When you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.

From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.

As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.

Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.

Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.

By Day 3 of Week 5

Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific a

Resources provided

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Chapter 22, “Data Mining as a Research Tool” (pp. 477-493)

Chapter 24, “Bioinformatics, Biomedical Informatics, and Computational Biology” (pp. 537-551)

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y., Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. 

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Laureate Education (Producer). (2018). Health Informatics and Population Health: Analyzing Data for Clinical Success [Video file]. Baltim

The Assignment: 5 pages

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Week 4 Project

Study the resources in your community related to the illness group chosen in Week 1 (Attached). In a Microsoft Word document of 4-5 pages formatted in APA style, describe the resources, including the following information:

·  Identify and discuss a minimum of three community or national resources for your illness group preferably in your community.

·  Include in your response all the information the patient should know about the services.

o  Benefits

o  Specific services they offer.

o  Fee schedules, if and when appropriate.

o  Criteria for eligibility.

o  Application process.

o  Availability of transportation.

·  Discuss integration of these resources into a plan of care.

·  Discuss potential advantages and disadvantages for vulnerable populations in seeking these resources.

Support your responses with examples and information from library resources, textbook and lectures.

·  Papers are professional papers so you should use third person.  Try not to use first or second person when completing.  Review APA format.

Please note that the title and reference pages should not be included in the total page count of your paper.

On a separate references page, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the  University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.

· 

QUESTION 1

1. A 67-year-old Caucasian woman was brought to the clinic by her son who stated that his mother had become slightly confused over the past several days. She had been stumbling at home and had fallen once but was able to ambulate with some difficulty. She had no other obvious problems and had been eating and drinking. The son became concerned when she forgot her son’s name, so he thought he better bring her to the clinic.  
   PMH-Type II diabetes mellitus (DM) with peripheral neuropathy x 20 years. COPD. Depression after death of spouse several months ago 
   Social/family hx – non contributary except for 30 pack/year history tobacco use.  
   Meds: Metformin 500 mg po BID, ASA 81 mg po qam, escitalopram (Lexapro) 5 mg po q am started 2 months ago 
   Labs-CBC WNL; Chem 7- Glucose-92 mg/dl, BUN 18 mg/dl, Creatinine 1.1 mg/dl, Na+120 mmol/L, 
   K+4.2 mmol/L, CO237 m mol/L, Cl-97 mmol/L.  
   The APRN refers the patient to the ED and called endocrinology for a consult for diagnosis and management of syndrome of inappropriate antidiuretic hormone (SIADH). 

   Question:
   Define SIADH and identify any patient characteristics that may have contributed to the development of SIADH.

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 2

1. A 43-year-old female presents to the clinic with a chief complaint of fever, chills, nausea and vomiting and weakness. She has been unable to keep any food, liquids or medications down. The symptoms began 3 days ago and have not responded to ibuprofen, acetaminophen, or Nyquil when she tried to take them. The temperature has reached as high as 102˚F.  

    Allergies: none known to drugs or food or environmental  

    Medications-20 mg prednisone po qd, omeprazole 10 po qam 

    PMH-significant for 20-year history of steroid dependent rheumatoid arthritis (RA). GERD. No other significant illnesses or surgeries. 

   Social-denies alcohol, illicit drugs, vaping, tobacco use 

   Physical exam 

   Thin, ill appearing woman who is sitting in exam room chair as she said she was too weak to climb on the exam table. VS Temp 101.2˚F, BP 98/64, pulse 110, Resp 16, PaO2 96% on room air.  

   ROS negative other than GI symptoms. 

   Based on the patient’s clinical presentation, the APRN diagnoses the patient as having secondary hypocortisolism due to the lack of prednisone the patient was taking for her RA secondary to vomiting.

   Question:

   Explain why the patient exhibited these symptoms? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 3

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had about of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
   The APRN examining the patient orders a Chem 7 which revealed a serum Ca++ of 13.1 mg/dl. The APN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
   Question:
   What is the role of parathyroid hormone in the development of primary hyperparathyroidism? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 4

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  

   The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 

   Question 1 of 2:

   Explain the processes involved in the formation of renal stones in patients with hyperparathyroidism. 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 5

1. A 64-year-old Caucasian female presents to the clinic with vague symptoms of non- specific abdominal pain, myalgias, constipation, polyuria, and says she feels “fuzzy headed” much of the time. She had a fracture of her right metatarsal without trauma and currently is wearing a walking boot. She also had a bout of kidney stones a few weeks ago and she fortunately was able to pass the small stones without requiring lithotripsy or other interventions. She was told by the urologist to follow up with her primary care provider after the kidney stones has resolved.  
   The APRN examining the patient orders a Chem 12 which revealed a serum Ca++ of 13.1 mg/dl. The APRN believes the patient has primary hyperparathyroidism and refers the patient to an endocrinologist who does a complete work up and concurs with the APRN’s diagnosis. 
   Question 2 of 2:
   Explain how a patient with hyperparathyroidism is at risk for bone fractures.  

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 6

1. A 64-year-old Caucasian female who is 4 weeks status post total parathyroidectomy with forearm gland insertion presents to the general surgeon for her post-operative checkup. She states that her mouth feels numb and she feels “tingly all over. The surgeon suspects the patient has hypoparathyroidism secondary to the parathyroidectomy with delayed vascularization of the implanted gland. She orders a Chem 20 to determine what electrolyte abnormalities may be present. The labs reveal a serum Ca++ of 7.1 mg/dl (normal 8.5 mg/dl-10.5 mg/dl) and phosphorous level of 5.6 mg/dl (normal 2.4-4.1 mg/dl).  

   Question:

   What serious consequences of hypoparathyroidism occur and why? — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 7

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  

   Question 1 of 6:

   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polydipsia.”

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 8

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 2 of 6:

   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyuria.”

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 9

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 3 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “polyphagia.”

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 10

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  

   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  

   Allergies-none know  

   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 

   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 

   Labs in office: random glucose 220 mg/dl.  

   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 4 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “weight loss.”

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 11

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 5 of 6:
   The patient exhibited classic signs of Type 1 diabetes. Explain the pathophysiology of “fatigue.”

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 12

1. A 17-year-old boy is brought to the pediatrician’s office by his parents who are concerned about their son’s weight loss despite eating more, frequent urination, unquenchable thirst, and fatigue that is interfering with his school/work activities. He had been seemingly healthy until about 3 months ago when his parents started noticing these symptoms but put these symptoms down to his busy schedule including a part time job. He admits to sleeping more and tires very easily. He denies any other symptoms.  
   PMH-noncontributory. No surgeries or major medical problems. Usual colds and ear infections as a child  
   Allergies-none know  
   Family history- maternal uncle with “some kind of sugar diabetes problem” but parents unclear on the exact disease process 
   Social-denies alcohol, tobacco or illicit drug use. Not sexually active. Junior at local high school and works in a fast food store after school and on weekends. 
   Labs in office: random glucose 220 mg/dl.  
   Based on his symptoms and the glucose level, the pediatrician makes a tentative diagnosis of Diabetes Mellitus type 1 and refers the boy and his parents to an endocrinologist for further work up and management plan.  
   Question 6 of 6:
   How do genetics and environmental factors contribute to the development of Type 1 diabetes?

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 13

1. A 17-year-old boy recently diagnosed with Type I diabetes is brought to the pediatrician’s office by his parents with a chief complaint of “having the flu”. His symptoms began 2 days ago, and he has vomited several times and has not eaten very much. He can’t remember if he took his prescribed insulin for several days because he felt so sick. Random glucose in the office reveals glucose 560 mg/dl and the pediatrician made arrangements for the patient to be admitted to the hospitalist service with an endocrinology consult.  

   BP 124/80mmHg; HR 122bpm; Respirations 32 breaths/min; Temp 97.2˚F; PaO297% on RA 

   Admission labs: Hgb 14.6 g/dl; Hct 58% 

   CMP- Na+ 122mmol/L; K+ 5.3mmol/L; Glucose 560mg/dl; BUN 52mg/dl; Creatinine 4.9mg/dl;  

   Cl- 95mmol/L; Ca++ 8.8mmol/L; AST (SGOT) 248U/L; ALT 198U/L; CK 34/35 IU/L; Cholesterol 198mg/dl;  

   Phosphorus 6.8mg/dl; Acetone Moderate; LDH38U/L; Alkaline Phosphatase 132U/L. 

   Arterial blood gas values were as follows: pH 7.09; Paco220mm Hg; Po2100mm Hg; Sao2 98% (room air) 

   HCO3-7.5mmol/L; anion gap 19.4 

   A diagnosis of diabetic ketoacidosis was made, and the patient was transferred to the Intensive Care Unit (ICU) for close monitoring.  

   Question:

   The hormones involved in intermediary metabolism, exclusive of insulin, that can participate in the development of diabetic ketoacidosis (DKA) are epinephrine, glucagon, cortisol, growth hormone. Describe how they participate in the development of DKA.

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 14

1. A 67-year-old African American male presents to the clinic with a chief complaint that he has to “go to the bathroom all the time and I feel really weak.” He states that this has been going on for about 3 days but couldn’t come to the clinic sooner as he went to the Wound Care clinic for a dressing change to his right great toe that has been chronically infected, and he now has osteomyelitis. Patient with known Type II diabetes with poor control. His last HgA1C was 10.2 %. He says he can’t afford the insulin he was prescribed and only takes half of the oral agent he was prescribed. Random glucose in the office revealed glucose of 890 mg/dl. He was immediately referred to the ED by the APRN for evaluation of suspected hyperosmolar hyperglycemic non ketotic syndrome (HHNKS). Also called hyperglycemic hyperosmolar state (HHS).  

   Question:

   Explain the underlying processes that lead to HHNKS or HHS.

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 15

1. A 32-year-old woman presented to the clinic complaining of weight gain, swelling in her legs and ankles and a puffy face. She also recently developed hypertension and diabetes type 2. She noted poor short-term memory, irritability, excess hair growth (women), red-ruddy face, extra fat around her neck, fatigue, poor concentration, and menstrual irregularity in addition to muscle weakness. Given her physical appearance and history, a tentative diagnosis of hypercortical function was made. Diagnostics included serum and urinary cortisol and serum adrenocorticotropic hormone (ACTH). MRI revealed a pituitary adenoma.  

   Question:

   How would you differentiate Cushing’s disease from Cushing’s syndrome? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 16

1. A 47-year-old female is referred to the endocrinologist for evaluation of her chronically elevated blood pressure, hypokalemia, and hypervolemia. The patient’s hypertension has been refractory to the usual medications such as beta blockers, diuretics, and angiotensin-converting enzyme (ACE) inhibitors. After a full work up including serum and urinary electrolyte levels, aldosterone suppression test, plasma aldosterone to renin ratio, and MRI which revealed an autonomous adenoma, the endocrinologist diagnoses the patient with primary hyper-aldosteronism.  

   Question:

   What is the pathogenesis of primary hyper-aldosteronism? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 17

1. A 47-year-old African American male presents to the clinic with chief complaints of polyuria, polydipsia, polyphagia, and weight loss. He also said that his vison occasionally blurs and that his feet sometimes feel numb.  He has increased hunger despite weight loss and admits to feeling unusually tired. He also complains of “swelling” and enlargement of his abdomen.  

   Past Medical History (PMH) significant for HTN fairly well controlled with and ACE inhibitor; central obesity, and dyslipidemia treated with a statin, Review of systems negative except for chief complaint. Physical exam unremarkable except for decreased filament test both feet. Random glucose in office 290 mg/dl. The APRN diagnoses the patient with type II DM and prescribes oral medication to control the glucose level and also referred the patient to a dietician for dietary teaching. 

   Question:

   What is the basic underlying pathophysiology of Type II DM? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 18

1. A 21-year-old male was involved in a motorcycle accident and sustained a closed head injury. He is waking up and interacting with his family and medical team. He complained of thirst that doesn’t seem to go away no matter how much water he drinks. The nurses note that he has had 3500 cc of pale-yellow urine in the last 24 hours. Urine was sent for osmolality which was reported as 122 mOsm/L. A diagnosis of probable neurogenic diabetes insipidus was made.  

   Question:

   What causes diabetes insipidus (DI)? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 19

1. A 43-year-old female patient presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and palpitations. She states she had had the symptoms for several months but attributed the symptoms to beginning to care for her elderly mother who has Alzheimer’s Disease. She has lost 15 pounds in the last 3 months without dieting. Her past medical history is significant for rheumatoid arthritis that she has had for the last 10 years well controlled with methotrexate and prednisone. Physical exam is remarkable for periorbital edema, warm silky feeling skin, and palpable thyroid nodules in both lobes of the thyroid. Pending laboratory diagnostics, the APRN diagnoses the patient as having hyperthyroidism, also called Graves’ Disease.

   Question:

   Explain how the negative feedback loop controls thyroid levels.

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 20

1. A 43-year-old female patient with known Graves’ Disease presents to the clinic with complaints of nervousness, racing heartbeat, anxiety, increased perspiration, heat intolerance, hyperactivity and severe palpitations. She states she had been given a prescription for propylthiouracil, an antithyroid medication but she did not fill the prescription as she claims she lost it. She had been given the option of thyroidectomy which she declined. She also notes that she is having trouble with her vision and often has blurry eyes. She states that her eyes seem “to bug out of her face”. She has had recurrent outs of nausea and vomiting. She was recently hospitalized for pneumonia.  Physical exam is significant for obvious exophthalmos and pretibial myxedema. Vital signs are temp 101.2˚F, HR 138 and irregular, BP 160/60 mmHg. Respirations 24. Electrocardiogram revealed atrial fibrillation with rapid ventricular response. The APRN recognizes the patient is experiencing symptoms of thyrotoxic crisis, also called thyroid storm. The patient was immediately transported to a hospital for critical care management. 

   Question:

   How did the patient develop thyroid storm? What were the patient factors that lead to the development of thyroid storm? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

1 points   

QUESTION 21

1. A 44-year-old woman presents to the clinic with complaints of extreme fatigue, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, and sleepiness. She also admits that she often bursts into tears without any reason and has been exceptionally forgetful. Her vision is occasionally blurry, and she admits to being depressed without any social or occupational triggers. Past medical history noncontributory. Physicalexam Temp 96.2˚F, pulse 62 and regular, BP 108/90, respirations. Dull facial expression with coarse facial features. Periorbital puffiness noted. Based on the clinical history and physical exam, and pending laboratory data, the ARNP diagnoses the patient with hypothyroidism.  

   Question:

   What causes hypothyroidism? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 22

1. A 44-year-old woman is brought to the clinic by her husband who says his wife has had some mental status changes over the past few days. The patient had been previously diagnosed with hypothyroidism and had been placed on thyroid replacement therapy but had been lost to follow-up due to moving to another city for the husband’s work approximately 4 months ago. The patient states she lost the prescription bottle during the move and didn’t bother to have the prescription filled since she was feeling better. Physical exam revealed non-pitting, boggy edema around her eyes, hands and feet as well as the supraclavicular area. The APRN recognizes this patient had severe myxedema and referred the patient to the hospital for medical management.  

   Question:

   What causes myxedema coma? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 23

1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
   Question 1 of 2:

   What is a pheochromocytoma and how does it cause the classic symptoms the patient presented with? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

0.5 points   

QUESTION 24

1. A 53-year-old woman presents to the primary care clinic with complaints of severe headaches, palpitations, highblood pressure and diaphoresis. She relates that these symptoms come in clusters and when she has these “spells”, she also experiences, tremor, nausea, weakness, anxiety, and a sense of doom and dread, epigastric pain, and flank pain. She had one of these spells when she was at the pharmacy and the pharmacist took her blood pressure which was recorded as 200/118. The pharmacist recommended that she immediately be evaluated for these symptoms. Past medical history significant for a family history of neurofibromatosis type 1 (NF1). Based on the presenting symptoms and family history of NF1, the APRN suspects the patient has a pheochromocytoma. Laboratory data and computerized tomography of the abdomen confirms the diagnosis. 
   Question 2 of 2:
   What are the treatment goals for managing pheochromocytoma? 

   — Font family —- Font size —- Format –HeadingSub Heading 1Sub Heading 2ParagraphFormatted Code– Font family –Andale MonoArialArial BlackBook AntiquaComic Sans MSCourier NewGeorgiaHelveticaImpactSymbolTahomaTerminalTimes New RomanTrebuchet MSVerdanaWebdingsWingdings– Font size –1 (8pt)2 (10pt)3 (12pt)4 (14pt)5 (18pt)6 (24pt)7 (36pt)Path: pWords:0

PLEASE FOLLOW THE INSTRUCTION BELOW 

FIVE REFERENCES

ZERO PLAGIARISM

Students will:

• Assess client families presenting for psychotherapy
• Develop genograms for client families presenting for psychotherapy

To prepare:

• Select a client family that you have observed or counseled at your practicum site.
• Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
• Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

Assignment

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

• Demographic information
• Presenting problem
• History or present illness
• Past psychiatric history
• Medical history
• Substance use history
• Developmental history
• Family psychiatric history
• Psychosocial history
• History of abuse and/or trauma
• Review of systems
• Physical assessment
• Mental status exam
• Differential diagnosis
• Case formulation
• Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).