A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patient’s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered: 

Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low) Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: ≤15 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L) Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL) Hematocrit (Hct), 36% (normal: 42%-52%) Rheumatoid factor (RF), Negative (normal: negative) Antinuclear antibodies (ANA), Negative (normal: negative) 

Diagnostic Analysis Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent. 

Critical Thinking Questions 1. What is the cardinal sign of Lyme disease? (always on the boards) 

2. At what stages of Lyme disease are the IgG and IgM antibodies elevated? 

 3. Why was the ESR elevated? 

4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment. 

(in APA format, two bibliographical references less than 5 years,  please)

Comment 1

Qualitative and quantitative methods differ in many ways, one being that quantitative data collection is much more structured than qualitative data collection method (DeFranzo, 2011). Qualitive research focuses on generating meaning and understanding to data that are related to opinions, concepts, values and behaviors of people in a social context. Quantitative research focuses on gathering numerical data to explain a particular phenomenon.  The use of either qualitative and quantitative methods depend on the research question of the study. However, researchers are now using mixed methodology research, which involves the use of both qualitative and quantitative methods with the assumption that it will address the research question more comprehensively then qualitative and quantitative method alone (Tarig & Woodman, 2013). Mixed methodology can be extremely beneficial to studies addressing complex multifaceted issues such as health service interventions.

A potential challenge in conducting mixed method research would be that qualitative and quantitative research methods belong to separate and incompatible paradigms. Both have different and conflicting ways of how they view the world and gather research data (Tariq & Woodman, 2013). Another challenge would be that it can be extremely time consuming to the researcher that it would benefit if it was conducted by a large team instead of just one researcher in order to conduct the study in a timely manner. Studies involving both quantitative and qualitative research can be challenging at times, however it also provides the researcher with a wider range of tools to answer their study question more efficiently.

Comment 2

With modern medicine advancing and new treatments invented each year, healthcare professionals including nurses need a reliable source of information to improve their practice and stay updated. Evidenced-based practice was implemented as a great tool that helps nurses to better provide their nursing care and improve patient’s outcomes. According to the article, “ Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making”. ( Wyant, 2017) 

There are few EBP models that are used nowadays in nursing. They all have five basic phases that make the process more effective: 

1. Identification of a clinical problem.
2. Review of the relevant literature.
3. Critical appraisal of the evidence.
4. Evaluation for practice change and potential implementation.
5. Evaluation of he outcomes.

( Wyant, 2017)

Certain organizations use specific EBP models. However, their only goal is to identify the problem and find the solution in order to improve nursing practice and patient’s outcomes. 

 Submit a paper describing a client, family member, or other individual you know who has a degenerative cognitive disorder. Possible conditions include Vascular dementia, Lewy Body disease, Alzheimer’s disease, Parkinson’s disease, AIDS-related dementia and delirium, among others. Include at least two APA citations from sources that provide information for this paper:

• Introduce the person with a brief social and medical history. What were the events leading up to the diagnosis? How did the person find out about the condition?
• Describe the disorder. What are the risk factors for the disorder?
• How is the condition diagnosed? Include any cognitive assessments, lab tests, or other medical exams.
• Describe treatment options. These may include psychotherapy, pharmacotherapy, environmental adaptations, nursing interventions, and referrals to support groups.
• Conclude with an update about the person you chose to discuss. Is this a reversible, treatable condition or an irreversible condition? What was the outcome?
• You may choose your material from the textbook or from other sources.
• It is expected that this essay will be 2-3 pages in length (not including the title page), double-spaced. Your paper should include an introduction and conclusion and proper APA citations from any source material you use, including your text.

 No Plagiarism please, assignment will be checked with Turnitin. 

Will need 4 full pages,  double spaced all throughout the page for the case study, APA Style, Times New Roman, font 12, Title Page and a Reference page. 

 Make sure all of the topics in the case study have been answered 

Cite at least 3 References; journal articles, textbooks, or evidenced-based websites to support the content. 

All sources must be within five years (2012-2017).

Case Study 3:  Disorders of Fluid and Electrolyte Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that a protein in her blood was low. The nurse further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away. 

What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?

What is the difference between the physiology of pitting and nonpitting edema? 

Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues?