Compose 400 words or more discussion to respond the following:

Name the 8 bones of the cranium and describe how the fix together. What bones make up the bony cage known as the thorax? How do these bones fit together to form this structure? Describe the vertebral column. What bones make up the shoulder girdle? What are the two bones of the forearm? In anatomical position which one is lateral and which one is medial? Name the bones of the hand and wrist. List the bones of the lower extremity and indicate their positions in the skeleton. What is the functional advantage of foot arches?

Module 2 Discussion Post 3

  • Read the initial comments posted by your classmates and reflect upon them.
  • Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates or restate their comments.
  • If the class is small, the discussion will be with your professor.
  • NOTE: You are not required to cite sources and include a reference list for the second post if it is simply your opinion. However, if your opinion is based on facts (as it should be), it is good practice to strengthen your position by citing sources.

post 1: 

Kelsey Adams posted May 27, 2021 10:23 AMSubscribe

According to The Medicare Resource Center, “ancillary services are medical services provided in a hospital while a patient is an inpatient, but paid by Medicare Part B (outpatient care) when the Part A (hospitalization) claim is denied because Medicare believes that it was unreasonable or unnecessary for the person to be admitted as an inpatient” (2021). Some examples of these services are but not limited to; diagnostic ancillary services, therapeutic ancillary services and custodial ancillary services. Diagnostic ancillary services include radiology and lab. Therapeutic ancillary services can include physical, speech and occupational therapy. Custodial ancillary services is usually in home health care. There are many services within these services but these are the main ones available to most people.

From my knowledge a rural area differs from an urban area because an urban area is largely populated and a rural area is smaller in comparison. I grew up in a rural area where the hospitals were about a 45 minutes from my house. There was a little specialized clinic about 30 minutes away but the main hospitals and urgent care offices were quite a bit away from my house so when we needed medical attention we had to travel. Living in an urban area you have a much quicker and easier access point to care. As for ancillary services, sometimes these services are not in the same location where patients are seen for medical care. Depending on the insurance carrier or recommendation from the documentation it could cause a burden.  For example, when I was in high school I was playing basketball and broke my ankle, I was rushed to the emergency room and once I was taken care of referred to 6 months of physical therapy after heeling. My hospital was in an urban area but because I lived so far away from everything I had to endure the travel. For major procedures or specialties it was more of a 4 hour drive which in some instances could hurt someone. A lot of employment doesn’t pay for time off for appointments so it could limit the duration of time a patient could have to get the treatment they need.

Some recommendations I would provide as a health care leader to lessen the disadvantages living in a rural area would be the delivery methods, access to care, and teleworking/telehealth.  I would of course canvas the area I am working and learn what works best for my facility/region. After some realignment and hard thought as a leader I would suggest the area consider “Community Paramedicine, a model of care where paramedics and emergency medicine technicians (EMTs) operate in expanded roles to assist with healthcare services for those in need without duplicating available services existing within the community” (Rural Health Information Hub, 2021). Having this throughout the community would vastly help the access to care. I also thinking having a line of communication like a hot line or a teleconference line for patients to be able to call a nurse with symptoms. There are many factors that need to be determined when considering adding certain things to a rural area and one of the main factors is money. There are many rural areas that have a lower income rate and this could cause a potential problem. Understanding the wants and needs of each area could be different depending on what is needed and where the focus is. Every area is different.

Rural Health Information Hub. Healthcare Access in Rural Communities Introduction. (2002-2021). 

What are ancillary services? (2021, March 11). 

Post 2:

Mateo Alba posted May 25, 2021 7:58 PMLast edited: Wednesday, May 26, 2021 12:06 AM PDTSubscribe

Ancillary services are the important services that completes the patient treatment or the provider’s diagnosis. There are three types of ancillary services, treatment, diagnosis and custodial. Some examples of ancillary services are Pharmacy, Laboratory and Radiology (x-ray). Treatment services provide the necessary modalities prescribed by the provider. Without it, the patient will remain sick or injured and possibly get worst. The diagnostic services are essential to confirm the provider’s diagnosis. It provides the treatment team a clear picture of what the best course of action or treatment plan for the patient.

Urban area ancillary services

Ancillary services in urban areas can be a very profitable business. Due to the demographics, cultural background, high tempo and social norms in an urban environment patients will always pay for the convenience of the location. As an example, services like Optometry, Pharmacy and Physical Therapy, can be found in or around the same parking lot of a big grocery store like Fred Myers, Super Walmart or Costco. It gives the patient the convenience of multitasking which in an urban environment is essential. Ancillary services that can be found in an urban area not only provides the basic services but also the convenience. If the patient requires special treatment or diagnostic modality, they can go to a hospital or treatment facility in their network within their local area. Additionally, Urgent care centers or clinics provides the majority of the ancillary services the patients needs. Again, it is a one-stop shopping and prevents the patient from sitting around for hours in the hospital. Majority of these services accepts most medical insurance which is great for the patient and good business for the services.

Rural area ancillary services

Ancillary services in a rural community can be isolated and austere. They are normally very limited, operating with bare essentials and sometimes none existent. These services are normally collocated within the medical clinic and with limited hours of operations. Since the services are limited, patients tend not to use them or just make do of what they have. For example, patients will travel long distance just to get their medicine.

Disadvantages of patients living in rural areas

It is a challenge for the patients and the providers. From the patient side, it can be frustrating because the time and distance it takes to travel to the medical facility. Limited hours of operations and services they offer, sometimes it is better making the effort of traveling to the urban community just to get the services they need. That means spending time and money which can be hard for the families. From the provider side, it is also a challenge. The issue are volume and cost to operations. Even though the rural providers would like to get the state-of-the-art diagnostic or therapeutic machines and the highly trained staff to operate it is not cost-effective. Rural areas normally do not have the patient load compared to the urban areas. Therefor, the providers must balance on what type and volume of patients they normally have, what modalities or treatment they can perform and the cost to business operations.

Recommendations to providers in rural areas

One recommendation which has been validated during the current COVID 19 pandemic is the use of telemedicine (Weisgrau. 1995). From the basic primary care patient visit to specialty appointments like allergy, dermatology appointments. Also, it is currently being used effectively by the military and the Veterans Healthcare system for mental health services. It was initially used in the Philippines and Iraq (Chen. 2016).

Invest in basic diagnostic equipment that is portable, easy to use, can conduct multiple test and cost-effective like the i-STAT-1 Handheld Blood analyzer (Abbott. n.d.). It will save lives and good for business.

Lastly, keep it simple and basic. Always remember to goal of healthcare (even in the most austere environment) is the same…save lives (U.S. Army. 2020).


Abbott. (n.d.). i-STAT-1 Point of care Blood analyser. Retrieved May 25, 2021, from

Chen, M. (2016, November 7). Lessons on Bringing Surgical Care and Telemedicine to Iraq Kurdistan. Linkedin. Retrieved May 25, 2021, from

U.S. Army. (2020). Army Health System FM 4-02 [PDF].

Post 3 :

Jaydin Davis posted May 28, 2021 7:39 PMSubscribe

Ancillary services are medical support services offered to primary physicians. They are the services offered by hospitals and medical institutions, other medical and nursing services. Ancillary services are divided into three categories: diagnostic services like laboratory tests, therapeutic services like hospice care services, and custodial services.

Access to medical services is the main problem facing the rural population. The same applies to ancillary services, where the main difference between rural and urban is access. The services are usually provided in different areas in rural areas. Rural hospitals are usually smaller in size than urban hospitals (Hatten & Connerton, 1986). The size leads to the geographical disbursement of ancillary services. Patients have to travel for distances to obtain ancillary services. Spasojevic et al., (2015) articulated that rural folks are more likely to travel more than 15 minutes to obtain medical services.

Rural consumers of medical services living in rural areas are at a disadvantage when receiving ancillary services. The services are disbursed in different places making access to the services a problem. The charges for ancillary service in rural areas are higher than in urban areas. Ancillary services follow a pattern where medical services are charged higher (Hatten & Connerton, 1986). This increases the cost of medical care for the patients in rural areas.

One way of improving access to health care services and ancillary services in rural areas is through better remuneration of physicians and providers of ancillary services. This will make the services in rural areas more attractive, attracting more professionals, and improving access. Medicare payments to rural physicians should be increased. Studies have shown that lower payments to physicians in rural areas may be why rural areas are not attractive to professionals.


Hatten, J. M., & Connerton, R. E. (1986). Urban and rural hospitals: how do they differ? Health care financing review8(2), 77–85.

Spasojevic N, Vasilj I, Hrabac B, Celik D. (2015). Rural – Urban Differences In Health Care Quality Assessment. Mater Sociomed. 2015 Dec;27(6):409-11. Doi: 10.5455/Msm.2015.27.409-411. Pmid: 26937222; Pmcid: Pmc4753384.

respondo weeko 4

 review the treatments and rationale below. Do you agree or disagree? Why? What information from this week’s content or outside information can you cite to support your opinions? 

The purpose of this discussion is to assess how a provider should council a 53 year old patient that has not been diagnosed with diabetes, has an LDL score of 170 mg/L, and has an atherosclerotic cardiovascular disease calculated risk score of 8. According to the National Vascular Disease Prevention alliance, a risk score of 8 suggests there is a minimal chance that a person will develop cardiovascular disease in the next 5 years (“What does your risk score mean,” 2012). Current recommendations also state that adults 40 to 75 without diabetes, an LDL score above 70, and a cardiovascular risk score over 7.5% should be started on a moderate statin (Pignone, 2021). Thus, one drug to initiate includes Simvastatin, 20 mg daily. After educating this patient on the side effects, administration, and purpose, I would arrange a follow up in six to eight weeks to re-check levels (Pignone, 2021). In addition to pharmacologic therapy, non-pharmacologic treatments include lifestyle changes, such as eating a healthy diet (full of fruits, vegetables, and fibers) and exercise (moderate intensity 150 minutes per week) (Hennekens, 2021). At this time, the patient would not need to be referred or any diagnostics. Thus, this patient should be referred to start on a statin with lifestyle changes. 

Discussion Question


 Discuss the concepts of meditation and how they may assist in helping your patient deal with stress/anxiety.


Please abide by APA 7th edition format in your writing. 

Answers should be 2-3 Paragraphs made up of 3-4 sentences each, at least 250 words (more or less) 

End-of-life care becomes an issue at some point for elderly clients


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.

Using 300-350 words APA format with references

Discussion Question

How do nurses can help in a chiropractic care?





 Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.

The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.

Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.

Critical thinking activities

Based on this case study, consider the following questions.

1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring 

Length: ~ 75-100 word each answer; 250 – 300 words, total. 

 Answer three (3) of these Discussion Questions (2 from the A set, and 1 from the B). Please give enough examples and information to support why you have the opinion you do.   

Length: ~ 75-100 word each answer; 250 – 300 words, total. 

Set A. Choose two (2) of these prompts to answer and discuss.

It is true that society and arts in the West are more secular than they were in the past. But to what extent does religion continue to influence popular arts? Choose a popular song or film and comment on elements of it that might be influenced by religion. Include an active link to a song and written lyrics, or to the trailer for a film.

The Hebrew and Christian Bibles and the Islamic Qur’an all present the commandments of God. They are strikingly similar.  Presumably all three religions pray to the same God.  Briefly explain some of the disputes they have with each other.

At the beginning of Whitman’s book of poems, Leaves of Grass, is the line, “For every atom belonging to me as good belongs to you.” While this would at first appear not have anything to do with religion, the text points out that in fact Whitman was strongly influenced by a certain religion.  What was it?  Explain the influence.

Would the discovery of life on other planets strengthen or diminish the role of religion in modern society? Explain.

Set B. Then, choose one (1) of these to answer and discuss:

5. In your opinion, are humans naturally inclined to greed, rebellion, and evil? What forces, both inner and outer, cause humans to do evil? What forces cause them to do good? You should also consider the fact that we need to discipline children and need governments to keep people in line.

6. Some philosophers claim that humans are naturally good, and that they are only corrupted by a depraved society. One might wonder, then, since society is made up of humans, where does this depravity come from?

Essay 2 pages spiritually

Compare and contrast your religious beliefs and health practices with the beliefs and health practices of someone with a different religion. Clearly state the two religions you are discussing. Write a 2page essay. Identify any reference used other than your textbook using Christianity to compare and contrast with any other religion . I have provided pages to books that can be used at references as long as the names of the books . Book Professional Nursing Concepts and challenges 9th edition By Beth perry black. 

Chapter 13 page 289-298 use for help also can search web. Be sure to identify references 

Chapter 35 culture and spiritual nursing care in ATI BOOK FUNDAMENTALS FOR NURSING  EDITION  10.0.

As a new nurse you are assigned to work with a preceptor in the Emergency Department. It is a very busy day and it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and/or acid-base balance. The first patient


As a new nurse you are assigned to work with a preceptor in the Emergency Department. It is a very busy day and it seems as if every patient, regardless of chief complaint, has an issue with fluid, electrolyte, and/or acid-base balance. The first patient you see is a 37-year-old landscaper who is brought to the ED after collapsing on a job at the local country club. He is slightly confused but is able to tell you he feels dizzy and weak. His skin is flushed, dry, and with poor turgor. He has dry, sticky mucous membranes. The nurse identifies a nursing diagnosis of deficient fluid volume.

1. Describe how each of the following would change and the rationale for the change in the presence of

   deficient fluid volume:

• Heart rate

• Blood pressure

• Serum hematocrit

• Urinary output

• Urine specific gravity

• Weight

2. What is usually the first indicator that an individual needs more fluids?

3. The ED physician orders IV fluids for this patient. What types of fluids are indicated for a fluid     volume deficit due to dehydration?

4. The fluid order is to start 1000 mL of fluid as ordered at 150 mL/hr. The infusion tubing has a drop factor of 15 gtt/mL. This infusion will run by gravity rather than an infusion pump. How many drops per minute should you time the infusion at to ensure the correct hourly rate?

5. The patient has a “full sleeve” tattoo on both arms. Discuss the implications of this finding and how you will initiate the intravenous site.

6. You have difficulty finding a vein in the presence of the deficient fluid volume.  List 3 strategies that you can use to help make a vein more visible/palpable?

7. Considering the diagnosis, patient presentation, and fluid orders, what size catheter is indicated in this situation? Give a rationale for your choice.

8. After 30 minutes of the infusion, the patient states, “My arm where the needle is feels funny.” What should you do first? What further data do you need from the patient?

Several hours later the patient is feeling better and is now oriented × 3. The ED physician wants the patient to be drinking oral fluids without difficulty prior to being discharged from the ED.

9. List 3 strategies to increase fluid intake that are most appropriate to this setting.

10. The patient is discharged after adequate hydration. Discharge teaching includes ways to prevent this from happening again on the job. What key points should the nurse include in the teaching applicable to the job site?