Help On Writing 2025
In your opinion, what are the trade offs between aggressive care at end of life and quality of life? What do you think about hospice care? Do you think hospice care is essential? Why and why not? What can we do to extend palliative care to more people? What are your thoughts on palliative care?
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Week 5 Discussion Advance Nursing 2025
Case stud is attached please read and answer the following questions. use apa style for references. Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know. Describe the physical assessment and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not? Please list 3 differential diagnoses for Mr. Payne and explain why you chose them. What was your final diagnosis and how did you make the determination? What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
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Week 5 Discussion Pharm 2025
Discussion Question #1 For this questions, please read the following case stud and then respond to the questions noted below. Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well. The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid. Mr. EBR’s physical assessment includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally What would you add to the current treatment plan? Why? Would you discontinue any of the currently prescribed medication? Why or why not? How does the diagnosis stage 3 chronic kidney disease affect your choices? Why is the patient prescribed more than one antihypertensive? What is the benefit of the aspirin therapy in this patient? Discussion Question #2 List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication? Your response should be at least 350 words.
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Week 5 Discussion Pharm 2025
Discussion Question #1 For this questions, please read the following case stud and then respond to the questions noted below. Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well. The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy. He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid. Mr. EBR’s physical assessment includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally What would you add to the current treatment plan? Why? Would you discontinue any of the currently prescribed medication? Why or why not? How does the diagnosis stage 3 chronic kidney disease affect your choices? Why is the patient prescribed more than one antihypertensive? What is the benefit of the aspirin therapy in this patient? Discussion Question #2 List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication? Your response should be at least 350 words.
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Conduct A Critical Appraisal Of Literature That Demonstrates An Understanding Of Qualitative Research. 2025
Conduct a critical appraisal of literature that demonstrates an understanding of qualitative research. Use the Critiquing Criteria for Qualitative Research (study 127-134 table 1) , write a critique of a qualitative research article that you have read related to your clinical practice. APA and 2-3 pages in length, excluding the title page, abstract, and references page. 3 current published research articles
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Veterans Mental Healthcare Logic 2025
A logic model is a systematic and visual representation for showing the relationship between program resources, activities, outputs, and outcomes the program hopes to achieve. The main components of a logic model are inputs (resources), activities (interventions or strategies), outputs (evidence of activities; products), and outcomes (results or effects for short-term, intermediate, and long-term outcomes).
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Discussion Board 4 2025
This discussion board forum will focus on Chapter 4 of the textbook, Disease Prevention and Control , Dan Dennett’s TED talk, Let’s teach religion – all religion – in schools , and the Believed podcast, The Basement . The Basement At Larry Nassar’s House : Believed : NPR Please also see attached.
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Pediatric – Week 5 Discussion 1st REPLY 2025
Please reply to the following discussion with one reference . Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. MB Discussion: How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for their age group? Which additional conditions would you want to screen for and why? In evaluating and managing a pediatric with hypertension and elevated body max index (BMI), I would begin with weekly weigh-ins and blood pressure. In addition, I would have the guardian monitor the child’s food intake with a dietary log. Furthermore, I would request the guardian to log the child’s activity level and their activities. Research shows that children involved in sports programs and regularly participate in physical activity have lower BMI’s. Furthermore, increased physical activity in children helps facilitate better nutrition and psychological support (Bülbül, 2020). Next, I would obtain a sleep hygiene history and habits. Finally, the child’s screen time would need to be assessed and monitored. This evaluation would allow the provider to assess which lifestyle modification would need to be enforced. If the assessment shows that the lifestyle does not impact the child’s blood pressure or weight, a further evaluation may need to be conducted. This evaluation would consist of diabetic screening and hypothyroidism. Diabetes increases 3% every year in children, and the prevalence of hypothyroidism in children is 2% (Fatourechi et al., 2017). Once the cause of high BMI and hypertension is identified, a treatment and action plan can be formulated. What physical exam findings and diagnostic results would be concerning to you in this patient and why? What would be three differentials in this case? The patient should have blood work done to rule out diabetes or a thyroid condition. The blood test would include a lipid panel, fasting glucose, and hemoglobin A1C. If the bloodwork reveals an A1C greater than 6.5%, it would suggest that the patient has diabetes mellitus (Bülbül, 2020). In addition, the patient has a family history of diabetes and hyperlipidemia. This increases the patient’s chance of having these conditions by two to six times (Burn et al., 2019). In addition, the patient’s exam revealed acanthosis nigricans and hypertension, which can indicate insulin resistance. Therefore, it would be recommended to rule out diabetes. The first diagnosis I would select would be hypertension due to elevated blood pressure. The second diagnosis I selected would be obesity due to an elevated BMI. The final diagnosis would be attention deficit hyperactivity disorder (ADHD) due to his learning disability. What are your final assessments (diagnoses) for this patient? What is your treatment recommendation and education for the patient and family? Why? In this case, the focus is aimed at this patient’s obesity, ADHD, and hypertension. During his six-month follow-up, the patient was diagnosed with ADHD using the assessments completed by his teachers and guardians. The provider then prescribed him an extended-release dextroamphetamine/amphetamine (Adderall XR) 5mg PO daily. The most effective plan for this patient is to continue this medication and other possible therapies necessary. These therapies can help address sleep disorders, sensory impairment, learning disabilities, mood disorders, and conduct disorders (Burns et al., 2019). His mother did verbalize the patient was not compliant with his medication. The patient and parent will need to be educated on the importance of medication compliance for effectiveness. The patient and his guardians will have to go through lifestyle modifications in proper diet and physical activity. These modifications will help him obtain a more appropriate BMI. A low sodium and sugar diet will be recommended with increased fresh fruits, vegetables, and water (Burn et al., 2019). References Bülbül S. (2020). Exercise in the treatment of childhood obesity. Turk pediatric arsivi, 55 (1), 2 10. https://doi.org/10.14744/TurkPediatriArs.2019.60430 Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN: 9780323581967 Fatourechi, A., Ardakani, H. M., Sayarifard, F., & Sheikh, M. (2017). Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients’ characteristics to disease severity. Clinical pediatric endocrinology: case reports and clinical investigations: official journal of the Japanese Society for Pediatric Endocrinology, 26 (2), 73–80. https://doi.org/10.1297/cpe.26.73
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Pediatric – Week 5 Discussion 2nd REPLY 2025
Please reply to the following discussion with one reference . Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. CBY Discussion: How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for his/her age group? Which additional conditions would you want to screen for and why? A physical examination of the child is always the first start in evaluating the patient. The American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) recommend measuring BMI in children 2 years old and older. For a pediatric patient with BMI greater than his or her age, I would manage the patient by educating the parent on healthy nutrition for the child. The parent would be aware on nutritious food and snacks to provide and to make the food enticing and enjoyable for the child. For help with adequate food resources I would also refer the parent to Women, Infants, and Children (WIC) program and Supplemental Nutrition Assistance Program (SNAP). Physical activity is also important to sustaining a healthy nutrition. It is recommended that children and adolescents engage in 60 minutes of physical activity every day. By increasing the child physical activity, it creates a demand for more calories and nutrients and improves weight status. The diagnostic studies recommended: are “HDL, cholesterol screening, random glucose test, Thyroid screen: TSH, T4, AST, ALT, HbA1c and Vitamin D level” (Burns, et al., 2019. pg. 232). The results would identify if the child has thyroid problems, high cholesterol, and liver problems from fatty food intake as well as type 2 diabetes mellitus from high consumption of sugar and carbohydrates. What physical exam findings and diagnostic results would be concerning to you in this patient and why? What would be three differentials in this case? The physical examination findings that are concerning to me in this patient are: Patients blood pressure was mildly elevated at 116/76 mmHg. Patient is 80th percentile for height. His repeat systolic BP of 116 mmHg places him between the 90th and 95th percentile which is elevated blood pressure category (Dell, 2021).This is concerning if it is not addressed as it could spill over into the category of stage 1 hypertension. The patient height age is 8 years old and his weight age is that of 13 years old. The patient height is 133 cm (52 in); 80th percentile for his age and weight is 45 kg (99 lbs) > 97th percentile for age. The patient is over the 95th percentile for his age which puts him in the obese category (Dell, 2021). Three differential diagnoses in this case are: Mood disorder : Children with ADHD also have a higher rate of mood disorders than control populations. The patient in this case has a history of ADHD (Dell, 2021). Dyslipidemia: Hypertriglyceridemia and low HDL cholesterol is strongly correlated with metabolic syndrome, which occurs almost exclusively as a consequence of obesity. The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category (Dell, 2021). Type 2 diabetes mellitus : Obesity is the most prominent risk factor for the development of type 2 DM in children. The average BMI for pediatric patients with type 2 DM ranges from 35 to 39 kg/m2. The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category (Dell, 2021). What are your final assessments (diagnoses) for this patient? ADHD: Patient has a history of ADHD Obesity: The patient in this case BMI of 25.4 kg/m2 and plots above the 97th percentile for an 8 year old boy puts him in the obese category. Hypertension : Patients blood pressure was mildly elevated at 116/76 mmHg and has an 80th percentile for height. Based on the blood pressure norms for height and age of 8 years old, the patient repeat systolic BP of 116 mmHg places him between the 90th and 95th percentile which is elevated blood pressure category (Dell, 2021). What is your treatment recommendation and education for the patient and family? Why? Medication: Adderall XR (dextroamphetamine/amphetamine, extended release) 5mg (one capsule) by mouth once daily in the morning. Adderall XR has a very positive effect on attention and behavior in most kids who have ADHD (Dell, 2021). Encourage parent to ensure medication adherence and to follow up for any questions or concerns regarding the medication. Regarding obesity and hypertension, As mentioned earlier I would encourage healthy diet and exercise and encourage patient to return for lab draws while patient is on fasting for and accurate cholesterol levels as well as fasting glucose Call clinician if having poor appetite, difficulty sleeping, or other problems. “Read through this website for parents on ADHD and questions or concerns can be addressed at the next visit” (Dell, 2021). References Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN:9780323581967. Dell, M.S. (2021). Pediatrics 04: 8-year-old male well-child check. Retrieved from https://southu-nur.meduapp.com/document_set_document_relations/30219?section_uid=root
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Medication Reconciliation Assignment 2025
a. Explain the medication reconciliation process b. Analyze the client scenario for any omissions, additions, or duplications of medications and discuss the implications to the client. c. Analyze the client scenario for potential risks associated with the client’s current condition and currently prescribed home medications d. Identify potential drug interaction and prioritize the drug interactions that are most concerning to you. e. Identify actions that the nurse should implement and provide a reason for each action. 1. Mr. H. is being admitted with a broken hip due to falling at home and will be having surgery the next morning. Past medical history includes hypertension and Type 2 diabetes. Allergies: Penicillin. The home medication list is provided to the nurse and includes the following medications: a. Metoprolol 25 mg PO daily b. Atenolol 50 mg PO daily c. Garlic 1000 mg PO daily d. Metformin 500 mg PO twice daily e. Aspirin 81 mg PO daily 2. The admitting orders include the following medication orders: a. Continue all home medications except metformin b. Insulin subcutaneous based on sliding scale B i. Blood sugar <150= 0 units ii. Blood sugar 151-175= 2 units iii. Blood sugar 176-200=3 units iv. Blood sugar 201-225=4 units v. Blood sugar 226-250=5 units vi. Blood sugar 251-300= 6 unites vii. Blood sugar > 300= notify healthcare provider c. Enoxaparin 40 mg subcutaneous daily, first dose tomorrow following surgery d. Piperacillin/tazobactam 3 gram/0.375 gram IV every 6 hours, first dose 30 minutes prior to surgery
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