1) Minimum 7 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

             Part 1: Minimum 2 pages

             Part 2: minimum 3 pages

             Part 3: Minimum 1 page

             Part 4: minimum 1 page

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

Part 2:  

  Must include: 

American Association of Colleges of Nursing [AACN]. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: Author. 

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.do

__________________________________________________________________________________

Part 1: Pharmacology

Chronic Stable Angina

E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina.

Diagnosis: Angina

1. List specific goals of treatment for E.H.

2. What dietary and lifestyle changes should be recommended for this patient?

3. What drug therapy would you prescribe for E.H. and why?

4. How would you monitor for success in E.H.?

5. Describe one or two drug–drug or drug–food interactions for the selected agent.

6. List one or two adverse reactions for the selected agent that would cause you to change therapy.

7. What would be the choice for the second-line therapy?

8. Discuss specific patient education based on the prescribed first-line therapy.

9. What over-the-counter and/or alternative medications would be appropriate for E.H.?

 

Part 2: Pathophysiology ( Remember is a Reflection about the class)

Purpose

The purpose of this assignment is to provide the student an opportunity to reflect on selected RN-BSN competencies acquired through the  course about Pathophysiology 

Mandatory:

1) Introduction (minimum 1/2 page):

Reflect the purpose of the paper from your role as an RN-BSN student about the Pathophysiology  course

2) Reflection  about 

1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. 

2. Recognize the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness, using a constructed pedigree from collected family history information as well as standardized symbols and terminology. 

3. Implement holistic, patient centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health illness continuum, across the lifespan, and in all healthcare settings.

4. Communicate effectively with all members of the healthcare team, including the patient and the patient’s support network. 

3)  Conclusion (minimum 1/2 page)

An   effective conclusion identifies the main ideas and major conclusions from the   body of your essay. Minor details are left out. Summarize the benefits of the   pertinent BSN Essential and sub-competencies (AACN, 2008) pertaining to scholarship for   evidence-based practice

Part 3: Ethical (Write in the first person)

 

The four principles, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. 

1. How would you rank the importance of each of the four principles? 

2. How do you believe they would be ordered in the context of the Christian biblical narrative?

Part 4: Ethical (Write in the first person)

  

1. What do the four parts of the Christian biblical narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? 

2. From where would one find comfort and hope in the light of illness according to this narrative? 

3. Explain in detail each part of the narrative above and analyze the implications.

 

• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.

 Your essay will be 4-5 pp (not including Title / Reference pages.  1) Review and summarize the Learning Resources from the Lesson (or other source), and indicate how this school of ethics differs from those of earlier weeks; 2), explore how Virtue Ethics might play a role in your daily life and work.

Include in-text citations in your essay (last name, date, pg#) along with an APA formatted References page. 

Resources:

http://classics.mit.edu/Aristotle/nicomachaen.1.i.html

 

Test: Module 3 Knowledge Check

  

QUESTION 1

1. A 45-year-old male comes to the clinic with a chief complaint      of epigastric abdominal pain that has persisted for 2 weeks. He describes      the pain as burning, non-radiating and is worse after meals. He denies      nausea, vomiting, weight loss or obvious bleeding. He admits to bloating      and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

1 of 2 Questions:

What factors may have contributed to the development of PUD? 

             

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QUESTION 2

1. A 45-year-old male comes to the clinic with a chief complaint      of epigastric abdominal pain that has persisted for 2 weeks. He describes      the pain as burning, non-radiating and is worse after meals. He denies      nausea, vomiting, weight loss or obvious bleeding. He admits to bloating      and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

2 of 2 Questions:

How do these factors contribute to the formation of peptic ulcers? 

             

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QUESTION 3

1. A      36-year-old morbidly obese female comes to the office with a chief      complaint of “burning in my chest and a funny taste in my mouth”. The      symptoms have been present for years but patient states she had been      treating the symptoms with antacid tablets which helped until the last 4      or 5 weeks. She never saw a healthcare provider for that. She      says the symptoms get worse at night when she is lying down and has had to      sleep with 2 pillows. She says she has started coughing at night which has      been interfering with her sleep. She denies palpitations, shortness      of breath, or nausea. 

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2) 

Family history-non contributary   

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn 

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping    

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD). 

Question:

The client asks the APRN what causes GERD. What is the APRN’s best response? 

             

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QUESTION 4

1. A 34-year-old construction worker presents to his Primary Care Provider      (PCP) with a chief complaint of passing foul smelling dark, tarry      stools. He stated the first episode occurred last week, but it      was only a small amount after he had eaten a dinner of beets and beef. The      episode today was accompanied by nausea, sweating, and weakness. He states      he has had some mid epigastric pain for several weeks and has been taking      OTC antacids. The most likely diagnosis is upper GI bleed which won’t be      confirmed until further endoscopic procedures are performed.

Question:

What factors can contribute to an upper GI bleed? 

             

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QUESTION 5

1. A 64-year-old steel worker presents to his Primary Care      Provider (PCP) with a chief complaint of passing bright red blood      when he had a bowel movement that morning. He stated the first episode      occurred last week, but it was only a small amount after he had eaten a      dinner of beets and beef. The episode today was accompanied by nausea,      sweating, and weakness. He states he has had some left lower      quadrant pain for several weeks but described it as “coming and      going”. He says he has had a fever and abdominal cramps that have      worsened this morning. The likely diagnosis is lower GI bleed secondary to      diverticulitis.

Question:

What can cause diverticulitis in the lower GI tract? 

             

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QUESTION 6

1. A      48-year-old man presents to his gastroenterologist for increasing      abdominal girth and increasing jaundice. He has a long history of      alcoholic cirrhosis and has multiple admissions for encephalopathy      and GI bleeding from esophageal varices. He has been diagnosed with portal      hypertension and tells the APRN that he was told he had chronic,      non-curable cirrhosis.    

Question:

How does cirrhosis cause portal hypertension? 

             

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QUESTION 7

1. A 48-year-old man presents to his gastroenterologist for      increasing abdominal girth and increasing jaundice. He has a long history      of alcoholic cirrhosis and has multiple admissions for encephalopathy and      GI bleeding from esophageal varices. He has been diagnosed with portal      hypertension. The increased abdominal girth has been progressive, and he      says it is getting hard to breathe. The APRN reviews his last      laboratory data and notes that the total protein is 4.6 gm/dl      and the albumin is 2.9 g/dl. Upon exam, he has icteric sclera,      jaundice, and abdominal spider angiomas. There is a significant fluid wave      when percussed. The APRN tells the patient that he has      ascites.  

Question:

Discuss how ascites develops as a result of portal hypertension. 

             

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QUESTION 8

1. A 45-year-old man      with known alcoholic cirrhosis, portal hypertension, and ascites is      brought to the ED by his family due to increasing confusion. The family      states that he had been stumbling for several days but had not      fallen. The family also noted that he had been “flapping his hands” as      well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia      (NH3) level is 159 μmol/L. The APRN informs      the family that the patient has developed hepatic encephalopathy      (HE). 

Question:

Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

             

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QUESTION 9

1. A 65-year-old      man with a history of atrial fibrillation presents to his PCP’s      office 2 months after suffering from a myocardial      infarction.  He declined anticoagulation due to fear he would      bleed to death. He has had sudden-onset, moderately      severe diffuse abdominal pain that began 18 hours ago. He has been      vomiting, and he has had several episodes of diarrhea, the last      of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of      15,000/mm3. 

Question:

What is the most likely mechanism behind his current symptoms?  

             

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QUESTION 10

1. A 46-year-old Caucasian female presents to the PCP’s office      with a chief complaint of severe, intermittent right upper quadrant pain      for the last 3 days. The pain is described as sharp and has occurred      after eating french fries and cheeseburgers and radiates to      her right shoulder. She has had a few episodes of vomiting “green stuff”.      States had fever and chills last night which precipitated her trip to the      office. She also had some dark orange urine, but she thought she was      dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 1 of 2:

Describe how gallstones are formed and why they caused the symptoms that the patient presented with. 

             

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QUESTION 11

1. A 46-year-old Caucasian female presents to the PCP’s office      with a chief complaint of severe, intermittent right upper quadrant pain      for the last 3 days. The pain is described as sharp and has occurred      after eating french fries and cheeseburgers and radiates to      her right shoulder. She has had a few episodes of vomiting “green stuff”.      States had fever and chills last night which precipitated her trip to the      office. She also had some dark orange urine, but she thought she was      dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 2 of 2:

Explain how the patient became jaundiced.

             

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QUESTION 12

1. Ruth is a 49-year-old office worker who presents to the clinic      with a chief complaint of abdominal pain x 2 days. The pain has      significantly increased over the past 6 hours and is now accompanied by      nausea and vomiting. The pain is described as “sharp and boring” in      mid epigastrum and radiates to the back. Ruth admits      to a long history of alcohol use, and often drinks up to a fifth of vodka      every day.  

Physical Exam: 

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air. 

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly. 

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs 

Resp-decreased breath sounds in both bases with poor inspiratory effort 

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed.  Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.  

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis. 

Question:

Explain how pancreatitis develops and the role alcohol played in this patient’s case.

             

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QUESTION 13

1. A 23-year-old bisexual man with a history      of intravenous drug abuse presents to the clinic with a chief complaint      of fever, fatigue, loss of appetite, nausea, vomiting, abdominal      pain, and dark urine. He says the symptoms started about a month ago      and have gotten steadily worse. He admits to reusing needles and had      unprotected sexual relations with a man “a couple months ago”.  

PMH-noncontributory.   

Social/family history-works occasionally as a night clerk in a hotel. Parents without illnesses. Admits to bisexual sexual relations and intravenous heroin use. He has refused drug rehabilitation. 3 year/pack history of tobacco but denies vaping.  

Physical exam unremarkable except for palpable liver edge 2 fingerbreadths below costal margin. No ascites or jaundice appreciated.  

The APRN suspects the patient has Hepatitis B given the strong history of risk factors. She orders a hepatitis panel which was positive for acute Hepatitis B. 

Question:

What are the important hepatitis markers that indicated the patient had acute hepatitis B? 

             

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QUESTION 14

1. Hannah is a 19-year-old college sophomore who came to Student      Health with a chief complaint of lower abdominal pain. She says the pain      has been present for 2 months and she has had multiple episodes      of diarrhea alternating with constipation, and anorexia. She says she      has lost about 10 pounds in these 2 months without dieting. The abdominal      pain has gotten worse in the last 2 hours, but she thought she had “the GI      bug” like other students at her Synagogue had.  

Physical exam-noncontributory except for the abdomen which was lightly distended with no visible masses. Normoactive BS x 4. Diffuse tenderness throughout but increased pain on deep palpation LUQ & LLQ. Slight guarding but no rebound tenderness or rigidity. 

Rectal-tight anal sphincter and patient grimacing in pain during exam. Slightly + guaiac stool. 

Based on her history and current symptoms, the APN arranges for a consult with a gastroenterologist who diagnoses Hannah with ulcerative colitis (UC). 

Question:

How does ulcerative colitis develop in a susceptible person?  

             

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QUESTION 15

1. A 64-year-old woman with long standing coronary artery disease      presents to the clinic with lower extremity swelling, abdominal      distension, and shortness of breath. Patient states she has a 30-pound      weight gain in 6 weeks and is now requiring 3 pillows to sleep.  

On physical exam the patient is a well-developed, well-nourished female exhibiting signs of respiratory distress with use of accessory muscles. Blood pressure 150/80, pulse 105, respirations 28 and labored. Body weight 89 kg. HEENT was unremarkable. Cardiac exam had an S1, S2 and S3 without S4 or murmur. Respiratory exam was positive for bilateral rales 1/2 up both lung fields. Abdomen was enlarged with a positive fluid wave. Lower extremities were remarkable for 3+ pitting edema. 

Laboratory data was significant for an increase in K+ from 3.4 mmol/l to 6.1 mmol/l in 2 weeks, BUN increased from 18 mg/dl to 104 mg/dl, and creatinine increased from 0.8 mg/dl to 6.9 mg/dl.  

CXR revealed congestive heart failure. The APRN calls the cardiologist on call who admits the patient to the hospital and orders a nephrology consult.  

She was diagnosed with exacerbation of congestive heart failure (CHF) and acute kidney injury (AKI).  

Question:

What type of acute kidney injury does the patient have and what factors contributed to this diagnosis? 

             

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QUESTION 16

1. The APRN is giving a pathophysiology lecture to APRN students      on renal blood flow, related hormones, and glomerular filtration      rate.  

Question:

What would be the most important concept of glomerular filtration rate that the APRN should address? 

             

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QUESTION 17

1. The APRN is giving a pathophysiology lecture to APRN students      on renal blood flow, glomerular filtration rate, autoregulation,      and related hormone factors regulating renal blood flow 

Question:

What would be the most important concept of autoregulation that the APRN should address? 

             

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QUESTION 18

1. The APRN is giving a pathophysiology lecture to APRN students      on renal blood flow, glomerular filtration rate, autoregulation, and      related hormone factors regulating renal blood flow 

Question:

What would be the most important concept of hormonal regulation that the APRN should address? 

             

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QUESTION 19

1. A 28-year-old female comes to the clinic with a chief      complaint of right flank pain, urinary frequency, and foul-smelling urine.      The symptoms have been present for 3 days but this morning, the patient      states she had a fever of 101 F and thought she should get it checked out.      Physical exam noncontributory with the exception of right      costovertebral angle (CVA) tenderness upon percussion. Urine dipstick      shows + blood, + bacteria and + white blood cells. Renal ultrasound      reveals right staghorn renal calculus and the patient was diagnosed with      acute pyelonephritis.  

Question:

How does a renal calculi calculus contribute to acute pyelonephritis? 

             

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QUESTION 20

1. Mr. Kent is a 45-year-old African American male with a history      of Type 2 diabetes, hypertension, and hyperlipidemia. His renal      function has slowly decreased over the past 4 years and his nephrologist      has
   

(1) Maintain a food diary for three days using MyFitnessPal, or a similar diet app. A list of common diet apps can be downloaded in the  Worksheets, Forms, and Templates area at left.

(2) Write a nutritional self-assessment paper. In your paper, you will analyze your eating habits, food patterns, and nutrition intake.    

 Maintaining your diary:You will use the MyFitnessPal food diary app to record everything that goes into your digestive system over the course of three days. Record everything you eat and drink, and record the name and dosage of any medications that you take, including vitamins, minerals, and herbal supplements.It is preferable to record your food intake for at least one non-school day or one non-weekday (for example, Thursday, Friday, Saturday, or Sunday, Monday, Tuesday). This way, you will see how your eating habits change with your schedule.It is important that you take time each day to record your food, drink, and drug intake rather than relying on your memory. An honest, detailed diary will help you gain a better understanding of yourself personally and professionally.  Take screenshots of your MyFitnessPal food diary to include in your analysis paper. At the end of the three days, print the final report in MyFitnessPal to include with your written paper.

• Your paper should be a minimum of 4 pages in length 
• Attach a copy of your final report from MyFitnessPal along with your completed nutrient spreadsheet with your paper.
• Use APA and include a title and reference page.