What could the hypothetical Chalmy people do to reduce their malnutrition levels despite the constraints they face?

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Please see attachment with case study, use APA and .edu references. Thank you.

Actions for Discussion 3: Healthcare Disparities

Your text, Chapter 7, provides compelling discussion on the sociocultural ecologies of disease and illness. With focus on the text’s Case Study: Impacts of a Cultural Ecology: Historical Trauma, American Indians/Alaska Natives, and Health (p. 92-97), discuss this case by sharing perspective on the questions below.

This obviously takes some referencing (minimum of one reference beyond text is required) and expect a good 175-200 words as a guide.

Can you think of any other internal cultural patterns that cause vulnerabilities to disease?

What could the hypothetical Chalmy people do to reduce their malnutrition levels despite the constraints they face?

Edberg (2013) describes the political-economic system is how resources and social benefits are distributed in a society, and more. What are some political-economic circumstances that could impede people from engaging in wellness activities, such as exercise as prevention for diabetes and cardiovascular disease?

What could be done to reduce the health consequences of historical trauma?

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Multiple Intelligences

Learner Needs: Multiple Intelligences
Prior to engaging in this discussion please read Chapter 7: Evolving Frameworks, in your e-book, watch the Theory of Multiple Intelligences (Links to an external site.)Links to an external site. video, read the article “Multiple Intelligences” (2011), and review the Instructor Guidance.
Traditionally, someone who is intelligent is defined as an individual  who can solve problems, use logic to answer questions, and think  critically. However, psychologist Howard Gardner has created a much  broader definition of intelligence called multiple intelligences, which  is more focused on our areas of learning preferences. For this  discussion, please complete the following:

  • Demonstrate an understanding of intelligence (IQ) and multiple  intelligences (MIs) by comparing and contrasting the differing variables  associated with each.
  • Thinking critically about these foundational differences, comment on  how Gardner’s ideas about learning preferences might change the way we  assess a person’s strengths and weaknesses.
  • Click the following link and take the MI assessment (Links to an external site.)Links to an external site.. Review your results.
    • Do you agree with the assessment? How can what you have learned about yourself help support your learning performance?  List at least two behaviors you could change or traits you could  develop in your own behaviors, and explain how they support your  assessment results.
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Education homework help

 Explain the similarities and differences between a school’s climate and a school’s culture.  Which is easier to change?  Does your school’s mission and vision statements reflect your school’s culture?  Explain.
Part B
Answer the following questions using APA format.  You should also include research from at least two sources when answering the following questions. Total response should be 1200 words in length
1.  What is the history of instructional improvement at your classroom, school or district?
2.  What efforts and initiatives have worked well? Why do you believe that is so?
3.  What efforts and initiatives have failed?  Why do you believe that is so?
4.  What lessons should be carried forward as you and your school or district engages in continuous instructional improvement?
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>& Finance homework help

An economic recession is typically defined as negative economic growth during two consecutive quarters. In a financial crisis, asset prices see a steep decline in value, businesses and consumers are unable to pay their debts, and financial institutions experience liquidity shortages. Although historically the two do not always coincide, in the United States, both recessions of 2001 and 2008 partially overlapped with a financial crisis. Why do you think that was the case? Do you think this was a coincidence? What type of conclusions can we draw from such events, if any, and why?
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Transition to Baccalaureate Nursing Rationale Essay

Educational Planning: Transition to Baccalaureate Nursing Rationale Essay – Instructions The Rationale Essay is a scholarly paper which you write to explain your degree plan. It describes how previous credits from other colleges and prior knowledge will blend with current studies to create the Bachelor of Science in Nursing (BSN) degree at SUNY Empire State College. The Nursing Assessment Committee approves your degree plan and rationale essay as a step in recommending the student for graduation. The degree plan must meet all of the following criteria: Degree Total credits Maximum advanced standing credits Minimum liberal studies credits Minimum SUNY.esc.edu/esconline/across_esc/academics.nsf/db1a77fb2f6bcf2085256bfa005466b0/4aef4626e390ff3e85256c1d00480fcc?OpenDocument”>general education .esc.edu/esconline/across_esc/academics.nsf/db1a77fb2f6bcf2085256bfa005466b0/4aef4626e390ff3e85256c1d00480fcc?OpenDocument”>credits Minimum advanced-level credits in your concentration Minimum advanced-level credits in your program B.S. in Nursing 124 93 62 30 40 45 Compose a 3-5 page paper following the.google.com/file/d/0B_MQFi-Mv1-yQi04RW8zLW1GU0k/edit?pli=1″>Written Assignment Rubric.png” alt=”Title: image of an icon that represents “opens in a new window” – description: image of an icon that represents “opens in a new window””>, including all requirements of APA format. There are eight sections to your Rationale Essay; the content for each section is outlined below. Unless otherwise stated, each of these sections should be used as a Level 1 heading in your paper “Centered, Boldface, Uppercase and Lowercase Heading” (American Psychological Association, 2010, p. 62). Sections of Paper: 1. Introduction: (no heading) briefly introduce the purpose of this paper to the reader and provide an overview of the key areas that will be addressed. 2. Goals in Pursuing the Bachelor of Science in Nursing: Drafted in Modules 1 and 2 · Describe your personal and professional goals in pursuing the BSN · Discuss what new knowledge, skills, and experiences you wish to develop during the program 3. Expectations of the Nursing Professional:Review and revise your content from the Discussion in Module 2 · Describe the professional expectations of the nurse with a baccalaureate degree · Discuss the professional opportunities that are available to the nurse with a baccalaureate degree and how your role might change 4. Academic Expectations:See Learning Activity in Module 2-Address how your degree plan will meet all of the following requirements. Indicate the number of credits being transferred in from other sources and the number of credits to be completed with SUNY Empire State College: · Bachelor of Science degree requirements at SUNY Empire State College (124 credits total) · SUNY General Education requirements (7 out of 10 knowledge areas; at least 30 credits) i. Math – required area ii. Basic Communication – required area · Required number of advanced level credits (at least 45 credits) · Required number of liberal credits (at least 62 credits) · Required nursing credits (at least 40 credits, advanced level) · ESC studies – 31 credits minimum 5. Degree Plan Narrative: · Identify that you will be taking the nine core nursing courses as required by the program. If you are taking each of these courses, there is no need to list them all by name… OR … · Identify modifications to the nursing core sequence if you are using transcript credit from another college or are planning to use the Prior Learning Assessment (PLA) process to meet the any of the nursing courses · Explain how your nursing elective will be met · Describe the courses you will use to meet any outstanding general education requirements. · Discuss any additional CBE/PLA credit that you intend to pursue with this degree · Identify the proposed timeline to degree completion 6. Conclusion: write a brief paragraph to summarize the key points of the paper 7. References: include any references as a separate last page of the essay, but before the planning grid 8. Degree Plan Grid: Drafted in Module 3 · Identify (by name) the courses and college term for completion · Outline the proposed sequence and course of study · Add a page break after the reference page (or final narrative if no references are used), and then include the Planning Grid as your final page. References American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: Author.

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How caregivers manage pain and distress in second stage labor.

Briefly answer each question. references/resources: Advances in Nursing Science http://journals.lww.com/advancesinnursingscience/Fulltext/2001/09000/Toward_a_Praxis_Theory_of_Suffering.7.aspx US National Library of Medicine http://www.ncbi.nlm.nih.gov/pubmed/12889579 •Bergstrom, L., Richards, L., Morse, J., & Roberts, J. (2010). How caregivers manage pain and distress in second stage labor. Midwifery, 55(1), 38–45. •Carter, B. (1994). Surviving breast cancer. Cancer Practice, 2(2), 135–140. •Ekman, P., & Friesen, W. (1978). Facial action coding system: A technique for the measurement of facial movement. Palo Alto, CA: Consulting Psychologists. •Ekman, P., Irwin, W., & Rosenberg, E. (1994). EMFACS: Coders instructions (EMFACS-8). San Francisco, CA: University of California, San Francisco. •Morse, J. (1997). Responding to threats to integrity of self. Advances in Nursing Science, 19(4), 22–36. •Morse, J. M. (1992). Comfort: The refocusing of nursing care. Clinical Nursing Research, 1, 91–113. •Morse, J. M. (2000b). On comfort and comforting.American Journal of Nursing, 100(9), 34–38. •Morse, J. M. (2001). Toward a praxis theory of suffering. Advances in Nursing Science, 24(1), 47–59. •Morse, J. (2011). The praxis theory of suffering. In J. B. Butts & K. L. Rich (Eds.), Philosophies and theories for advance nursing practice. (pp. 569–595). Sudbury, MA: Jones & Bartlett Learning. •Morse, J., Beres, M., Spiers, J., Mayan, M., & Olson, K. (2003). Identifying signals of suffering by linking verbal and facial cues. Qualitative Health Research, 13(8), 1063–1077. •Morse., J., & Carter, B. (1996). The essence of enduring and the expression of suffering: The reformulation of self. Scholarly Inquiry for Nursing Practice, 10(1), 43–60. •Morse, J., Havens, G., DeLuca, A., & Wilson, S. (1997). The comforting interaction: Developing a model of nurse-patient relationship. Scholarly Inquiry for Nursing Practice, 11(4), 321–343. •Morse, J., & Mitcham, C. (1998). The experience of agonizing pain and signals of disembodiment. Journal of Psychosomatic Research, 44(6), 667–680. •Morse, J., & O’Brien, B. (1995). Preserving self: From victim, to patient, to disabled person. Journal of Advanced Nursing, 21, 886–896. •Morse, J., & Pooler, C. (2002). Patient-family-nurse interactions in the trauma resuscitation room. American Journal of Critical Care, 11(3), 240–249. •Morse, J., & Proctor, A. (1998). Maintaining patient endurance: The comfort work of trauma nurses. Clinical Nursing Research, 7(3), 250–274. •Olson K., Morse, J. M., Smith, J., Mayan, M., & Hammond, D. (2000–2001). Linking trajectories of illness and dying. Omega, 42(4), 293–308. •Proctor, A., Morse, J., & Khonsari, E. (1996). Sounds of comfort in the trauma center: How nurses talk to patients in pain. Social Sciences & Medicine, 42, 1669–1680.

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Select either the quantitative or the qualitative article and utilize the American Nurses Association Framework for How to Read and Critique a Research Study found below.

Below are two articles for the final paper; one quantitative and one qualitative.  Select either the quantitative or the qualitative article and utilize the American Nurses Association Framework for How to Read and Critique a Research Study found below.

Moore, J., Prentice, D., & McQuestion, M. (2015). Social interaction and collaboration among oncology nurses. Nursing Research and Practice, 2015(Article ID 248067), 1-7. doi: http://dx.doi.org/10.1155/2015/248067

Walker, R., Huxley, L., Juttner, M., Burmeister, E., Scott, J., & Aitken, L. M. (2016, February 12). A pilot randomized controlled trial using prophylactic dressings to minimize sacral pressure injuries in high-risk hospitalized patients. Clinical Nursing Research: An International Journal. 1-20. doi: 10.1177/1054773816629689

Assignment Criteria:

For this assignment, develop a scholarly paper that addresses the following criteria:

1.         Compare and contrast qualitative and quantitative research designs.

2.         Critique the selected article using section one (1), a-n of the ANA Framework for How to Read and Critique a Research Study posted in the Weekly Guide/Week 7-SEE ATTACHED

3.         Provide rationale for the responses to the questions supporting the conclusions about the chosen article.

4.         Include level 1 and 2 headings to organize the paper.

5.         Include an introductory paragraph, purpose statement, supporting paragraphs, a conclusion, and a reference page.

6.         Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’).

7.         The scholarly paper should be five to six pages excluding the title and reference pages.

7.         Include a minimum of five (5) references from professional peer-reviewed nursing journals to support the paper. One reference may be the textbook. References should be from scholarly peer-reviewed journals (review in Ulrich Periodical Directory) and be less than five (5) years old.

8.         APA format is required (attention to spelling/grammar, a title page, introductory paragraph, purpose statement a reference page, and in-text citations). 

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what factors do you need to consider in your psychological testing for the forensic assessment report?

 Psychology homework help
 

  • Improve your interview and referral questions for the case vignette you selected in M1 Assignment 3. Using this case vignette, add to your referral questions by integrating the feedback that you received from your instructor in M4 Assignment 2 on your mock interview questions and formulated hypothesis on why the individual needs the referral.

Example Referral Questions:

  • As a forensic mental health professional, what factors do you need to consider in your psychological testing for the forensic assessment report?
  • What are the pertinent multicultural consideration?
  • What behavioral observations do you make about the client by reading the case vignette?
  • What are your assessment options in working with the client?
  • What standard and accepted psychological tests might you apply to your client in a forensic setting? Select from the instruments you researched in M3 Assignment 2 RA.
  • How will you recognize and evaluate your client’s offender behaviors associated with malingering and deception? What theoretical orientation do you want to use in this case for your treatment recommendations?
  • What is the case scenario that you have selected?
  • What is the reason for referral?
  • What is the purpose of the forensic assessment and report?
  • What is the nature of the problem presented in your selected case vignette?
  • What is the context in which the forensic assessment report will be used?
  • What is the background of your client? What are the symptoms displayed by your client and their significance in this case?
  • What is the mental status of your client? Be sure to elaborate on every major component addressed in the mental status examination.
  • What interview type and approach did you use with your client?
  • What tests are appropriate to use in your forensic assessment report? Identify one intelligence test, one objective personality test, and one projective test.
  • What collateral information will you use in the process of the evaluation?
  • How will you present your impressions of the client?
  • Revise your copy of Forensic Mental Health Professional Individual Assessment Report on the basis of your instructor’s feedback. Using the Forensic Mental Health Professional Individual Assessment Report template that you downloaded for M4 Assignment 2, revise your evaluation and interpretation of the information provided to you in the case vignette that you selected. Synthesize the information you collected to create a forensic mental health professional individual assessment report. Your findings should be in a report format.
    In a 10- to 12-page report, include only the following components:

    • Reason for Referral: Explain the objective of your case vignette analysis, clearly bringing out the aspects or reasons that motivated you to carry out the study.
    • Presentation: Create mock interview data and collateral information (you are to identify the questions to ask in the interview). Provide a synopsis of the interview. To support the mental status of your client, provide data based on your forensic assessment report and the mental status components you have identified.
    • Current Life Situation and Background Information: Explain the problem provided in your selected case vignette using the interview and mental status data. How does the data relate to the background and multicultural characteristics of your client and your behavioral observations?
    • Objective Testing: Identify the assessment instruments you would recommend to evaluate the client and explain the rationale for your recommendations. Describe the objective tests you have selected and their use. How did you apply these tests to your selected case vignette? According to your study, what is your analysis of the symptoms displayed by your client? What ethical and multicultural issues do you need to address? You will apply what you have learned from M3 Assignment 2 RA to this section.
    • Provide your diagnostic impressions based on DSM-5 criteria. What is your principal diagnosis? What is your secondary diagnosis? Are there other conditions that may be the focus of clinical attention to consider?
    • Conclusion and Recommendations: What is your hypothesis after taking into account the mental status examination, the interview, personality tests, and the symptom analysis? Explain your hypothesis and substantiate it using instances from your case study. Discuss your results with conclusions and recommendations. The final version of Forensic Mental Health Professional Individual Assessment Report should contain all the assigned components and the corresponding information and include revisions and improvements based on your feedback from M4 Assignment 2.
  • Synthesize the data and write a reflection statement in 2–3 pages. In a separate document, address the following:
    • Describe your professional role and relationship with the court and the third party requesting the assessment or evaluation.
    • Explain the hypothesis you have formulated.
    • Explain why you chose the tests for the assessment of the client.
    • Discuss potential ethical dilemmas that might arise in your assessment of the client.
    • Discuss the pertinent multicultural perspectives you considered.
    • Explain how you would prepare yourself to defend your evaluation in the court setting or to relevant third parties. Be sure to support your explanation with professional literature.
    • If you recommended treatment for your client, discuss the evidence-based approaches used with the disorder you diagnosed.
    • Discuss the influence of cultural factors on the assessment process. The final version of Forensic Mental Health Professional Individual Assessment Report should contain all the assigned components and the corresponding information and include revisions and improvements based on your feedback from M4 Assignment 2.
  • Synthesize the data and write a reflection statement in 2–3 pages. In a separate document, address the following:
  • Describe your professional role and relationship with the court and the third party requesting the assessment or evaluation.
  • Explain the hypothesis you have formulated.
  • Explain why you chose the tests for the assessment of the client.
  • Discuss potential ethical dilemmas that might arise in your assessment of the client.
  • Discuss the pertinent multicultural perspectives you considered.
  • Explain how you would prepare yourself to defend your evaluation in the court setting or to relevant third parties. Be sure to support your explanation with professional literature.
  • If you recommended treatment for your client, discuss the evidence-based approaches used with the disorder you diagnosed.
  • Discuss the influence of cultural factors on the assessment process.

Your final deliverables are:

  • A selected case vignette
  • A list of interview and referral questions
  • The assessment template
  • The final assessment report
  • A reflection statement

Your report and reflection statement combined should be approximately 12–15 pages. You are to utilize outside resources in your reflection statement only.
 
Assignments to work from
4:2
Mock Individual Assessment (Rough Draft)
Create a mock forensic assessment report based on a patient in a selected vignette. Provide your diagnostic impressions based on the DSM-5 criteria.
For this assignment you are to:

  • Improve your interview and referral questions for the case vignette you selected in M1 Assignment 3. Use the case vignette you selected in M1 Assignment 3 for this assignment.
  • Next, create and document a set of mock interview questions and potential referral questions to ask your client and yourself. You can determine the questions in relation to the case vignette that you choose.
  • You might also want to consider some of the example referral questions listed below.
  • Analyze all the information provided in the case vignette and begin to formulate a hypothesis as to why the individual needs referral.
  • Example Referral Questions:
    • As a forensic mental health professional, what factors need to be considered in your psychological testing for the forensic assessment report?
    • What behavioral observations do you make about the client by reading the case vignette?
    • What are your assessment options in working with the client?
    • What standards and accepted psychological tests might you apply to your client in forensic settings? Select from the instruments you researched in M3 Assignment 2 RA.
    • How will you recognize and evaluate your client’s offender behaviors associated with malingering and deception?
    • What theoretical orientation do you want to use in this case for your treatment recommendations?
    • What is the case scenario you have selected?
    • What is the reason for referral?
    • What is the purpose of the forensic assessment and report?
    • What is the nature of the problem presented in your selected case vignette?
    • What is the context in which the forensic assessment report will be used?
    • What is the background of your client? What are the symptoms displayed by your client and the significance they have in this case?
    • What is the mental status of your client? Be sure to elaborate on every major component addressed in the mental status examination.
    • What interview type and approach did you use with your client?
    • What tests are appropriate to use in your forensic assessment report? Identify one intelligence test, one objective personality test, and one projective test.
    • What collateral information will you use in the process of the evaluation?
    • How will you present your impressions of the client?
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>Nursing homework help

Scenario 1: Polycystic Ovarian Syndrome (PCOS)
A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 12 years of age. She began to develop dark, coarse facial hair when she was 14 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.
Question 1 of 2:
What is the pathogenesis of PCOS?
Question 2 of 2:
How does PCOS affect a woman’s fertility or infertility?
Scenario 2: Pelvic Inflammatory Disease (PID)
A 20-year-old female college student presents to the Student Health Clinic with a chief complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 4 days. She denies nausea, vomiting, or difficulties with defecation. Last bowel movement this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular. Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having pelvic inflammatory disease (PID).
Question:
What is the pathophysiology of PID?
Scenario 3: Syphilis
A 27-year-old male comes to the clinic with a chief complaint of a “sore on my penis” that has been there for 3 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. Social history: works as a bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms. Physical exam within normal limits except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis.
Question:
Describe the 4 stages of syphilis
Scenario 4: Genital Herpes
A 19-year-old female presents to the clinic with a chief complaint of “fluid filled bumps” and intense pruritis of her vulva. She states these symptoms have been present for about 10 days, but she thought she had a yeast infection. She self-medicated with over the counter (OTC) metronidazole (Flagyl™) intravaginally but the symptoms got worse. No other complaints except for fatigue out of proportion to her activity level. Past medical history noncontributory. Social history: sexually active with several men and did forget to use a condom during one sexual encounter. Physical exam negative except for pelvic exam which revealed multiple fluid filled (vesicular) lesions on the vulva and introitus. Positive lymph nodes in inguinal areas. The APRN diagnoses the patient with herpes simplex virus-type 2 known as genital herpes.
Question:
What is the pathophysiology of HSV-2?
Scenario 5: Epididymitis
A 27-year-old male presents to the clinic with a chief complaint of a gradual onset of scrotal pain and swelling of the left testicle that started 2 days ago.  The pain has gotten progressively worse over the last 12 hours and he now complains of left flank pain. He complains of dysuria, frequency, and urgency with urination. He states his urine smells funny. He denies nausea, vomiting, but admits to urethral discharge just prior to the start of his severe symptoms. He denies any recent heavy lifting or straining for bowel movements. He says the only thing that makes the pain better is if he sits in his recliner and elevates his scrotum on a small pillow. Past medical history negative. Social history + for sexual activity only with his wife of 3 years. Physical exam reveals red, swollen left testicle that is very tender to touch. There is positive left inguinal adenopathy. Clean catch urinalysis in the clinic + for 3+ bacteria. The APRN diagnoses the patient with epididymitis.
Question:
Discuss how bacteria in the urine causes epididymitis.
Scenario 6: Prostatitis
A 42-year-old male presents to the clinic with a chief complaint of fever, chills, malaise, arthralgias, dysuria, urinary frequency, low back pain, perineal, and suprapubic pain. He says he feels like he can’t fully empty his bladder when he voids. He states these symptoms came on suddenly about 12 hours ago and have gotten worse. He noticed some blood in his urine the last time he voided. He tried to have a bowel movement several hours ago but could not empty his bowel due to pain. Past medical and social history noncontributory. Physical exam reveals an ill appearing male. Temperature 101.8 F, pulse 122, respirations 20, BP 108/68. Exam unremarkable apart from left costovertebral angle (CVA) tenderness. Rectal exam difficult due to enlarged and extremely painful prostate.  Complete blood count revealed an elevated white blood cell count, elevated C-reactive protein and elevated sedimentation rate. Urine dip in the clinic + for 2+ bacteria.
Question:
Explain the differences between acute bacterial prostatitis and nonbacterial prostatitis
Scenario 7: Endometriosis
A 32-year-old woman presents to the clinic with a chief complaint of pelvic pain, excessive menstrual bleeding, dyspareunia, and inability to become pregnant after 18 months of unprotected sex with her husband. She states she was told she had endometrioses after a high school physical exam, but no doctor or nurse practitioner ever mentioned it again, so she thought it had gone away. She has no other complaints and says she wants to have a family. Past medical history noncontributory except for possible endometriosis as a teenager. Social history negative for tobacco, drugs or alcohol. The physical exam is negative except for the pelvic exam which demonstrated pain on light and deep palpation of the uterus. The APRN believes that the patient does have endometriosis and orders appropriate laboratory and radiological tests. The diagnostics come back highly suggestive of endometriosis.
Question:
Explain how endometriosis may affect female fertility.
Scenario 8: Platelets
An APRN working in an anticoagulation clinic has been asked by the local college to present a lecture on platelets and their role in blood clotting to the graduate pathophysiology nursing students.
Question:
What key concepts should the APRN include in the presentation?
Scenario 9: Iron Deficient Anemia (IDA)
A 36-year-old woman presents to the clinic with complaints of dyspnea on exertion, fatigue, leg cramps on climbing stairs, craving ice to suck or chew and cold intolerance. The symptoms have come on gradually over the past 4 months. The only thing that make the symptoms better is for her to sit or lie down and stop the activity. She denies bruising or bleeding and states this is the first time this has happened. Past medical history noncontributory except for a new diagnosis of benign uterine fibroids 6 months ago after experiencing heavy menstrual bleeding every month. Social history noncontributory and she denies alcohol, tobacco, or drug use. Physical exam: pale, thin, Caucasian female who appears older than stated age. Physical exam remarkable for a soft I/IV systolic murmur, pallor of the mucous membranes, spoon-shaped nails (koilonychia), glossy tongue, with atrophy of the lingual papillae, and fissures at the corners of the mouth. The APRN suspects the patient has iron deficient anemia (IDA) secondary to excessive blood loss from uterine fibroids. The appropriate laboratory tests confirmed the diagnosis.
Question:
Discuss iron deficiency anemia and how the patient’s menstrual bleeding contributed to the diagnosis.
Scenario 10: Pernicious Anemia
A 67-year-old woman presents to the clinic with complaints of weakness, fatigue, paresthesias of the feet and fingers, difficulty walking, loss of appetite, and a sore tongue. These symptoms have been present for several months but the patient thought they were due to her recent retirement and geographic move from the Midwest to New England. The symptoms have gotten worse over the past few weeks and she has noticed that she is much more forgetful. This is of great concern as she worries she might have the beginning stages of Alzheimer’s Disease. Past medical history significant for Hashimoto thyroiditis that she developed in her early 20s. The rest of PMH and social history non- contributory. Physical exam reveals an average sized female whose skin has a sallow appearance. BP 128/74, Pulse 120, respirations 18 and temperature 99.0F orally. Examination of the head and neck reveals a smooth and beefy red tongue. Abdominal exam negative for hepatomegaly or splenomegaly.
The APRN recognizes these symptoms and physical exam indicate the patient has pernicious anemia. After appropriate laboratory data received, the definitive diagnosis of pernicious anemia was made.
Question 1 of 2:
How does pernicious anemia develop?
Question 2 of 2:
How does pernicious anemia cause the neurological manifestations that are often seen in patients with PA?
Scenario 11: Anemia of Chronic Disease (ACD)
A 49-year-old man with a 22-year history of severe rheumatoid arthritis (RA) presents to clinic for his preadmission testing (PAT) and medical clearance for a planned right total hip arthroplasty. The patient had been severely limited in ambulation due to the RA. Current medications include prednisone 20 mg po qd and methotrexate 7.5 mg Thursdays, 5mg Fridays, and 7.5 mg Saturdays.  The patient had a complete blood count (CBC) with manual differentiation and red blood cell indices, complete metabolic panel (CMP) and coagulation studies (prothrombin time [PT], international normalized ratio [INR] and activated partial thromboplastin time [aPTT]). All the laboratory studies come back within normal limits except for the red blood cell indices. The hemoglobin and hematocrit were low along with mean corpuscle volume, plasma iron and total iron binding capacity, and transferrin also being low. There was a normal reticulocyte count, normal ferritin, serum B12, folate and bilirubin.
The APRN in the PAT clinic recognizes that the patient has anemia of chronic disease (ACD).
Question 1 of 2:
What is ACD and how does it develop?
Question 2 of 2:
Why do patients with chronic kidney disease (CKD) develop ACD?
Scenario 12: Immune Thrombocytopenia Purpura (ITP)
A 14-year-old female is brought to the Urgent Care by her mother who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. Past medical history not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning.
Labs at Urgent Care demonstrated normal hemoglobin and hematocrit with normal white blood cell (WBC) differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at Urgent Care referred the patient and her mother to the ED for a complete work up of the low platelet count including a peripheral blood smear for suspected immune thrombocytopenia purpura (ITP).
Question:
What is ITP and why do you think this patient has acute, rather than chronic, ITP?
Scenario 13: Heparin Induced Thrombocytopenia (HIT)
A 22-year-old male is in the Surgical Intensive Care Unit (SICU) following a motor vehicle crash (MVC) where he sustained multiple life-threatening injuries including a torn aorta, ruptured spleen, and bilateral femur fractures. He has had difficulty maintaining his mean arterial pressure (MAP) and has required various vasopressors. He has a triple lumen central venous catheter (CVC) for monitoring his central venous pressure, administration of medications and blood products, as well as total parenteral nutrition. Per hospital protocol, he is receiving an unfractionated heparin 1:1000 flush after administration of each of the triple antibiotics that have been ordered to maintain patency of the lumens.  Seven days post injury, the APRN in the SICU is reviewing the patient’s morning labs and notes that his platelet count has dropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. The APRN suspects the patient is developing heparin induced thrombocytopenia (HIT).
Question 1 of 2:
What is underlying pathophysiology of heparin induced thrombocytopenia?
Question 2 of 2:
The APRN assesses the patient and notes there is a decreased right posterior tibial pulse with cyanosis of the entire foot. The APRN recognizes this probably represents arterial thrombus formation. How does someone who is receiving heparin develop arterial and venous thrombosis?
Scenario 14: Thrombotic Thrombocytopenic Purpura (TTP)
A 33-year-old female is brought to Urgent Care by her husband who states his wife has gotten suddenly confused and complains of a severe headache. He also noticed large bruises on her legs which were not there yesterday. Only significant past medical history is that the patient developed herpes zoster 2 weeks ago and was given acyclovir for treatment. Physical exam revealed well developed female who is only oriented to person. Large areas of ecchymosis noted on both arms and legs. Stat CBC revealed a platelet count of 18,000/mm3, hemoglobin of 8 g/dl and hematocrit of 24%. The patient was immediately transported to the Emergency Room by Emergency Medical Services (EMS) where further work up demonstrated idiopathic thrombotic thrombocytopenic purpura (TTP).
Question:
What is the pathophysiology of TTP?
Scenario 15: Heparin Induced Thrombocytopenia (HIT)
A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection that was found on the preoperative urine culture and sensitivity (C & S). The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately transferred to the surgical intensive care unit (SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were:
CBC with markedly decreased platelet count, peripheral blood smear showed decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin time. The d-dimer was markedly elevated, and fibrinogen level was low. The diagnosis of disseminated intravascular coagulation (DIC) was made based on clinical picture and laboratory data.
Question 1 of 2:
What is DIC and how does it develop?
Question 2 of 2:
What factors contribute to the development of DIC?
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Life begins at forty

Discussion—Midlife—Making The Most Of The “Second Half”

Have you heard the saying, “Life begins at forty?” Unfortunately the cultural messages we receive about midlife are often negative (an emphasis on the development of wrinkles and gray hair, for example) rather than positive (a time of advancement in one’s career, freedom from the responsibilities of caring for young children). Midlife is often a time of transition. People may change careers or end long-term marriages as they assess where they are in life and how they would like to spend the remainder of their lives. Because these transitions are sometimes painful, the concept of the “midlife crisis” has been created and has become popular in American culture. However, there has also been some debate questioning whether the midlife crisis is a universal experience and, in fact, whether it even exists. In this assignment, you will review research on the concept of the midlife crisis and draw your own conclusions about its existence and prevalence in American culture. You will also discuss some ways that we can create a more positive image of midlife.
Use your module readings, the Argosy University online library resources and the Internet to research the concept of midlife crisis.
Select one research paper for review and analysis. Use the module readings and the selected research paper to respond to the following:

  • What is the evidence for the existence of the midlife crisis?
  • Why has the concept become so pervasive in American culture?
  • Discuss at least two ways that we can create a more positive image of midlife in our culture.

Support your arguments with research, citing sources.
Write your initial response in 150–200 words. Apply APA standards to citation of sources.

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