Category: Applied Sciences

Patient With Fatigue

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EM is a 74-year-old male with a history of rheumatoid arthritis (RA) who presents in the clinic with a complaint of fatigue. EM is ambulatory with a walker and recently has had intermittent flare-ups of his rheumatoid arthritis (RA) disease activity, with increasing pain and swelling in his affected joints. His energy has been declining over the past few months, so he thought it was a good time to come in for follow-up laboratory testing and reassessment of his medications. Most troublesome, he has fainted twice in the past 2 weeks, which resulted in falls onto his carpeted floor. He is afraid to go out into public and even more afraid to drive his car. He has also had some chest pains with exertion. He is eating and sleeping okay, although he does sleep better if his head is elevated on a few extra pillows. He lives alone and gets meals delivered by a local organization.

Past Medical History
RA for 35 years, affecting hands, feet, knees, hips, and cervical spine
Systolic hypertension
Presbycusis
Medications
Ibuprofen, 600 mg three to four times per day as needed
Methotrexate, 7.5 mg weekly
Atenolol, 25 mg daily
Hydrocodone/acetaminophen, 5 mg/500 mg every 6 hours as needed for pain
Physical Examination
Height: 71 inches; weight: 160 lbs.; BMI: 22.3; blood pressure: 162/60; pulse: 84; respiration rate: 16; temperature: 98.6 °F
Well-developed, well-nourished elderly male in no distress; pale
Lungs: bibasilar rales
Heart: regular rate and rhythm, grade 3/6 systolic murmur, audible S3; positive carotid bruit on the left
Abdomen: no masses, nontender
Rectal: prostate 3+ enlarged, hemoccult negative brown stool
Extremities: marked ulnar deviation of MCP and IP joints in both hands
Labs and Imaging
Hemoglobin: 8.9 g/dL
Mean corpuscular volume (MCV): 80 fL
White blood cell count: 10.7 × 109/L
Platelets: 250,000/L
Reticulocyte count: 0.8%
Ferritin: 415 mcg/L
Electrocardiogram: no acute findings; some evidence of left ventricular hypertrophy
Discussion Questions
1.What is EM’s diagnosis?

2.What is the underlying pathophysiology of EM’s condition?

3.What is the best therapeutic approach to the treatment of EM’s condition?

 

ArcGIS

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Imagine that you are planning to open a dating service in Virginia. Your preliminary research indicates that such a service would expect to gross $3 for every divorced person, $2 for every single (never married) person, and $1 for every widowed person in a typical county.
Calculate the projected Gross Income for each county in Virginia, and create a graduated color map showing the projected income for each county.
What is the Total Projected Gross income for the entire State?

 

The Case of Lonnie and Dorothy

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Individuals or families who need case management services do so because they have a number of problems. Like Lonnie and Dorothy, they may “get by” for a period of time. At some point, their problems escalate, multiply, or both, making it difficult to cope. It is at the end of this case, when Lonnie is beginning to experience some serious medical problems, that you enter their lives as a case manager.
Lonnie and Dorothy live in the southern part of town in a low-income area. At one time, the neighborhood was nice. This was long before Lonnie and Dorothy arrived. They have two grown sons, John and Leroy, who occasionally come by to visit, and a grown daughter they never talk to. Lonnie, 62, works at a nursing home as a janitor. Dorothy, 60, does not work due to health problems, though she has worked as a personal nurse at some time in the past. They have been married for thirty-nine years but do not get along very well. They bicker constantly, and Dorothy has talked of times when Lonnie would lock her in the house due to jealousy while he was at work. Now, they basically coexist together without much substantial interaction.
Lonnie’s job is rough on him—he works seven-day shifts and then has three days off. He drives forty-five minutes to work in his 1985 pickup, on which he is still making payments. He spends all day on his feet and is exhausted when he gets home. For years, Lonnie was the head janitor at a truck stop and enjoyed the job. Unfortunately, he was laid off due to cutbacks and has been trying to find a job with better pay. He has found that his age has kept him from getting better work. He has been working at the nursing home since. He has talked of finding better work, but because he and Dorothy live from paycheck to paycheck, they cannot afford for him to take any kind of pay cut, even temporarily. Lonnie spends most of his spare time in front of the television.
This is hard on Dorothy. Due to heart problems, she is on disability and rarely gets away from the house, often spending days alone in the house. This causes her to be lonely and to have a limited view of the world—the “other side of town” is like another world to her. If she does get away, it is only to go to the grocery store or the pharmacy. She also has a tendency to be paranoid. For instance, if her disability check does not come on the exact day it did the previous month, she spends the afternoon on the phone talking to the disability office and the post office, positive someone has “made a mistake” or has “taken her check.” In some ways this is understandable, since Lonnie and Dorothy need the check to pay their bills. Dorothy’s check pays the rent and what little spending money she gets, while Lonnie’s covers the car payment, food, utilities, and medical bills. They spend every penny each month, leaving nothing for savings. Last month, Lonnie started to have medical problems himself and has had to go the doctor more frequently than usual.
List the needs that Lonnie and Dorothy have. Then prioritize them.
Identify the necessary case management roles and purposes for each of the three most important needs Lonnie and Dorothy have.
The three methods of delivering case management you read about in Chapter 3 provide a structure for the case manager’s roles, responsibilities, and length of involvement with a client. Review the methods.
Which one would be most effective with Lonnie and Dorothy’s situation? Why?
Book: for chapter 3 question (#3)
https://gateway.pinata.cloud/ipfs/bafykbzaceb6qsegaccorhc6opcszwh5pmyllajnpcv7723zevms4kwz7lgtts?filename=generalist-case-management-a-method-of-human-5–annas-archive–libgenrs-nf-3370559.pdf

The Case of Lonnie and Dorothy

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Individuals or families who need case management services do so because they have a number of problems. Like Lonnie and Dorothy, they may “get by” for a period of time. At some point, their problems escalate, multiply, or both, making it difficult to cope. It is at the end of this case, when Lonnie is beginning to experience some serious medical problems, that you enter their lives as a case manager.
Lonnie and Dorothy live in the southern part of town in a low-income area. At one time, the neighborhood was nice. This was long before Lonnie and Dorothy arrived. They have two grown sons, John and Leroy, who occasionally come by to visit, and a grown daughter they never talk to. Lonnie, 62, works at a nursing home as a janitor. Dorothy, 60, does not work due to health problems, though she has worked as a personal nurse at some time in the past. They have been married for thirty-nine years but do not get along very well. They bicker constantly, and Dorothy has talked of times when Lonnie would lock her in the house due to jealousy while he was at work. Now, they basically coexist together without much substantial interaction.
Lonnie’s job is rough on him—he works seven-day shifts and then has three days off. He drives forty-five minutes to work in his 1985 pickup, on which he is still making payments. He spends all day on his feet and is exhausted when he gets home. For years, Lonnie was the head janitor at a truck stop and enjoyed the job. Unfortunately, he was laid off due to cutbacks and has been trying to find a job with better pay. He has found that his age has kept him from getting better work. He has been working at the nursing home since. He has talked of finding better work, but because he and Dorothy live from paycheck to paycheck, they cannot afford for him to take any kind of pay cut, even temporarily. Lonnie spends most of his spare time in front of the television.
This is hard on Dorothy. Due to heart problems, she is on disability and rarely gets away from the house, often spending days alone in the house. This causes her to be lonely and to have a limited view of the world—the “other side of town” is like another world to her. If she does get away, it is only to go to the grocery store or the pharmacy. She also has a tendency to be paranoid. For instance, if her disability check does not come on the exact day it did the previous month, she spends the afternoon on the phone talking to the disability office and the post office, positive someone has “made a mistake” or has “taken her check.” In some ways this is understandable, since Lonnie and Dorothy need the check to pay their bills. Dorothy’s check pays the rent and what little spending money she gets, while Lonnie’s covers the car payment, food, utilities, and medical bills. They spend every penny each month, leaving nothing for savings. Last month, Lonnie started to have medical problems himself and has had to go the doctor more frequently than usual.
List the needs that Lonnie and Dorothy have. Then prioritize them.
Identify the necessary case management roles and purposes for each of the three most important needs Lonnie and Dorothy have.
The three methods of delivering case management you read about in Chapter 3 provide a structure for the case manager’s roles, responsibilities, and length of involvement with a client. Review the methods.
Which one would be most effective with Lonnie and Dorothy’s situation? Why?
Book: for chapter 3 question (#3)
https://gateway.pinata.cloud/ipfs/bafykbzaceb6qsegaccorhc6opcszwh5pmyllajnpcv7723zevms4kwz7lgtts?filename=generalist-case-management-a-method-of-human-5–annas-archive–libgenrs-nf-3370559.pdf

Aesop’s Last FableBy William March (1893-1954)

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Aesop, the messenger of King Croesus, finished his business with the Delphians and went back to the tavern where he had taken lodgings. Later, he came into the taproom where a group of Delphians were drinking. When they realized who he was, they crowded about him, “Tell us,” they began, “is Croesus as rich as people say?”
I. Aesop, since the habit of speaking in fables was so strongly fixed in him, said, “I can best answer your question with a parable, and it is this: the animals gathered together to crown their richest member king. Each animal in turn stated what he possessed, and it was soon apparent that the lion had the largest hunting preserves, the bee the most honey, the squirrel the largest supply of acorns, and so on; but when the voting began, the difficulty of arriving at a decision was plain to all, for to the bee, the nuts that represented the wealth of the squirrel were of no consequence; to the lion, the hay that the zebra and the buffalo owned was worthless; and the panther and the tiger set no value at all on the river that the crane and crocodile prized so highly.”
Then Aesop called for his drink, looking into the faces of the Delphians with good-natured amusement. He said, “The moral of the fable is this: Wealth is an intangible thing, and its meaning is not the same to all alike”.
II. The stolid Delphians looked at one another, and when the silence was becoming noticeable, one of them tried again; “How was the weather in Lydia when you left home?”
“I can best answer that question with another fable,” said Aesop, “and it is this: During a rain storm, when the ditches were flooded and the ponds had overflowed their banks, a cat and a duck met on the road, and wanting to make conversation, they spoke at the same instant. ‘What a beautiful day this is’ said the delighted duck. ‘What terrible weather we’re having,’ said the disgusted cat.”
Again the Delphians looked at one another, and again there was silence. “The moral of the tale,” said Aesop, “is this; What pleases a duck distresses a cat.” He poured wine into his glass and leaned against the wall, well satisfied with the start he had made in instructing the barbarous Delphians.
III. The Delphians move uneasily in their seats, and after a long time, one of the said, “How long are you going to be here?”
“That,” said Aesop, “can best be answered in the Fable of the Tortoise, the Pelican, and the Wolf. You see, the pelican went to visit his friend the tortoise and promise to remain as long as the latter was building his new house. Then one day as they were working together, with the tortoise burrowing and pelican carrying away the dirt in his pouch, the wolf came on them unexpectedly, and—”
But Aesop got no farther, for the Delphians had surrounded him and were, an instant later, carrying him toward the edge of the cliff on which the tavern was built. When they reached it, they swung him outward and turned him, loose, and Aesop was hurled to the rocks below, where he died. “The moral of what we have done”, they explained later, “is so obvious that it needs no elaboration.”
The End

Discussion question
Would Aristole blame the Delphians for taking the shortest way with Aesop?

Hypothetical business case report for additional nursing care funding

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Develop a hypothetical business case report for additional nursing care funding

W​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​rite a hypothetical business case for additional nursing care funding for one of the following: 1. A service adaptation Or 2. A new service or innovation The Following Report Structure and Subheadings to be included: Executive Summary 1. Background & Context 2. Business Case Solution 3. Financial Plans 4. Implementation & Evaluation Plans 5. Critical Reflection 6. Reference List 7. Appendices (not included in the word count) Learning Outcomes 1.Appraise the principles of health economics and their relevance to resource allocation in health and social care organisations and other agencies 2 Evaluate a rationale for a hypothetical business case for additional nursing care funding relating to their own field of nursing, applying knowledge of finance, resources and safe staffing levels 3 Critically reflect upon own leadership, management and team working skills in relation to the demands of professional practice in their own field of nursing Please note in preparation of your business case report you should not carry out any primary research or audits in practice. This report should be written in the passive voice. Keep your idea simple and ensure there are lots of resources/ references available, so your work is evidence based. It also helps if you choose something you are interested in doing. You will need to demonstrate critical appraisal throughout your assignment not just the evaluation / reflection so relevant evidence and literature to support your statements is crucial. You should provide a well-structured academically written piece of work. To be successful in this assessment you are required to use the following report structure and subheadings: (Suggested word count for each section as a guide) Executive Summary (A Succinct Overview) of the business case (200 words) This should grab the reader’s attention and give a clear, general overview of the report. Remember to include references. 1.0 Background & Context (450 words) (LO1) Critically discuss and analyse the rationale for your business case idea, what happens now /who and what are the drivers, how does the idea link to health care policy and local/national strategic priorities. It can be useful to demonstrate your problem-solving strategy by using a service improvement tool e.g., fishbone analysis. Ensure you evidence your rationale including all policy, drivers, guidance, definitions and tools accurately. 2.0The Business Case Solution (450 words) (LO1, LO2) Tell the reader your “business case idea”. Critically discuss the main advantages and limitations of your business case. 3.0 Financial Planning (450 words) (LO1, LO2) How much will the business idea cost and how much will it save. Identify costs and ​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​what resources are required, people, equipment etc. Are stakeholders needed and what value do they bring? Ensure you include: 3.1 Pump Priming –How much funding required is required upfront 3.2 Ongoing costs- How much funding is required to continue e.g., staffing, equipment, IT costs 3.3 Potential Returns/savings This section requires you to appraise principles of health economics and their relevance to resource allocation in health and social care organisations and other agencies. Demonstrate your knowledge and understanding of the financial implications for your business case. If you are unable to gather the exact costings you need to explain how you would obtain these. 4.0 Implementation & Evaluation Plans (450 words) (LO1, LO2) This section needs to include a timeline about taking the idea forward and if you have used a pilot study approach. Ensure you explain and evidence why or why not a pilot was used such as financial implications. Include critical discussions of how it will be monitored, how the outcomes will be measured and challenges / barriers, especially linked to resource allocation and stakeholder demands. You could also use a model E.g., Plan, do study Act, (PDSA) or a GANTT chart. Who is needed to evaluate and why? Why is evaluation important? It is crucial you evidence your work so use references to support these discussions. 5.0 Critically reflect upon your own leadership, management and team working skills in relation to the demands of professional practice. (500 words) (LO3) You can write in the first person for this section and use a model of reflection of your choice or not one at all. Ensure you consider your nursing training overall and critically reflect on your own leadership style and skills, management skills and team working with reference to leadership theory, the NMC Code and relevant policy / guidance. This will include awareness of challenges and how these reflections will influence your practice going forward. Ensure relevant definitions and theories are presented and accurately referenced. 6.0 Reference List – (Not included in wordage) These are crucial to support your in-text statements / references so ensure your references are accurate and you follow the recommended referencing guidance which you will find in the module KLE 7.0 Appendix – (Not included in wordage) These are optional and should match and support the in-text signposting of your appendices. Ensure you use a separate sheet for each one. Examples include: • Service delivery tool such as a Fishbone Analysis • Financial planning for pump priming / upfront costs, ongoing costs and potential returns • Tables that demonstrate resources required and costings • Quality Service Improve​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ment Tools e.g., PDSA

Care models for nursing practice specific to the older adult

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Compare the care models for nursing practice specific to the older adult.
Transferable Skill:
Information Literacy: Discovering information reflectively, understanding how information is produced and valued, and using information to create new knowledge and participate ethically in communities of learning.
Your nursing supervisor likes the topic you chose for the in-service presentation and wants you to start researching! To make sure you get the project on the right track, your supervisor has asked you to do the following:

Using the Rasmussen Library, identify at least 2 resources pertaining to your topic.
Prepare an annotated bibliography for the resources you identified. Each entry will include:
the full APA formatted reference
an annotation consisting of the following elements:
2 to 4 sentences to summarize the main idea(s) of the source
1 or 2 sentences to assess and evaluate the source
1 or 2 sentences to reflect on the source
For information about making a research appointment with a Rasmussen librarian, evaluating the credibility of a source, or creating an annotated bibliography, consult the resources below.

What is an annotated bibliography and how do I do one? Do you have a sample I can see?
How can I make a research appointment with a Rasmussen College Librarian?
How do I know if a source is credible?

Health care is changing rapidly, and health care marketers

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Write 300-500 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Health care is changing rapidly, and health care marketers must be prepared to face the challenges the future will bring. Discuss the following:

Examine and discuss 2 emerging trends in health care.
Analyze what the health care marketer can do to address the challenges that are associated with those trends.
The use of APA Style and scholarly references published within the last 5 years is required.