Mr. B is a 70-year-old man who developed sub sternal chest pains radiating down his left arm while at home. He was taken to the ER via ambulance. His breathing was labored, pulses rapid and weak, and his skin was cold and clammy. An ECG was done which revealed significant “Q” waves in most leads. Troponin level was elevated. Arterial blood was draw with the following results:

Ph 7.22

PCO2 30 mm

Hg pO2 70 mm

Hg O2 sat 88%

HCO3 22 meq/liter

1. Aside from the obvious diagnosis of MI, what is Mr. B’s acid base status and what caused this  disturbance?   a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required .

Answer the Discussion Board board questions in paragraph

1.     A woman went to the physician with severe stomach pains. She was examined by a surgeon who, she stated, told her that her spleen was “hanging by a thread” from her collarbone. The surgeon recommended surgery to “build up ligaments” in her spleen. Following the operation, the surgeon informed her husband that it had been necessary to remove the spleen. The pathology report revealed no evidence of any disease in the spleen. The woman and her husband brought a cause of action against the surgeon for fraud. Should the court rule in their favor?

2.     Charles Venner swallowed 24 or 25 balloons of hashish oil in Morocco, flew to New York, passed 5 balloons, went on to Baltimore, and was brought by friends to the emergency room of Sinai Hospital “euphoric, disoriented, and lethargic, but responding to verbal orders.” While under observation, he passed in bedpans the remainder of the balloons, one broken. The hospital staff saved the balloons and turned them over to the Baltimore police without a warrant. Should the police require a search warrant to use the balloons as evidence in a cause of action for possession of an illegal substance with the intent to distribute?

1) Your response should be in depth (3-4 paragraphs for the initial post) to fully develop your answer. Defend your position with concrete examples from the weekly content and real-life cases, if applicable.

2) APA citation is required.

Recommended Resources

These resources provide additional real-life stories about crimes that took place in medical offices:

• Hewlett, M. (2014, June 25). Employee at doctor’s office accused of stealing prescriptions. Winston-Salem Journal. Retrieved from 33Thttp://www.journalnow.com/news/crime/employee-at-doctor-s-office-accused-of-stealing-prescriptions/article_48d3362c-fc9a-11e3-ada7-0017a43b2370.html33T

• Department of Justice, U.S. Attorney’s Office, Central District of California. (2016, August 29). Two doctors faced with federal charges of illegally writing prescriptions for addictive narcotics connected to gang’s drug trafficking. Press release. Retrieved from 33Thttps://www.justice.gov/usao-cdca/pr/two-doctors-face-federal-charges-illegally-writing-prescriptions-addictive-narcotics33T

• Department of Justice, U.S. Attorney’s Office, Central District of California. (2017, April 4). Gresham medical practice manager sentenced to prison for false billing and tax fraud. Press release. Retrieved from 33Thttps://www.justice.gov/usao-or/pr/gresham-medical-practice-manager-sentenced-prison-false-billing-and-tax-fraud33T

 

As a new nurse you are assigned to work with a preceptor in the Emergency Department. It is a very busy day and it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and/or acid-base balance. The first patient you see is a 37-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but is able to tell you he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

1. Describe how each of the following would change and the rationale for the change in the presence of

   deficient fluid volume:

• Heart rate

• Blood pressure

• Serum hematocrit

• Urinary output

• Urine specific gravity

• Weight

2. What is usually the first indicator that an individual needs more fluids?

3. The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid     volume deficit due to dehydration?

4. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL. This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate?

5. The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.

6. You have difficulty finding a vein in the presence of the deficient fluid volume.  List 3 strategies that you can use to help make a vein more visible/palpable?

7. Considering the diagnosis, patient presentation, and fluid orders, what size catheter is indicated in this situation? Give a rationale for your choice.

8. After 30 minutes of the infusion, the patient states, “My arm where the needle is feels funny.” What should you do first? What further data do you need from the patient?

Several hours later the patient is feeling better and is now oriented × 3. The ED physician wants the patient to be drinking oral fluids without difficulty prior to being discharged from the ED.

9. List 3 strategies to increase fluid intake that are most appropriate to this setting.

10. The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the teaching applicable to the job site?

Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 9, 10
• Minimum of 1 primary source (from artist)
• Minimum of 1 scholarly source. In addition to the textbook – from critic

Initial Post Instructions
Choose one of the music or dance movements that you read about this week and at least one work from that movement. Then, address the following:

• Examine the movement and specific work in relation to historical and political influences of the movement.
• Identify characteristics of the movement and how the work reflects these characteristics.
• Include a statement from the artist and one from a critic.
• Include a link to the lyrics and/or video depending on your choice.

Follow-Up Post Instructions
Respond to at least one peer. Further the dialogue by providing more information and clarification.

(Follow up post below)

Shirley James

Hey Professor Pisano and Classmates,

Music is one of the most powerful of the arts partly because sounds- more than any other sensory stimulus- create in us involuntary reactions, pleasant or unpleasant (Jacobus & Martin, 2019).  Music has the power to change a mood, ignite excitement and happiness, and calm your spirit after a long stressful day.  It is an escape from the sorrows and pain of life and can be used as a stress reducer. Music therapy involves the planned use of music to treat physical, cognitive, psychological, emotional, and social needs of individuals and groups (Korusky, 2018).

In The humanities through arts chapter nine, Jacobson and Martin explain how music can be experienced in two ways: “listening” and “hearing”.  The hearer does not listen to detail, instead they concentrate on the rhythm and the melody of the music and what emotions it promotes.  The listener understands and listen to the details of the music, they know when the melody changed, and another instrument was introduced into the background (Jacobus & Martin, 2019).  For my choice is Blues and Jazz.  The personal reason I chose to discuss this type, is I grew up in a strict Pentecostal home, where music words were not only screened by mother, but if she felt the meaning was not Christian “like” it was forbidden to be played in our household.

But she allowed what she called “soft Jazz”, and I remember Saturday morning cleaning sessions and my siblings, and I loved when she would play Jazz loud in the house.  The blues was developed and popular in the African American communities and still to this day is an international phenomenon (Jacobus & Martin, 2019).  The music became an inspiration of hope to the African American people, allowing them to express their feelings through music.  They embraced it and held on to it.  Billy Holliday is remembered for her role in the genre of Blues and in 1997 a movie about her life was titled “Lady sings the blues”. “The blue to me”, Holiday told Time magazine in 1957, are like being very sad, very sick-and again, like going to church and being very happy” (O’Neal, 2016).  One of Holliday’s most memorable songs was “God bless the child”.  The song is enclosed below in the YouTube hyperlink.  

References:

Korusky, J. Music Therapy and Schizophrenia, 2018, eds-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=4&sid=1663a8d7-64a8-4237-91f8-0f6a6cfaf599%40sdc-v-sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3D%3D#AN=T702758&db=nup.

Martin, F. D., & Jacobus, L. A. (2019). The humanities through the arts.  New York: McGraw-Hill Education. 

O’Neal, Jim. “Billie Holiday.” Blues Foundation, 10 Nov. 2016, blues.org/blues_hof_inductee/billie-holiday/.

https://youtu.be/Z_1LfT1MvzI (Links to an external site.)

Writing Requirements

• Minimum of 2 posts (1 initial & 1 follow-up)
• Minimum of 2 sources cited (assigned readings/online lessons and an outside source)
• APA format for in-text citations and list of references

Due Date for Initial Post: By 11:59 p.m. MT Recommended by Thursday
Due Date for Follow-Up Posts: By 11:59 p.m. MT on Saturday