Comment 1

If you are trying to decide whether to use a z-test or a t-test, you are trying to determine how well your sample size represents the entire population. A larger sample size will better represent the entire population to a certain point because after a certain size, t and z distributions begin to look the same. If a sample size is to small it will be less representative of the entire population and it is more likely to either miss characteristics of the entire population or over emphasize characteristics. There are different critical values for distributions t and z (Foltz, 2012).

The z-test chart would be best to use with sample sizes over 30 and represents what is considered a normal distribution. If you want to know how many people in a school scored over 95 on a test and you know the average is 85 with a standard deviation of 15, and you take a sample size of 40 people, this would be a good time to use the z-test (Foltz, 2012).

The t-test chart would be best to use with smaller sample sizes and allows greater room for error. The distribution of the t-test curve is more platykurtic when compared to normal distribution or the curve for the z-test. If you wanted to know how many people in a school scored over 95 on a test and you know the average is 85 with a standard deviation of 15, and you take a sample size of 20 people, this would be a good time to use the t-test. The benefit of using the t-distribution is that you can use a smaller sample size with the understanding that there may be a greater margin of error (Foltz, 2012).

It may also be appropriate to use the t-test if the population standard deviation is unknown (Grove & Cipher, 2017).

Comment2

Z-test and T-test are methods for hypothesis testing (which is the main goal of statistics). Hypothesis testing determines which statements about the population is most reliable based on data available.

For example, a hypothesis that claims those individuals who take Airborne regularly are less likely to become sick during influenza season than those who do not take the supplement. A hypothesis test can be done by giving sample (sample of 40 individuals for instance) doses of Airborne for a certain period of time compared to a control group.

Z-test is utilized for larger set of data or when sample size is greater than 30 (n ≥ 30). Based on the previous example, there were 40 individuals mentioned. Therefore, Z-test is more appropriate to use over T-test. Z-test is done to compare two groups when population variance (standard deviations) are known. Therefore, when standard deviation is known, z-core can be calculated. With normal distribution, researcher can determine probabilities using mean from the sample. This method allows researcher to compare scores from different normal distributions.

Sometimes, samples are small so T-tests are used. T-test is more applicable when participants are less than 30 (n ≤ 30). T-test is applicable when standard deviation is not known and when certain data sets are not suited for analysis using normal distribution. While z-test follows normal distribution, t-test follows t-distribution (or Student’s t-distribution).

In a short essay (500-750 words), answer the Question at the end of Case Study 2. Cite references to support your positions.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to LopesWrite.

This is the case study:

Max Points: 20.0

Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
5. Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)

Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

By day 2 (Tuesday) post a brief description of how epidemiology can be used to evaluate health services. Then describe an example of an epidemiological study that has been used to evaluate a screening program, include the methodological issues that an epidemiologist may face while conducting these epidemiological studies. Your post must be written in APA format.

   APA Format.

-Introduction or abstract page  

-Summary or Conclusion page  

 -Four pages minimum, no including Introduction or abstract,  summary or conclusion, and Bibliography pages  

 -It is completely unacceptable to Copy and Paste from the Internet, or other resources  

 -Bibliography has to be in APA Format, minimum 3, no more than 3 years old.

APA format 3 peer review references 1 page long 

 

Geriatrics 

Aging is a normal part of life and every person plays the course a little differently. As an advanced practice registered nurse (APRN) it is important to understand the aging process and how each body system changes throughout that time. Older individuals process drug therapy differently and it is important to note the changes that may need to be made to their medication regimen as a patient gets older (Arcangelo, Peterson, Wilbur, & Reinhold, 2017, p. 73). 

Older adults have numerous barriers that they need to overcome, such as multiple medications due to several medical problems. A lag in memory may lead to improper medication administration. Furthermore, a long list of medications could lead to adverse mediation reactions (Arcangelo et al., 2017, p. 73). 

Cardiovascular Patients

When looking at the cardiovascular system you are considering the make-up of the vascular system and the heart muscle. The blood flow to each of the body’s organs is vital for its survival. Furthermore, medications you give for heart conditions can change the way the heart pumps, how fast it pumps, and how much pressure is within the heart. Each of these factors is extremely important as medications are dosed and determined. 

Response to Drug Therapy

Older adults typically have a delayed response to gastric emptying, therefore, this will delay medication absorption. There is also a decreased amount of gastric secretions which will affect mediation absorption (Arcangelo et al., 2017, p. 74). 

Older adults naturally have a lower amount of albumin, which is a protein that aids in mediation metabolism. For example, some medications, like propranolol, bind to protein sites. Propranolol is often given for high blood pressure, chest pain, or atrial fibrillation. When the patient takes up less binding sites, the medications takes up more sites and toxicity can occur in the patient. For a patient taking Propranolol, his or her blood pressure may drop more than needed is the dose isn’t adjusted with age (Arcangelo et al., 2017, p. 74). 

A drop in lean body mass and an increase in total fat also often occur. This is important to note because some medications are absorbed better by lean body mass and the medication will stay in the elderly patient’s body longer because they don’t have much for lean body mass (Arcangelo et al., 2017, p. 74-75). 

The liver metabolizes most of the drugs in the body. In the elderly patients, you see less blood flow and a smaller liver. Again, smaller medication dosages may be needed to prevent hepatic toxicity (Arcangelo et al., 2017, p. 75)

Drug excretion typically happens in the kidneys. Blood flow in the kidneys decreases after the age of 40, so it when giving medications you may have to leave more time between doses to ensure proper clearance (Arcangelo et al., 2017, p. 75). 

Drug Therapy

When treating a medical condition like hypertension, the patient will often be prescribed two medications from different classes to fix the problem. This can be beneficial for the patient because less of each medication is being asked to be metabolized through the body. There is a smaller risk the patient will have toxicity of the drug (Huether & McCance, 2017, p. 604).  

Furthermore, there are disadvantages for patients taking multiple medications. For example, they are more likely to have a medication reaction. Polypharmacy is a probing problem for older adults, and it cause confusion for these individuals. By keeping there mediations regimen small, compliance is more likely to occur (Agbonjinmi, 2017). 

Agbonjinmi, L. A. (2017). Polypharmacy: Inappropriate median use in elderly and its associated 

effects. West African Journal Of Nursing, 28(1), 56-65.

Arcangelo, V. P., Peterson, A. M., Wilbur, V. &  Reinhold, J. A.  (Eds.). 

(2017). Pharmacotherapeutics  for advanced practice: A practical approach (4th ed.). 

Ambler, PA:  Lippincott Williams & Wilkins.

Huether, S. E., & McCance, K. L. (2017). Understanding  pathophysiology (6th ed.). St. Louis, 

MO: Mosby.