Page 1“Bad Fish: Human Anatomy and Physiology Edition” by James A. Hewlett
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
by James A. Hewlett Science and Technology Department Finger Lakes Community College
Bad Fish: Human Anatomy and Physiology Edition
Part I – Poisoned! One evening during a recent trip to Indonesia, Dr. Marshall Westwood from the Montana Technical Institute sat down to a meal of puff erfi sh and rice. Within an hour of returning to his hotel room, Dr. Westwood felt numbness in his lips and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his stomach and throat, which produced feelings of nausea and eventually severe vomiting.
Fearing that he had eaten some “bad fi sh” for dinner, Dr. Westwood called a local hospital to describe his condition. Th e numbness in his lips and face made it almost impossible for him to communicate, but the hospital staff managed to at least understand the address he gave them and they sent an ambulance in response. As Dr. Westwood was rushed to the hospital, his breathing became increasingly diffi cult.
Doctor’s Notes Th e patient presented in the ED with severe headache, diaphoresis, motor dysfunction, paresthesias, nausea, and an ascending paralysis that spread to the upper body, arms, face, and head. Th e patient was cyanotic and was hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of 90/50. Atropine was administered in response to the bradycardia. IV hydration, gastric lavage, and activated charcoal followed a presumptive diagnosis of tetrodotoxin poisoning based on the clinical presentation in the ED. Five hours after intervention, the following vitals were noted:
• BP 125/79 • HR 78bpm • Oxygen saturation: 97% on room air
Follow-up Within a few hours, Dr. Westwood’s condition improved and he was on his way to a full recovery. After discussing his case with his physician, he learned that he had probably been the victim of a puff erfi sh poisoning. Th e active toxin in the tissues of this fi sh is a chemical called tetrodotoxin. Tetrodotoxin is in a class of chemicals known as neurotoxins due to the fact that it has its eff ects on nerve cells (neurons). Specifi cally, tetrodotoxin blocks voltage-gated sodium ion channels on neurons.
Questions 1. Present the “Doctor’s Notes” portion of the case with a description of the following terms or concepts:
• diaphoresis • motor dysfunction
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Page 2“Bad Fish: Human Anatomy and Physiology Edition” by James A. Hewlett
• paresthesias • cyanotic • hypoventilating • bradycardia • gastric lavage • oxygen saturation
2. How many diff erent elements are contained in a molecule of tetrodotoxin? What are the names of these elements?
3. What type of chemical bonds are found in this molecule? Describe the structure of those bonds. 4. As mentioned in the case description, tetrodotoxin is a molecule that blocks voltage-gated sodium ion channels.
Describe the structure of a sodium ion. 5. What is a voltage-gated sodium ion channel? What is it made of? What is its function? 6. Why do sodium ions need channels in order to move into and out of cells? 7. Describe the process involved in the movement of ions through these channels. 8. When nerve cells are at rest, there is an unequal amount of positive and negative charges on either side of a
nerve cell membrane. Th is charge diff erence is called an electrical potential. Describe this “potential” when the neuron is at rest (resting potential).
9. What is happening to the electrical potential of a neuron when it generates an action potential? What is the function of the action potential in neurons?
10. Describe the role of sodium ions and sodium channels in the action potential. 11. What would happen to a neuron if it were exposed to tetrodotoxin? Be specifi c regarding its eff ect on the ability
of a neuron to communicate. 12. Now that you have addressed some of the basic biology of this case, explain why Dr. Westwood experienced
numbness after eating the puff erfi sh meal. 13. Paralysis is a term used to describe the loss of function of muscle. If tetrodotoxin’s eff ect is on neurons, why did
Dr. Westwood experience paralysis? 14. Explain how tetrodotoxin is involved in the development of hypotension and hypoventilation. 15. Briefl y describe the role of the autonomic nervous system in human physiology. What are the two divisions of
this system? 16. Atropine was administered in the ED as part of Dr. Westwood’s care. What eff ect did it have on his vitals after
it was administered? Atropine acts as an antagonist within the central nervous system, which means it acts as a blocker of specifi c cellular functions. What part of the autonomic nervous system does atropine block to produce its eff ect on Dr. Westwood?
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Page 3“Bad Fish: Human Anatomy and Physiology Edition” by James A. Hewlett
Part II – Oh No! Not Again After recovering from his TTX poisoning, Dr. Marshall Westwood decided to take a vacation. An avid birder, he decided to go to Papua New Guinea with Bill Whitlatch, an ornithologist friend of his from Montana Technical Institute.
Th ree days into their trip, Bill netted bird with an orange body and black wings and head for closer study. Dr Westwood was very curious and asked Bill if he could have a closer look at the bird. After handling the bird and then later wiping his mouth with his hand, Dr. Westwood noticed that his fi ngers and lips were going numb. His mind immediately fl ashed back to the disastrous trip to Indonesia and he began to panic. Luckily, the symptoms faded before they progressed into anything more serious.
His friend Bill used a key to identify the animal as a pitohui. Th e pitohui are small, social songbirds that live in Papua New Guinea. Th ey are generally about 23 centimeters long with strong legs and a powerful beak. Th eir encounter was the fi rst time anyone had scientifi cally realized the birds’ toxicity.
Before releasing the bird, Dr. Westwood collected feather and tissue samples to bring back to the lab. After returning to Montana, he set out to isolate the toxic compound that he believed was being produced by the pitohui. It appeared that the active ingredient was a homobatrachotoxin. Homobatrachotoxin is a steroidal alkaloid that is similar to batrachotoxin, the toxic principle of the Central American poison arrow frog Phyllobates aurotaenia. Batrachotoxin and homobatrachotoxin are both known to act on the voltage-sensitive sodium channels in excitable tissues.
You and your colleagues received a call from Dr. Westwood asking if you could help elucidate the mechanism of action of this toxic compound. One of the hypotheses is that this toxin acts similarly to TTX.
Questions 17. In your fi rst experiment, you generated action potentials in axons of large neurons obtained from squid in the
presence of this new toxin. You found that after depolarizing, the membrane potential remained positive for an extended length of time, and the repolarization was often extremely delayed. Draw a graph (membrane potential in mV vs. time) to illustrate this eff ect.
18. As you continued to experiment with higher concentrations of the toxin, you found cases when the cell could not repolarize at all, or if it began to repolarize, it would immediately depolarize again. Using this description and the description in the previous question, describe how this toxin acts on voltage-gated sodium ion channels.
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Page 4“Bad Fish: Human Anatomy and Physiology Edition” by James A. Hewlett
Image credits: Photograph on page 1, Arothron meleagris, © John E. Randall. Used with permission. Photograph on page 3, Hooded Pitohui, Jack Dumbacher. Courtesy of the Smithsonian National Museum of Natural History.
Case copyright held by the National Center for Case Study Teaching in Science, University at Buff alo, State University of New York. Originally published April 13, 2003. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.
Part III – Pharmacology In this section, you (or your group) will become a small pharmaceutical company that is trying to develop a drug that can be used in the ED to treat tetrodotoxin poisoning. Th ere is no antidote to tetrodotoxin poisoning. Th erefore, it is extremely important that your company is successful in this endeavor. In your report, you need to include the following:
• Your Company Name: o What do you want to call your company? Be creative!
• Name of Your Drug: • Treatment of:
o What does your drug treat? o What other diseases, problems etc. might it be useful for?
• Mechanism of Action: o Describe how your drug will work. o Be sure to provide details regarding its action. You are now familiar with the activity of this toxin at the
level of molecules and cells, so your description should contain details of how your drug works at that level.
• Dosage Form: o How will it be administered to patients?
• Side Eff ects: o What type of side eff ects might your drug have?
Some of your information will come from your understanding of what tetrodotoxin does to neurons. Th ere is no right or wrong answer to how your drug will work because there currently is no drug to treat this problem.
After you decide how your drug might work, you should consider if its mechanism would lead to side eff ects. In addition, your drug may be useful for other problems related to nerve function. You may want to do some research on drugs that have actions at neurons (specifi cally sodium ion channels) and diseases that involve sodium ion channels. Th is will help you develop your drug.

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Identify the heritage of health and healing in faith based communities. Use multiple resources to collaborate community nursing with faith based nursing. Be sure to discuss at least three benefits of community nurses forming partnerships with parish nurses and faith based communities; to discuss a nurse’s role as parish nurse in faith communities for health promotion and disease prevention; to analyze how communities of faith may include Healthy People 2020 guidelines in program planning; and to consider legal, ethical, or financial issues related to parish nursing. Submit your answers in a 4- to 5-page Microsoft Word document.

Q2

1. Assume you are the director of your college or university’s athletic department. A major story hits the news claiming that several of your athletes received inappropriate assistance writing term papers. Supposing the story is untrue (in other words, that this is nothing but a rumor), how would you handle this negative publicity?

2. Faced with the rumor about Corona beer being contaminated with urine (see the discussion earlier in the chapter), what course of action would you have taken if the Heineken distributor in Reno had not been identified as starting the rumor? In other words, if the source of the rumor were unknown, what steps would you have taken?

Introduction: Include a title slide. Next, include an introductory slide where you introduce yourself and explain what you are about to present. Part I: The U.S. Healthcare System – Define the U.S. healthcare system by addressing the items below:

  • Describe the history of the U.S. health care system. Include at least three of the revolutionary factors (e.g., teacher’s union in Dallas, Texas; the American Medical Association; Civil War, and the First Marine Hospital, etc.). Chapter two in our textbook discusses the evolution of our system and is a good resource for this part of your presentation.
  • Identify at least one major development from each of the following: financial, legal, ethical, regulatory, and social [i.e., consumer demand]) that transformed the system into what it is today. You may want to revisit the health care timelines available in your course textbook.
  • Differentiate the stakeholders and their roles (i.e., health care professionals, clients [patients], government, colleges, and health care agencies.
    • Include the positive and negative contributions of how they affect our health care system.
Part II: The Cost of the U.S. Healthcare System
  • Describe the costs and how they are set (i.e., reimbursement methods, managed care organizations, Medicare, Medicaid, and private insurance).
  • Explain how technology has affected costs (e.g., EHR, medical research, equipment improvements like MRI, mammography, etc.) and delivery of quality care (e.g., personalized medicine, mobile services like ePrescribing, disease registries, etc.).
Part III: The United States Versus Other Health Care Systems—an International Perspective
  • Contrast the U.S. health care system with at least one other (e.g., Canada’s universal health care vs. U.S. healthcare or South Africa vs. U.S. health care, etc.).
    • Include at least one positive aspect from the other country’s health care system that you would like to see added to the U.S. healthcare system. Explain why you would like to see this in our system.
Part IV: Reforms and Improvements
  • Describe any potential reforms and improvements that are currently being discussed at either the local, state, or federal level. Your work must be based upon scholarly research, not media commentary.
    • Examples could include the following:
      • Federal modifications (i.e., Medicare reform, repealing PPACA, universal type system, etc.)
      • State modifications(i.e., Medicaid reform, income tax credits, etc.)
      • Increased consumer controls
Note: The PPACA is not an appropriate reform or improvement to be described here because it is already law and not a future improvement. However, if there is a proposal to amend or eliminate, then you can include that potential reform. Conclusion: Future of the U.S. healthcare system
  • Explain what you believe the U.S. healthcare system will look like in the next 10 years. Give at least two recommendations for change.
  • Address access to care, quality of care, and cost of care including an example of each in your vision of our future healthcare system.
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In this assignment, you will be exploring actual and potential health problems in the childhood years using a functional health assessment and Erickson’s Stages of Child Development. To complete this assignment, do the following:

Using the textbook, complete the “Children’s Functional Health Pattern Assessment.” Follow the instructions in the resource for completing the assignment. Cite and reference any outside sources used in your answers. Include in your assessment a thorough discussion of Erickson’s Stages of Child Development as it pertains to the development age of the child. While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

NRS-434VN-R-Childrens-functional-health-pattern-assessment-Student.docx

Translation of a research-based intervention to practice involves a critical review of numerous published research studies to discern if individuals – research subjects – were treated according to the ethical values and principles as defined by the Code of Federal Regulations (CFR). Reflect upon your selected practice problem and the eventual research-based intervention you select for your practice change project and address the following. (OBESITY)
1-What are the potential benefits and harms related to your selected practice problem when considering a research-based intervention for your practice change project?
2-Are there competing personal or professional values related to this research-based intervention that might impact the implementation of this intervention in your practice setting?
3-What types of objections might be raised? How will you explain your decision to key stakeholders to address these objections?
 
Please answer these questions separated and use at least 3 sources no later than 5 years.
You can use this sources:
 
Resnik, D. B. (2015, May). Glossary of commonly used terms in research ethics. Retrieved from National Institute of Environmental Health Sciences website: https://www.niehs.nih.gov/research/resources/bioethics/glossary/index.cfm
·  Resnik, D. B. (2018, July). Research ethics timeline (1932–Present). Retrieved from National Institute of Environmental Health Sciences website: https://www.niehs.nih.gov/research/resources/bioethics/timeline/index.cfm (Links to an external site.)

Unit 4: Discussion
5
Topics
1. What makes an agreement illegal?
2. What are the effects of illegality in a contract?
3. What are consequences of illegal agreements?
4. What does it mean to have an agreement contrary to public policy?  How would one know?
5. What information must be in a written contract?
6. What are the various methods of writing a signature?
7. Are electronic signatures legal?
8. Define and explain the Best Evidence rule.
Discussions should be thoughtful contributions to the class and at least 1-2 paragraphs in length.  Although discussions may be less formal than a research project, students should still present themselves in a professional manner that respects the opinions of classmates.  Students should also reference materials they utilize to support their discussion posts using APA format.  See the assignments and grading page in the course information module for the rubric.

Develop a 3–5-page report that explains how an organization serves the health care concerns and needs of a population. The report should identify gaps in the health care service, explain strategies to bridge the gaps, and describe potential barriers to those strategies. 

This assignment is the 2nd part of the windshield survey previously posted.  
Preparation
Now that your team has a better understanding of the population served by the organization, you need to evaluate how able the organization is to serve the specific health care needs of the population identified in the Windshield Survey assessment.

Use the Internet  to locate at least three academic or professional resources to use in this assessment.
Follow the same formatting instructions that you used in the Windshield Survey assessment. Your assessment should be done as a report for your team, using APA formatting for in-text citations and references.

Requirements
In your organizational evaluation, complete the following:

Describe the primary health concern for a vulnerable or diverse population.
Explain how the organization currently serves this health care concern. Be sure you include information on how the organization communicates to the population.
Identify gaps in the health care service provided to the population.
Explain evidence-based strategies to bridge the gaps in health care service provided to the population.
Identify any possible barriers to implementing your strategies.

Additional Requirements

Include a title page and reference page. The completed assessment should be 3–5 pages in length, not including the title page and reference page.
Reference at least three current scholarly or professional resources.
Use current APA format for citations and references.
Use Times New Roman font, 12 point.
Double space.
*Attached is an example of a well graded paper to use as a reference. 

 Prepare for interprofessional stakeholders a 10–12-slide presentation (not including title and reference pages) explaining how nurse leaders can use information technology to improve nursing practices that support and sustain positive patient outcomes. You do not need to actually present your assessment but be sure to include speaker’s notes for each slide.

The dissemination of evidence-based practice outcomes helps nurses build stakeholder engagement and support for the use of information system and technology for health care delivery.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

· Competency 1: Describe the importance of effective scholarship and evidence-based information to advance the profession of nursing. 

o Describe the basic differences between research (qualitative and quantitative) and evidence-based practice (EBP).

o Describe how nurse leaders use evidence-based practice to support and sustain patient-care outcomes.

o Describe how theory development and research exploration supports nursing practice changes that increase positive patient outcome.

· Competency 3: Explain the use of information management tools and technologies to monitor and improve health care delivery and patient outcomes. 

o Identify a nursing practice that has recently changed in a specific health care setting.

o Describe how nurse leaders use communication to build interprofessional stakeholder engagements.

· Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional. 

o Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

For this assessment, imagine a group of interprofessional stakeholders involved with patient care in your health care setting would like to increase positive patient outcomes. Nurse leaders have recommended changes in the practice that incorporate informatics and the application of new knowledge into your nursing practices.

You are asked to present a brief overview using PowerPoint (or some other presentation software) to a small group of student nurses. After the session has concluded, the training department would like to use your presentation as a training resource.

Preparation

Select a nursing practice in your own health care setting that has changed for the better since you first began nursing.

Directions

Use the tools in your presentation software to develop a creative and engaging presentation. Use the notes portion of PowerPoint to capture your narrative script for each slide. Include the following in your presentation:

· Describe briefly an example of a nursing practice that has changed in the last two years.

· Explain how theory development, research exploration, and information technology supports the changes you have described.

· Describe the basic differences between research (qualitative and quantitative) and evidence-based practice (EBP).

· Explain how nurse leaders use communication practices and technology to build interprofessional stakeholder engagements in support of the change you have identified.

· Describe how nurse leaders use evidence-based practice to support and sustain patient-care outcomes.

Additional Requirements

· Length: Submit a presentation of 10–12 slides (not including title and reference slides). Include both a title slide and a reference slide with 4–6 references to support your presentation information and ideas.

· Formatting Guidelines: Create streamlined slides with minimal information. 

o Be precise.

o Keep bulleted content on one line.

o Use images instead of words when appropriate.

· Narrative Script: Use the notes portion to create a detailed narrative for each slide.


Write 3–4 pages describing the effective use of patient-care technologies, communication systems, and information systems across the care continuum of a health care system of your choice. Add a one-page executive summary your organization could use to disseminate these ideas.

Because a lack of knowledge when using technology can lead to errors in patient care, effective use of technology in health care is paramount to providing a safe health care delivery environment.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

  • Competency 3: Explain the use of information management tools and technologies to monitor and improve health care delivery and patient outcomes.       
    • Describe effective use of technology across the care continuum in a health care setting.
    • Describe how to manage change and technology to improve positive outcomes.
    • Support description of effective patient care with current nursing and informatics theoretical ideas.
  • Competency 4: Communicate in a manner that is consistent with expectations of a nursing professional.       
    • Write coherently to support a central idea in appropriate format with correct grammar, usage, and mechanics.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

  • How might standardized nursing language (SNL), interprofessional communication, information system support, staff and patient education, organizational culture, and state and national regulations influence technology use?      
    • What are the complexities in using technology across a continuum of care?
    • What are the opportunities?
    • What are the barriers?
  • How can we manage change and technology use to develop improved patient outcomes?

Assessment Instructions 

In the role of a nurse leader, describe the effective use of patient-care technologies across the care continuum in a chosen health care system.

Preparation

Choose any type of health care system, for example, acute, ambulatory, or home health or telehealth.

Directions

Submit the following for this assessment:

Technology Across the Care Continuum

Include the following in your 3–4-page description:

  • A brief overview of the care continuum in your selected health care system.
  • Describe the types of patient-care technologies and how they are used across the care continuum in your system. Be sure to include communication and information systems.
  • Identify strengths and weaknesses in the systems and describe how to manage change and technology to improve patient outcomes.
  • Support your description of effective patient care with current nursing and informatics theoretical ideas.
Executive Summary

Based on the description above, add a 1-page executive summary that captures the following points:

  • Current state of technology across the care continuum in your system.
  • Proposed improvements.
  • Risks of making or not making changes or improvements.
  • Recommended next steps.

Additional Requirements

  • Written communication: Ensure written communication is free of errors that detract from the overall message.
  • APA formatting: Format resources and citations according to current APA style and formatting guidelines.
  • Number of resources: Cite a minimum of four peer-reviewed resources.
  • Length: Submit 4–5 typed, double-spaced pages.
  • Font and font size: Use Times New Roman, 12 point.

SEARCH JOURNAL OF NURSING CARE QUALITY FIND AN ARTICLE OF INTEREST (RELATING TO EBP)

Search Journal of Nursing Care Quality
Find an article of interest (relating to EBP), current within the last 5 years.
Summarize what you learned
Post the article in the requested format: author (year) short version of title
Journal/article link:
https://ovidsp-tx-ovid-com.db22.linccweb.org/sp-3.27.2b/ovidweb.cgi?WebLinkFrameset=1&S=OPPOFPNCEMDDMIEKNCFKABGCLAFLAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23.26.31%257c0%257c00001786-201801000-00004%26S%3dOPPOFPNCEMDDMIEKNCFKABGCLAFLAA00&directlink=https%3a%2f%2fovidsp.tx.ovid.com%2fovftpdfs%2fFPDDNCGCABEKEM00%2ffs047%2fovft%2flive%2fgv024%2f00001786%2f00001786-201801000-00004.pdf&filename=Multilevel+Factors+Associated+With+Injurious+Falls+in+Acute+Care+Hospitals.&link_from=S.sh.22.23.26%7c4&pdf_key=FPDDNCGCABEKEM00&pdf_index=/fs047/ovft/live/gv024/00001786/00001786-201801000-00004&D=ovft