Instructions: Response must be at least 510 words written in current APA format with at least two academic references cited. References must be within the last five years.

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Health Care Improvement

Review the “How to Study Improvement Interventions: A Brief Overview of Possible Study Types” article on health care improvement.

In your initial post:

• Provide a synopsis of ways an improvement focus might be useful in bringing evidence to your practice.
• Discuss if your own project might work as an improvement project. How do you see improvement ideas integrated into your own work?

Post according to the Faculty Expectations Response Guidelines. Be sure to include at least one APA-formatted citation (in-text plus full reference). The citation should be from materials you have read during this unit. It may be from course textbooks, assigned readings, or an outside source.

Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this  happens all the time.” Appearance of both mother and child is disheveled. The child’s wheezing can be heard across the room. When asked if her son is better at any certain time of the day the mother responds: “It’s like this all the time and has been for the past year, we just don’t come to the doctor because we don’t have any money.”

Mrs. Cason’s son was diagnosed of asthma.

• Discuss short and long term treatment options for this child, inhaled beta2-adrenergic agonists. Include rationale for your recommendations.
• What is your educational plan for the child?
•  All posts must be supported by peer-reviewed references within 5 years of publication.  

Pediatric nursing immunization 

Respond to the questions below using the cdc link the attached books and at least three evidence-based articles. 

 https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html  

1. in 200 words. Which vaccines protect against Meningitis (you need to look at your PowerPoint and read about the vaccines in your book to properly answer this). What is the benefits of taking this vaccine? Who should receive this vaccine and at what age are they typically give? What is the route of administration?

2. In 200 words. Why would you wait to vaccinate a child who is immunosuppressed or acutely ill? (this is not a little runny nose and low-grade temp). What happens if you do not wait to administer the vaccine to a client that is immunosuppressed? Review one evidence-based practice article that speaks on this topic. 

3. In 200 words. Name at least three vaccines that are given Subcutaneous? What is rationale for given vaccination subcutaneous vs IM? What happens if you give a vaccine by the incorrect route of administration (example subcutaneous vs IM) what impact does it have on the efficacy and absorption? What are the benefits of giving a vaccine subcutaneous and intramuscularly? 

4. In 200 words. name at least 4 allergies that a patient have that would be contraindicated to give a vaccine? What reaction would the client have if the medication was given, provide data on the frequency of this occurrence.  Review one evidence-based practice article that speaks on this topic. 

Case Study

Select a patient population ( pediatric, young adult, adult or geriatric) and briefly analyses a common /acute EENT condition (Sinuses, Pharyngitis, Epiglottitis, Infectious Mono, Epistaxis, Allergy rhinitis, hearing loss, common eye conditions etc…. there are several to choose from) that may affects this population. Briefly tell how it impacts the patient s quality of life and analyze the current research evidence on this topic and gold standard of care if any for your chosen population. ( You may use any clinical example) Describe how you the Family Nurse practitioner can or have made a difference In the care of patients with this specific disease and tell of one specific patient care teaching That he/she may do to help minimize disease symptoms.