Assignment 1: Sociocultural Norms, Health, and Nursing  The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.  Post a response to one of the two discussion topics below, using information from the lectures, reading assignments, library resources, and Internet resources. All responses should be posted to the appropriate topic in the Discussion Area.  

Topic 1: Vulnerable Populations  As you discovered in this week’s lectures and textbook readings, numerous vulnerable populations exist in the community. Identify three local organizations in your community that deliver healthcare services to vulnerable populations. Based on your research findings, answer the following: 

•Which population does each organization serve? 

•What services does it provide? 

•Where does it get its funding (local, state, or federal sources)? 

•Evaluate the relative value of each organization’s services to individuals and families in the vulnerable population it serves.  

Topic 2: Stigma Associated with Disease  Some vulnerable populations may have diseases, health impairments, and pregnancy that bring humiliation and predisposed judgment. Unfortunately, these health conditions can cause vulnerable populations to become ostracized by the general public. 

•What ways would you choose to function as an advocate for vulnerable populations? 

•Discuss the types of assistance you might provide to each of the following clients: ◦A 24-year-old pregnant woman who is currently homeless and unmarried ◦A 16-year-old girl who has run away from her foster home and who has an IV drug habit ◦An immigrant worker whose TB skin test just came back positive ◦An employed, married man who contracted Hepatitis B through a blood transfusion 30 years ago  Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

Discussion: Introduction to the Planning Process

 

The nursing process provides a cornerstone for care. Engaging in assessment, diagnosis, planning, implementation, and evaluation helps to move the patient from his or her current state toward a desired outcome.

 

How does this correlate with the strategic planning process?

 

In this Discussion, you examine similarities and differences between the nursing process and strategic planning. You also consider why it is important for a nurse leader-manager to be familiar with the planning hierarchy and to apply business principles to promote strategic change at the organizational or systems level.

 

To prepare:

 

Review the information related to the nursing process and the strategic planning process addressed in Chapter 4 of the Sare and Ogilvie text and the other Learning Resources. Think about how the nursing process is similar to and different from the strategic planning process.

Reflect on the value of nurse leader-managers’ contributions to strategic planning, as discussed by Dr. Huston in this week’s media.

Using the Walden library, identify an example from the literature that demonstrates why it is beneficial for nurse leader-managers to be familiar with the planning hierarchy and why they should be engaged in strategic planning in addition to and in contrast with operational planning.

 

Post an explanation of how you view the similarities and differences between the nursing process and the strategic planning process. Share an example from the literature that demonstrates why it is beneficial for nurse leader-managers to be aware of the planning hierarchy and why they should be engaged in strategic planning in addition to and in contrast with operational planning.

 

Read a selection of your colleagues’ responses.

 

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

Ask a probing question, substantiated with additional background information or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional resources.

 

Required Readings

 

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Chapter 7, “Strategic and Operational Planning” (pp. 138–161)

 

(Note: You may have read this in a previous course.)

 

This chapter describes the planning hierarchy and provides foundational information on strategic planning. As you read, think about distinctions between strategic and operational planning, as well as why a nurse leader-manager needs to be aware of and engaged in both.

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

“Introduction” (pp. xiii–xiv)

Chapter 1, “Why Nursing Needs Strategic Planning: Professional Empowerment in the New Millennium” (pp. 3–16)

 

Chapter 2, “The Healthcare Habitat: The Evolving Professional Home of Nursing” (pp. 17–40)

 

Chapter 3, “The Business That We Find Ourselves In” (pp. 41–53)

 

Chapter 4, “Just What Is Strategic Planning?” (pp. 57–82)

 

Chapter 1 sets the context for why strategic planning is important for nurses and introduces key terms, while Chapter 2 addresses the evolving landscape of healthcare. Chapter 3 explores the merging of nursing care and business, as well as developments leading up to the current business model of care. Chapter 4 examines the nursing process and strategic planning.

Carney, M. (2009). Enhancing the nurses’ role in healthcare delivery through strategic management: Recognizing its importance or not? Journal of Nursing Management, 17(6), 707–717.

Retrieved from the Walden Library databases.

 

The author examines the importance of strategic planning for nurse leader-managers and the extent to which nurses have adopted strategic planning into language and self-perception.

Fairholm, M. R., & Card, M. (2009). Perspectives of strategic thinking: From controlling chaos to embracing it. Journal of Management and Organization, 15(1), 17–30.

Retrieved from the Walden Library databases.

 

This article addresses strategic planning and strategic thinking,which can be used to fill the gaps of strategic planning.

 Lafley, A. G., Martin, R. L., Rivkin, J. W., & Siggelkow, N. (2012). Bringing science to the art of strategy: Leaders rarely succeed in marrying empirical vigor and creative thinking. Here’s how they could do better. Harvard Business Review, 90(9), 56–66.

Retrieved from https://cb.hbsp.harvard.edu/cbmp/pl/57319184/57319186/32e10ac6b49a087fb3f3b290416c5148

 

This article outlines how to blend creativity with a scientific method to succeed in strategic planning.

 Paul, J., Charles, T., & Davis, S. (2011). Plan for success. An effective planning cycle can reap big rewards. Marketing Health Services, 31(4), 13–15.

Retrieved from the Walden Library databases.

 

This article describes the planning process used by Geisinger Health System.

Peled, R., & Schenirer, J. (2009). Healthcare strategic planning as part of national and regional development in the Israeli Galilee: A case study of the planning process. Health Information Management Journal, 38(3), 43–50.

Retrieved from the Walden Library databases.

 

This case study demonstrates the application of three phases of strategic planning to optimally allocate scarce resources.

 American Nurses Association. (2012b). The nursing process. Retrieved from http://nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html

 

This item outlines the nursing process, which is a foundation for nurses in varying roles and different settings. The nursing process involves assessment, diagnosis, outcomes/planning, implementation, and evaluation.

 Authenticity Consulting. (n.d.a). All about strategic planning. Retrieved March 8, 2013, from http://managementhelp.org/strategicplanning/index.htm

 

View the description of strategic planning.

 Harvard Business Review. (2013). HBR blog network. Retrieved from http://blogs.hbr.org

 

Search for and read blog posts related to strategic planning.

 Healthy People 2020. (n.d.). Retrieved January 28, 2012, from http://healthypeople.gov/2020/default.aspx

 

View the information related to health care-related issues in the United States and consider their significance for strategic planning.

 Institute of Medicine of the National Academies. (n.d.).Retrieved January 28, 2012, fromhttp://www.iom.edu

 

Search this site for information related to the current health care environment and strategic planning.

 National Institute of Nursing Research. (2011). Bringing science to life: NINR strategic plan. Retrieved from http://www.ninr.nih.gov/AboutNINR/NINRMissionandStrategicPlan

 

Read the information related to strategic planning for the National Institute of Nursing Research.

 Society for Healthcare Strategy & Market Development. (n.d.). Retrieved January 28, 2012, from http:/www.shsmd.org/

 

Review the information on this website for information related to strategic planning.

Required Media

Laureate Education (Producer). (2013g). Skills of a nurse leader [Video file]. Retrieved from https://class.waldenu.edu

 

Note:  The approximate length of this media piece is 7 minutes.

 

Dr. Carol Huston discusses why it is important for nurse leader-managers to become strategic planners regardless of their role within an organization and how they can develop the skills and disposition for proactive approaches to change rather than being reactive to change.

 

 

Accessible player  

Optional Resources

Lewis, B. E. (2011). Narrative medicine and healthcare reform. The Journal of Medical Humanities, 32(1), 9–20.

Retrieved from the Walden Library databases.

1. A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 0.4)       [removed] Decreased mean corpuscular volume (MCV)       [removed] Decreased hemoglobin and hematocrit       [removed] Microcytic, hypochromic red cells       [removed] Decreased erythropoietin levels

 

Question 2. 2. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)       [removed] Hypocoagulation       [removed] Iron and ferritin deficiencies       [removed] Splenomegaly and hepatomegaly       [removed] Neutropenia

 

Question 3. 3. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)       [removed] A mild parasitic infection       [removed] A severe bacterial infection       [removed] A mild viral infection       [removed] A severe fungal infection

 

Question 4. 4. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 0.4)       [removed] “Stem cells can help correct autoimmune diseases and some congenital defects.”       [removed] “Stem cells can be used to regenerate damaged organs should the need ever arise.”       [removed] “Stem cells can be used as a source of reserve cells for the entire blood production system.”       [removed] “Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”

 

Question 5. 5. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 0.4)       [removed] The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.       [removed] Her liver and spleen are both enlarged.       [removed] Blood work reveals an increased white blood cell count.       [removed] Chest auscultation reveals crackles in her lower lung fields bilaterally.

 

Question 6. 6. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? (Points : 0.4)       [removed] Her neoplasm originates in secondary lymphoid structures.       [removed] The lymph nodes involved are located in a large number of locations in the lymphatic system.       [removed] The presence of Reed-Sternberg cells has been confirmed.       [removed] The woman complains of recent debilitating fatigue.

 

Question 7. 7. A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner’s explanation? (Points : 0.4)       [removed] Tissue destruction results from neutrophil deactivation.       [removed] Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.       [removed] Macrophages are unable to digest the bacteria, resulting in immune granulomas.       [removed] Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

 

Question 8. 8. A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely? (Points : 0.4)       [removed] The woman has depleted blood volume due to her ongoing blood loss.       [removed] She will have iron-deficiency anemia due to depletion of iron stores.       [removed] The patient will be at risk for cardiovascular collapse or shock.       [removed] She will have delayed reticulocyte release.

 

Question 9. 9. A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history? (Points : 0.4)       [removed] A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident       [removed] A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks       [removed] A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism       [removed] A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

 

Question 10. 10. A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? (Points : 0.4)       [removed] “Interferon can help your father’s unaffected cells adjacent to his infected cells produce antiviral proteins that limit the spread of the infection.”       [removed] “Interferon can help limit the replication of the virus that’s affecting your father.”       [removed] “Interferon helps your father’s body recognize infected cells more effectively.”       [removed] “Interferon can bolster your father’s immune system by stimulating natural killer cells that attack viruses.”

 

Question 11. 11. A nurse practitioner is providing prenatal care and education for a first-time expectant mother, 22 weeks’ gestation, who has a diagnosis of a sexually transmitted infection. Which of the following statements by the expectant mother demonstrates an adequate understanding of vertical disease transmission and congenital infections? (Points : 0.4)       [removed] “Gonorrhea and chlamydia pose the greatest risks of transmission from mother to child.”       [removed] “I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.”       [removed] “My baby could become infected either across the placenta or during the birth itself.”       [removed] “Prophylactic immunization will reduce my baby’s chance of being born with an illness.”

 

Question 12. 12. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 0.4)       [removed] Impaired immune function       [removed] Acid-base imbalances       [removed] Impaired thermoregulation       [removed] Fluid imbalances

 

Question 13. 13. A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing, and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man’s T lymphocytes and adaptive immune system? (Points : 0.4)       [removed] Presentation of a foreign antigen by a familiar immunoglobulin       [removed] Recognition of a foreign MHC molecule       [removed] Recognition of a foreign peptide bound to a self MHC molecule       [removed] Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation

 

Question 14. 14. Which of the following phenomena would be least likely to result in activation of the complement system? (Points : 0.4)       [removed] Recognition of an antibody bound to the surface of a microbe       [removed] The binding of mannose residues on microbial glycoproteins       [removed] Activation of Toll-like receptors (TLRs) on complement proteins       [removed] Direct recognition of microbial proteins

 

Question 15. 15. A tourist presented to a primary care health clinic complaining of malaise, fever, and headache. She has subsequently been diagnosed with Rocky Mountain spotted fever, a pathology caused by Rickettsiaceae. Which of the followed statements best captures a characteristic trait of Rickettsiaceae? (Points : 0.4)       [removed] They are eukaryotic.       [removed] They have both RNA and DNA.       [removed] They have a distinct spiral-shaped morphology.       [removed] They are neither gram-negative nor gram-positive.

 

Question 16. 16. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)       [removed] Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.       [removed] Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.       [removed] Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.       [removed] Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.

 

Question 17. 17. A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his nurse practitioner to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the nurse practitioner’s suggestion? (Points : 0.4)       [removed] Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.       [removed] Aspirin helps to inhibit adenosine disphosphate (ADP) action and minimizes platelet plug formation.       [removed] Aspirin can reduce unwanted platelet adhesion by inhibiting thromboxane A2 (TXA2) synthesis.       [removed] Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

 

Question 18. 18. Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? (Points : 0.4)       [removed] Increased thrombopoietin levels       [removed] Decreased platelet count       [removed] Normal vitamin K levels       [removed] Normal leukocyte levels

 

Question 19. 19. A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body’s fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? (Points : 0.4)       [removed] “Inflammation can help to remove the body tissue cells that have been damaged by infection.”       [removed] “Inflammation will start your body on the path to growing new, healthy tissue at the site of infection.       [removed] “Inflammation helps your body to produce the right antibodies to fight the infection.”       [removed] “Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix.”

 

Question 20. 20. A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines? (Points : 0.4)       [removed] “A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use.”       [removed] “Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold.”       [removed] “Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine.”       [removed] “Cytokine actions are self-limiting in that activation of one precludes activation of other cytokines with similar actions.”

 

Question 21. 21. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 0.4)       [removed] The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.       [removed] Viruses are killing some of his B cells and becoming incorporated into the genomes of others.       [removed] The EBV inhibits the maturation of white cells within his peripheral lymph nodes.       [removed] The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

 

Question 22. 22. Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely: (Points : 0.4)       [removed] Chlamydial       [removed] Viral       [removed] Mycoplasmal       [removed] Bacterial

 

Question 23. 23. A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections? (Points : 0.4)       [removed] Viruses have limited or absent genetic material of their own.       [removed] Some viruses are capable of transforming normal host cells into malignant cells.       [removed] Viruses are often implicated in cases of transmissible neurodegenerative disease.       [removed] Viruses require stimulation after a latent period before they are able to produce symptoms.

 

Question 24. 24. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 0.4)       [removed] A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use       [removed] A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM       [removed] A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells       [removed] A 9-year-old girl who has a diagnosis of IgA deficiency

 

Question 25. 25. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child’s recurrent infections? (Points : 0.4)       [removed] Antibody production by plasma cells is compromised because of impaired communication between B and T cells.       [removed] The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.       [removed] The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.       [removed] The child lacks the antigen presenting cells integral to normal B-cell antibody production.

 

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology. 3PAGESUSE APA FORMAT CITING 3 SOURCES

Learning Resources

Required Readings (click to expand/reduce) 

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. Chapter 1, Neural Sciences Chapter 2, Contributions of the Psychosocial Sciences Chapter 3, Contributions of the Sociocultural Sciences Chapter 4, Theories of Personality and Psychopathology Chapter 31.17c, Child Psychiatry: Other Conditions: Identity Problem 

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3–14). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000065-001

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 127–147). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000064-006

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 65–90). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000064-004

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 15–36). American Psychological Association. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1037/0000065-002

Case Study, Chapter 31, Assessment and Management of Patients With Hypertension

1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of the medications and she recently lost her job to outsourcing. The patient is slightly drowsy and complains of a headache and blurred vision. The patient’s blood pressure is 220/130 mm Hg upon presentation.

(Learning Objective 6)

1. According to the definitions set by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which type of hypertensive crisis is the patient currently experiencing?
2. Describe the treatment goals for handling the hypertensive crisis and apply the goals to the case study. Determine the current mean arterial pressure (MAP) and the goals for treatment.

The physician orders nicardipine hydrochloride (Cardene) 25 mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and titrate by 2.5 mg/hr every 15 minutes to reach the goal for the first hour, which is to achieve 25% reduction of the initial MAP. 

• Call the physician if the dosing range of 15 mg/hr has been reached and the MAP is still not at target goal for the first hour of treatment, or up to four dose increases.
• Lower the BP within 6 hours to 160/100 mm Hg.
• Adjust the IV rate so that the IV fluids plus the nicardipine IV drip are equal to 100 mL/hr, in total. Call the physician if the IV fluids must go above 100 mL/hr to provide the nicardipine.

c. Explain what rate to set initially for both the nicardipine drip and the NS maintenance fluids.

d. Explain the process of titrating the nicardipine drip for the first hour to achieve the final MAP goal of 25% reduction of the original MAP. 

2. The community health nurse is preparing a program about hypertension for a local community center. The focus of the program is on the reduction of risk factors and compliance for those who have been diagnosed with high blood pressure. The target population includes older adults. (Learning Objectives 1 to 4) 

1. The nurse focuses on primary hypertension because it accounts for 90% to 95% of hypertension in the United States. What risk factors does the nurse include for this population?
2. The nurse prepares to discuss the changes in how the JNC 7 defines hypertension. What ranges and descriptions should the nurse include?
3. Because this is a gerontologic audience, the nurse needs to review why blood pressure increases with age. Explain how the structural and functional changes of aging contribute to higher blood pressure in the older adult.
4. What information does the nurse include about lifestyle modifications that may decrease risk of hypertension (or complications associated with diagnosed hypertension)?