The Case of Will Smithers: To Exhume or not Exhume 2025

The Case of Will Smithers: To Exhume or not Exhume, that is the Question A surprising amount of information can be gleaned about an individual just from one’s tissues. In this case, you have been assigned to shadow histopathologist Dr. Jonas Riehm as he attempts to identify the cause of death of 42-year-old Will Smithers. Mr. Smithers’s body was discovered sitting in his car near an alley several miles from his home. There was no obvious cause of death, necessitating an autopsy to determine if the death was from natural causes or foul play. However, due to a clerical error, the decedent’s body was released and interred before a proper autopsy could be performed, and an official cause of death was not established. Fortunately, several tissue samples were taken before the interment and remain available for examination. Mr. Smithers’s family does not wish to have his body exhumed, so local law enforcement professionals have asked Dr. Riehm to examine the tissue samples in the hopes of determining his cause of death and whether or not an exhumation is needed. The following sections have been taken from the official report that Dr. Riehm sent to the local coroner’s office. You are to report to Dr. Riehm’s office with your anatomy and physiology textbook. He expects students to answer questions related to the work that he does in his histopathology laboratory. Dr. Riehm enjoys teaching, and has a collection of microscope slides that he uses to introduce students to the fascinating universe of histology. He starts with the following definition: histology is the study of the normal structure of tissues. Although Dr. Riehm is an expert in the study of the diseases and abnormalities of tissues, histopathology, he is a firm believer that you must be able to recognize normal tissue before you can understand diseased tissue. He has set up four microscope stations for students to get familiar with how the microscopes function and to view slides of normal tissues. Each station has a microscope with a slide of one of the four primary tissue types. (a) Define tissue and organ, and then describe how each fits into the levels of body organization. (b) Describe what you would expect to observe on the epithelial tissue slide. What are the general functions of this tissue? (c) Describe what you would expect to see on the connective tissue slide. What are the general functions of this tissue? (d) Describe what you would expect to see on the muscle tissue slide. What are the general functions of this tissue? (e) Describe what you would expect to observe on the nervous tissue slide. What are the general functions of this tissue? Satisfied that you are properly introduced to the concepts of normal tissue, Dr. Riehm begins to fill you in on the details of Mr. Smithers’s case, whose tissue samples have coincidentally arrived just in time for your shadowing visit. The first set of slides included an epithelium sample taken from Mr. Smithers’s forehead. The slide was taken from some oddly colored patches of skin that revealed some abnormal cells, specifically, squamous cell carcinoma. These cancerous cells were in the early stages of the disease and had not spread, or metastasized, to cause disease in other tissues. Dr. Riehm documented that while there was pathology noted in the epithelial slides provided, the squamous cell carcinoma, this was not the cause of Mr. Smithers’s death. Dr. Riehm continued to ask questions about epithelial tissues. Dr. Riehm has asked you to look at the epithelial tissue slide from the skin of Mr. Smithers’s forehead, and describe how the normal epithelium appeared. (a) Describe the difference between simple and stratified epithelium. Which type would you expect to see in Mr. Smithers’s tissue slide? (b) What are the different shapes that epithelial cells can assume in different epithelial tissues? Which cell shape would you expect to see in Mr. Smithers’s tissue slide; what type of specific epithelium is found in the skin? How would you describe the other two cell shapes? (c) Define what the basement membrane is and discuss the functions of its two components. (d)Which cellular junctions would you expect to find holding these cells to one another? (e) Describe where the apical, basal, and lateral surfaces of an epithelial cell are located. Dr. Riehm began to review the next set of tissue samples, which included slides prepared from liver tissue and blood smears. He began with the slides taken from the liver and documented the following: the microscopic evaluation of the liver tissue is abnormal. Large deposits of adipose tissue can be seen interspersed throughout the normal structure of the liver tissue that is suggestive of hepatic lipidosis, or fatty liver. The most likely cause of hepatic lipidosis is excessive alcohol consumption, but this would need to be corroborated by further investigation outside the scope of this inquiry. For the record, he documented his findings of hepatic lipidosis. He then explained to you that these findings only indicate that the patient had tissue evidence of an unhealthy behavior, likely alcoholism, which could be a contributing factor in his cause of death but unlikely the cause itself. His family and friends would need to fill in the details about Mr. Smithers’s personal life. This wasn’t enough individually to warrant an exhumation of the body, nor was it enough to establish the cause of death as liver failure. He explained that this is a common histological finding in several long-standing illnesses, but in particular hepatitis, obstructive jaundice, and acute and chronic alcoholism with liver disease. This was still not enough to establish a cause of death but it was more information that would support an exhumation order by the state authorities. A review of Mr. Smithers’s medical history or a report from his personal physician would be helpful in determining the relevance of this finding. Dr. Riehm moved on to Mr. Smithers’s peripheral blood smear slides. The erythrocytes appeared abnormally large, which provided more evidence that Mr. Smithers had done some significant damage to his body and tissues with alcohol consumption. Dr. Riehm documented his findings from the blood smear as abnormal, having found these large round erythrocytes called macrocytes. This condition called megaloblastic anemia leads to fewer normal cells, which limits the amount of oxygen and metabolic waste products that can be transported. This is a common finding in the peripheral blood smears of alcoholic patients with anemia. Many people suffering from alcohol dependence also have nutritional deficiencies, including poor intake of vitamin B12 and folate, both of which are critical for the normal development of erythrocytes in the bone marrow. Dr. Riehm asked you to quickly finish your work on the connective tissue slides and take a look at the new set of cardiac muscle samples. Has he finally found something that could have caused Mr. Smithers’s death? Dr. Riehm has been keeping you busy cataloging the slides that he has finished with while he prepares to review the slides of Mr. Smithers’s cardiac muscle tissue. Dr. Riehm described regions of necrosis, or dead tissue, as he explains, where cardiac muscle cells have died after being separated from the blood supply. This finding indicated that Mr. Smithers had a myocardial infarction or heart attack. Before you are able to even speculate “Was this the cause of Mr. Smithers’s death,” Dr. Riehm poses this question—are heart attacks always fatal, or in other words, can we determine from this slide that this event preceded and therefore caused Mr. Smithers’s death? People survive heart attacks, don’t they? Dr. Riehm would need to look at the slides more closely later in the day before he completed this portion of his report. He was not ready to sign off on myocardial infarction as the cause of death just yet. Dr. Riehm reviewed the remaining slides in the set. He selected a blood vessel slide and discovered hypertrophy, or an enlargement of the smooth muscle, and damage to the endothelium lining the vessel walls. Both were signs of vascular disease, as was the finding of atherosclerosis, or plaque, which had probably clogged Mr. Smithers’s arteries and veins. All of these were pathological findings that supported a diagnosis of vascular disease. Vascular disease increases the likelihood of myocardial infarction. Mix the cardiovascular findings with fatty liver disease, anemia, and enough alcohol, and that could explain this man’s death. But it would still be speculation. All of these certainly could lead to a myocardial infarction, no doubt. There was evidence that a cardiac event had happened at some point in Mr. Smithers’s life. Like his fatty liver, these findings indicated that Mr. Smithers was unhealthy. A review of Mr. Smithers’s medical history or a report from his personal physician would be helpful in determining the relevance of these finding. A pathologist would probably need to see the actual heart itself to make a cause of death by myocardial infarction determination. Dr. Riehm reminded you to get those slides filed away so we could move on to the last set of samples from Mr. Smithers’s brain tissue. Dr. Riehm suggested that you make flashcards of the following information: (a) briefly describe the structural characteristics and functions of skeletal muscle; (b) briefly describe the structural characteristics and functions of cardiac muscle; (c) briefly describe the structural characteristics and functions of smooth muscle; and (d) discuss the similarities and differences between the three different muscle tissue types. Finally, being thorough, Dr. Riehm wanted to review his assessment of the cardiac tissue slides. Finding evidence of fibrous tissue interspersed among cardiac muscle cells indicated that the heart had tried to heal itself. Mr. Smithers would have had to have been alive long enough for scar tissue to form in his heart. The evidence from the cardiac tissue was consistent with an old myocardial infarction that Mr. Smithers survived. There was no evidence in the tissue samples to suggest that he had had an acute myocardial infarction. Dr. Riehm could only document what he observed in a small amount of cardiac tissue. Mr. Smithers could have had an acute and fatal myocardial infarction in a region of the heart from which no tissue samples were collected. For what he observed from the available tissue slide, however, a cardiac event as the cause of his death was unlikely. His report would undoubtedly leave more unanswered questions about the cause of Mr. Smithers’s death. A full gross examination of Mr. Smithers’s heart would be needed, which would obviously require that his body be exhumed. Dr. Riehm has found evidence of fibrosis in the cardiac muscle tissue slides, scattered throughout the dead cardiac muscle cells. This suggested that Mr. Smithers had survived that particular cardiac event. Which of the following statements is true with regard to how cardiac muscle tissue is repaired? Cardiac muscle cells are only capable of regeneration if the degree of damage is minimal. Extensive damage results in healing by fibrosis. Cardiac muscle cells are incapable of tissue regeneration because they are no longer capable of dividing by mitosis. Damaged cardiac tissue is replaced with scar tissue. Cardiac muscle cells differentiate into fibroblasts and regenerate functional cardiac tissue through the process of fibrosis. Fibroblasts secrete cardiac tissue ECM and once surrounded differentiate into mature cardiac muscle cells. This leads to regeneration of fully functional cardiac tissue. WRAPPING UP THE CASE Based on his findings, Dr. Riehm is fairly confident that the cause of Mr. Smithers’s death could not be determined based on an examination of tissue slides alone. Given the liver and vascular disease, he certainly wasn’t healthy, and a heart attack is a common outcome associated with both conditions. However, one question remains unanswered: the damage to the brain. This could have been the result of an accident or deliberate blunt force trauma. Mr. Smithers’s body would need a full autopsy to answer these questions. Tissue slides could provide details not seen with the naked eye but a close look at the body is required—this could be a criminal case. Mr. Smithers’s remains would need to help answer these questions. Due to the unknown cause of head trauma, Dr. Riehm recommends that Mr. Smithers’s body be exhumed so that it can be examined more closely. The details of the pathology will be available in the continuation of Mr. Smithers’s case (see Chapter 12). Assignment Expectations Length: 750 – 1250 words Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. Be sure to include an introduction and conclusion paragraph for the assignment. References : Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

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Health Care Delivery Models and Nursing Practice 2025

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment. Include the following: 1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility. 2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations. 3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings. 4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care. 5) Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes. You are required to cite to a minimum of three sources to complete this assignment. Sources must be from GCU library and 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. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite.

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Ethical and Legal Implications of Prescribing Drugs 2025

For the Week 1 Assignment , you will explore the ethical and legal implications of the following scenario, and consider how to appropriately respond: As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult. Review the scenario assigned by your Instructor for this Assignment. Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor. Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family. Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors. By Day 7 of Week 1 Write a 2- to 3-page paper that addresses the following: Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family. Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state. Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. Explain the process of writing prescriptions, including strategies to minimize medication errors. MUST HAVE 4 REFERENCES LESS THAN 5 YEARS OLD (2015 OR NEWER) APA 7 FORMAT TITLE PAGE, AND REFERENCE PAGE

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Essay two to three pages 2025

Based upon your reading of Dr. Christina Sommers’ article on Virtue Ethics and & the video lecture by Tamar Gendler on the same topic, write a 2 to 3 page essay (double-spaced; MS doc file or rtf) answering the questions given in the instructions. You must support your analysis with at least two short quotations from the reading and/or video, properly notated. Proper MLA or APA in text citations are required. Each quotation must be no more than 40 words. Topic Instructions are given below. Instructions: Based upon your reading of Dr. Christina Sommers’ article on Virtue Ethics & the video lecture by Tamar Gendler on the same, write a 2 to 3 page essay (double-spaced) on what virtue ethics is and how each of these philosophers explains it. You will need to answer the following questions: According to Sommers, what is the main problem today and what is her basic answer both in terms of content and scope? And then, from the lecture by Dr. Gendler, explain how we can turn normative commitments into descriptive laws and what does it mean to do that, according to her explanation of Aristotle’s virtue ethics (video link)? Do you think it is fair to say that virtue ethics, as Tamar Gendler explains this moral theory, is a type of human programming and, if so, does this view challenge or undercut the idea of good human behavior as a matter of choice rather than response without thought? Explain. Do you think this approach of Professor Gendler to how virtue ethics becomes part of us goes along with Professor Sommers’ thesis on what is needed in schools today or not? Explain. Finally, what part of Christina Sommers’ analysis and proposal you find convincing, if any, and what part of it, if any, do you find questionable?

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NURS 6052 WEEK 5 ASSIGNMENT 2025

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course. Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available. Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research. The Assignment (Evidence-Based Project) Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Create a 6- to 7-slide PowerPoint presentation in which you do the following: Identify and briefly describe your chosen clinical issue of interest. Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article. Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

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