End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.

 

In 500-750 words, post in your assigned group your response to the prompt. In your initial post, refer at least one article related to your entry from a reputable newspaper (can be online) or other media source that is current within one month and post the link. You must have at least two references in your initial posting, and the media source can be one of the two. An easy way to find current articles on health policy is through Kaiser Health News.

Discussion Topic: In your post, you should discuss if and how the ACA has impacted your topic, and the impact of Republican proposals to repeal/replace the ACA on your topic.

• Group 1: Health Disparities: What are two public policies needed to reduce racial and ethnic disparities in health care?

Required Resources:

 

• Munoz, P., Kim, M., Chang, M. (2015). . Retrieved from https://www.bostonfed.org/publications/one-time-pubs/color-of-wealth.aspx
• Hayes, S., Riley, P., Radley, D. (2017). . Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2017/aug/reducing-racial-and-ethnic-disparities-access-care-has
• Derose, K., Gresenz, C., Ringel, J. (2011). . Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2011.0644
• . Content last reviewed June 2018. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/nhqdr15/access.html

Participate: Teamwork

Evaluation Title:  Team Contract

Each of you should now be assigned to a group for the Team Project.  To begin the project, you will work together with your team to complete a team agreement in the form of a team contract. Please complete the following tasks:

• Open the attached Team Contract document provided above.
• Each team member should complete the contract.
• Submit your completed contracts by clicking on the assignment title above and attaching the completed document.

Estimated time to complete: 30 minutes

Assignment File(s)

• [Word document]

Evaluate: Personality Tests

Evaluation Title: Personality Assessments

Select two of the personality assessments from the Personality Tests list below. Compare the two personality assessments and respond to the following questions:

• Describe the history of each test.
• Who developed it and why?
• Where would it be administered? (as part of job interview, in a psychiatric setting, to determine a field of study, to set up a good dating match)
• What is your opinion of each test? Be sure to include evidence to support your opinion.
• What are the pros and cons or strengths and weaknesses of each test?

Personality Tests

• The Rorschach Inkblot Test
• The Thematic Apperception Test (TAT)
• Rotters Internal Locus of Control Test
• The NEO-PI Test
• The MMPI-2 Test
• The Myers-Briggs Type Indicator (MBTI)

Your assignment should be typed into a Word or other word processing document, formatted in APA style.

• Please include 2 to 3 credible resources as evidence to support your comparisons.

The assignments must include:

• Running head
• A title page with Assignment name
• Your name
• Professors name
• Course

 Respond to all the questions and include the questions and answers in the Paper work. APA style and 3 references.   this is the course book:Seidel’s Guide to Physical Examination 8th 

• W hat comprises the lymphatic system
• Which set of lymph nodes is a common site of metastatic disease, and why?
• Mrs. Kline, a postoperative patient who has just undergone a right modified mastectomy, is found to have edema of the right arm. What is the cause of the edema, and what teaching is necessary to help Mrs. Kline? 
• Mr. Jackson is a 76-year-old nursing home patient who has persistent wound infections and upper respiratory infections. What is the cause of Mr. Jacksons recurring infections? 
• Describe the correct way to examine the lymphatic system
• Define lymphedema
• Provide the differential diagnosis of mumps versus cervical adenitis
• What is elephantiasis?

JS is a 17-year-old adolescent who presents to the office with complaints of fatigue and overall body aches. He states that several of his classmates have been home sick as well. His past medical history is negative for medical illness, but he had myringotomy tubes placed when he was 5 years old. The patient lives with his mother, stepfather, and two siblings.

What is the most common cause of his diagnosis?

During the history, what positive findings will be in the HPI?

On physical examination of JS, what positive assessment results would you expect to find?

Name the primary muscles of respiration.

What is a normal rate of respiration per minute in an adult?

Prepare a teaching pamphlet on the effects of smoking on the chest and lungs.

Define the following terms and discuss when the examiner might see these conditions:

1. Dyspnea
2. Orthopnea
3. Apnea
4. Paroxysmal nocturnal dyspnea
5. Platypnea
6. Tachypnea
7. Bradypnea
8. Hyperpnea
9. Kussmaul breathing
10. Hypopnea
11. Periodic breathing (Cheyne-Stokes)
12. Air trapping
13. Biot respiration
14. Ataxia
15. Retractions

what they would expect to find when assessing children or adolescents with the assigned condition.

• Cystic fibrosis
• Epiglottis
• Croup
• Tracheomalacia
• Bronchiolitis
• Respiratory distress syndrome

Differentiate between a pneumothorax and a hemothorax.

List risk factors associated with respiratory disability.

HG is a 62-year-old man with a significant history of COPD and emphysema. He has a positive PMH of frequent episodes of pneumonia. His social history includes cigarette smoking for 45 years. Identify your findings on HG and the emphysema.

What is the primary etiology of the emphysema?

What are the expected findings on inspection, palpation, percussion, and auscultation?

What are the subjective and objective findings in HGs presentation?

Healthcare Coverage Gap

The ACA was meant to provide quality health care coverage for all yet a coverage gap for some populations especially in states that oppose Medicaid expansion. Based on what you have learned so far in this course, create a PowerPoint presentation that addresses the coverage gap problem, who is impacted by the coverage gap, the role the ACA plays in the coverage gap, why the coverage gap should be closed, and solutions/ recommendations for closing the gap. Address the following in your PowerPoint: 

• Select one state opposed to Medicaid expansion and describe why. Then, consider your own state. What are the benefits and drawbacks to Medicaid expansion in your state?
• Define what the coverage gap is (problem/issue)
• Discuss how the coverage gap impact low income healthcare consumers population.
• What role does the ACA have in widening or closing the coverage gap?
• Why is it important to close the gap (implications for positive social change)?
• What are some solutions to closing the coverage gap and how can healthcare equity help close the gap? Include recommendations and/or solutions.

Your PowerPoint presentation should include/address:

• Title Slide (1 slide)
• Objectives Slide (1 slide)
• Medicaid expansion (1-2 slides)
• Coverage gap – define/problem/issue (1-2 slides)
• Coverage gap impact on low income healthcare consumers (2-3 slides)
• Role ACA has in widening or closing the coverage gap (1-2 slides)
• Close the gap (1-2 slides)
• Solutions to closing the coverage gap and how can healthcare equity help close the gap? (2-3 slides)
• Reference slide (1-2 slides).

Assignment Expectations

Length: 9-14 slides (in addition to the title slide and reference slides) 

Structure: Include a title slide and reference slide in APA format.  These do not count towards the minimum slide count for this assignment.  Your presentation must include an objectives slide.  Be sure to fully explain all slides in the Speaker Notes.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three (3) scholarly sources are required for this assignment. 

Format: Save your assignment as a Microsoft PowerPoint document (.pptx) 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)

Submission: Submit to the D2L dropbox for grading 

please use California as model state

Population Health Advocacy

Human trafficking, extreme poverty, preventable diseases, the opioid crisis and the lack of adequate low-income housing are a few current societal concerns worthy of social change. Nurses and healthcare leaders are in a good position to shape and influence health care policy. 

Think of a cause you believe in strongly. Access the website of your elected officials either at the local, state, or federal level using the following link:  or use the website of your choice. Explore some of the issues and committees your legislators are involved in and select at least one that interest you or align with your beliefs. You may also contact your legislators office and speak to his or her legislative assistant by calling the U.S. Capitol switchboard operator at (202) 224-3121 for the Senate and (202) 225-3121 for the House. Legislator assistants are very knowledgeable about the legislators agenda and can provide a wealth of information.  

This assignment will be at least 1500 words or more. This week reflect on advocacy, collaborative partnerships with other health care practitioners and stakeholders, and the policy making process and write a paper that addresses the following:

• Describe the policy issue, policy problem of interest or a particular bill that your legislator has introduced
• Elaborate on why the policy matters and what you can possibly do to strengthen the policy?  
• Briefly define the role you would play as an advocate for the healthcare consumer and healthcare professionals. 
• Explain how the policy impacts the public at large or a particular population.  
• What stakeholders would you collaborate with to promote the cause?  

Assignment Expectations

Length: 1500-2000 words in length

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

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

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

Submission: Submit to the D2L dropbox for grading

Use California state as model state

 

Group A will complete the initial post. Group B will respond. You are called to the room and find Michael 2 hours old has been very irritable and spitting up large amounts of formula. He is very jittery. You do not know the maternal history before coming into the room so you advise the mother that you would like to return the baby to the nursery for an assessment and monitoring. In the medical record you focus on prenatal history. You witness the baby having some significant tremors. What would you suspect? Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert, irritable, and does not console easily. Is moving constantly, and sucking very vigorous on the pacifier you provide for comfort. You place the baby under the warmer and obtain what labs?It is determined that this baby is going through opioid withdrawal. Neonatal Abstinence Syndrome requires close observation and scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the signs of withdrawal, scoring and the nursing care of a baby with .
Group B Response
What is your feeling and knowledge regarding breastfeeding this baby?

DISCUSSION B

Group B will complete the initial post. Group A will respond. Baby Leah had a very traumatic vaginal birth. After a vacuum extraction for fetal heart rate tracing changes and a resultant shoulder dystocia, Leah has a mild Erb’s palsy, some facial and truncal bruising. Pediatrician has ordered physical therapy for the palsy and the doctor expects routine care to be provided to her. In addition, do not forget the education you must give to the new parents regarding this injury. Due to the bruising there is an increase in bilirubin levels and some behavioral changes occur with Leah. Please describe what is different and what will you discuss with the family to ensure safety? The bilirubin level requires phototherapy. What precautions must you take? What is essential to manage and treat the elevated bilirubin in addition to phototherapy?Group A Response Phototherapy is discontinued at the hospital, but at home the parents are encouraged to provide some ‘routine’ therapy for Hyperbilirubinemia. What would you suggest? Do not forget routine discharge instruction for this parent.

DO GROUP B ONLY, ANSWER ALL QUESTIONS, IN TEXT CITATION, 3-4 REFERENCES 

 

Personal Philosophy of Nursing

In a 6- to 7-page paper in APA format describe your personal approach to professional nursing practice. Be sure to address the following:

• Which philosophy/conceptual framework/theory/middle-range theory describes nursing in the way you think about it? Discuss how you could utilize the philosophy/conceptual framework/theory/middle-range theory to organize your thoughts for critical thinking and decision making in nursing practice.
• Formulate and discuss your personal definition of nursing, person, health, and environment.
• Discuss a minimum of two beliefs and/or values about nursing that guide your own practice.
• Analyze your communication style using one of the tools presented in the course. In your paper, discuss the strengths and weaknesses associated with your style of communication and the impact on your ability to collaborate as part of an interdisciplinary team.
• On a separate references page, cite all sources using APA format.
  • Use this as a convenient reference for properly citing resources.
  • This handout will provide you the details of
  • You may create your essay in this

DERMATOLOGY CASE STUDY

Chief complaint:   My right great toe has been hurting for about 2 months and now its itchy, swollen and yellow. I cant wear closed shoes and I was fine until I started going to the gym.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and yellow right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills. 

PMH: Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

Assessment:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.

As an NP student, you need to determine the medications for onychomycosis.

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

2.  What labs for baseline and follow up of therapy would you order for this patient? Give rationale.