possible bariatric surgery for obesity

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The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2–3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control with sodium restriction. He current works at a catalog telephone center.

Objective Data

Height: 68 inches; Weight 134.5 kg

BP: 172/96, HR 88, RR 26

Fasting Blood Glucose: 146/mg/dL

Total Cholesterol: 250mg/dL

Triglycerides: 312 mg/dL

HDL: 30 mg/dL

Critical Thinking Questions

What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?

Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered:

Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime.

Ranitidine (Zantac) 300 mg PO at bedtime.

Sucralfate/Carafate 1 g or 10ml suspension (500mg / 5mL) 1 hour before meals and at bedtime.

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

Assess each of Mr. C.’s functional health patterns using the information given. (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance.)

What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.

 

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Nursing Discussion

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To support your work, use your course and text readings and also use resources from the  University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

Post your initial response to one of the scenarios below.

Male & Female Reproductive System
Using the University Online Library, the Internet and your textbook, research the conditions affecting the male and female reproductive systems.

Scenario 1:
Mrs. Smith is a 50 year old Caucasian woman who has 4 children ages 17, 15, 13, and 10. She was 33 with the birth of her first child. Her BMI is 25. She has no personal or family history of breast cancer. She lives with her husband in a suburban community. She is an elementary school teacher who is working part-time as a substitute so she can be home with her children. She has been healthy with no previous medical history. One year ago she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her health insurance would be expiring in the next month so she reluctantly decided to have a mammogram. She called for an appointment and they were unable to see her for another 2 months.

After waiting 2 months, her mammogram confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

• What are the primary concerns for the patient right now? Why?
• What are some of the expected medical surgical interventions?
• What further assessment will be needed?
• What pharmaceutical drugs are approved treatments for breast cancer patients?

Scenario 2:

Mr. B is a 77 year old African American man who complains of difficulty urinating.

• What could be the underlying cause of these symptoms?
• What are his risk factors?
• What laboratory tests would be needed to confirm possible differential diagnoses?
• What interventions would you expect?

 
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Guido's MORAL model

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Assignment:

Complete both case studies:

1.  Apply Guido’s MORAL model to resolve the dilemma presented in the case  study described in EXERCISE 4–3 (Guido textbook). How might the nurses  in this scenario respond to the physician’s request? How would this  scenario begin to cause moral distress among the nursing staff, and what  are the positive actions that the nurses might begin to take to prevent  moral distress?

2.  Read the case study entitled You be the Ethicist, presented at the end  of Chapter 3 (Guido textbook). What are the compelling rights that this  case addresses? Whose rights should take precedence? Does a child  (specifically this competent 14-year-old) have the right to determine  what will happen to him? Should he ethically have this right? How would  you have decided the outcome if his disease state had not intervened?  Now, examine the scenario from the perspective of health care policy.  How would you begin to evaluate the need for the policy and the possible  support or lack of support for the policy from your peers, nursing  management, and others who might be affected by the policy? Do the 10  framework questions outlined by Malone in chapter 4 (Guido textbook)  assist in this process? Create a process proposal for the organization  with possible guidelines, procedures, and policies to address the issues  you have identified.

EXERCISE 4–3

Mrs. R., an 87-year-old patient, has a past history that includes coronary artery disease, a previous stroke, and advanced Alzheimer’s disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.’s condition occur.

Her primary physician has practiced in this community for multiple years; he is well-known for his reluctance to discontinue any type of life support for any patient. When questioned, Dr. G.’s consistent response is, if this were his frail 92-year-old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long-term nursing care facility.

How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among the nursing staff and what are the positive actions that the nurses should begin to take to prevent moral distress?

You be the Ethicist

Until recently, Tyrell Dueck was a normal eighth-grader in Canada, hoping that his favorite team would win the Stanley Cup for the third time. Then, early in the school year, he slipped climbing out of the shower and discovered a lump on his leg. He was then diagnosed with bone cancer.

After receiving two rounds of chemotherapy and being told that further therapy would mean the amputation of his leg, he announced that he wanted therapy stopped. He and his parents, devout fundamentalist Christians, decided to leave his health in God’s hands and seek alternative therapy. The decision sparked a court battle between his parents, who supported Tyrell’s decision, and the health care team, who sought to compel continued medical treatment and the planned amputation. The battle ultimately ended when doctors said that his cancer had spread to his lungs and that there was little more that could be done for Tyrell.

TEXTBOOK:

Legal and Ethical Issues in Nursing

Ginny Wa Guido

 

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Generalized linear models homework # please do it in r

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Goal

Implement a basic character recognition system of handwritten digits using logistic regression. The data set provided contains instances of the 10 digits available (0 through 9). Your goal is to train and test a logistic regression model that classifies the image of a digit as even or odd.

Task

Download the training and test sets (https://drive.google.com/file/d/1uMCvIV-KPzFQBeOCVvFWqvISUUrySLzH/view?usp=sharing). 

Two files are provided. Each of these files contains thousands of 28×28 grayscale images.

Each image is encoded as a row of 784 integer values between 0 and 255 indicating the brightness of each pixel. The original label is an integer between 0 and 9 and it represents the actual digit the image actually encodes. The file contain 785 columns. The first column corresponds to the digit labels (0-9) and the remaining 784 columns correspond to the pixel values of the 28×28=784 pixels of the image.

If you want to see the image encoded in each row, you can use the following functions (in R):

rotate <- function(x) {

  return(t(apply(x, 2, rev)))

}

plot_matrix <- function(vec) {

  q <- matrix(vec, 28, 28, byrow = TRUE)

  nq <- apply(q, 2, as.numeric)

  image(rotate(nq), col = gray((0:255)/255))

}

If you want to plot the third image, for example, you can call the plot function as follows: 

plot_matrix(mydata[3, 2:785])

=========================================================================================

1. Relabel each row with a 1 if the digit it corresponds to is even, and 0 if it is odd.

2. Train a logistic regression model to learn the binary variable you just created using all the columns that correspond to pixel values as inputs.

3. Study and use the ROC (https://en.wikipedia.org/wiki/Receiver_operating_characteristic (Links to an external site.)) to understand the effects of various threshold values for classification.

# Please do it in R