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What is the pathophysiological basis of hypertension in a patient with chronic kidney disease?

SBI241
Assessment 2:
A 49-year-old male farmer presents to the emergency department with intractable nausea and vomiting, dyspnoea on exertion, and dizziness. The nausea began about two weeks prior to admission. There is no history of medication or toxin exposure. He has lost some weight recently and his current body weight is 52 kg. His past medical history is positive for hypertension diagnosed 4 years ago with no follow-up. He has smoked 1 packet per day for 20 years.
The attending nurse in the emergency department reports his blood pressure to be 160/120
mmHg, temperature 36.7°C, pulse 93/min. His skin is pale with numerous areas of
spontaneous bruising. Chest x-ray shows increased pulmonary vascular markings and hazy obliteration of the lower lung bases. Abdominal ultrasound examination shows a right kidney size of 7 cm and a left kidney size of 6.8 cm (normal kidney size approx. 10 cm).
Laboratory evaluation reveals:
Urinalysis
Protein 1+
Blood 1+
Glucose Neg
Casts Neg
Bacteria
Blood report Reference range
WBC 10.7 x 109/L 4.5-11 x 109/L
Platelets 245 x 109/L 150-400 x 109/L
Haematocrit 0.31 0.40-0.54 (adult male)
Creatinine 540 umol/L 60-110 umol/L (adult male)
Urea 35.2 mmol/L 3.0-8.0 mmol/L (adult)
Calcium 1.75 mmol/L 2.10-2.60 mmol/L
Uric Acid 0.68 mmol/L 0.20-0.45 mmol/L (male)
He’s admitted to the nephrology ward for further evaluation and management of his condition.
Please answer the following TWO questions:
QI. What is the pathophysiological basis of hypertension in a patient with chronic kidney disease?
(350-400 words)
Q2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage?
(100-150 words)
Support your answers with appropriate evidence (references). This assignment tests your ability to search scientific literature and present your answer in a scientific language. CDU library has heaps of resources to support you. Please make full use of these helpful resources:
Tips on academic/scientific writing:
General Guidelines on how to write your assignment
.. The word limit for this assignment is 450 to 550 words, this does not include references. Please stick to word limit, failing to do so will result in losing marks.
:• Only word and pdf formats are acceptable. Do not copy the case study questions in your file, just write QI, Q2 and provide your answer.
. This assignment must be submitted via Safe Assign/Turitin on Learnline. No other form of submission is acceptable including email, hand delivery or post.
. It is advised to have a foot note on your assessment containing your name, student
number and unit code. No COVER PAGE REQUIRED.
Please note there is NO DRAFT SUBMISSION for this assignment. Once you upload your file and click submit, it will be submitted for grading.
All the information about the assignment is available on Learnline; please take time to locate the necessary documents prior to sending an email to me enquiring about the assignment details.

  1. Proof reading or feedback of any kind of ASSIGNMENT QUESTIONS will not be provided prior to submission.
  2. Please contact the Learnline technical support if you have problems submitting the assignment.
    FORMAT:
  3. Font size 12; Font type: preferably Calibri or Arial.
  4. Line spacing 1.5 to 2.
    REFERENCING:
    Please use APA referencing style (7th edition). Number of references: between 5-10. Please refer to CDU library for referencing guide.
    EXTENSION:
    You will have to submit an official extension request with supporting documents at least 5 days before the deadline.
    ASSIGNMENT MARKS RELEASE:
    It is expected to take around 2 weeks or more to get your assignment marks being released after submission

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complementary, alternative and integrative health practices and how they impact patient care

Discussion Question – Complementary, Alternative and Integrative Health Practices

Discussion question (NUMBER- 1)

Discussion Prompt

Discuss the differences between complementary, alternative and integrative health practices and how they impact patient care. Describe one example of each.  Discuss, with rationale, whether you would consider using any of these interventions in your advanced nursing role.

Expectations

· Length: A minimum of 250 words, not including references

· Citations: At least two high-level scholarly reference in APA from within the last 5 years

Reflective journal paper (NUMBER-2)

Points: 200

Assignment Prompt

Discuss the most meaningful aspects of this course to you(Cultural and spiritual care across the lifespan- class) Include the topics of culture, spirituality, vulnerable populations; religious diversity and complementary, alternative and integrative health practices. Describe how this course content will be beneficial to you in your future advanced nursing role.

Expectations

· Length: three- four pages (excluding title and reference page)

· Format: APA 7th ed.

· References: A minimum of 3,(three) recent, high level scholarly reference citations within last 5 years

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Patient satisfaction is a key metric that influences both hospital ratings and reimbursement

1. Choose one of the following scenarios (1-5) to develop a PICO question, search string and a summary table and complete the template provided in page 2.
2. Please note that there is no word limit for this assessment, and It does not require introduction and conclusion.
Scenario 1
Patient satisfaction is a key metric that influences both hospital ratings and reimbursement. Studies have suggested that purposeful nursing rounds can improve patient satisfaction.
Gemma wants to know the impact of hourly rounding by nursing staff on patient satisfaction and safety.
Scenario 2
Pressure, from lying or sitting on a particular part of the body results in reduced oxygen and nutrient supply, impaired drainage of waste products and damage to cells. Kiana works in a medical ward where number of patients cannot reposition themselves and require assistance. Kiana is worried that the number of pressure ulcers may increase and wants to clarify the role of repositioning in the management of patients with pressure ulcers.
Scenario 3
Leg ulcers arising from venous problems are called venous (or varicose or stasis) ulcers. The main treatment is the application of a firm compression garment (bandage or stocking) in order to aid venous return. There is a large number of compression garments available and it was unclear whether they are effective in treating venous ulcers and, if so, which method of compression is the most effective. RN Mia wants to know whether compression bandages or stockings aid venous ulcer healing.
Scenario 4
Dementia is a chronic condition which progressively affects memory and other cognitive functions, social behaviour, and ability to carry out daily activities. To date, no treatment is clearly effective in preventing progression of the disease. RN Koby wants to evaluate the efficacy and safety of animal-assisted therapy for people with dementia.
Scenario 5
Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. There are several interventions designs to reduce falls in older people in hospitals. Emma wants to confirm whether implementing an exercise programmes can reduce the rate of falls

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A patient just called. The patient has an appointment at her physician’s office in one hour and wants copies of her health record to take to the office.

Processing a Request for Release of Information You are the ROI coordinator. During the day you face a variety of ROI situations. How should you handle the situations described next and what, if any, additional information will you need before you can make your decision? If you will need to provide copies of the health record, explain which forms (information) you would provide. Include dates if appropriate.

 1. A patient just called. The patient has an appointment at her physician’s office in one hour and wants copies of her health record to take to the office. The department has a policy that requires a 48-hour notice except in medical emergencies. The patient did not specify what health records she needs. 

2. A patient has complained that he had requested that his health records be sent to the state department of disability three times and that the department says that it has still not received them. Your records show that they have been sent twice. The patient is very upset as his request for a copy of his health record cannot be processed without these health records.

 3. A Homeland Security agent shows up and flashes a badge at you. He demands that you release a patient’s health record to him immediately as it is a matter of national security. 

4. Dr. Lawrence calls and requests a copy of the health record on Stephanie Smith. The records show that Dr. Jones was the patient’s physician. Dr. Jones and Dr. Lawrence are not partners.

 5. You receive a subpoena requesting your presence in court. You do not want to appear, so you talk to the court clerk. The subpoena specifies all charts for a patient for the period of June 2015 to January 2017. The hospital has records for the period of April 1999 to the present

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Describe how these cuts will benefit patient care or business systems.

You have been placed on a committee in your health care organization. The committee has to create a set of cost containment strategies that will positively impact (decrease) operating expenses. The committee is also challenged with increasing reimbursement.

  • Provide 5 cost-cutting strategies that the committee could recommend to the executive board.
    • Describe how these cuts will benefit patient care or business systems.
  • Provide 5 ideas on how to increase revenue or reimbursement. This answer can include short-term and long-term goals.
    • Describe how these revenue or reimbursement systems benefit patient care or the business systems.

Provide at least 4 references within the last five years that reinforce the strategies you have chosen. APA style with 5-6 pages not including title page and reference page 

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  • Describe how these cuts will benefit patient care or business systems.

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A 65-year-old patient is 8 days post op after a total knee replacement.

a 2-3-page discussion based on a case study scenario which is listed below. Remember that this is an Advanced Pathophysiology class. We are not discussing treatment, management, or diagnostics. You will cover those aspects in Advanced Health Assessment and Pharmacology. Your pathophysiological processes should begin at the cellular level. You should be able to distinguish between genetics, gender, and racial/ethnic. When explaining symptoms, you are being asked what is going on within the body systems to cause these symptoms. Simply stating, “there is a genetic component and symptom A is classic for disease A” is not sufficient. You must be specific. Omit unneeded information. Synthesize the material to maximize the space in limiting your discussion to 3 pages. You do not need to restate the case as it takes up space; you will be referring to it throughout your discussion. Your instructions provide a general overview. However, your rubric tells you specifically what should be included in your discussions.

Week 4 Scenario: A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). 

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Collaborate in healthcare delivery systems settings for improved patient outcomes.

Module 05 Assignment – Scheduling and Staffing

Module 05 Content

  1. Scheduling and Staffing
    Competency
    Collaborate in healthcare delivery systems settings for improved patient outcomes.
    Scenario
    You are making a staffing assignment knowing that you are short-staffed. You have five registered nurses (RNs), two licensed practical nurses (LPNs), and two nursing assistants. Those nine employees need to provide a 12-hour shift of services to 30 clients with a high acuity required to a ratio of nurse to client at 1:3.
    Client acuity level
    • Six acuity level 1
    • Eight acuity level 2
    • Nine acuity level 3
    • Seven acuity level 4
    • You will use the acuity-based staffing model to develop the staffing assignment based on the needs of the clients. You will use the created template.


      NUR2832_Staffing

      Instructions
      As you create this assignment, include the following in an email to your manager to justify your short-staffing plan:
    • Complete the staffing assignment based on the acuity level.
    • Defend how you would direct the staff to their assigned roles for this shift and provide a rationale for the staffing assignment.
    • Describe how you would communicate with each level of care provider to assure the best outcomes possible.
    • Address how you would ensure client equity in the delivery of services.
    • Provide stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar.
    • Resources
      For assistance completing this assignment, review the article titled Patient Acuity Model.
      Submit your completed assignment by following the directions linked below. Please check the

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Why is the hospital required to report this patient’s death to the medical examiner/coroner?

On Thursday a 75-year-old patient at Wesley Glen Senior Living Facility became agitated and physically abusive to himself and others, so he was placed in wrist and ankle restraints. An hour later, staff found the patient unconscious and called the EMT squad for assistance. The patient was taken to the medical center emergency department (ED), where he awoke and once again became physically abusive. The physician ordered the patient to be restrained to protect the patient and others while the physician examined the patient. Upon examining the patient the physician noted that the patient had multiple bruises on his back, buttocks, and thighs. In addition, the patient had a cardiac defibrillator implanted during his last inpatient visit. The hospital had received a medical device alert regarding the implant device and was notifying patients with the device to contact their physician for follow-up. The patient was sedated and the restraints removed. However, 15 hours later the patient expired. The hospital reported the death to the medical examiner/coroner’s office. Consider the following:

  1. Why is the hospital required to report this patient’s death to the medical examiner/coroner? Do medical examiners and coroners have the right to receive patient information needed to investigate a case?
  2. What additional required reporting must be done by Wesley Glen and the hospital in regard to the patient’s death?
  3. Who is responsible for notifying the hospital that a medical device in use may cause harm to patients? If the patient’s death was attributed to the cardiac implant defibrillator, what is the hospital’s responsibility for reporting the death to the FDA? How is the death reported?

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Define patient-centeredness in the context of evidence-based practice.

 Define patient-centeredness in the context of evidence-based practice. Describe barriers to the implementation of patient-centered evidence-based care in your practice environment and share actions that might be taken to alleviate these barriers. 

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length. 

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What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?

Develop a Focused SOAP Note, including differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into the responses in the template:

· Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

· Objective: What observations did you make during the psychiatric assessment?  

· Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide at least three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

· Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.

· Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (think beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

· Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old)

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