This week’s graded discussion topic relates to the following Course Outcome (CO).

• CO 5: Apply improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare. (PO 8)

Discussion

In Huston’s (2010) brief, but impressive article (required reading this week), the author outlines several leadership competencies that EVERY nurse leader will need for 2020. That year is not too far in the future, is it?

1. Select one of the eight leadership competencies Huston described and relate it to your own leadership of nurses and nursing. This should promote a robust discussion as we come from different clinical and nonclinical perspectives.
2. Discuss how the BSN-prepared nurse can assist a nurse leader in the budgeting process by contributing data readily available to the staff nurse.

Huston, C. (2010). What skills will the nurse leaders of 2020 need? (2010). Kai Tiaki Nursing New Zealand, 16(6), 14–15. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105060080&site=ehost-live&scope=site

1. Discuss health care disparities and health inequities at the local, state, and national. 

level.   At (New York). USA

*2 Paragraph Only*

1 Reference/ 1 Citation within 2016-2020 only. 

APA Style

Discussion should be based in New York State, local, and national level in USA.

Please follow Instructions

Correct grammar error.

*I will rate  you base on the good work.*

 

What causes the rapid change in the resting membrane potential to initiate an action potential?
 Question 1 options:
                 Potassium gates open and potassium rushes into the cell, changing the membrane potential from negative to positive
                 Sodium gates open and sodium rushes into the cell, changing the membrane potential from negative to positive.
                 Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative.
                 Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative.
 

Question 2
 

What is a consequence of leakage of lysosomal enzymes during chemical injury?
 Question 2 options:
                 Enzymatic digestion of the nucleus and nucleolus occurs, halting deoxyribonucleic acid (DNA) synthesis.
                 Influx of potassium ions into the mitochondria occurs, halting the adenosine triphosphate (ATP) production.
                 Edema of the Golgi body occurs, preventing the transport of proteins out of the cell.
                 Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton.
 

Question 3
 

In hypoxic injury, sodium enters the cell and causes swelling because:
 Question 3 options:
                 The cell membrane permeability increases for sodium during periods of hypoxia.
                 Adenosine triphosphate (ATP) is insufficient to maintain the pump that keeps sodium out of the cell.
                 The lactic acid produced by the hypoxia binds with sodium in the cell.
                 Sodium cannot be transported to the cell membrane during hypoxia.
 

Question 4
 

What mechanisms occur in the liver cells as a result of lipid accumulation?
 Question 4 options:
                 Obstruction of the common bile duct, preventing the flow of bile from the liver to the gallbladder
                 Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
                 Increased binding of lipids with apoproteins to form lipoproteins
                 Increased conversion of fatty acids to phospholipids
 

Question 5
 

Which solution is best to use when cleaning a wound that is healing by 101. During an Immunoglobulin E (IgE)-mediated hypersensitivity reaction, the degranulation of mast cells is a result of which receptor action?
 Question 5 options:
                 Histamine bound to H2
                 Chemotactic factor binding to the receptor
                 Epinephrine bound to mast cells
                 Acetylcholine bound to mast cells
 

Question 6
 

What is the mechanism that results in type II hypersensitivity reactions?
 Question 6 options:
                 Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators.
                 Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues.
                 Cytotoxic T (Tc) lymphocytes or lymphokine-producing helper T 1 (Th1) cells directly attack and destroy cellular targets.
                 Antibodies bind to the antigens on the cell surface.
 

Question 7
 

Type III hypersensitivity reactions are a result of which of the following?
 Question 7 options:
                 Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators
                 Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues
                 Cytotoxic T (Tc) cells or lymphokine-producing helper T 1 (Th1) cells directly attacking and destroying cellular targets
                 Antibodies binding to the antigen on the cell surface
 

Question 8
 

Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host deoxyribonucleic acid (DNA) is the cause of which disease?
 Question 8 options:
                 Hemolytic anemia
                 Pernicious anemia
                 Systemic lupus erythematosus
                 Myasthenia gravis
 

Question 9
 

Why does tissue damage occur in acute rejection after organ transplantation?
 Question 9 options:
                 Th1 cells release cytokines that activate infiltrating macrophages, and cytotoxic T (Tc) cells directly attack the endothelial cells of the transplanted tissue.
                 Circulating immune complexes are deposited in the endothelial cells of transplanted tissue, where the complement cascade lyses tissue.
                 Receptors on natural killer (NK) cells recognize antigens on the cell surface of the transplanted tissue, which releases lysosomal enzymes that destroy tissue.
                 Antibodies coat the surface of the transplanted tissue to which mast cells bind and liberate preformed chemical mediators that destroy tissue.
 

Question 10
 

Oncogenes are genes that are capable of:
 Question 10 options:
                 Undergoing mutation that directs the synthesis of proteins to accelerate the rate of tissue proliferation
                 Directing synthesis of proteins to regulate growth and to provide necessary replacement of tissue
                 Encoding proteins that negatively regulate the synthesis of proteins to slow or halt the replacement of tissue
                 Undergoing mutation that directs malignant tissue toward blood vessels and lymph nodes for metastasis
 

Question 11
 

After the baroreceptor reflex is stimulated, the resulting impulse is transmitted from the carotid artery by which sequence of events?
 Question 11 options:
                 From the vagus nerve to the medulla to increase parasympathetic activity and to decrease sympathetic activity
                 From the glossopharyngeal cranial nerve through the vagus nerve to the medulla to increase sympathetic activity and to decrease parasympathetic activity
                 From the glossopharyngeal cranial nerve through the vagus nerve to the medulla to increase parasympathetic activity and to decrease sympathetic activity
                 From the glossopharyngeal cranial nerve through the vagus nerve to the hypothalamus to increase parasympathetic activity and to decrease sympathetic activity
 

Question 12
 

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot formation?
 Question 12 options:
                 Inflammation and roughening of the endothelium of the artery
                 Hypertrophy and vasoconstriction of the endothelium of the artery
                 Excessive clot formation and lipid accumulation in the endothelium of the artery
                 Evidence of age-related changes that weaken the endothelium of the artery
 

Question 13
 

What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
 Question 13 options:
                 Prolonged QT interval
                 ST elevation myocardial infarction (STEMI)
                 ST depression myocardial infarction (STDMI)
                 Non-ST elevation myocardial infarction (non-STEMI)
 

Question 14
 

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when the patient is lying down. These clinical manifestations describe:
 Question 14 options:
                 Myocardial infarction (MI)
                 Pericardial effusion
                 Restrictive pericarditis
                 Acute pericarditis
 

Question 15
 

Respirations that are characterized by alternating periods of deep and shallow breathing are a result of which respiratory mechanism?
 Question 15 options:
                 Decreased blood flow to the medulla oblongata
                 Increased partial pressure of arterial carbon dioxide (PaCO2), decreased acid-base balance (pH), and decreased partial pressure of arterial oxygen (PaO2)
                 Stimulation of stretch or J-receptors
                 Fatigue of the intercostal muscles and diaphragm
 

Question 16
 

Which cytokines activated in childhood asthma produce an allergic response?
 Question 16 options:
                 IL-1, IL-2, and interferon-alpha (IFN-α)
                 L-8, IL-12, and tumor necrosis factor–alpha (TNF-α)
                 IL-4, IL-10, and colony-stimulating factor (CSF)
                 IL-4, IL-5, and IL-13
 

Question 17
 

Which statement accurately describes childhood asthma?
 Question 17 options:
                 An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation
                 A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest X-ray imaging
                 A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that lines the airways, the pancreas, the sweat ducts, and the vas deferens
                 An obstructive airway disease characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency
                 Improvement on a trial of asthma medication
 

Question 18
 

Which statement best describes cystic fibrosis?
 Question 18 options:
                 Obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation
                 Respiratory disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest X-ray imaging
                 A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that obstructs the airways, the pancreas, the sweat ducts, and the vas deferens
                 A pulmonary disorder characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency
 

Question 19
 

What are the abnormalities in cytokines found in children with cystic fibrosis?
 Question 19 options:
                 A deficit of IL-1 and an excess of IL-4, IL-12, and interferon-alpha (IFN-α)
                 A deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating factor (G-CSF)
                 A deficit of IL-10 and an excess of IL-1, IL-8, and TNF-α
                 A deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF)
 

Question 20
 

Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication?
 Question 20 options:
                 Retropharyngeal abscess
                 Laryngospasms
                 Rupturing of the tonsils
                 Gagging induced aspiration
 

Question 21
 

Free radicals play a major role in the initiation and progression of which diseases?
 Question 21 options:
                 Cardiovascular diseases, such as hypertension and ischemic heart disease
                 Renal diseases, such as acute tubular necrosis and glomerulonephritis
                 Gastrointestinal diseases, such as peptic ulcer disease and Crohn disease
                 Muscular diseases, such as muscular dystrophy and fibromyalgia
 

Question 22
 

What is a consequence of plasma membrane damage to the mitochondria?
 Question 22 options:
                  Enzymatic digestion halts deoxyribonucleic acid (DNA) synthesis.
                 Influx of calcium ions halts adenosine triphosphate (ATP) production.
                 Edema from an influx in sodium causes a reduction in ATP production.
                 Potassium shifts out of the mitochondria, which destroys the infrastructure.
 

Question 23
 

In addition to osmosis, what force is involved in the movement of water between the plasma and interstitial fluid spaces?
 Question 23 options:
                 Oncotic pressure
                 Buffering
                 Net filtration
                 Hydrostatic pressure
 

Question 24
 

Venous obstruction is a cause of edema because of an increase in which pressure?
 Question 24 options:
                 Capillary hydrostatic
                 Interstitial hydrostatic
                 Capillary oncotic
                 Interstitial oncotic
 

Question 25
 

At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because:
 Question 25 options:
                 The interstitial hydrostatic pressure is higher than the capillary hydrostatic pressure.
                 The capillary hydrostatic pressure is higher than the capillary oncotic pressure.
                 The interstitial oncotic pressure is higher than the interstitial hydrostatic pressure.
                 The capillary oncotic pressure is lower than the interstitial hydrostatic pressure.
 

Question 26
 

Secretion of antidiuretic hormone (ADH) and the perception of thirst are stimulated by:
 Question 26 options:
                 A decrease in serum sodium
                 An increase in plasma osmolality
                 An increase in the glomerular filtration rate
                 A decrease in osmoreceptor stimulation
 

Question 27
 

Some older adults have impaired inflammation and wound healing because of which problem?
 Question 27 options:
                 The circulatory system cannot adequately perfuse tissues.
                 Complement and chemotaxis are deficient.
                 Underlying chronic illnesses exist.
                 The number of mast cells is insufficient.
 

Question 28
 

Lead poisoning affects the nervous system by:
 Question 28 options:
                 Interfering with the function of neurotransmitters
                 Inhibiting the production of myelin around the nerves
                 Increasing the resting membrane potential
                 Altering the transport of potassium into the nerves
 

Question 29
 

Carbon monoxide causes tissue damage by:
 Question 29 options:
                 Competing with carbon dioxide so that it cannot be excreted
                 Binding to hemoglobin so that it cannot carry oxygen
                 Destroying the chemical bonds of hemoglobin so it cannot carry oxygen
                 Removing iron from hemoglobin so it cannot carry oxygen
 

Question 30
 

Which statement is true regarding the difference between subdural hematoma and epidural hematoma?
 Question 30 options:
                 No difference exists, and these terms may be correctly used interchangeably.
                 A subdural hematoma occurs above the dura, whereas an epidural hematoma occurs under the dura.
                 A subdural hematoma is often the result of shaken baby syndrome, whereas an epidural hematoma rapidly forms as a result of a skull fracture.
                 A subdural hematoma usually forms from bleeding within the skull, such as an aneurysm eruption, whereas an epidural hematoma occurs from trauma outside the skull, such as a blunt force trauma.
 

Question 31
 

What physiologic change occurs during heat exhaustion?
 Question 31 options:
                 Hemoconcentration occurs because of the loss of salt and water.
                 Cramping of voluntary muscles occurs as a result of salt loss.
                 Thermoregulation fails because of high core temperatures.
                 Subcutaneous layers are damaged because of high core temperatures.
 

Question 32
 

Hemoprotein accumulations are a result of the excessive storage of:
 Question 32 options:
                 Iron, which is transferred from the cells to the bloodstream
                 Hemoglobin, which is transferred from the bloodstream to the cells
                 Albumin, which is transferred from the cells to the bloodstream
                 Amino acids, which are transferred from the cells to the bloodstream
 

Question 33
 

Hemosiderosis results in what substance being stored in excess as hemosiderin in cells of many organs and tissues?
 Question 33 options:
                 Hemoglobin
                 Ferritin
                 Iron
                 Transferrin
 

Question 34
 

What two types of hearing loss are associated with noise?
 Question 34 options:
                 Acoustic trauma and noise induced
                 High frequency and low frequency
                 High frequency and acoustic trauma
                 Noise induced and low frequency
 

Question 35
 

What type of necrosis results from ischemia of neurons and glial cells?
 Question 35 options:
                 Coagulative
                 Liquefactive
                 Caseous
                 Gangrene
 

Question 36
 

During cell injury caused by hypoxia, sodium and water move into the cell because:
 Question 36 options:
                 Potassium moves out of the cell, and potassium and sodium are inversely related.
                 The pump that transports sodium out of the cell cannot function because of a decrease in adenosine triphosphate (ATP) levels.
                 The osmotic pressure is increased, which pulls additional sodium across the cell membrane.
                 Oxygen is not available to bind with sodium to maintain it outside of the cell.
 

Question 37
 

In decompression sickness, emboli are formed by bubbles of:
 Question 37 options:
                 Oxygen
                 Nitrogen
                 Carbon monoxide
                 Hydrogen
 

Question 38
 

What is an example of compensatory hyperplasia?
 Question 38 options:
                 Hepatic cells increase cell division after part of the liver is excised.
                 Skeletal muscle cells atrophy as a result of paralysis.
                 The heart muscle enlarges as a result of hypertension.
                 The size of the uterus increases during pregnancy.
 

Question 39
 

Current research has determined that chemical-induced cellular injury:
 Question 39 options:
                 Affects the permeability of the plasma membrane
                 Is often the result of the damage caused by reactive free radicals
                 Is rarely influenced by lipid peroxidation
                 Seldom involves the cell’s organelles
 

Question 40
 

What is the inflammatory effect of nitric oxide?
 Question 40 options:
                 It increases capillary permeability and causes pain.
                 It increases neutrophil chemotaxis and platelet aggregation.
                 It causes smooth muscle contraction and fever.
                 It decreases mast cell function and decreases platelet aggregation. 

Advanced Pharmacology

            A number of large studies have investigated the topic of epidemiology of allergies and much depends on the type and symptoms.  Three studies used a random calling methodology with administration of a survey, with methodologic variations among the studies (Hutyrová & Bystroň, 2018).  Epidemiological studies on representative populations clearly demonstrate a significant general increase of atopic diseases during the last decades, mainly for pollinosis. For the manifestation of an atopic disease both allergen exposure, which leads to specific IgE antibody formation, and the presence of additional realization factors are required. The nature of the latter is still partially unknown.

            Most pharmacoeconomic treatment options for allergies can be obtained from over-the-counter medications.  Lifestyle changes like using air filters and avoiding triggers are important, too.  Prescription antihistamines include Azelastine eyedrops (Optivar), Azelastine nasal sprays, Astelin, Astepro), Carbinoxamine (Palgic) and Cyproheptadine.

            Compared to second generation, H1 antagonists, also called H1 blockers, are a class of medications that block the action of histamine at the H1 receptor, helping to relieve allergic reactions. Agents where the main therapeutic effect is mediated by negative modulation of histamine receptors are termed antihistamines; other agents may have antihistaminergic action but are not true antihistamines.

            Allergies can put a strain on the patient, which underlies the need to educate this patient on how to maintain a state of health that enables him to continue working. Determination of symptoms and identification of allergens will ensure that the patient acquires knowledge on how to adopt preventive measures.

References

Beasley, S. (2018).  Addressing allergies and treatment options. Virginia Quarterly Review, 94(4), 20–27.

Hutyrová, B., & Bystroň, J. (2018). Treatment options for severe allergic asthma and allergic comorbiditie. Advances in Dermatology & Allergology / Postepy Dermatologii i Alergologii, 35(5), 510–515. https://doi.org/10.5114/ada.2018.77243