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Environmental Factors And Health Promotion

Environmental Factors And Health Promotion Pamphlet: Accident Prevention And Safety Promotion For Parents And Caregivers Of Infants

To prepare for this assignment view the following brief video from the American Medical Association titled, “Health Literacy and Patient Safety: Help Patients Understand.” The video can be accessed through the following link:

Part I: Pamphlet

  1. Develop a pamphlet to inform parents and caregivers about environmental factors that can affect the health of infants.
  2. Use the “Pamphlet Template” document to help you create your pamphlet. Include the following:
  3. Select an environmental factor that poses a threat to the health or safety of infants.
  4. Explain how the environmental factor you selected can potentially affect the health or safety of infants.
  5. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
  6. Offer examples, interventions, and suggestions from evidence-based research. A minimum of three scholarly resources are required.
  7. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.
  8. In developing your pamphlet, take into consideration the healthcare literacy level of your target audience.

Part II: Pamphlet Sharing Experience

  1. Share the pamphlet you have developed with a parent of an infant child. The parent may be a person from your neighborhood, a parent of an infant from a child-care center in your community, or a parent from another organization, such as a church group with which you have an affiliation.
  2. Provide a written summary of the teaching / learning interaction. Include in your summary:
  3. Demographical information of the parent and child (age, gender, ethnicity, educational level).
  4. Description of parent response to teaching.
  5. Assessment of parent understanding.
  6. Your impressions of the experience; what went well, what can be improved.

Submit Part I and Part II of the Accident Prevention and Safety Promotion for Parents and Caregivers of Infants assignment by the end of Topic 1.
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.

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GLOBALIZATION AND DIVERSITY IMPACT ON HEALTHCARE ORGANIZATIONS UNIT OUTCOMES

Globalization and Diversity Impact on Healthcare Organizations
Unit outcomes addressed in this Assignment:

Explain the attributes of a successful health leader.
Describe issues related to globalization, power, followership, and culture change from a health leader’s perspective.

Course outcome addressed in this Assignment:
HA515-2: Evaluate approaches to leading individuals and teams, and eliciting support from senior principles.
HA515-3: Identify change management practices by discussing change sponsorship versus agency of change theory.
HA515-4: Evaluate leadership strategies essential to successfully accomplish change including interpersonal, organizational, and cultural dimensions.
Instructions
For this Assignment, outline issues related to globalization, power, followership, and cultural change from a health leader’s perspective. Identify at least three major global health issues that have impacted the U.S. health care system, and describe how this has affected and influenced stakeholders.
Relate the global leadership style differences and similarities within the constructs of transformational leadership. Discuss at least three critical elements of culture and diversity on the modern health care organization. Also, provide a table or list of cultural attributes to be cognizant of.
Finally, categorize global leadership differences according to a leader’s use of power, technology, and knowledge management. Provide at least two leadership approaches for implementing change.
Requirements

Your paper must be at least 5 pages in length.
Use a minimum of three academic references.
Cite all references using APA format.

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The AACN Essentials of Baccalaureate Education for Professional Nursing Self-Assessment Essay

The AACN Essentials of Baccalaureate Education for Professional Nursing Self-Assessment Essay
Understanding the competencies related to the AACN Essentials of Baccalaureate Education for Professional Nursing Practice provides you with valuable information as you begin to study this course. Complete this self-assessment, which is based on The Essentials of Baccalaureate Education for Professional Nursing from the American Association of Colleges of Nursing (2008) prior to posting to the discussion on this topic Place a check mark or X in the column that best describes your current level of competency or understanding of the Essential’s statement. There are no incorrect answers. After you have completed the assessment, total the number of points that you earned. Record this number in a location where you will be able to retrieve it at the end of the course, when it will serve as the basis for a future discussion. AACN (American Association of Colleges of Nursing) Baccalaureate Essentials Poor 1 Good 2 Very Good 3 Excellent 4 Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety Apply leadership concepts, skills, and decision-making in the provision of high qualitynursing care, healthcare team coordination, and the oversight and accountability for care delivery in a variety of settings. Demonstrate leadership and communication skills to effectively implement patientsafety and quality improvement initiatives within the context of the interprofessional team. Participate in quality and patient safety initiatives, recognizing that these are complex systemissues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and system-wide practice improvements that will improve the quality of healthcare delivery. Essential V: Healthcare Policy, Finance, and Regulatory Environments Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, state, national, and global healthcare trends. Explore the impact of sociocultural, economic, legal, and political factors influencing healthcare delivery and practice. Examine the roles and responsibilities of the regulatory agencies and their effect on patient care quality, workplace safety, and the scope of nursing and other health professionals’ practice. Advocate for consumers and the nursing profession. Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes Use inter and intrarofessional communication and collaborative skills to deliver evidence-based, patient-centered care. Incorporate effective communication techniques, including negotiation and conflict resolution to produce positive professional working relationships. Demonstrate appropriate teambuilding and collaborative strategies when working with interprofessional teams. Advocate for high-quality and safe patient care as a member of the interprofessional team Essential VIII: Professionalism and Professional Values Demonstrate the professional standards of moral, ethical, and legal conduct. Promote the image of nursing by modeling the values and articulating the knowledge, skills, and attitudes of the nursing profession. Reflect on one’s own beliefs and values as they relate to professional practice. Articulate the value of pursuing practice excellence, lifelong learning, and professional engagement to foster professional growth and development. Total for each column Grand total (add all columns) Source: American Association of Colleges of Nursing (AACN). (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf/ After you have completed your self-assessment, answer the following questions: If you are willing, please share your total score on the AACN Essentials Self-Assessment. If you do not wish to share your score, give a general description of your current KSA levels. Candidly identify and share with your classmates areas where knowledge, skills or abilities (KSAs) are lacking? Describe the relationship between the AACN Essentials and your new-found knowledge about Patient Centered Care. Are there opportunities for you to improve?

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differences between research and evidence-based practice.



Question Description

Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

References:

Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

Words Limits

  • Response posts: Minimum 100 words excluding references.



Discussion 2

We are looking at the differences between research and evidence-based practice. According to (LoBiondo -Wood & Haber, 2014, p. 6), the term research involves systematic, scientific approaches whereas the goal is to answer specific questions about nursing developments. Research further breaks down into two major categories which are qualitative research and quantitative research. (LoBiondo -Wood & Haber, 2014, p. 8)

An example of a research study would be to sit down face to face and interview 20 adults who tested positive for Influenza A, 10 who took Tamiflu and 10 who did not. The research question would be, “What is the relationship between those adults who were diagnosed with pneumonia after testing positive for Influenza A, amongst those who took Tamiflu and those who did not?”

Evidence-based practice is best described by (Stevens, 2013, para. 3) as combining our current knowledge on a particular subject and adding that to our plan of care to improve the outcomes of our patients. In other words, the knowledge and research now exists, we just have to translate the information into our daily practice and possibly keep patients from going through something we can predict may happen, based on what we have already learned.

An example of evidence-based practice would be to find your source, and as (Hoyka & Heese, 2006, p. 348) states, it can be books and journals, among several other materials. As we have been told since day one of writing research papers, not all sources are correct and it is our job to know how to locate reputable ones. To implement evidence-based practice, for example, a patient’s mother may want to know the correlation between her 12 month old child receiving the Measles, Mumps, Rubella (MMR) vaccine. For the clinical question, I would ask, “In 12 month old children, does receiving the MMR vaccine increase the risk of developing autism?”

To summarize, there are differences between research in nursing and evidence-based practice in nursing. There are times throughout our career that we will use one or both practices to gain knowledge and apply that to our plans of care.

References

(2010). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.

Hoyka, L., & Heese, D. (2006). Finding and evaluating sources. Upper Saddle River, NJ: Pearson Prentice Hall.

LoBiondo -Wood, G., & Haber, J. (2014). Nursing Research Methods and Critical Appraisal for Evidence-Based Practice (8th ed.). St. Louis, MO: Elsevier.

Stevens, K. R. (2013, May 31). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN, 18. https://doi.org/10.3912/OJIN.Vol18No02Man04

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice. St. Louis, MO: Elsevier.

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>Law homework help

What ethical and moral responsibility does the government of one country have to people who wish to immigrate from another country? How does this responsibility change, if at all, depending on factors such as

  • the political or economic stability/instability of the immigrant’s home country;
  • the political or economic stability/instability of the country the immigrant is seeking admission to;
  • the legal or illegal status of the immigrant within a host country; or
  • demographic variables pertaining to the immigrant such as his or her wealth, income, ethnicity, educational background, political status, family size, or other relevant variables?

Describe the ethical theory or perspective that reflects the viewpoint you are expressing here. Use at least one academic source in addition to the Mosser textbook that supports your main argument. Be sure to review and observe the class rules on the use of netiquette and show common courtesy to your classmates and instructor before posting your discussion.
Your initial post should be at least 250 words in length. Support your claims with examples from the required resources and/or other scholarly sources, and properly cite any references in APA Style as outlined in the Ashford Writing Center resources Introduction to APA (Links to an external site.) and Integrating Research (Links to an external site.).
Guided Response: Think about how concepts like xenophobia and/or xenophilia may apply to this discussion. Respond to at least two of your classmates’ posts by Day 7.

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>Management homework help

Assignment 1.2: Conflicting Viewpoints Essay – Part II
Synthesizing and Writing
Due Week 5 and worth 100 points
When looking for information about a particular issue, how often do you try to resist biases toward your own point of view? This assignment asks you to engage in this aspect of critical thinking.
The assignment is divided into two (2) parts.
For Part I of the assignment (due Week 3), you read a critical thinking process: “The Believing Game and How to Make Conflicting Opinions More Fruitful” by Peter Elbow. , reviewed the Procon.org Website in order to gather information, and engaged in prewriting to examine your thoughts.
* Remember that in the Week 2 Discussion, you examined the biases discussed in Chapter 2 of the webtext.
In Part II of the assignment (due Week 5), you will write a paper to synthesize your ideas.
Part II – Writing
Write at three to four (3-4) page paper in which you:

  1. State your position on the topic you selected for Assignment 1.1.
  2. Identify (3) three premises (reasons) from the Procon.org website that support your position and explain why you selected these specific reasons.
  3. Explain your answers to the “believing” questions about the three (3) premises opposing your position from the Procon.org website.
  4. Examine at least two (2) types of biases that you likely experienced as you evaluated the premises for and against your position.
  5. Discuss the effects of your own enculturation or group identification that may have influenced your biases.
  6. Discuss whether or not your thinking about the topic has changed after playing the “Believing Game,” even if your position on the issue has stayed the same.

The paper should follow guidelines for clear and organized writing:

  • Include an introductory paragraph and concluding paragraph.
  • Address main ideas in body paragraphs with a topic sentence and supporting sentences.
  • Adhere to standard rules of English grammar, punctuation, mechanics, and spelling.

Your assignment must follow these formatting requirements:

  • This course requires use of Strayer Writing Standards (SWS). The format is different than other Strayer University courses. Please take a moment to review the SWS documentation for details.
  • Based on the guidelines in SWS, “A well-researched assignment has at least as many sources as pages.” Since this assignment requires you to write at least 3-4 pages, you should include at least 3-4 references.

The specific course learning outcomes associated with this assignment are:

  • Identify the informal fallacies, assumptions, and biases involved in manipulative appeals and abuses of language.
  • Create written work utilizing the concepts of critical thinking.
  • Use technology and information resources to research issues in critical thinking skills and informal logic.
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IMPLICATIONS OF HEALTH ECONOMIC CONCEPTS FOR HEALTHCARE

Assignment: Implications of Health Economic Concepts for Healthcare

Select at least five (5) economic concepts covered in the first four weeks’ readings, and discuss the primary manner in which these concepts impact the world of health care economics. Some examples of selected concepts are health demand and supply, elasticity, resources, health measures, and costs.

Write a four to six (4-6) page paper in which you:

1. Assess the value of healthcare professionals and decision makers understanding the discipline of health economics. 2. Defend or critique the importance of considering the complex nature of health and healthcare when examining the economic principles related to healthcare delivery. 3. Analyze the primary potential benefits of learning about health economics related to government involvement in healthcare economics, financing, and delivery. 4. Analyze the main potential benefits of learning about health economics related to private sector government involvement in healthcare economics, financing, and delivery. 5. Use at least five (5) current references. Three of these references must be from current peer-reviewed sources to support and substantiate your comments and perspectives.

Your assignment must follow these formatting requirements:

Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

Explain how selected economic principles apply to the health care market and the provisions of health care services. Analyze the factors that are influencing the demand and supply of health care services in the U.S. Assess current economic trends that influence the cost, quality, and access to care. Use technology and information resources to research issues in health economics. Write clearly and concisely about health economics using proper writing mechanics.

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sychosis and schizophrenia

Discussion
I want this assignment asap -PLAGIARISM MUST BE LESS THAN 10%
Sychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Objectives

Students will:
  • Assess client factors and history to develop personalized plans of antipsychotic therapy for clients
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy
  • Evaluate efficacy of treatment plans
  • Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

 
To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment
Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • SAMPLE  ONLY

 
NURS 6630
WEEK SEVEN
Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady
Introduction
Briefly, this is a scenario of a 42 year- old woman with a complex psychiatric history extending from depression, posttraumatic stress disorder, insomnia, visual hallucinations (little man)and impaired behavior with aggression. In the course of more than 36 months, the client was treated with Paroxetine (SSRI), Bupropion ( NDRI), Tiagabine, Ramelteon and , but finally a combination of Lexapro, Bupropion and quetiapine was able to decrease her symptoms . The client’s medical history includes diabetes, hypertension, CAD, hyperlipidemia, COPD, OSA, GERD, Glaucoma, overweight and a remote history of substance abuse.
Related Professional Questions
Certain medications or supplements can cause symptoms of mental illness and also due to her extensive medical history and usage of multiple medications I would ask the following questions:
1. Do you take any over -the – counter, herbal supplements or remedies and I would check for interactions with current medication regimen?
2. When and how often do you use your albuterol inhaler ? Some of the side effects of albuterol include anxiety, nervousness, and insomnia ( Cunha, 2016)
Sleep Hygiene: Do you keep regular sleep schedule ? Do you drink caffeine beverages close to bedtime?
Patient History
The patient may not be a reliable source of information, particularly that she has a significant mental illness that affects her functioning, hence verifying her responses with her direct family members, and mental social workers to get clues to the underlying or precipitating causes of mental crisis. Also checking facility records from previous encounters, or any psychiatric hospitalizations would be useful.
Diagnostics Testing
1. Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017)
2. Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of cardio complications. In the setting of taking antidepressants and antipsychotics, baseline ECG and possibly every three to six months would be appropriate.  Several atypical antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)
Differential Diagnoses
1. Posttraumatic Stress Disorder ( PTSD)_
2. Major Depressive Disorder  (MDD)
3. Insomnia Disorder.
Pharmacotherapy Options for Sleep/ Wake cycle
1. Zolpidem (Ambien) 5mg oral at bedtime for Seven days.
Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA (Stahl, 2017). With its side effects of sedation,  low dose prescribed as the client has respiratory problems (sleep apnea OSA)).  Studies have shown that Zolpidem did not significantly worsen OSA as measured by the numbers and duration of pauses in breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels during the night when compared with placebo ( Mason & Smith, 2015).
2. Trazadone 25 mg oral at bedtime for Thirty days.
Trazadone is a serotonin 2 antagonist/reuptake inhibitor, used in management of depression and insomnia. It is absorbed well, metabolized by CYP 450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem (Stahl, 2017)
The best choice for the client would be Trazadone as there is no reliable evidence of dependence or withdraws and it can also work for the client’s depression.
Conclusion
The case was a perfect example how it is sometimes difficult to find effective pharmacological treatments of psychiatric illnesses. In the course of four years, the client was prescribed 5-6 medications targeting different neurotransmitters to improve the symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her medical comorbidities increased risks of adverse reactions. Lesson learned from this study was  that treatment  should be optimally initiated after diagnosis, and augment or switching to a new agent must be carefully  done in consideration of possible  side effects and better outcomes.
References
Bhagwat, N., Tayde, P., Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism and depression: Are cytokines the link? Indian Journal of Endocrinology and Metabolism, 21(6), 886. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-40a4-bd10-f956796bc9e8%40sessionmgr101
Cunha, J. (2016). Common Side Effects of Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htm
Mason, M., & Smith, I. (2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea (OSA) in adults with known OSA | Cochrane. Retrieved from http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-medications-obstructive-sleep-apnoea-osa-adults-known-osa
Zhai, D., Lang, Y., Dong, G., Liu, Y., Wang, X., Zhou, D., … Zhang, R. (2017). QTc interval lengthening in first-episode schizophrenia (FES) patients in the earliest stages of antipsychotic treatment. Schizophrenia Research, 179, 70-74. Retrieved from https://resolver-ebscohost-com.ezp.waldenulibrary.org/openurl?ID=pmid%3a27727006&genre=article&atitle=QTc+interval+lengthening+in+first-episode+schizophrenia+(FES)+patien

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Health Assessment & Nursing Care Plan- Kevin Jones Case Study- Paralysis

NURBN 2009: Health Assessment & Nursing Care Plan- Kevin Jones Case Study- Paralysis- Nursing Assignment Help

Task:

You are required to complete a comprehensive health assessment and nursing care plan on information given to you in the case study- Mr. Kevin Jones.

To demonstrate your developing skills required to produce a comprehensive nursing health assessment by the clinical decision making process, identification /assessment of nursing problems (nursing diagnosis), planning and implementation of nursing care, documentation of nursing data and evaluation of nursing care.Students are required to discuss in 2000 words the physical and mental health components for the assessment case study.

1. This needs to be written according to academic standards and conventions.
2. Students will be required toidentify4 major issuesof the case study and write a summary of your overall assessment of this person.
3. Ensure that ‘objective’ language is used. This would be similar to what is written in nursing notes as an admission history.
4. Using the Nursing diagnosis section of the Adult health assessment booklet, identify and list as many nursing diagnosis as may relate to the Case study and provide the evidence from assessment that supports this.
5. Now prioritise the3 most important nursing problems (diagnoses)to formulate a nursing care plan. As the overall goal is discharge planning, consider this in formulating the nursing care plan and related interventions.
6. Develop a nursing care plan with rationale and related interventions that could be implemented for Kevin (Case Study) .
7. Be sure to identify ways that you could measure success in relation to each of these Interventions – complete the evaluation sections of the care plan.
8. This assessment requires you to develop a critical assessment of the relevant information surrounding the case study.

Case Study – Mr Kevin Jones

Mr Kevin Jones is a 75 year old gentleman who is under your care. He has been widowed for 13 yearsand has recently suffered a stroke. He lives alone in a rural location and was a farmer during hisworking life.

Kevin has 3 grown up children, two of whom live outside of Victoria and his middle son livesnearby but leads a busy working and family life. He does not get along too well with his daughter in law. Kevinis fiercely independent and during hishospitalisation has verbalised his wish to return to his home and manage on his own, against the wishes ofhis family.

Finances are limited. He lives in anold farm house which hasn’t seen renovations for 30 years. He has a wood fire and stove and noshower (just a bath).

Past history: Prostate Enlargement, Hypertension, Alcoholism, Depression and Anxiety

Currently Kevin has right side paralysis due to his CVA (stroke). Kevin does not appear to notice that he leans to one sideand forgets where his right hand may be. His speech is slurred and he has trouble saying some words. This causeshim some frustration and he has emotional outbursts at times.He has just started to mobilisewith a three pronged stick and he is anxious about his balance.

Kevin is anxious about returning home and seems to be fretting about his home, land and animals (currently being taken care of by one of his sons). Some days, Kevin barely talks to the staff and will often get agitated and irritable with the nurses, physiotherapists, cleaners etc. He appears to be ruminiating about his past and his wife.

Kevin has been complaining of a chronic cough with a small amount of discoloured greenish yellow sputum, fever,flushed skin, chills, loss of appetite, taking little fluids, malaise and body aches over the past few days. Temp 38.3, BP – 90/60, Resp rate – 24/ min, P 90 , O2 sats – 93%. Crackles & wheezes on auscultation, diminished breath sounds.

Chest X-Ray revealed (R) lower lobe pnuemonia.

Kevin also has someswallowing difficulties and some vision problems with neglect. When he does eat, he prefers puree and soft style deserts e.g. custard. He is not drinking much. Kevin appears to have lost weight. His skin turgor is dry, mucous membranes dry, urine specific gravity is 1.025, decreased urinary output, increased urine concentration and he has an elevated blood urea nitrogen.

He is finding that he is more likely todribble following passing urine and sometimes he is incontinent of urine. His bowels are a little erraticand his stool has been hard and dry lately. Lately, this is causing him considerable distress.

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