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J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia

Part 1: 

Hematopoietic: J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy. Past Medical History (PMH): Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries. Case Study Questions

  1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia. In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Part 2:

Cardiovascular Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills. Case Study Questions

  1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
  2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
  3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
  4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
  5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

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14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation

Respond to the following psychiatric evaluation with rationales 2 APA references no older than 5 years 

a 14-year-old Hispanic female Patient who presents today with mother for an initial psychiatric evaluation. Wt 198 lbs, BMI 37.9 Index, 

•  The Patient stated that she has been feeling depressed a lot more than before, and its taking over her to the point that she lays down on the bed and does not want to do anything, and sometimes, will have no energy to do anything. She stated that she does not have motivation at all, feeling depressed and no energy to do anything. This started since October 2021. She stated that she could remember that it started because of the pressure from school work because they were being overloaded with a lot of home works especially during Pandemic. She mentioned that it started first by her pulling, cutting herself on the arms and legs, though it has stopped. Current presenting symptoms: trichotillomania, no motivation, feeling of hopeless, feelings of insecurity and often does not want to take her mask off, and always putting her Jacket on, feelings of self worthlessness, low self-esteem, crying frequently, fatigue, appetite changes, insomnia ( 5 hours), social withdrawal, anhedonia. laying on bed and does not want to do anything, feeling guilt, concentration issue, anxiety and worrying a lot, racing thoughts, irritable, sad, feeling on edge, no focus. She complains of hearing voices so loud she believes were her thoughts. She is not able to sleep at night. 

The Patient rated her mood at 5/10 and anxiety at 7/10 on a scale of 1-10 with 1 being the least and 10 being the worst. Alleviating factor: laying on bed. Aggravating factor: any stressful situation. She denies using any illicit drug or alcohol or smoking cigarette. She denies physical, emotional or sexual abuse. She denies SI/HI/AH/VH. Medication reconciliation done

•  Home Environment: living arrangements: living with parents and 2 siblings plus uncle and auntie. , no violence in the home , no exposure to violence in the neighborhood , no smoker in the home. Education: school name: Ida B Wells Middle School, Washington DC , does not enjoy school/is bored in school , no concerns from school about learning or behavior , , goals when finishes school: Physician. Exercise: plays outside , goes to the park , spends most of the time watching TV or playing video/computer games. Activities: Denies , activities with friends and have no issues with peer pressure, no issues with bullying , no gang involvement. Suicide/Depression/Mental Health: feels stressed/anxious most of the time , low self-esteem , has friend/family member to talk to if having problems , has good anger management skills , no behavior problems at school she endorses frequent crying or depressed mood , withdrawal from family, friends or school , no issues with bullying , no history of suicidal thoughts. There was history of self-harm (i.e. cutting), but , no history of violence towards others , no history of homicidal thoughts , no history of emotional, physical or sexual abuse. Safety: feels safe at home , feels safe at school , feels safe in neighborhood (no gangs/territory groups) , uses internet and social media safely. Sleep Patterns: gets less than 8 hours of sleep, have trouble falling asleep , bedtime established , goes to bed at (time): 10:30P , no television / screens in the bedroom 

Diagnosis  Major Depressive Disorder

• Plan: Psychoeducation provided Supportive therapy provided Safety plan setup and encouraged Options reviewed for dealing with triggers for self-harm Appropriate sleep hygiene reviewed Healthy diet encouraged Exercise discussed Mature coping skills reviewed Medication side effects, risks, and potential interactions reviewed medication dosage, frequency, and other instructions Reviewed how long it may take for medication to work. 

• Perform blood analyses, including CBC, TSH/T4, Hemoglobin A1C levels, lipid panel, 

Preventative Medicine

Activity: Get involved in activities that you enjoy and are interesting to you. These activities may be related to school, after school programs, volunteering or community organizations. Try to limit watching TV or playing video games. Consider a family media plan including time for physical activity and unplugged family time. Exercise is also very important. You should get at least 60 minutes of exercise every day. Be careful when using the internet; being online is the same thing as being in public. Remember that anything you share on line you are sharing with many people and it cannot be erased. Do not meet up with strangers you connect with online. All internet use should be in public areas of the home so parents can ensure online activity is safe.. Sleep: Sleep is very important at your age and you need plenty of sleep to do well in school. You should get at least 8 hours of sleep per night. Some tips for improving your sleep include: Not watching TV/ phone or screens while going to sleep, avoid napping during the day, avoid caffeine and chocolate a couple hours before bedtime, avoid large meals right before going to bed, and establish a regular bedtime.. Mental Health: Sometimes people get angry, upset, stressed or sad about a certain situation. It is not ok to hurt yourself or others when this happens. It is also not good to use violence (ex: fighting) to solve problems. There are healthier ways to deal with your feelings. If you ever feel angry, upset or sad please talk to an adult or your doctor. You can also call the Access HelpLine at 1(888)7WE-HELP or 1-888-793-4357 at any time. Safety: Everyone should wear seatbelts while riding in a car. Younger adolescents may still need to be in booster seat, low-profile backless boosters may be more acceptable to the adolescent. Your child should continue to ride in the back seat until 13 years of age. Youth under 16y should not ride ATVs. Model safe behavior by always wearing your seat belt. Make sure your child is always wearing a helmet while riding a bike/scooter/skating etc. Use sunscreen with SPF greater than 15, reapply every 2 hours. Develop safety rules with your child such as not riding in a vehicle with someone who has been using drugs or alcohol. Guns, knives and other weapons are extremely dangerous and should not be used to fix problems. It is best not to have a firearm in your home, however if necessary firearms should be stored unloaded and locked with ammunition locked separately. Do not listen to loud music in ear buds

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Rogerian argument is one that presents two sides of a debate and argues for a solution that will satisfy both sides

ASSIGNMENT: As you learned in this unit, a Rogerian argument is one that presents two sides of a debate and argues for a solution that will satisfy both sides. Given two articles presenting opposing sides of an issue (mandatory uniforms in schools), construct your own 2-3 page Rogerian argument essay in which you attempt to arrive at a workable solution or “middle ground.”

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A real-world business problem as it presents the case of AUDI AG and its attempts to implement big data analytics in its organization

The attached pdf file introduces a real-world business problem as it presents the case of AUDI AG and its attempts to implement big data analytics in its organization.

For your first individual case analysis, you need to critically analyze this case study, summarize the key idea, discuss the IT challenges and present your recommendations. This analysis should be done individually not in groups, so each student should do the analysis by themselves.

This report will be organized as follows:

1.       Introduction – Short summary of the business problem. This section will also include a background of the organization.

2.       Challenges – Provide for a brief description of the challenges that the organization is facing and how they are planning to address them. This section will provide the audience with a picture of how the organization is planning to address some of the challenges.

3.       Change Management – Discuss how change is being managed by the organization. 

4.       Recommendations – Discuss what you would have done differently and why.

5.       Conclusions – Discuss the lessons learned and the key messages that you would like the audience to take away.

The report should not be more than 1000 words

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This 72-year-old female presents with a biopsy-proven adenocarcinoma

Purpose

The purpose of this discussion forum is to create a collaborative environment in which you can strengthen your use of medical terminology and critical thinking skills while constructively sharing ideas and opinions regarding a medical scenario.

Directions

SCENARIO

Identifying Data:

This 72-year-old female presents with a biopsy-proven adenocarcinoma

of the sigmoid colon at 20 cm.

History of Present Illness:

The patient has been noted to have some bright red bleeding intermittently for approximately 8 months, initially presumable of a hemorrhoidal basis. She recently has had an intensification of rectal bleeding but no weight loss, anorexia, or obstructive pain. No significant diarrhea or constipation. Some low back pain, probably unrelated. A recent colonoscopy by Dr. Scoma revealed a large sessile (attached by a broad base) polyp, which was partially excised at 20-cm level, showing infiltrating adenocarcinoma at the base. The patient is to enter the hospital at this time after home antibiotic and mechanical bowel prep, to undergo sigmoid colectomy and possible further resection. 

1. Using the scenario above, answer the following questions:

A. What chronic symptoms did this patient have? Describe the symptoms using medical terms.

B. What was the cause of her chronic symptoms?

C. What procedure did she have recently that diagnosed her condition? Name the procedure and briefly describe.

D. The patient is scheduled for what procedure? Briefly explain the procedure.

Follow these guidelines when answering the questions: 

  • Use a maximum of 100 words.
  • Be clear, concise, and well organized using as many pertinent medical terms as possible.
  • Be free of grammatical, mechanical, and format errors.
  • Be in your own words (do not copy text directly from a website, text, or other reference materials) and contain citations from all

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G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic

 Instructions: Response must be 510 words per case study written in current APA format with at least two academic references cited. References must be within the last five years. 1020 words in total.

Musculoskeletal Function:
G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

  1. Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
  2. Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
  3. Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
  4. How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.

Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

  1. Name the most common risks factors for Alzheimer’s disease
  2. Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
  3. Define and describe explicit and implicit memory.
  4. Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
  5. What would be the best therapeutic approach on C.J
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A 21-year old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days

Using the case study below, prepare a 2 – 3-page paper.

A 21-year old female (A.M.) presents to the urgent care clinic with symptoms of nausea, vomiting, diarrhea, and a fever for 3 days. She states that she has Type I diabetes and has not been managing her blood sugars since she’s been ill and unable to keep any food down. She’s only tolerated sips of water and juices. Since she’s also been unable to eat, she hasn’t taken any insulin as directed. While helping A.M. from the lobby to the examining room you note that she’s unsteady, her skin is warm and flushed, and that she’s drowsy. You also note that she’s breathing rapidly and smell a slight sweet/fruity odor. A.M. has a challenge answering questions but keeps asking for water to drink.

You get more information from A.M. and learn the following:

  • She had some readings on her glucometer which were reading ‘high’
  • She vomits almost every time she takes in fluid
  • She hasn’t voided for a day but voided a great deal the day before
  • She’s been sleeping long hours and finally woke up this morning and decided to seek care

Current labs and vital signs:

  1. What is the disorder and its pathophysiology that you expect the health care provider to diagnose and treat?
  2. Describe the etiology of the disorder A.M is experiencing.
  3. Identify and describe the clinical manifestations of the disorder A.M. is experiencing.
  4. Identify and describe the expected treatment options for A.M. based on the disorder and clinical manifestations.

Instructions:

Summarize the questions above and formulate what may be happening with A.M. and how you would improve her condition.

Use at least one scholarly source to support your findings. Examples of scholarly sources include academic journals, textbooks, reference texts, and CINAHL nursing guides. Be sure to cite your sources in-text and on a References page using APA format.

You can find useful reference materials for this assignment in the School of Nursing guide: https://guides.rasmussen.edu/nursing/referenceebooks

Have questions about APA? Visit the online APA guide: https://guides.rasmussen.edu/apa

Case study adapted from:

Harding, M.M. & Snyder, J.S. (2015). Winningham’s critical thinking cases in nursing: Medical-surgical, pediatric, maternity, and psychiatric. Retrieved from: https://ebookcentral.proquest.com/lib/ras/detail.action?docID=2072336.

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Construct a work-back schedule that presents the steps involved in implementing your project

Project rollout begins after a project has been implemented, tested, and judged stable and functional enough to be moved into production. The project rollout process comprises specific steps that must be scheduled carefully to enable the project to hit production deadlines and meet business expectations.

For this assignment, you will create an implementation project plan, which outlines the steps involved in implementing your project. This document is sometimes called a work-back schedule because you begin with the date that your project needs to go live, and then work back from there to determine what needs to be done when.

You will also conduct a post-mortem on the work you have submitted to date. Post-mortem (from the Latin for “after death,” but referring to it in the context of business) is the analysis of a project’s process and results conducted by key project stakeholders after the project has been moved into production, which means it’s functionally complete. The goal of a post-mortem is to identify what went right and what went wrong post-implementation so that project managers can apply these lessons learned to future projects.

For this three-part assignment, you will:

  • Construct a work-back schedule that presents the steps involved in implementing your project.
  • Construct a post-mortem using the template on the work you have submitted to date in this course.
  • Create updated project documents based on the results of your post-mortem.

Review the Project Implementation Plan Example.

Create a project implementation plan for your project based on the example document. You may use Microsoft Word or other software to create your project implementation plan.

Complete the Post-Mortem template based on your experiences with completing the course project over the last five weeks.

Update the project documents you have submitted thus far in the course based on your completed post-mortem.

Submit your project implementation plan, post-mortem, and updated project documents

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manager of imaging and your lead ct tech refuses to do a head ct on a 18yr old male who presents with head trauma due to drunk driving and hitting and killing a mother and her 7yr old daughter

you are the manager of imaging and your lead ct tech refuses to do a head ct on a 18yr old male who presents with head trauma due to drunk driving and hitting and killing a mother and her 7yr old daughter, the lead ct feels he is getting what he deserved and there is not another ct on duty. The lead ct tech has worked here over 20yrs and is respected and looked up to by other staff and you have never had a problem out of her before. How would you effectively and ethically handle this situation?

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Banta presents a cycle of activities to promote institutional effectiveness including evaluation

Banta’s Planning, Evaluation, and Improvement Cycle

Supporting Lecture:

Review the following lecture:

  • Linking Assessment and Planning

Before beginning work on this discussion forum, please review the link Doing Discussion Questions Right, the expanded grading rubric for the forum, and any specific instructions for this topic.

Banta presents a cycle of activities to promote institutional effectiveness including evaluation, improvement, planning and budgeting, and implementation. But this cycle reflects the efforts of one university with respect to higher education assessment. What strategies do you think are employed by other universities and how do those activities compare with Banta’s ideas? Are they different, better, or less comprehensive?

From the bullet point list below, select one topic for which you will lead the discussion in the forum this week. Early in the week, reserve your selected topic by posting your response (reservation post) to the Discussion Area, identifying your topic in the subject line. Be specific about your topic so that someone else could select the same bullet point but focus their post differently. By the due date assigned, research your topic and start a scholarly conversation as you respond with your initial or primary post to your own reservation post in the Discussion Area. Make sure your response does not duplicate your colleagues’ responses.

  • Compare and contrast the Assessment Cycle from The George Washington University with the cycle proposed by Banta, highlighting specific advantages and disadvantages of each approach.
  • Compare and contrast the Outcomes and Assessment Cycle from Southern University with the cycle proposed by Banta, highlighting specific advantages and disadvantages of each approach.
  • Compare and contrast the Assessment Cycle from James Madison University with the cycle proposed by Banta, highlighting specific advantages and disadvantages of each approach.

Additionally, provide a brief paragraph describing which assessment model you personally prefer and why.

As the beginning of a scholarly conversation, your initial post should be:

  • Succinct—no more than 500 words.
  • Provocative—use concepts and combinations of concepts from the readings to propose relationships, causes, and/or consequences that inspire others to engage (inquire, learn). In other words, take a scholarly stand.
  • Supported—scholarly conversations are more than opinions. Ideas, statements, and conclusions are supported by clear research and citations from course materials as well as other credible, peer-reviewed resources
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