What strategies should the hospice nurse take to resolve the ethical dilemma?

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1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort.

  1. What ethical dilemma exists?
  2. Who are the stakeholders and what gains or losses do each have?
  3. What strategies should the hospice nurse take to resolve the ethical dilemma?

2. The nurse receives a 12-year-old girl from the operating room after an emergent appendectomy due to ruptured appendix. Upon arrival to the postanesthesia care unit, the patient is drowsy, but arousable to voice; she was extubated in the operating room and is receiving oxygen by facemask at 40%. She has two peripheral IVs in her left arm that are infusing Lactated Ringers solution at 100 mL/hr. A nasogastric tube is attached to low constant suction, and a small amount of aspirate is noted. She has a urinary catheter that is draining clear, yellow urine. Her abdominal dressing is dry and intact. Upon arousal, she complains of abdominal pain.

  1. What NANDA-approved nursing diagnoses may be relevant to this patient?
  2. Once the nursing diagnoses are determined, what steps does the nurse take to complete the Planning Phase of the Nursing Process?
  3. What is the difference between nursing diagnoses and collaborative problems?

What genetic-related diseases do the patient’s second-order relatives have?

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Mrs. Jones, a 40-year-old female patient, is presenting for a history and physical. The nurse gathers a family history from the patient. She shares that her mother died at 70 years of age of colon cancer and had adult onset diabetes controlled with oral agents, hypercholesterolemia, and hypertension. She had a stroke before passing away. Her father died at 67 years of age from a stroke. He had a long history of alcoholism and smoked two packs per day of cigarettes for 50 years. He had hypertension, hypercholesterolemia, and two heart attacks; the first heart attack was at 30 years of age and the second at 52 years of age. He had adult onset diabetes controlled with oral agents since 50 years of age. He had renal stenosis that was unsuccessfully treated with a renal angioplasty and he developed end-stage renal failure requiring hemodialysis. Mrs. Jones has two brothers. One brother developed hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents at 50 years of age. The second brother has no health problems. The maternal grandmother died at 88 years of age of a stroke and had hypertension. The maternal grandfather died at 70 years of age of a massive heart attack and had a history of hypertension. The paternal grandmother died at 80 years of age of a heart attack. The paternal grandfather died at 50 years of age from bleeding esophageal varices related to long-standing alcoholism. The patient shares that her mother’s first cousin, George, died at 52 years of age of Hodgkin lymphoma. She has another first cousin Mabel, 72 years of age, who is alive but has had cancer of the colon and had a recent stroke, and has a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with diet. Her mother’s sister, who is 68 years of age, is alive and has a history of hypertension and hypercholesterolemia. Her mother’s brother died at 68 years of age of renal cancer and had a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents. He also had a heart attack at 45 years of age and a coronary artery bypass graft operation of three vessels at 55 years of age. He smoked cigarettes for 50 years. The patient’s father was an only child and her father’s family all lived to be over 80 years of age.

  1. What genetic-related diseases do the patient’s first-order relatives have?
  2. What genetic-related diseases do the patient’s second-order relatives have?
  3. Optional: Draw a genogram of the patient’s family’s health history using the example in the textbook (see Fig. 5-2) as a guide.

2. The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds.

  1. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?
  2. Calculate her ideal body weight. What is your assessment of her BMI and weight?
  3. Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.
  4. Mrs. Varner’s waist circumference is 38 inches. What is your assessment?
  5. What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed. 

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Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

· Examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015). Can locate at this link: https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

· Review your Work Environment Assessment Template.

——Copy of my Template attached under files

· Reflect on your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.

—–Main Discussion posting is attached as files

· Select and review one of the following articles found in the Resources:

o  Clark, Olender, Cardoni, and Kenski (2011)

o  Clark (2018)

o Clark (2015)- Will use this article, same as above, here is link: : https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

o  Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

· Review the Work Environment Assessment Template you completed for this Module’s Discussion.

· Describe the results of the Work Environment Assessment you completed on your workplace.

· Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.

· Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

· Briefly describe the theory or concept presented in the article you selected.

· Explain how the theory or concept presented in the article relates to the results of your Work Environment Assessment.

· Explain how your organization could apply the theory highlighted in your selected article to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

· Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.

· Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.

Which solution is best to use when cleaning a wound that is healing by 101. During an Immunoglobulin E (IgE)-mediated hypersensitivity reaction, the degranulation of mast cells is a result of which receptor action?

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What causes the rapid change in the resting membrane potential to initiate an action potential?
Question 1 options:
Potassium gates open and potassium rushes into the cell, changing the membrane potential from negative to positive
Sodium gates open and sodium rushes into the cell, changing the membrane potential from negative to positive.
Sodium gates close, allowing potassium into the cell to change the membrane potential from positive to negative.
Potassium gates close, allowing sodium into the cell to change the membrane potential from positive to negative.
Question 2
What is a consequence of leakage of lysosomal enzymes during chemical injury?
Question 2 options:
Enzymatic digestion of the nucleus and nucleolus occurs, halting deoxyribonucleic acid (DNA) synthesis.
Influx of potassium ions into the mitochondria occurs, halting the adenosine triphosphate (ATP) production.
Edema of the Golgi body occurs, preventing the transport of proteins out of the cell.
Shift of calcium out of the plasma membrane occurs, destroying the cytoskeleton.
Question 3
In hypoxic injury, sodium enters the cell and causes swelling because:
Question 3 options:
The cell membrane permeability increases for sodium during periods of hypoxia.
Adenosine triphosphate (ATP) is insufficient to maintain the pump that keeps sodium out of the cell.
The lactic acid produced by the hypoxia binds with sodium in the cell.
Sodium cannot be transported to the cell membrane during hypoxia.
Question 4
What mechanisms occur in the liver cells as a result of lipid accumulation?
Question 4 options:
Obstruction of the common bile duct, preventing the flow of bile from the liver to the gallbladder
Increased synthesis of triglycerides from fatty acids and decreased synthesis of apoproteins
Increased binding of lipids with apoproteins to form lipoproteins
Increased conversion of fatty acids to phospholipids
Question 5
Which solution is best to use when cleaning a wound that is healing by 101. During an Immunoglobulin E (IgE)-mediated hypersensitivity reaction, the degranulation of mast cells is a result of which receptor action?
Question 5 options:
Histamine bound to H2
Chemotactic factor binding to the receptor
Epinephrine bound to mast cells
Acetylcholine bound to mast cells
Question 6
What is the mechanism that results in type II hypersensitivity reactions?
Question 6 options:
Antibodies coat mast cells by binding to receptors that signal its degranulation, followed by a discharge of preformed mediators.
Antibodies bind to soluble antigens that were released into body fluids, and the immune complexes are then deposited in the tissues.
Cytotoxic T (Tc) lymphocytes or lymphokine-producing helper T 1 (Th1) cells directly attack and destroy cellular targets.
Antibodies bind to the antigens on the cell surface.
Question 7
Type III hypersensitivity reactions are a result of which of the following?
Question 7 options:
Antibodies coating mast cells by binding to receptors that signal its degranulation, followed by the discharge of preformed mediators
Antibodies binding to soluble antigens that were released into body fluids and the immune complexes being deposited in the tissues
Cytotoxic T (Tc) cells or lymphokine-producing helper T 1 (Th1) cells directly attacking and destroying cellular targets
Antibodies binding to the antigen on the cell surface
Question 8
Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host deoxyribonucleic acid (DNA) is the cause of which disease?
Question 8 options:
Hemolytic anemia
Pernicious anemia
Systemic lupus erythematosus
Myasthenia gravis