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Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
3. Consider the course discussions so far and any insights gained from it.
4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

Data-Based Changes

Write an essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount. Review the rubric criteria for this assignment.

1. Identify one aspect of big data and data mining that is interesting to you. Explain the concept and how it might bring value to healthcare. 
2. Describe the concept of continuity planning. If you were the director or manager for your current workplace, describe the preparedness program you would recommend.
3. Locate an article discussing the use of informatics in healthcare education of the general public or of nursing students. Discuss the benefits and drawbacks to using technology in this situation and recommendations from the author. Do you feel this use of technology is a viable method of educating (the public or nursing students)? Why or why not?

Assignment Expectations:

Length: 500 words per essay prompt/section (1500 total for this assignment)

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion.

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.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)

File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

Clinical Scenario:

REASON FOR CONSULTATION: Desaturation to 64% on room air 1 hour ago with associated shortness of breath.

HISTORY OF PRESENT ILLNESS: Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.

REVIEW OF SYSTEMS:

Constitutional:  Negative for diaphoresis and chills. Positive for fever and fatigue.

HEENT: Negative for hearing loss, ear pain, nose bleeds, tinnitus. Positive for throat pain secondary to her laryngeal cancer.

Eyes:  Negative for blurred vision, double vision, photophobia, discharge or redness.

Respiratory: Positive for cough and shortness of breath. Negative for hemoptysis and wheezing.

Cardiovascular: Negative for chest pain, palpitations, orthopnea, leg swelling or PND.

Gastrointestinal: Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.

Genitourinary: Negative for dysuria, urgency, frequency, hematuria and flank pain.

Musculoskeletal: Negative for myalgias, back pain and falls.

Skin: Negative for itching and rash.

Neurological: Negative for dizziness, tingling, tremors, sensory changes, speech changes.

Endocrine/hematologic/allergies: Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.

Psychiatric: Negative for depression, hallucinations and memory loss.

PAST MEDICAL HISTORY:

1. Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric bypass surgery, which she had approximately 3 years ago.
2. Laryngeal cancer
3. Hypertension
4. Hypercholesterolemia
5. Pneumonia
6. Arthritis
7. Hypothyroidism
8. Atrial fibrillation
9. Acute renal failure
10. Chronic kidney disease, stage IV – on 07/30/2013 a renal biopsy was completed, which showed focal acute tubular necrosis and patchy tubular atrophy, moderate to severe interstitial fibrosis with patchy acute and chronic interstitial nephritis, normal cellular glomeruli with no white microscopic evidence of a primary glomerulopathy. Baseline creatinine is 1.9.
11. Peptic ulcer disease
12. Skin cancer
13. Anemia
14. Osteoporosis

PAST SURGICAL HISTORY:

1. Laparoscopic gastric bypass – 3 years ago
2. Closure of mesenteric defect.
3. Radical neck resection on -3 months ago

FAMILY HISTORY:

1. Mother has diabetes diagnosed at age 55 and high blood pressure. She is deceased.
2. Father had heart disease diagnosed at age 60. He is deceased.
3. She had a sister with diabetes, thyroid disease, CKD, on dialysis, with unknown etiology.

SOCIAL HISTORY: She denies any smoking or alcohol use. She denies any drug use.

MEDICATIONS:

1. Calcitriol 0.5 mcg PO every other day
2. Vitamin B12 2500 mcg sublingual every Monday and Thursday
3. Docusate sodium 100 mg PO BID
4. Fentanyl patch 100 mcg every 72 hours
5. Gabapentin 800 mg PO BID
6. Levothyroxine 50 mcg daily
7. Multivitamin 1 PO Daily
8. Oxybutynin 5 mg PO BID
9. Hydrocodone 5/325 1-2 tablets every 6 hours PRN pain

ALLERGIES: SHE IS ALLERGIC TO CIPRO, WHICH CAUSES URTICARIA AND HIVES, CONTRAST DYE, HONEY AND BEE VENOM, ADHESIVE, AND SULFAS, WHICH CAUSE HIVES.

PHYSICAL EXAMINATION:

Vital signs: 38.6, 120, 22, 138/38, 64% on room air. O2 sat of 91 on 4 liters nasal cannula.

Constitutional: She is somnolent. Oriented to person and place. Appears ill and mildly dyspneic.

Head: Normocephalic and atraumatic. Nose: Midline, right and left maxillary and frontal sinuses are nontender bilaterally.

Oropharynx: Clear and moist. No uvula swelling or exudate noted.

Eyes:  Conjunctivae, EOM and lids are normal. PERL. Right and left eyes are without drainage or nystagmus. No scleral icterus.

Neck: Normal range of motion and phonation. Neck is supple. No JVD. No tracheal deviation present. No thyromegaly or thyroid nodules. No cervical lymphadenopathy noted bilaterally.

Cardiovascular: rapid rate, S1 and S2 without murmur or gallop. Brachial, radial, dorsalis pedis, and posterior tibial are 2+/4+ bilaterally.

Chest: Respirations are regular and even with mild dyspnea.

Lungs are coarse and with some rales posterior bases.

Abdomen:  Soft. Bowel sounds are active, nontender, no masses noted. No hepatosplenomegaly noted. No peritoneal signs.

Musculoskeletal: Full range of motion of the bilateral shoulders, wrists, elbows.

Neurologic: Somnolent. Cranial nerves II-XII are intact.

Skin: Warm and dry.

Psychiatric: Mood and affect are normal. Calm and cooperative. Behavior, judgment is intact.

LABORATORIES AND DIAGNOSTICS:

WBC 7.2, Neutrophil 63%

Creatinine 2.5 mg/dL, BUN 45 mg/dL, Na 144 mEq/L, Potassium 4.4 mEq/L, Total Bilirubin is 0.9 mg/dL, Platelets 100,000

BNP 242 pg/mL

Lactate 1.0 mg/dL

All other labs are unremarkable

Chest x-ray: Right lower lobe infiltrate

EKG: NSR, no ST or T wave changes

Questions:

1. Develop a list of differential diagnoses specific to hypoxia. What are the four most important differential diagnoses to consider? 
2. Based on the available clinical data, what is the most likely diagnosis for the hypoxia? What other acute (new) diagnoses do you need to treat? List them all below. There are a total of 4 diagnoses. 
3. What additional diagnostic tests should be ordered to further evaluate this patient? 
4. Write an assessment and treatment plan for all four acute diagnoses you identified in question 2. Each diagnoses must have a complete treatment plan. All written orders must have complete instructions. For instance, a medication order must have the name, dose, frequency, and route. Lab orders must include the lab name and frequency. If an order should be done now, stat, urgent or routine that also should be indicated. 
5. What is the most appropriate level of care for this patient?
6. What physician specialty or other interprofessional consults should be ordered?
7. What anticipatory guidance/patient education should you provide to the patient?

 Select an ethnic minority group that is represented in the United States (American Indian/Alaskan Native, Asian American, Black/African American, Hispanic/Latino, Native Hawaiian, or Pacific Islander). Using health information available from Healthy People, the CDC, and other relevant government websites, analyze the health status for this group.
In a paper of 1,000-1,250 words, compare and contrast the health status of your selected minority group to the national average. Include the following:
Describe the ethnic minority group selected. Describe the current health status of this group. How do race and ethnicity influence health for this group?
What are the health disparities that exist for this group? What are the nutritional challenges for this group?
Discuss the barriers to health for this group resulting from culture, socioeconomics, education, and sociopolitical factors.
What health promotion activities are often practiced by this group?
Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective in a care plan given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.
What cultural beliefs or practices must be considered when creating a care plan? What cultural theory or model would be best to support culturally competent health promotion for this population? Why?
Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

  

· Review the Case Study Assigned by your Instructor for this Assignment

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

· Justify Why you would recommend this Drug Therapy Plan for this patient. 

· -Be Specific and provide Examples.