Samples

- 1. What approach might the nurse take to assist in resolving the conflict between Mrs. Lieberman and her daughter?

- 1. What approach might the nurse take to assist in resolving the conflict between Mrs. Lieberman and her daughter?

2. What actions by the nurse help ensure that clients participate in the decision-making process about their care?

3. Discuss Mrs. Lieberman's right to accept, refuse, or modify the plan of care.

4. What is considered informed consent and how is obtained?

5. Reflect on the how your approach regarding client rights might be altered if Mrs. Lieberman lacked sufficient mental competence to make sound decisions?

a. What types of patient and family teaching needs to be provided to understand the principles associated with informed consent, refusal of treatment, and advance directives?

b. How would your interactions make the patient, and their family members feel?

c. How would therapeutic communication play a role in this interaction?

 Evaluation

Activity:

� Individual student response to video challenge question

Criteria:

� Response submitted in Video Case Study.

� Time spent in Video Case Study.

� Post detailed, well organized, thoughtful responses to questions."

 1. Approach to Resolving Conflict Between Mrs. Lieberman and Her Daughter:Approach to Resolving Conflict Between Mrs. Lieberman and Her Daughter:

 To resolve the conflict, the nurse should employ the patient’s view of the situation as well as the nurse’s view of the situation. This could involve:

 Active Listening: Spend time with both Mrs. Lieberman and her daughter having the conversation where both of them has a chance to voice their opinion without interjection.

 Empathy and Validation: Recognise the feelings at play, for example, of Mrs. Lieberman wanting to regain a certain level of control and her daughter wanting to protect her.

 Facilitation of Open Dialogue: Engage both parties to offer each other the respect they seek and make each of them appreciate the feelings of the other. The nurse might invite each of the individuals to state his or her goal, and then find substantiality in it.

 Mediation: The nurse may sit between them and facilitate this decision making and make sure that Mrs. Lieberman’s self-determination is respected as well as perceived risks from Leslie are understood.

 2. Ensuring Clients Participate in the Decision-Making Process:Ensuring Clients Participate in the Decision-Making Process:

 Providing Comprehensive Information: Some important aspects that the nurse should support concerning clients include providing them with actual and suitable information regarding their state and therapeutic strategies as well as foresee potential dangers, advantages, and other possibilities.

 Respecting Autonomy: Help clients to speak, inquire, and choose according to the values and assumptions that would be helpful for each one of them.

 Shared Decision-Making: The client and the family members should be involved in coming up with care plan that suits the clients need.

 Advocacy: Always respect clients’ decisions be it for their care and ensure that all that is planned on their behalf is done.

 3. Mrs. Lieberman’s Right to Accept, Refuse, or Modify the Plan of Care:Mrs. Lieberman’s Right to Accept, Refuse, or Modify the Plan of Care:

 Self-determination: Mrs. Lieberman has the privilege of decision making over her care, choices to accept, or reject, changes in the treatments. Therefore, the clients’ decisions must be honored no matter how irrational they may seem, so long as the lady in question has the capacity to make those decisions.

 4. Informed Consent:

 Informed consent is a legal and ethical requirement when client is educated about the kind of treatment or procedure in terms of advantages and disadvantages, risks and benefits, and other available choices. It involves:

 Explanation: It is usual that the provider has to give the patient information on the procedure and its advantages and/or drawbacks.

 Competence: The client has to be rational, that is, should be able to comprehend the information provided to him and take an informed decision.

 Voluntariness: The client should come to a conclusion on his/her own, though being guided by the necessary information.

 Obtaining Consent: Consent is normally documented in writing where the client affirms to the consent through an autograph to the signature that the client understood and agreed to be subjected to the treatment.

 5. Approach if Mrs. Lieberman Lacks Mental Competence:Approach if Mrs. Lieberman Lacks Mental Competence:

 If Mrs Lieberman was mentally incompetent then the management reverts to the legally nominated proxy such as a health-care durable power of attorney or an heir. The nurse would:

 Determine Legal Authority: Clarify who is legally able to take decisions.

 Provide Clear Information: Make sure the surrogate has all the information about Mrs. Lieberman’s condition, choices, and prognosis.

 Respect Pre-existing Wishes: If the client has an advance directive it must be the basis for the decision making.

 a. Patient and Family Teaching Needs:a. Patient and Family Teaching Needs:

 Informed Consent: Explain the good of realizing that there are procedures to follow before agreeing to anything and that everyone is entitled to ask questions.

 Refusal of Treatment: Inform clients that they have the freedom of decision making insomuch that they have the freedom to turn down the doctors advice.

 Advance Directives: Inform the public about the importance of the living wills and the appointment of the durable power of attorney in case of their disability.

 b. Impact on Patient and Family:b. Impact on Patient and Family:

 The patient and family members would end up feeling empowered as well as being respected if the nurse were to ensure that adequate communication, honesty, as well as stressing on the rights of the patient was made at this point. When one respects the other, it paves way for trust and make them feel that they are included.

 c. Role of Therapeutic Communication:c. Role of Therapeutic Communication:

 Therapeutic communication is a way of communicating in which there is understanding, the use of probing and nodding and avoiding criticism. Making the communication with the family members empathetic and trusting, the nurse can help them to make appropriate and sensitive decision. Reflecting feelings, acknowledging concerns, and giving clear, much of the time data are a portion of those methods.

 Evaluation Criteria:

 For a comprehensive response:

 In the perfect style, make specific and orderly answers in video case studies.

 Exercise critical thinking when it comes to ethical and legal issues which are complicated.

 Show how to embrace therapeutic communication and the use of time.

How do the board of nursing implement CEU requirements for the first time?

How do the board of nursing implement CEU requirements for the first time?

The following is usually followed by the Board of Nursing to ensure conduction of Continuing Education Unit: Here’s an overview of how it generally works when CEU requirements are introduced for the first time:

 1. Regulation Development and Approval

 BON is also involved in the development of regulations concerning the amount of CEUs mandatory, content areas that will be considered appropriate and guidelines on approval of CEU providers.

 Ordinarily, it is the stakeholders including the nursing associations and institution of learning that offer the feedback.

 The regulations once completed go through legal procedures to become effective; they sometimes have to go through public hearings, legislative ratification for instance.

 2. Announcement and Communication

 The BON officially communicates the new CEU requirements through newsletters, posting on the official BON website, direct mailing or emailing to the licensed nurses.

 Meetings and seminars may be held in relation to the change in the requirements.

 3. Phase-In Period

 Some violations are followed by phase-in periods to allow the nurses to conform. For instance, the nurses can be expected to do their CEUs within the course of one or two renewal cycles.

 The phase-in period also helps nurses that are still within their renewal period to upgrade their understanding of the new requirements with out the fear of the repercussions.

 4. Specific CEU Requirements

 The BON gets to determine the number of CEUs required in most circumstances, which is normally within the two-year renewal period. In the first cycle, it may be possible for first timers to be allowed partial implementation of the assessment plan.

 The material that CEUs deliver may pertain to certain aspect of practice like ethics, pharmacology, or patient safety depending of course on the state’s concentration.

 5. Provider Accreditation

 The BON has the role of pointing out or approving organizations that can, in their turn, provide CEUs that have educational relevance.

 CEU courses can either be approved directly by the BON or with the help of a third party such as the ANCC.

 6. Tracking and Compliance

 It is obligatory for nurses to maintain records of their CEUs although such records can be easily compiled by submitting certificates of completion during license renewal.

 The BON may occasionally embark on random audits in order to check compliance.

 Noncompliance with the provisions is punishable with sanctions that include a delay in license renewal or additional CEUs.

 7. Ongoing Monitoring and Adjustments

 The BON also assures how the CEU requirement impacts the practice of nursing in the state and makes changes to it in terms of hours or content as may be of relevance with the current trends in healthcare and or the nursing profession.

Referring to the ten 'must-do' AHA strategies, describe five examples of actions that could be taken in your workplace to better prepare for the second curve."

Referring to the ten 'must-do' AHA strategies, describe five examples of actions that could be taken in your workplace to better prepare for the second curve."

Structure of communication, truthfulness, and openness in the promotion of cost control while ensuring quality client care and employee satisfaction.

 1. Foster Open Communication:

 Regular Meetings: Conduct staff meetings as part of training sessions in which staff will be in a position to deliberate on ways of managing costs in relation to the care of patients. This ensures that everyone contributes his/her suggestions and realize that there is constraint on the amount of money available.

 Feedback Channels: Cultivate well-defined mechanism through which the staff can communicate regarding just-patient uses of the resources and patient caring practices. Tending to their suggestions enables one to come across sections that need to be reduced on the expenses without making compromises on quality.

 2. Promote Transparency in Financial Matters:Promote Transparency in Financial Matters:

 Budget Education: Sensitize the workers on the financial aspect of health delivery, the share of resources and how this will fit into the overall budget. Cost awareness enables the staff to be more careful when using resources and planning on how to gain more funds.

 Cost Reporting: Disclose information in regard to costs and other performance indicators with workers. Clear portrayal of decision making processes in areas of finance, and the effect they have on the organisation’s functioning, creates trust and responsibility.

 3. Encourage Honest Dialogue:

 Addressing Concerns: Ensure freedom of speech in staff to report issues to do with resources scarcities or ineffective utilization without any form of punishment. This helps spot some areas that may seem to be costly to realise and it promotes staff relation.

 Recognition of Efforts: Encouraging people to be ingenious and reap grateful for the concepts that cut on the costs while enhancing the quality of care. To promote improved morale and job satisfaction honest recognition of their efforts should be made.

 4. Integrate Cost-Conscious Practices with Quality Care:Integrate Cost-Conscious Practices with Quality Care:

 Evidence-Based Practices: Encourage and incorporate the use of concepts which are efficient in proposition cost as well as effective in the delivery of quality services. Educate staff on the utilization of these practices so that they would have a clue of how these practices benefit in cost reduction as well as the patients.

 Resource Utilization: Ensure careful use of physical assets, human resources, finances, space and time etc. For instance, the omission of special tests and treatments, or the formulation of a pattern of work, should allow cost savings to occur without compromising the quality of care.

 5. Support Employee Job Satisfaction and Retention:Support Employee Job Satisfaction and Retention:

 Career Development: Provide for staff training and promotion. The value and career growth which the employees received helps them to remain loyal with the organization.

 Work-Life Balance: Ensure the employees are well taken care of, encourage healthy lengthy of work and personal life. There is evidence suggesting that when employees have good attitude to their working environment, then there is high likelihood that they will be more committed to the organization.

 Practical Examples:

 1. Cost-Saving Initiatives:

 Inventory Management: Combine transparency and open door-policy and disclose the cost of inventory to the personnel and make them look for ways to minimize the costs of inventory.

 Energy Efficiency: Involve staff in energy conservation activities like switch off policies for non-used systems, which adds to productivity in cutting costs.

 2. Quality Improvement Projects:

 Patient Care Protocols: Engage the staff in creating and optimizing the best and more organic ways to deliver the patient care at reasonably low costs.

 Benchmarking: Employ benchmarking data to determine how your organization measures up to other organizations in measures that would allow for comparison with relative organizations and discover where specific shortcomings could be adjusted to have cost controlling implications which do not affect the quality of service delivery.

 3. Employee Feedback and Recognition:

 Suggestion Programs: Introduce suggestion schemes that would allow members of staff to forward consolationable ideas and be rewarded should these be adopted by the organization.

 Regular Surveys: Employee job satisfaction surveys should be conducted on a regular basis to define their level of satisfaction, workload, availability of resources or financial pressure.

Suggest ways in which dialogue, honesty and transparency can translate into creating a cost-conscious environment

Suggest ways in which dialogue, honesty and transparency can translate into creating a cost-conscious environment while promoting quality care provision and employee job satisfaction (directly influencing retention)."

Structure of communication, truthfulness, and openness in the promotion of cost control while ensuring quality client care and employee satisfaction.

 1. Foster Open Communication:

 Regular Meetings: Conduct staff meetings as part of training sessions in which staff will be in a position to deliberate on ways of managing costs in relation to the care of patients. This ensures that everyone contributes his/her suggestions and realize that there is constraint on the amount of money available.

 Feedback Channels: Cultivate well-defined mechanism through which the staff can communicate regarding just-patient uses of the resources and patient caring practices. Tending to their suggestions enables one to come across sections that need to be reduced on the expenses without making compromises on quality.

 2. Promote Transparency in Financial Matters:Promote Transparency in Financial Matters:

 Budget Education: Sensitize the workers on the financial aspect of health delivery, the share of resources and how this will fit into the overall budget. Cost awareness enables the staff to be more careful when using resources and planning on how to gain more funds.

 Cost Reporting: Disclose information in regard to costs and other performance indicators with workers. Clear portrayal of decision making processes in areas of finance, and the effect they have on the organisation’s functioning, creates trust and responsibility.

 3. Encourage Honest Dialogue:

 Addressing Concerns: Ensure freedom of speech in staff to report issues to do with resources scarcities or ineffective utilization without any form of punishment. This helps spot some areas that may seem to be costly to realise and it promotes staff relation.

 Recognition of Efforts: Encouraging people to be ingenious and reap grateful for the concepts that cut on the costs while enhancing the quality of care. To promote improved morale and job satisfaction honest recognition of their efforts should be made.

 4. Integrate Cost-Conscious Practices with Quality Care:Integrate Cost-Conscious Practices with Quality Care:

 Evidence-Based Practices: Encourage and incorporate the use of concepts which are efficient in proposition cost as well as effective in the delivery of quality services. Educate staff on the utilization of these practices so that they would have a clue of how these practices benefit in cost reduction as well as the patients.

 Resource Utilization: Ensure careful use of physical assets, human resources, finances, space and time etc. For instance, the omission of special tests and treatments, or the formulation of a pattern of work, should allow cost savings to occur without compromising the quality of care.

 5. Support Employee Job Satisfaction and Retention:Support Employee Job Satisfaction and Retention:

 Career Development: Provide for staff training and promotion. The value and career growth which the employees received helps them to remain loyal with the organization.

 Work-Life Balance: Ensure the employees are well taken care of, encourage healthy lengthy of work and personal life. There is evidence suggesting that when employees have good attitude to their working environment, then there is high likelihood that they will be more committed to the organization.

 Practical Examples:

 1. Cost-Saving Initiatives:

 Inventory Management: Combine transparency and open door-policy and disclose the cost of inventory to the personnel and make them look for ways to minimize the costs of inventory.

 Energy Efficiency: Involve staff in energy conservation activities like switch off policies for non-used systems, which adds to productivity in cutting costs.

 2. Quality Improvement Projects:

 Patient Care Protocols: Engage the staff in creating and optimizing the best and more organic ways to deliver the patient care at reasonably low costs.

 Benchmarking: Employ benchmarking data to determine how your organization measures up to other organizations in measures that would allow for comparison with relative organizations and discover where specific shortcomings could be adjusted to have cost controlling implications which do not affect the quality of service delivery.

 3. Employee Feedback and Recognition:

 Suggestion Programs: Introduce suggestion schemes that would allow members of staff to forward consolationable ideas and be rewarded should these be adopted by the organization.

 Regular Surveys: Employee job satisfaction surveys should be conducted on a regular basis to define their level of satisfaction, workload, availability of resources or financial pressure.

Objectives

Objectives

 Identify common pathogens that can be spread related to the client's diagnosis

Assemble and identify correct personal protective equipment for the presumed pathogens

Identify the order of Donning and doffing personal protective equipment as instructed by the Centers for Disease Control's guidance

Identify the proper technique in preventing spreading contamination within the care setting

Handoff Report

The patient is a 56-year-old male who is complaining of flu-like symptoms, which have been getting    worse over the last few days.

Case History

 Your patient is a 56-year-old male who is retired.

 He is very lethargic and states his wife is also not feeling well at home.

 He presents with general malaise, fever, a loose productive cough, and diarrhea.

 He states it has become increasingly more difficult to breathe over the last two hours.

Triage Vital Signs

56 Year Old Male, VS T. 103, HR 110, BP 156/60, RR 33, O2 90%. Chief Compliant, Fever, Cough, Shortness of Breath, and a Sore Throat.

Patient Assessment

General Appearance: Anxious, and a little Unkempt

Cardiovascular: Sinus Tachycardia

Respiratory: Rhonchi all fields 

GI: Hyperactive bowel sounds

GU:  Voiding dark yellow urine

Extremities: General weakness

\ Skin: Pale, Hot, Diaphoretic

Neurological: Alert and oriented to person, place, and time

Other Assessment Data

      Labs:  Pending

     Fall Risk:  High

   Pain: 4 out of 10

Social History

    Social drinking

    2 pack-a-day smoker (previously)

   Travel History: None provided by patient.

Provider Orders

IV D5 1/2NS with 20mEq KCL at 125mL/Hr continuous infusion to urine output 30mL/Hr for 4 hours.  Then reduce to 60mL/Hr.

  Call if vital signs indicate: O2 <90% on Oxygen, HR >120 or <60, BP systolic >200 or <90

 O2 dependent at 2 LPM

 Xopenex

 Diagnosis: R/O Flu and COVID-19

 Droplet/Contact Isolation

 Condition: Stable

 Code Status: Full

Patient Presentation

    When initially contacted, the client is pleasant and cooperative, oriented but sleepy.

     He states, ""The last thing I ate before having the diarrhea started was a salad with grilled chicken.""    This was about 48 hours ago.

His skin turgor if fair, while his oral mucosa appear pale and dry. He presented to the emergency     room 6 hours ago Your patient is a 56-year-old male who is retired. He is very lethargic and states his  wife is also not feeling well at home. He presents with general malaise, fever, a loose productive cough, and diarrhea. He states it has become increasingly more difficult to breathe over the last two hours.

 He has been admitted to hospital with a diagnosis R/O Flu and COVID-19

Secondary Assessment:

   Weight 70 kg

Height 5' 9""

 Enlarged lymph nodes

 Lungs with rhonchi and poor air exchange

 Abdomen soft with no pain on palpations

 Lower extremities normal with +1 pitting pedal edema

Distal pulses are weak bilaterally

Template of Clinical Reasoning Questions to Develop Nurse Thinking

(Formulate and reflect before and after report, but BEFORE seeing patient the first time)

 1.     What is the primary problem and what is the underlying cause/pathophysiology of this problem?

 The 56 Year Old Male, VS T. 103, HR 110, BP 156/60, RR 33, O2 90%. Chief Compliant, Fever, Cough, Shortness of Breath, and a Sore Throat.

   2.     What clinical data from the chart is RELEVANT and needs to be trended because it is clinically significant?

  3.     What nursing priority captures the ""essence"" of your patient's current status and will guide your plan of care?

  4.     What nursing interventions will you initiate based on this priority and what are the desired outcomes?

  5.     What body system(s) will you focus on based on your patient's primary problem or nursing care priority?

  6.     What is the worst possible/most likely complication(s) to anticipate based on the primary problem?

  7.     What nursing assessments will identify this complication EARLY if it develops?

  8.     What nursing interventions will you initiate if this complication develops?

  While Providing Care...(Review and note during shift after initial patient assessment)

9.     What clinical assessment data did you just collect that is RELEVANT and needs to be TRENDED because it is clinically significant to detect a change in status? 

  10.  Does your nursing priority or plan of care need to be modified in any way after assessing your patient?

  11.  After reviewing the primary care provider's note, what is the rationale for any new orders or            changes made?

 12.  What educational priorities have you identified and how will you address them?

 Caring and the ""Art"" of Nursing

13.  What is the patient likely experiencing/feeling right now in this situation?

  14.  What can I do to engage myself with this patient's experience, and show that he/she matters to me as a person?"

Clinical Reasoning – Questions and Answers

 1. What is the primary issue? What is the reason for existence of this issue or pathology of the condition?

 Primary Problem:

 The patient has fever, productive cough, shortness of breath, and diarrheal disease. It is differential with flu and COVID-19 since both present with a clinical condition and the orders of the provider.

 Underlying Cause/Pathophysiology:

 Flu/ COVID-19: Both lead to fever, cough, worsened breathing due to respiratory system and systemic inflammation. From this disease, one is likely to develop pneumonia and this would result to the development of breathlessness and overall body weakness.

 Dehydration: Indeed, the patient was receiving a milk-based diet and had suffered from diarrhoea, sending her into potentially severe dehydration which was proven due to her pale and dry oral mucosa and fair skin turgor.

 2. What of the clinical data from the chart are relevant and has to be trended out because of its clinical implications?

 Vital Signs: Hyperthermia, tachycardia, hypoxemia, hypertension, tachypnea.

 Respiratory Findings: Rhonchi and inability to mix fresh and stale air indicates that lower respiratory tract infection is possible or the patient has an exacerbation.

 Urine Output: Impiration of colour to weak brown and dark yellow urine suggest that the body is dehydrated.

 Laboratory Results: Awaiting, but could be used to look for the development of infection, check renal function and electrolyte abnormalities.

 3. Which nursing list reflects the ‘nature’ of your patient and will be the focus of planning?

 Unfortunately, in this case and in general status asthmaticus treatment is the primary nursing priority for airway clearance and control of fluid. Because the patient does have SOB, fever, and has the possibilities of being dehydrated, it is essential to address these factors to be able to stabilize the patient and rule out the worsening of problems.

 4. Which other nursing interventions will you embark on given this priority and what are the expected outcomes?

 Administer IV Fluids as Ordered: To relieve headaches, to regulate metabolism and to prevent the occurrence of dehydration.

 Desired Outcome: Optimise the hydration state and renal function.

 Provide Supplemental Oxygen: Minimally, the oxygen level should not drop below 90 percent.

 Desired Outcome: Optimise the levels of oxygen and reduce pressure to the respiratory muscles and organs.

 Monitor Respiratory Status: Perform breath sounds, respiratory rate, and oxygen saturation assessment: for example, daily or when indicated by acuity.

 Desired Outcome: There should have been early identification of changes in respiratory function and where evident appropriate management should have been done.

 Encourage Deep Breathing and Coughing Exercises: For use in the treatment of lung infections and conditions that compromise the normal functioning of the lungs as well as for coughs and secretions.

 Desired Outcome: Enhance lung ventilation and avoid mostly associated risks such as atelectasis.

 Educate the Patient and Family: About some aspects that signal the worsening of conditions and when it is necessary to address to doctors again.

 Desired Outcome: Raising he unit level of patient and family engagement in care.

 5. On which body system(s) will you mainly concentrate depending on the patient’s main issue or your main nursing concern?

 Respiratory System: Because of respiratory difficulties, they are unable to breathe properly, have a persistent cough, and low oxygen levels.

 Cardiovascular System: Considering that the patient has tachycardia and hypeension.

 Gastrointestinal System: Responding to issues on diarrhea and or dehydration.

 6. From the identified primary problem what is the worse that could happen/ most likely to happen complication(s)

 Acute Respiratory Distress Syndrome (ARDS): Because of severe infection that has an impact on lung capacities.

 Severe Dehydration: Resulting in; Electrolyte disorders and renal dysfunction.

 Sepsis: If the root infection is invasive and manifests a systemic nature.

 7. Which of the following will early detect this complication if it occurs in the nursing assessment?

 Respiratory Assessments: Supervision for the features of decompensated respiratory deterioration or hypoxaemia.

 Vital Signs: Regular checks to the patient’s temperature, blood pressure, pulse rate and oxygen levels.

 Fluid Status: Appropriate monitoring of the patient’s intake and output especially if the patient is on NPO for a long time, checking of the skin turgor to determine level of dehydration.

 8. Which of these complications will you implement if this complication occurs?

 For ARDS: Amplify the oxygen support to the patient in consideration of mechanical ventilation if essential.

 For Severe Dehydration: Bolster bicarbonate infusion rates and check electrolytes.

 For Sepsis: Get the cultures and sensitivities and also give broad-spectrum antibiotics and observe for signs of organ failure.

 While Providing Care. . .

 9. What clinical assessment data did you just collect that is germane and must be trended because the change in status is clinically meaningful?

 Respiratory Status: In particular, its worsening of breath sounds and oxygen saturation.

 Vital Signs: Variations in pressure and pulse, and any alterations in temperature that is detected.

 Fluid Intake/Output: The continuous evaluation of urine output or features fo fluid retention.

 10. After assessing your patient do you require to change your nursing priority or plan of care in anyway?

 Adjustments may be needed based on:Adjustments may be needed based on:

 Changes in Respiratory Status: If over this rate is not feasible, the level of respiratory support given has to be increased.

 Fluid Balance: Adjusting the patient’s fluids according to the urinary output along with other symptoms of deterioration or fluid retention.

 11. If there is a new order or alteration of an order, it is articulated what the rationale for the change is, based on the review of note made by the primary care provider?

 New orders may address:

 Infection Management: Administering antibiotics in cases whereby the dog is infected.

 Fluid and Electrolyte Management: Here the possible changes would be made on the basis of an ongoing evaluation of the situation, regarding the rates of the fluids.

 Oxygen Therapy: Raising the oxygen to at least meet the basal oxygen requirements of the patients.

 12. List of the educational priorities and how you would plan to meet them:

 Patient Education: Some of the important facts to include are the ways of dealing with symptoms and sign indicating that conditions are aggravating.

 Family Education: Teach on when to monitor and when to seek help from other professional or service.

 Caritas and the “Fine” Art of Nursing

 13. How does the patient feel or what can the patient be going through in a situation that he/she is experiencing such?

 The patient may be experiencing anxiety, being preoccupied with the symptoms, and probably fearful for his life. He may also be carrying some health concern of his wife or any of his family members with him.

 14. Engage with this patient’s experience of the mental disorder and let him/her know, I care as a person.

 Active Listening: Emotion must be displayed, the patient’s worries and emotions must be recognized.

 Provide Reassurance: Be specific when explaining to him the care plan and the measures that are being taken to alleviate his symptoms.

 Involve Family: Incare process involve the family and also help the family as well.

How does methadone helps addiction?

How does methadone helps addiction?

How does methadone helps someone to stop opioids?

How does it work in the brain?"

Clinical Reasoning Questions and Answers

1. What is the primary problem and what is the underlying cause/pathophysiology of this problem?

Primary Problem: The patient presents with fever, cough, shortness of breath, and diarrhea. The differential diagnosis includes flu and COVID-19, given the clinical presentation and the provider's orders.

Underlying Cause/Pathophysiology:

• Flu/COVID-19: Both can cause fever, cough, and difficulty breathing due to their effects on the respiratory system and systemic inflammatory response. The infection can lead to pneumonia, which contributes to shortness of breath and may cause generalized weakness.
• Dehydration: The patient’s diarrhea and potentially inadequate fluid intake could lead to dehydration, evidenced by pale, dry oral mucosa and fair skin turgor.

2. What clinical data from the chart is RELEVANT and needs to be trended because it is clinically significant?

• Vital Signs: Elevated temperature (103°F), tachycardia (HR 110), low oxygen saturation (O2 90%), high blood pressure (BP 156/60), and increased respiratory rate (RR 33).
• Respiratory Findings: Rhonchi and poor air exchange suggest potential lower respiratory tract infection or exacerbation.
• Urine Output: Dark yellow urine indicates possible dehydration.
• Laboratory Results: Pending, but should be monitored for signs of infection, renal function, and electrolyte imbalances.

3. What nursing priority captures the "essence" of your patient's current status and will guide your plan of care?

The primary nursing priority is to ensure effective airway clearance and manage fluid balance. Given the patient’s shortness of breath, fever, and potential for dehydration, addressing these issues is crucial for stabilizing the patient and preventing further complications.

4. What nursing interventions will you initiate based on this priority and what are the desired outcomes?

• Administer IV Fluids as Ordered: To address dehydration and maintain fluid balance.
• Desired Outcome: Improve hydration status and normalize urine output.
• Provide Supplemental Oxygen: Ensure oxygen levels are maintained above 90%.
• Desired Outcome: Improve oxygen saturation and alleviate respiratory distress.
• Monitor Respiratory Status: Regularly assess breath sounds, respiratory rate, and oxygen saturation.
• Desired Outcome: Detect changes in respiratory function early and intervene as necessary.
• Encourage Deep Breathing and Coughing Exercises: To improve lung function and clear secretions.
• Desired Outcome: Improve respiratory function and prevent complications like atelectasis.
• Educate the Patient and Family: About recognizing signs of worsening conditions and when to seek further medical help.
• Desired Outcome: Increase patient and family awareness and involvement in care.

5. What body system(s) will you focus on based on your patient's primary problem or nursing care priority?

• Respiratory System: Due to shortness of breath, cough, and decreased oxygen saturation.
• Cardiovascular System: Given the patient’s tachycardia and hypertension.
• Gastrointestinal System: Addressing diarrhea and dehydration concerns.

6. What is the worst possible/most likely complication(s) to anticipate based on the primary problem?

• Acute Respiratory Distress Syndrome (ARDS): Due to severe infection affecting lung function.
• Severe Dehydration: Leading to electrolyte imbalances and renal impairment.
• Sepsis: If the underlying infection spreads systemically.

7. What nursing assessments will identify this complication EARLY if it develops?

• Respiratory Assessments: Monitoring for signs of worsening respiratory distress or hypoxia.
• Vital Signs: Frequent monitoring of temperature, blood pressure, heart rate, and oxygen saturation.
• Fluid Status: Regular assessment of urine output and skin turgor to detect dehydration.

8. What nursing interventions will you initiate if this complication develops?

• For ARDS: Intensify respiratory support, including possible mechanical ventilation if necessary.
• For Severe Dehydration: Increase IV fluid rates and reassess electrolytes.
• For Sepsis: Administer broad-spectrum antibiotics and monitor for signs of organ dysfunction.

While Providing Care...

9. What clinical assessment data did you just collect that is RELEVANT and needs to be TRENDED because it is clinically significant to detect a change in status?

• Respiratory Status: Any worsening of breath sounds or oxygen saturation.
• Vital Signs: Changes in blood pressure, heart rate, or temperature.
• Fluid Intake/Output: Monitoring for changes in urine output or signs of fluid overload.

10. Does your nursing priority or plan of care need to be modified in any way after assessing your patient?

Adjustments may be needed based on:

• Changes in Respiratory Status: Increasing the level of respiratory support if needed.
• Fluid Balance: Modifying fluid administration based on urine output and signs of dehydration or fluid overload.

11. After reviewing the primary care provider's note, what is the rationale for any new orders or changes made?

New orders may address:

• Infection Management: Implementing antibiotics if an infection is confirmed.
• Fluid and Electrolyte Management: Adjusting fluid rates based on ongoing assessment.
• Oxygen Therapy: Increasing oxygen support to ensure adequate oxygenation.

12. What educational priorities have you identified and how will you address them?

• Patient Education: Provide information on managing symptoms and recognizing signs of worsening conditions.
• Family Education: Instruct on monitoring and when to seek additional help.

Caring and the "Art" of Nursing

13. What is the patient likely experiencing/feeling right now in this situation?

The patient may be feeling anxious, overwhelmed by symptoms, and possibly frightened about the seriousness of his condition. He may also be concerned about his wife’s health.

14. What can I do to engage myself with this patient's experience, and show that he/she matters to me as a person?

• Active Listening: Show empathy and acknowledge the patient’s concerns and feelings.
• Provide Reassurance: Offer clear explanations of the care plan and the steps being taken to address his symptoms.
• Involve Family: Engage the family in the care process and provide support to them as well.

Case Study

Case Study

CHIEF COMPLAINT

A.J. is a 42 year old single Caucasian female who presents today stating that ""I can't get rid of this darned cough"" which she has had for the past five weeks.

HISTORY OF PRESENT ILLNESS

The patient says that her cough began five weeks ago when she developed a ""cold"" with accompanying symptoms of stuffy nose, cough, and sore throat: all of those symptoms resolved except for a persistent cough. The cough occurs daily and is productive of green sputum. She gets short of breath with minimal exertion and needs to sit down frequently to catch her breath. She thinks she has bronchitis because she had frequent bronchitis as a child. She is requesting antibiotics today because she says her primary care provider always gives her antibiotics for these symptoms. She denies smoking or chest pain. Cold weather seems to be making her symptoms worse and she is no longer able to participate in her weekly exercise regime due to the shortness of breath. She is also now experiencing episodes of being awakened at night by coughing.

PAST MEDICAL HISTORY

Denies any serious illness, no hospitalizations, no surgeries, no transfusions, denies any allergies including allergies to medications, takes no routine medications.

FAMILY HISTORY

Minimal knowledge of family health history but thinks mother had asthma: mother died before age 40 - cause unknown. One brother with allergies. Father unknown.

SOCIAL HISTORY

Works as a CNA in a local nursing home; formerly worked as a prison guard for two years. Lives in an apartment which she shares with her male partner whom she met while working at the prison and where he is still employed. No children but she and her partner have three cats, one dog, a tank of fish, and a newly adopted parrot. Works four days a week for 10 hours each. Awakens at 5 A.M. and gets to bed no later than 10 P.M. most nights. Dietary intake is coffee and breakfast sandwich from Dunkin Donuts on way to work, snack from vending machine of honey bun, lunch of soup and sandwich which she packs the night before, snack of peanuts when she gets home and meat with vegetable and salad if her partner is home for dinner; otherwise, she says she just heats a frozen dinner. Exercise is walking the dog a mile or two each day before and after work.

REVIEW OF SYSTEMS

Positives noted in history given above. Otherwise, negative.

PHYSICAL EXAMINATION

Appears stated age in no acute distress when sitting. No obvious deformities or difficulty communicating.

Vitals: BP 110/70 RR 16 HR 80 T 98.2 Ht. 67"" (5'7"")  Wt. 160lb (72.7kg)

HEENT: All WNL

Cardiovascular: HR RRR; no murmurs or abnormal sounds

Lungs: Expiratory wheezing heard bilaterally in lower lobe

Abdomen: All WNL

PROBLEMS LIST

1)    Bronchitis

2)    Persistent mild asthma

3)    Allergic Rhinitis (Hay fever) vs. Sinusitis vs. common cold

4)    Pneumonia with/without pleural effusion

5)    Inadequate sleep due to persistent nocturnal episodes of cough

6)    Dyspnea on exertion (DOE) vs Activity intolerance due to decreased FRC/oxygenation

7)    Persistent cough with sputum x 5 weeks

8)    Ineffective airway clearance due to increased mucus production

9)    Adventitious breath sounds

10) Ineffective therapeutic regimen (history of)

11) Nutritional imbalance

12) Obesity

RATIONALE FOR TOP 5 PROBLEMS

�     Asthma vs Bronchitis

o  Asthma: the patient has a persistent cough, expiratory wheezing, shortness of breath with minimal exertion, difficulty sleeping caused by coughing and shortness of breath, and coughing spells which were exacerbated by acute respiratory infection. Patient believes that her mother (died age 40) suffered from asthma. Cold, dry air may trigger asthma flare-ups as well.

o  Bronchitis: the patient has a previous history of bronchitis. She also has productive cough with green sputum, fatigue, shortness of breath and wheezing; all symptoms of bronchitis (Kinkade,2016). Could weather could exacerbate bronchitis and cause symptoms of wheezing, cough, and dyspnea.

�      Allergic Rhinitis (Hay Fever) vs. x Sinusitis vs. Common Cold

o  The patient was previously experiencing stuffy nose and sore throat (since resolved). Her cough, however, has not resolved. The patient's cough is exacerbated by cold weather and accompanied by dyspnea and nocturnal coughing spells; likely from postnasal drip. States that her brother has allergies. The presence of green sputum leads us to suspect the presence a bacterial infection.

�     Pneumonia (With/Without Pleural Effusion): patient has history of multiple bronchial infections as a child. Patient has been trialed on numerous ineffective therapeutic regimens, which could have placed her at a higher right for resistant bacterial pneumonia. The patient is also experiencing wheezing and DOE.

�      Activity Intolerance: patient is unable to participate in her weekly exercise regime due to DOE and decreased FRC. Her lack of restful sleep is likely contributing to her activity tolerance as well.

 References

 Hose, B. Z., Hoonakker, P. L., Wooldridge, A. R., Brazelton Iii, T. B., Dean, S. M., Eithun, B., ... & Carayon, P. (2019). Physician perceptions of the electronic problem list in pediatric trauma care. Applied clinical informatics, 10(1), 113.

 Kinkade, S., & Long, N. A. (2016). Acute bronchitis. American family physician, 94(7), 560-565.

 Wheaton, A. G., Cunningham, T. J., Ford, E. S., & Croft, J. B. (2015). Employment and activity limitations among adults with chronic obstructive pulmonary disease�United States, 2013. MMWR. Morbidity and mortality weekly report, 64(11), 289.

3.    What additional data would you need?

We will need to gather a more extensive patient history while noted a more detailed and thorough physical examination.

Family History (including that of her male partner): try to gather any more information we can about family; presence of obesity, diabetes, heart/lung/kidney disease, blood dyscrasias/anemias, DVT/PE, alcohol or tobacco abuse, military service, job/occupation, disease exposure, mental health etc.

Allergies: any outdoor/environmental allergies? Any medication allergies? Triggers/Reactions/Symptoms/etc.?

Social History: Has she ever been married? revisit smoking history (secondhand smoke via family or male partner?); illicit drug use?; alcohol use? Presence of tattoos (where did she get them)?

Sexual History/OB GYN: Sexual preference/history/activity/contraceptive methods/STI exposure/etc.? Menarche/LMP? Does she has regular or irregular periods? Any problems (e.g., flow, pain, cramping, absence, etc.). Does she see a gynecologist?

Environmental History: History of hazardous exposure? Use or exposure to pesticides? Chemical (e.g., cleaning products) vs environmental exposures (home, work, etc.)? Where does she live (e.g., neighborhood; single apartment vs complex vs mobile home, etc.)? Living conditions of the house (e.g., mold, mildew, etc.)? How often does she was her linens? Clothes? Does she clean the fish tank/bathe pets? Are all of the pets living inside?

Health Maintenance: Has she received the appropriate childhood vaccinations? Adult vaccinations? Further investigate dietary and exercise habits (e.g., sodium intake). Does she have a PCP (and does she regularly see them)? When was the last time she was admitted to the hospital? Does she have insurance/able to pay for medical expenses? Does she have access to health care? Does she have any food insecurities? Does see any eye doctor/dentist/ear doctor? Last visit? Next Visit? Has she ever seen an allergist?

Surgical History: Has she had any childhood surgeries (e.g., tonsillectomy, adenoidectomy, etc.)?

History of Present Illness: How often does she get these symptoms? What does her prescribing physician believe that the problem is? What kind of antibiotics does she normally take (and do they work)? Has she ever experienced the latter symptoms of (persistent and nocturnal) cough and DOE before? Has she in close contact with any sick persons (e.g., family, roommate, NH residents)? Have there been any recent outbreaks of infection or illness at the nursing home where she works? Can she recall any outbreaks or exposures at her prison job (e.g., TB).

Subjective/Objective Health Assessment:  What health problems does she have? What medications is she prescribed? What medications/vitamins/herbs/supplements does she take? Any inhalers or nasal sprays? Has she had any fever, chills, or night sweats? Changes in diet, appetite or weight? Any cognitive, behavioral, psychiatric, or neurological (e.g., memory) problems? Has the patient been getting headaches (e.g., sinus)? Any sneezing or nasal drainage? Problems smelling? Ear aches, tinnitus, or drainage? Hearing problems? Eye problems (e.g., conjunctivitis, edema, lacrimation, skin flaking, burning, visual changes, etc.)? Problems with swallowing, taste, inflammation, mouth lesions/pain, dental infections, postnasal drip, hoarse voice/vocal changes, malodorous breath, etcetera? Any head, neck, or facial trauma? Any chest trauma (e.g., MVA, abuse, etc.)? Any history or presence of chest pain or tightness, jaw pain, back pain, dyspnea, etcetera? History or presence of TB, pneumonia, reactive airway disease, restrictive or obstructive lung disease? Any previous imaging studies (e.g. CXR, CT scan, MRI, CTA, etc.)? History of DVT and/or PE? History or presence of edema? Any JVD, pulsations, hepatojugular reflux, etc.? Chest heaves/dynamic precordium? Any nausea, vomiting, diarrhea, constipation, GERD/heartburn, s/s of bleeding (upper or lower GI), or excessive belching/flatulence? Organomegaly/tenderness? Abdominal masses, dilations, pulsations, lesions, etc.? Any visual clubbing, cyanosis, mottling, or pallor (or history of)? Capillary refill? Presence or absence of body hair? Discoloration of skin (e.g., axillae, neck, ground, legs, etc.)? Numbness, tingling, weakness, paresthesia, tremors, rigidity? What are her hobbies? Does she have insurance? Are her pets seen by a veterinarian (e.g., vaccinations, wellness visits, etc.?

Based on case study above:

-What health maintenance activities would you need to consider for AJ? Please include rationale for each."

https://www.coursehero.com/tutors-problems/Nursing/30670088-Compare-and-contrast-the-assessment-findings-for-the-following-3/,"Image transcription text

Compare and contrast the assessment findings for the following 3 STD's: for men and women: Chlamydia Genital

herpes Human Papilloma virus HPV"

Comparison of Assessment Findings for Three STDs: Chlamydia, herpes with focus on genital herpes, and human papillomaviruses.

 1. Chlamydia

 Men:

 Symptoms: Often asymptomatic. When symptoms occur, they include:When symptoms occur, they include:

 Secretion from the penis (clear or coloured).

 Dysuria (painful urination)

 Testicular pain or swelling

 Complications: Epididymitis, prostatitis, infertility.

 Women:

 Symptoms: Frequently asymptomatic. If symptomatic:

 Abnormal vaginal discharge (mucopurulent)

 Dysuria

 Pelvic pain

 A lesion that results in breakage of the uterine lining and leads to bleeding that is not regular is referred as Postcoital bleeding

 Complications: Salpingitis; endometritis; tuberculous peritonitis;chioitis; pericholecystitis; pleurisy; pneumonia; tuberculosis of genitourinary tract; TB meningitis; miliary tuberculosis; tuberculosis arthritis; tubercular lymphadenitis; scrofula; lupus vulgaris; adenoma of stomach; cancer of stomach; perforation peritonitis; pelvic inflammatory disease; ectopic pregnancy; infertility

 2. Genital Herpes (HSV)

 Men:

 Symptoms:

 Blisters or lesions in the penis, scrotum or the adjacent skin is another sign.

 Symptoms involving the skin or mucous membranes prior to the development of rash or other manifestations

 Headache during the first wave of the epidemic (fever, weakness, enlargement of lymph nodes)

 Complications: Recurrent flare up, psychological effect, enhanced likelihood of HIV transmission.

 Women:

 Symptoms:

 Painful sore or canker on the genitals or around the anus

 Dysuria

 When the mishap occurred a number of times earliest, people experienced flu like symptoms.

 Complications: Recurrent, neonatal transmission at the time of delivery, psychological ramifications.

 3. Human Papillomavirus (HPV)

 Men:

 Symptoms:

 Often asymptomatic

 Some of the styling can include genital warts (small, skin-colored, fleshy, or soft, raised or flat skin growths on the penis, scrotum, groin, or anus.

 Complications: Aids the development of cancers of the penis and anus.

 Women:

 Symptoms:

 Often asymptomatic

 Genital warts; tiny, hard, pinkish growths typically located on the vulva, vagina, on the cervix or on the arse.

 Complications: Cervical in early stages or cervical cancer, vulvar and vaginal cancers.

 A Summarized Analysis of Differences and Confomities

 Chlamydia: Neither symptomatic in the early stages in men nor in women. Malaise is notable only when symptoms are present and may include discharge and dysuria at times. It is dangerous to pregnancy and childbirth, or to fetal health, particularly for the woman.

 Genital Herpes (HSV): Described by some of the symptoms such as blisters or ulcers that are painful and have repeated occurrences. It has a psychological implication and is strongly linked to HIV risk.

 HPV: May manifest with genital warts but often is without any symptoms. The biggest concern is of cancers, principally cervical cancers in women.

Pharmacy delivers C.W.'s first bag of TPN

Pharmacy delivers C.W.'s first bag of TPN. You have an order to stop the

maintenance IV

infusion after starting the TPN. What is the purpose of this order?"

The rationale for discontinuing he maintenance IV infusion after beginning TPN is to avoid overloading the patient with fluids and to guarantee that the patient receives the nutritional requirements without receiving too much fluid volume. Here’s how this works:

 Fluid Volume Control: TPN has what the patient needs in fluids, electrolytes, glucose, amino acids, lipids, and vitamins in order to have his feeding. When continued administration of the maintenance IV along with the TPN, the patient may receive too much fluid that will cause complications such as fluid overload or electrolyte imbalance.

 Preventing Dilution of Nutrients: TPN is nutrition that is especially for the particular patient and their condition. The supplementation from a maintenance IV could also contaminate TPN altering the level of nutrition intended.

 Monitoring and Balancing Electrolytes: The TPN bag has the detail of balanced electrolyte and fluid for a particular client. By stopping the maintenance IV, it makes it possible to avoid administering unrequired electrolytes and fluids to the patient hence attaining a measure of precision on the patient’s nutritional and metabolic status.

 As the maintenance IV is stopped, the care team is able to concentrate on the administration of the TPN as the only source of fluids and nutrients, so the patient received suitable and balanced therapy.

Hey guys, make a justifiable response for the following.

Hey guys, make a justifiable response for the following.

As the worldwide response to the novel coronavirus (COVID-19) continues, nurses are working to assist the sick, quell community fears and address concerns. Nurses, the largest sector of healthcare workers in every country, play a pivotal role in preparation for a possible pandemic. The nurses' role in a pandemic begins even before a disease has an opportunity to cause widespread devastation, the World Health Organization (WHO), the American Nurses Association (ANA) and other healthcare organizations said. In a 2018 policy brief, the ANA said nurse leaders are the key to preventing and containing widespread illnesses. They have the skills and education to develop coordinated global networking and properly identifying of infectious diseases. As frontline responders, nurse leaders are the first to recognize symptomatic patients and harmonize response efforts, the ANA said. ""The American Academy of Nursing asserts that nurses are prepared for the leadership roles in policy decisions of health systems and government agencies and can prepare for, identify, respond to and direct recovery efforts from global pandemics that require an informed, internationally coordinated response,"" the ANA said in ""Expanding nursing's role in responding to global pandemics."" In preparation for advanced roles, registered nurses (RNs) who earn a master's in nursing degree (MSN), including through online master's in nursing programs, can be prepared for the worst. In an MSN career, RNs have an opportunity to provide expert help and guidance through devastating illnesses, including COVID-19.

1. In a fact-filled manner, rationalize or falsity the following concerning the polypeptide second configuration.

The hydrophobic/hydrophilic quality of amino elements is vital to secondary configuration.

2.Basically, given a double portion of polypeptides have a mutual scope of series

recognition during chain configuration, a similar execution has low chances of being

shared. Is the inference true or false? Elucidate.

3.State three facts about secondary polypeptide arrangement.

4.identify the least complex amino elements series and state its components.

5.Using data from genomes, determine the mechanism that interlinks

the cell configuration incident in animals.

6.Basically, what initiates the convenience of polythene chromosomes? Describe the mechanism.

7.Fundamentally, an arrangement with hydrogen bonds between polypeptide chains set

side by side is?

8.Alternative sorts of facts for a relationship between two genes are also given that are

not dependent in sequence similarity. Falsify or justify the following.

phylogenetic outlines unveil the genes are not that regularly present in organisms

9.From bioinformatics concept, determine an integral implication of the two inferences

below.

Genes are transcribed from the same DNA strand and genes are closely connected on

the same chromosomes

10.What is the implication of the inference below basing on bioinformatics concepts?

Gene syntheses are pragmatic amid otherwise distinct genes."

Some comments in relation to Nursing Roles in a Pandemic

 The Legal Profession and the Current Pandemic

 Nurses being the largest profession in the field of healthcare are instrumental in combating and containing diseases such as COVID-19. The nurses also have the responsibility of early identification, reporting of the disease and coordination in the management and control of infection diseases according to WHO and ANA. Senior nurses with education and experience have influential roles in the global health policy and can steer the global coordinated response. They are the first line in the diagnosis of infectious diseases and are most likely to note signs of a sick person and put in measures to ensure adequate response is initiated.

 When nursing professionals are aiming at assuming more in-depth leadership roles during such global health emergencies, they may seek for Master’s in Nursing (MSN). Clinical experience together with leadership skills enables these professionals to bring their best in implementing the strategies that will reduce the spread of diseases to the population.

 Answers to Polypeptide and Bioinformatics Questions

 Appearence of Hydrophobic / Hydrophilic property of Amino Acids in Secondry structure

 It’s true that hydrophobic and hydrophilic characteristics of amino acids are tremendously important for secondary structures. Hydrophobic residues are often found in the protein’s interior, whereas hydrophilic ones are found externally. This distribution helps in the formation of alpha helices and beta sheets by maintaining the hydrogen bonding that are involved.

 The concept of mutual scope in polypeptide chain configuration is as follows.

 The statement is true. There can be differences in the interactions between side chains in two polypeptides, the bond between atoms or chains, or the environment (such as pH or temperature) which may result in gross differences in configuration even where the primary structures are similar. This process is very sensitive to these and many other factors.

 The following are changes are attributes of Secondary Polypeptide Arrangement;

 Among the secondary structures, alpha helices and beta sheets are abundantly found.

 Secondary structure is stabilised predominantly by the hydrogen bonds of the backbone amides.

 The nature of the amino acid determines whether a region of the polypeptide is going to be in the form of alpha helix, beta sheet or it is going to have random coiling.

 Simplest Amino Acid Sequence

 This product is referred to as glycine and due to the presence of only single hydrogen side chain, it is considered the simplest of all the amino acids. It brings conformational flexibility to polypeptide chains, and is often seen in turns or loops of a protein.

 Signalling Process that Connects Cell Configuration Events in Animals through Genome Information

 It is the modulation of genes by using transcription factors and enhancers. Cell signaling such as Wnt, Hedgehog, Notch and others are involved in the regulation of cellular processes during development and according to the genomic regulatory elements.

 Initiation of Polytene Chromosomes

 Polytene chromosomes are formed when there is a DNA replication without cell division to result in large chromosome masses which are visible. They are present in some organisms such as Drosophila and are important in gene expression analysis.

 Organization with Hydrogen Bonds Side Chain to Side Chain

 Beta-sheet has hydrogen bonds between one polypeptide chain and the other either parallel or antiparallel to each other.

 Hierarchical or Analogous Interactions of Genes which are not Structurally Aligned

 The statement is justifiable. This is because using phylogenetic analysis one may see that gene presence or absence in the examined organisms may or may not correspond to the level of sequence similarity, for instance in case gene loss, horizontal gene transfer or convergent evolution has taken place.

 A Consequence of Genes Transcribed from the Same Strand or Which Are Neighboring

 When genes are co-transcribed or are neighbours or in close physical proximity, it is likely that they are regulated and function together for example in the same pathway.

 Promoting Both Scission and Synthesis While Otherwise Rather Discrete Genes

 Such outcomes imply that those genes may be regulated in a similar method at certain circumstances, thus can provide an indication of coordinated regulation mechanisms for these genes even if they belong to different functional classes.

Mai Nguyen, Nam's 76 year old mother, has been complaining she feels tired all the time;

Mai Nguyen, Nam's 76 year old mother, has been complaining she feels tired all the time; she just can't do what she normally does.  She describes having a hard time catching her breath as she walks up stairs and goes about her day.  Nam has noticed that his mother's ankles are more swollen than he has ever seen them.  So he schedules an appointment for his mother at the family clinic where you are the nurse.  Mrs. Nguyen appears pale and not her usual energetic self.  Nam tells you that his mom is ""not right"" and seems to be confused about things at home, which is not like her.  She has a history of chronic congestive heart failure.

You decide to include a nursing diagnosis of Acute Confusion in Mrs. Nguyen's plan of care.

What symptoms does she have that support this nursing diagnosis?

What physiological changes are causing these symptoms?

In addition to the meds ordered, what additional therapies do you anticipate the physician will prescribe?

Mrs. Nguyen asks you, ""What can I do to make sure I never get this sick again?  How would you answer this question?"

1. Symptoms Supporting the Nursing Diagnosis of Acute Confusion:Symptoms Supporting the Nursing Diagnosis of Acute Confusion:

 Mrs. Nguyen is confused judging from Nam’s words whereby he says that things he tells her are confusing to his mother.

 She also has fatigue and shortness of breath (dyspnea) complaints which are not characteristic in her case.

 Confusion is common in older people and it’s made worse if the patient has a pale appearance and swollen ankles (edema) which could mean the patient’s condition has worsened.

 2. Physiological Changes Causing These Symptoms:Physiological Changes Causing These Symptoms:

 Mr. Nguyen has the medical care history of chronic congestive heart failure (CHF). Moreover, in CHF the strength with which the heart is pumping blood is diminished and the cardiac output is subsequently decreased. This leads to decreased blood supply of oxygen to the tissues and organs of the body such as the brain leading to confusion (cerebral hypoxia).

 CHF results in oedema in the peripheries and specifically ankles, brevit up, and fatigability. It also leads to edema that adds pressure on the heart and even decreases its pumping method.

 These symptoms of fatigue and dyspnea are consequent of reduced levels of blood flow and which make it very hard for Mrs. Nguyen to perform activities which are basic thus worsening her confusion.

 3. Additional Therapies the Physician May Prescribe:Additional Therapies the Physician May Prescribe:

 Diuretics: To aid in elimination of excess fluid in the body to decrease on oedema and lessen the load on the heart.

 Oxygen therapy: To increase the level of oxygen in the blood and, therefore, avoid hypoxemia.

 ACE inhibitors or beta-blockers: In order to enhance heart function by lowering the pressure on blood vessels and also the load on heart.

 Dietary counseling: In order to regulate salt consumption and the levels of fluid in your body, since such foods are normally high in salt content.

 Physical activity regimen: Gentle exercises that ensure that she builds her stamina as a patient with the condition without getting worse.

 4. How to Answer Mrs. Nguyen’s Question About Preventing Severe Illness in the Future:How to Answer Mrs. Nguyen’s Question About Preventing Severe Illness in the Future:

 Needless to say, it is advisable not to get this sick again and this requires you to manage your heart failure well. Some key steps include:

 Taking your medications as prescribed: It is always important to take your heart medications as prescribed as this will help manage your symptoms, and any progress in your heart diseases.

 Monitoring your weight daily: Weight gain that happens quickly might mean the buildup of fluid and one should seek medical attention about this.

 Following a low-sodium diet: Avoiding intake of salty foods, and minimize your salt intake, to avoid the problem of fluids buildup and also to give your heart a rest.

 Staying active within your limits: Strenuous and intense exercises will exert pressure on the entire body while walking exercises help to improve the condition of the heart without necessarily exerting more effort.

 Attending regular check-ups: They let your doctor monitor the health status concerning with one’s treatment and can easily detect those that are worsening.