What      is the most likely genetic disease that this presents and why?

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PART No. 1:

You are contacted by an attorney representing a client who has been charged with child abuse and whom faces loss of her child and 15 years in prison. The record indicated that the child was 4 years old and presented to the ER room with a broken arm and a broken leg. There also appeared to be multiple previous fractures. Now, you examine the child and find blue sclera, a sunken chest wall, severe scoliosis, and you observe a triangular face and prominent forehead. You confirm that there have been multiple previous fractures by evaluating the previous X-rays. This is a genetic disorder.

  • What      is the most likely genetic disease that this presents and why?
  • What      is the molecular basis of this disease?
  • Before,      calling the police what should the initial clinician have done?

PART No 2:

Johnny is a 5-year-old Asian boy who is brought to a family practice office with a “runny” nose that started about 1 week ago but has not resolved.  He has been blowing his nose quite frequently and “sores” have developed around his nose.  His mother states, “The sores started as ‘big blisters’ that rupture; sometimes, a scab forms with a crust that looks like “dried maple syrup” but continues to seep and drain.”  She is worried because the lesions are now also on his forearm.  Johnny’s past medical and family histories are normal.  He has been febrile but is otherwise asymptomatic.  The physical examination was unremarkable except for moderate, purulent rhinorrhea and 0.5- to 1-cm diameter weeping lesions around the nose and mouth and on the radial surface of the right forearm.  There is no regional lymphadenopathy.

  • Write      a differential of at least three (3) possible diagnoses and explain how      each may be a possible answer to the clinical presentation above.      Remember, to list the differential in the order of most likely to less      likely.
  • Based      upon what you have at the top of the differentials how would you treat      this patient?
  • When      would you allow the student back to school? Elaborate on your reasoning?

PART No. 3:

Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and a fever of about 104 F, She also has a rash on her face a possibly the beginning of a rash on her arms. About 10 days ago she was around another student who had similar symptoms.

  • Write      three (3) differential diagnoses?
  • What      are some of the complications of this disease, assume that the top of your      differential is the definitive?
  • Assume      that the second item you place on your differential is the definitive      diagnosis. What are some complications of that disease?

PEER:

NR 507 Week No. 6 Quiz Solutions:

1. Considering the pathophysiology of osteoporosis, which cytokines and hormones decrease receptor activator of RANKL expression?(Points : 2)

2. Rhabdomyolysis is characterized by (Points : 2)

3. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula? (Points : 2)

4. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? (Points : 2)

5. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon? (Points : 2)

6. Which statement is false about giant cell tumors? (Points : 2)

7. What pattern of bone destruction is described as not well defined and not easily separated from normal bone? (Points : 2)

8. The pain experienced in Legg-Calvé-Perthes disease is referred to as involving (Points : 2)

9. In osteomyelitis, bacteria gain access to the subperiosteal space in the metaphysis, which is considered the “path of least resistance.” What factor makes this route for bacteria the path of least resistance? (Points : 2)

10. Molecular analysis has demonstrated that osteosarcoma is associated with (Points : 2)

11. Ewing sarcoma arises from (Points : 2)

12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta? (Points : 2)

13. The _____ is cartilage that retains the ability to form and calcify new cartilage and deposit bone until the skeleton matures. (Points : 2)

14. Osteochondrosis is caused by a(n) (Points : 2)

15. An insufficient dietary intake of vitamin _____ can lead to rickets in children. (Points : 2)

16. In latex allergies, which immunoglobulin is associated with an immediate reaction? (Points : 2)

17. Chickenpox may be followed years later by (Points : 2)

18. Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen. (Points : 2)

19. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck? (Points : 2)

20. Scleroderma is more common in women and is associated with a(n) (Points : 2)

21. Thrush is a superficial infection that commonly occurs in children and is caused by (Points : 2)

22. What is the cause of chickenpox? (Points : 2)

23. Which vascular anomaly is a congenital malformation of dermal capillaries that does not fade with age? (Points : 2)

24. What is a common source of tinea corporis? (Points : 2)

25. Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or wheal with hemorrhagic puncture site?(Points : 2)

What are characteristics of a humanbecoming nurse?  What are strengths and weaknesses to this theory of nursing?

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The hospice nurse sat with Ann’s husband, Ben. Ann was resting quietly as the increased dosage of IV pain medication gradually reached its therapeutic level. Ben turned his head and slowly turned, looking out the room’s only window. As he glanced up, a small flicker of light caught his breath. It was a shooting star. A tear fell from the corner of his eye and he turned to Ann. The nurse sensed that something significant to Ann and Ben was unfolding. Shuffling to Ann’s bedside, he took her small fragile hand in his. These hands had rocked cradles, burped babies, and groomed the horses she loved to ride. Gently holding her hand, he turned to the nurse. “She would ride like the wind was chasing her.” Looking back to Ann his voice broke; choking back tears “Ann, Ann I saw Jessie…Jessie is calling.” Ben turned “Jessie was our daughter. She died having a baby that was too big. When she died it was a pitch-black night. Cold, so cold, the baby died too, a little boy, named him Abe, Jr. after Jessie’s husband. I took Ann outside so she could cry to God above and there in this dark sky we saw two falling stars…together…just falling. We knew it had to be Jessie and Abe…two angels to light up the night.” Ben turned back as a deep sign escaped from Ann’s lips. A soft smile remained as she joined Jessie and Abe.

  • Based on this case study how would the nurse actualize Parse’s theory of Human Becoming?
  • What are characteristics of a humanbecoming nurse?  What are strengths and weaknesses to this theory of nursing?
  • What challenges exist for healthcare institutions to switch to this nursing approach?
  • How might Parse’s understanding of transcendence guide the nurse, as Ann’s death became a reality to Ben?
  • From the nursing theories we have discussed, what theory would you apply to this case study? Develop a plan of care to include both nursing theories (be specific and provide reasons)

The APA formatted paper should include 2 outside references and your book. The essay should be 1250 words

Write a 1,200-1,500-word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

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Write a 1,200-1,500-word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

1. Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?

2. Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James?

3. According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?

4. According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and treating James?

Prepare this assignment according to the guidelines found in the APA Style Guide, MINIMUM OF 3 REFERENCES PLEASE.

How might the actions of the individuals influence the success of the organization?

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Throughout your education, patient safety and improving the quality of patient care have been examined. Through numerous readings and media pieces, you have heard about Never Events. These are serious and costly medical errors that are preventable, such as wrong-side surgery, medication errors, and hospital-acquired infections. Each of these types of medical errors is preventable. The consequences of such errors are now financial as well as legal and emotional. The Centers for Medicare & Medicaid Services no longer reimburse for medical errors classified as Never Events.

As a nurse, how can you help to prevent these types of medical errors? What is your accountability for clinical outcomes? There are standards and core measures in place that guide nursing practice. In addition, the National Database of Nursing Quality Indicators (NDNQI) examines those components of clinical care that are specific to nursing. The NDNQI quantifies, or assesses, these nurse-sensitive components and provides specific feedback on how well nursing practice is being executed in those areas related to patient care.

This week, you will consider a series of articles that focus on strategies for ensuring safety and quality care for patients. You will also explore how successful, efficient teamwork between nurses, nursing leaders, physicians, and other medical personnel can help prevent many of the Never Events from occurring and decrease the likelihood of such events in the future.

Learning Objectives

Students will:
  • Analyze the core measures and standards for nursing practice that promote patient safety and quality of care outcomes
  • Analyze the impact of the nurse’s role in clinical outcomes for organizations
  • Analyze nurse-specific challenges for influencing change in quality improvement
  • Analyze the role of the nurse in supporting the organization’s strategic agenda in improving clinical outcomes

Photo Credit: PhotoAlto/Odilon Dimier / PhotoAlto Agency RF Collections / Getty Images

Learning Resources

Prior Knowledge

It is not uncommon for students to be required to complete group projects or to work as part of a team. While obtaining your RN credentials, or at some time in your work career, you have more than likely at some point been part of a unit or a collaborative team. Reflect on that experience of working with others to achieve a common goal. How did the actions of your team members impact your success as a team? Consider how this same philosophy applies within an organization. How might the actions of the individuals influence the success of the organization?

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Amin, A. N., Hofmann, H., Owen, M. M., Tran, H., Tucker, S., & Kaplan, S. H. (2014). Reduce readmissions with service-based care management. Professional Case Management, 19(6), 255–262. doi: 10.1097/NCM.0000000000000051

Note: You will access this article from the Walden Library databases.

Forster, A. J., Dervin, G., Martin, C., & Papp, S. (2012). Improving patient safety through the systematic evaluation of patient outcomes. Canadian Journal of Surgery, 55(6), 419–425. doi: 10.1503/cjs.007811

Note: You will access this article from the Walden Library databases.

Johansen, M. L. (2014). Conflicting priorities: Emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care. Journal of Emergency Nursing, 40(1), 13–19. doi: 10.1016/j.jen.2012.04.013

Note: You will access this article from the Walden Library databases.

McDowell, D. S., & McComb, S. A. (2014). Safety checklist briefings: A systematic review of the literature. AORN, 99(1), 125–137. doi: 10.1016/j.orn.2013.11.015

Note: You will access this article from the Walden Library databases.

Payne, D. (2014). Elderly care: Reflecting on that ultimate ‘never event.’ British Journal of Nursing, 23(13), 702. doi: 10.12968/bjon.2014.23.13.702

Note: You will access this article from the Walden Library databases.

Thornlow, D. K., & Merwin, E. (2009). Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes. Health Care Management Review, 34(3), 262–272. doi: 10.1097/HMR.0b013e3181a16bce

Note: You will access this article from the Walden Library databases.

American Hospital Association. (2016). Retrieved from http://www.aha.org/

 

Explore the American Hospital Association’s website. Focus on the information on improving patient safety and quality of care.

 

 

American Organization of Nurse Executives. (2016). Retrieved from http://www.aone.org

 

“Since 1967, the American Organization of Nurse Executives (AONE) has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. AONE is a subsidiary of the American Hospital Association” (AONE, 2016).

 

 

Centers for Medicare & Medicaid Services. (n.d.). Quality of care center. Retrieved August 11, 2016, from http://www.cms.gov/Center/Special-Topic/Quality-of-Care-Center.html?redirect=/center/quality.asp

 

Most health care organizations receive some amount of reimbursement from the Centers for Medicare & Medicaid Services (CMS). Reimbursement continues to be jeopardized and reduced by pay for performance standards. Health care organizations are being held to higher standards by CMS. Explore the standards set to improve patient safety and the quality of care. Consider how they affect acute care providers and nursing practice.

 

 

The National Academies of Sciences, Engineering, and Medicine. (2016). Health and Medicine Division. Retrieved from http://www.nationalacademies.org/hmd/

 

The Health and Medicine Division (HMD) promotes policies and best practices in an effort to improve patient safety and delivery of quality care. Review a few of the publications available at this site.

 

 

The Joint Commission. (2016). National Quality Forum (NQF) endorsed nursing-sensitive care performance measures. Retrieved from http://www.jointcommission.org/national_quality_forum_nqf_endorsed_nursing-sensitive_care_performance_measures/

 

The Joint Commission (TJC) also accredits health care organizations. Through funding provided by the Robert Wood Johnson Foundation, the Joint Commission developed the Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. Review this guide as you consider how core measures and national guidelines improve nursing practice.

 

Required Media

Laureate Education. (Producer). (2009b). Topics in clinical nursing: Accountability for clinical outcomes and promoting safety and quality [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 15 minutes.

 

Discussion: Promoting Safety and Quality

In the article “Managing to Improve Quality: The Relationship Between Accreditation Standards, Safety Practices, and Patient Outcomes,” the authors discuss the growing trend by medical insurance companies to eliminate reimbursement for Never Events. As these types of mistakes should be easily preventable, hospitals have developed protocols to lessen or extinguish the occurrence of these events. In addition, The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) have developed core measures to guide health care providers’ efforts in improving patient safety and the quality of care delivered.

Health care organizations have developed strategic agendas to help meet these standards and reduce the incidence of Never Events. Nurses significantly influence the overall quality of health care provided and play a pivotal role in improving patient outcomes.

For this Discussion, you will consider the standards that are in place for nurses and how they can be used to improve quality of care.

To prepare for this Discussion:

  • Review the information at the Joint Commission and Centers for Medicare & Medicaid Services websites on the core measures and standards presented in this week’s Learning Resources.
  • Consider the nurse’s role in supporting the organization’s strategic agenda as it relates to improving clinical outcomes.
  • Conduct an Internet search for either a Never Event or a core measure, and select one to address in your post.
By Day 3

Respond to the following:

  • How has the emphasis on quality of care, patient safety, and clinical care outcomes been impacted by specific standards emanating from TJC and/or CMS? Cite your selected core measure or Never Event in your response.
  • What is the impact of the nurse’s role in clinical outcomes for the organization?
  • Discuss nurse-specific challenges in influencing change in quality improvement.
  • How does this influence the ability of the organization to achieve its strategic agenda?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 250–350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).