Instructions: Response must be at least 510 words written in current APA format with at least two academic references cited. References must be within the last five years.

J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.

5 DQ 2

“Continuous Quality Improvement (CQI) in Health Care is a structured organizational process that involves physicians and other personnel in planning and implementing ongoing proactive improvements in processes of care to provide quality health care outcomes.”

With high regards to positive patient outcomes, utilization of CQI is demonstrated daily in my position within the ICU. Collaborating with members of the health care team to strategize a treatment and wellness plan is completed every shift and as needed. Utilization of evidence based practice methods to ensure high quality and consistent outcomes when providing care. Precepting trainees utilizing the basic principles of CQI is also applied in the duties as a nurse.

 Continuous quality improvement (CQI) is the responsibility of all nurses and is vital when addressing the challenges of the health care industry. Provide an example of how you would apply CQI in your current or past position. 

 Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years 

 This week, we will have two case studies:

• Case of the Reluctant Associate
• From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice

These case studies will cover topics on leadership/management, which include making decisions and addressing concerns as a healthcare leader. You will have the opportunity to discuss a case among your fellow students and perform a written analysis on the case.

Your Learning Objectives for the Week:

• Evaluate issues on human behavior in healthcare organizational settings, including issues pertaining to leadership and change interventions to enhance organizational effectiveness.
• Interpret the formulation and implementation of business strategies in health care organizations, models of strategic management, and the role of stakeholders in the strategic management process.
• Critique healthcare reform process in the US health care system, reviewing major proposals for system reform currently under consideration including governance and accountability models.

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

• Textbook: Chapter 1, 2
• Lesson
• Minimum of 1 scholarly source (in addition to the textbook)

Initial Post Instructions
The study of ethics and philosophy is one that brings many different kinds of “thinkers” together. One person’s philosophy on ethics is another person’s philosophy on evil. We will be working this term on constructing personal ethical bases and understanding how ethical codes (both personal and professional) are created and followed.

To start us thinking about the different areas of philosophy and ethics, and how we fit into the different molds or world views, let’s imagine the following scenario:

It is 2019. The federal law banning female circumcision is still under appeal in the courts. You are a nurse assisting a plastic surgeon at a local hospital. The plastic surgeon comes from a country where they practice “female circumcision”. This practice is also sometimes called “female genital mutilation”.

Fire Eyes: Female Circumcision, Written by Soraya Mire, Directed by Soraya Mire, Ethnographer Soraya Mire, Narrated by Carol Christiansen (New York, NY: Filmakers Library, 1995), 57 minutes

You are not a member of the doctor’s culture, but reside in a state where this practice is still legal. The plastic surgeon has agreed to perform this practice on a young girl, the daughter of a friend of the surgeon. The friend has authorized the procedure. The girl only knows this is a custom. You did not know that today you would be asked to assist in this procedure. You can refuse to participate (your job may be on the line in the future due to that decision). Or, you can assist the surgeon. What ought you to do? We now want to examine the ethical issues involved. To do this, let’s look at the role of relativism, moral truths, and other issues.

Initial Post Instructions
For the initial post, address the following questions:

• What would a subjective moral relativist say about what this doctor is doing? Do you agree with the subjective moral relativist? Why or why not?
• Examine what a cultural moral relativist would say here. Do you agree with the cultural relativist? Why or why not?
• Name and evaluate general criticisms of cultural relativism as being the wrong moral approach.
• Is there an objective moral truth about any of the possible actions by the nurse and/or doctor in this case? Why or why not?

Think About: OUR NATIONAL BULLYING EPIDEMIC

No matter what your age or where you are from, you almost certainly experienced elementary school, middle school or high school bullying at some point in your childhood (either as a victim, a witness, or maybe even the perpetrator). Keep in mind that many of us actually fit into all three of these categories. Bullies have typically been bullied and bullying victims often go on to bully others. 

First Response Post: Whatever your perspective or place in the bullying aggression, try to remember how the school addressed the behavior. Answer the following questions: 

What was the response of the school administration (teachers, principal, counselors, etc)?  Was the response sufficient (did it stop the behavior)? If the response was not sufficient, what more could/should  the school administration have done?