SELECT ONLY ONE QUESTION TO WORK ON!!!!!!!!!!!!!!!!!!!!!!!!!!!

·      Follow the discussion questions participation and submission guidelines.

·      Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.

Chapter 12: Leadership and Systems-Based Professional Nursing Practice

1.  What are the differences between microsystems and macrosystems in health care? Identify some issues in the microsystem where you practice as a student nurse that could be improved.

2.  What are some similarities and differences between the leadership role in nursing and the manager role in nursing?

Case Study

CM is a 43-year-old female who presents with concerns regarding two painless right-breast lumps that she detected four months ago. She missed an appointment for evaluation by her primary-care provider at that time and presents today with reportedly no change in these findings since that time. There has been no breast discharge, bleeding, overlying skin changes, lymphadenopathy, or fevers; she denies recent or past breast trauma. She did, however, undergo a stereostatic breast biopsy three years ago that demonstrated atypical lobular hyperplasia, and there is a known family history of breast cancer (mother, diagnosis at age 48). Current review is significant for a 10-pound weight loss due to diminished appetite over the last two months. Amenorrheic x three years; no current hormonal-replacement therapy or previous oral-contraceptive use; had levonorgestrel implantation at age 28, removed at age 33 and has only used condoms since, but nothing now as she is not sexually active.
This case is meant to highlight indications for breast-cancer screening and to outline the standard evaluation of a female who presents with a breast mass.

Learning objectives for the case:

• Distinguish between the common types of breast masses.
• Know the guidelines for breast-cancer screening.
• Explain the reasoning behind the standard diagnostic approach to a patient with a breast mass.

Also review with following in order to adequately answer the questions in regard to the case above:

• Epidemiology: what is the latest information regarding Breast Cancer?
• Clinical considerations: what are the considerations you should explore in regard to this disorder (e.g. most common presenting symptom, less common symptoms, physical exam findings, testing to order (with rationale) – which is most recommended in regard to this case and why.
• Review the TMN classification system.
• Review the SEER staging system as an alternative rating system for epidemiology reporting.
• Explain the Risk factors for developing breast cancer. What risk factors does this patient have for breast cancer?

After completing your Case Study and reviewing the guidelines for breast-cancer screening, answer the following Discussion Board questions using the latest evidenced based guidelines:

• Discuss the questions that would be important to include when interviewing a patient with this issue, including any risk factors she may have.
• Describe the clinical findings that may be present in a patient with this issue.
• Are there any diagnostic studies that should be ordered on this patient? Why?
• List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
• Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

3.3 Provide individualized education to diverse patient populations in a variety of health care settings.

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation based on the Teaching Work Plan and present the information to your community.

Options for Delivery 

Select one of the following options for delivery and prepare the applicable presentation:

1. PowerPoint presentation – no more than 30 minutes
2. Pamphlet presentation – 1 to 2 pages
3. Audio presentation
4. Poster presentation

Selection of Community Setting

These are considered appropriate community settings. Choose one of the following:

1. Public health clinic
2. Community health center
3. Long-term care facility
4. Transitional care facility
5. Home health center
6. University/School health center
7. Church community
8. Adult/Child care center

Community Teaching Experience Approval Form 

Before presenting information to the community, seek approval from an agency administrator or representative using the “Community Teaching Experience Approval Form.” Submit this form as directed in the Community Teaching Experience Approval assignment drop box.

General Requirements

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

 What do the four parts of the Christian biblical narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? From where would one find comfort and hope in the light of illness according to this narrative? Explain in detail each part of the narrative above and analyze the implications 

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

1. Height: 68 inches; weight 134.5 kg
2. BP: 172/98, HR 88, RR 26
3. 3+ pitting edema bilateral feet and ankles
4. Fasting blood glucose: 146 mg/dL
5. Total cholesterol: 250 mg/dL
6. Triglycerides: 312 mg/dL
7. HDL: 30 mg/dL
8. Serum creatinine 1.8 mg/dL
9. BUN 32 mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

1. Describe the clinical manifestations present in Mr. C.
2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
6. Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide,