Identify the leader or change agent by name as well as their role from the level you noted in question 2. Tell us who is appropriate to advocate for this policy change or adoption. Example: Ted Cruz, US Senate, Texas; Adam Anderson, State House of Representatives, Florida; Dr. Olivia Smith, Director, Office of Health Equity.  After identifying the appropriate leader or change agent, in 2-4 sentences, describe why this individual is the most appropriate to advocate for this policy change or adoption. 

Question 6

What is the leader or representative’s mailing address AND email address? 

Question 7

State the member of your community who you can elicit feedback from regarding your policy advocacy efforts. Please tell us their first name and their role in your community as well as an email or phone number to contact them. This individual can be a neighbor, coworker, family member etc.. who lives in your community and interacts with the healthcare system in any way (patient family member, healthcare provider). Upload the completed Stakeholder Validation Tool here.

Pulmonary Function:
D.R. is a 27-year-old man, who presents to the nurse practitioner at the Family Care Clinic complaining of increasing SOB, wheezing, fatigue, cough, stuffy nose, watery eyes, and postnasal drainage—all of which began four days ago. Three days ago, he began monitoring his peak flow rates several times a day. His peak flow rates have ranged from 65-70% of his regular baseline with nighttime symptoms for 3 nights on the last week and often have been at the lower limit of that range in the morning. Three days ago, he also began to self-treat with frequent albuterol nebulizer therapy. He reports that usually his albuterol inhaler provides him with relief from his asthma symptoms, but this is no longer enough treatment for this asthmatic episode.

Case Study Questions

1. According to the case study information, how would you classify the severity of D.R. asthma attack?
2. Name the most common triggers for asthma in any given patients and specify in your answer which ones you consider applied to D.R. on the case study.
3. Based on your knowledge and your research, please explain the factors that might be the etiology of D.R. being an asthmatic patient.

Fluid, Electrolyte and Acid-Base Homeostasis:
Ms. Brown is a 70-year-old woman with type 2 diabetes mellitus who has been too ill to get out of bed for 2 days. She has had a severe cough and has been unable to eat or drink during this time. On admission, her laboratory values show the following:

• Serum glucose 412 mg/dL
• Serum sodium (Na+) 156 mEq/L
• Serum potassium (K+) 5.6 mEq/L
• Serum chloride (Cl–) 115 mEq/L
• Arterial blood gases (ABGs): pH 7.30; PaCO2 32 mmHg; PaO2 70 mmHg; HCO3– 20 mEq/L

Case Study Questions

1. Based on Ms. Brown admission’s laboratory values, could you determine what type of water and electrolyte imbalance does she has?
2. Describe the signs and symptoms to the different types of water imbalance and described clinical manifestation she might exhibit with the potassium level she has.
3. In the specific case presented which would be the most appropriate treatment for Ms. Brown and why?
4. What the ABGs from Ms. Brown indicate regarding her acid-base imbalance?
5. Based on your readings and your research define and describe Anion Gaps and its clinical significance.

Submission Instructions:

• You must complete both case studies
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. 

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer. 

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. You don’t need to make a presentation page.