Week 6

Week 6: Comprehensive Case Study on COPD, Heart Failure, Hypertension, and Diabetes Mellitus

Review the following case study and complete the questions that follow. For this assignment, write your responses to each question as one narrative rather than separating your responses by question number. Include an introduction and a conclusion. Submit your answers using APA format, well-written sentences, and detailed explanations. Your analysis must be scientifically sound, necessary, and sufficient.

You must also include a bibliography of at least 3 sources (with at least one non Internet source). Your textbook may not be included as a source for this assignment. Refer to the rubric for more information on how your assignment will be graded.

Case Study

M.K. is a 45-year-old female, measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking about 22 years along with a poor diet. She has a history of Type II diabetes mellitus along with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the Type II diabetes mellitus.

The following are lab findings that are pertinent to this case:

1. What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis?

1. Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops.

1. According to the B.P. value, what stage of hypertension is M. K. experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population.

1. According to the lipid panel, what other condition is M.K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and Type II diabetes mellitus?

1. Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function?

Refer to the rubric for more information on how your assignment will be graded.

Due: Sunday, 11:59 p.m. (Pacific time)

Points: 300

Safe Assign results below:

1 COMPREHENSIVE CASE STUDY ON COPD, HEART FAILURE, HYPERTENSION AND DIABETES MELLITUS

Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus

1 The following is a comprehensive case study on COPD, Heart Failure, Hypertension and Diabetes Mellitus.

The patient is a 45 year old, obese female with an extensive smoking history along with a poor diet. In addition, she has Type II DM along with hypertension and was recently diagnosed with chronic bronchitis which is manifested in some of her current symptoms. 3 Current home medications include, Lotensin, Lasix and Glucophage.

Patients with chronic bronchitis are often overweight and has a history of smoking as in this case. 2 Cigarette smoking is the most important risk factor for the development of chronic bronchitis.

Over 90 percent of patients with chronic bronchitis have a smoking history, although only 15 percent of all cigarette smokers are ultimately diagnosed with some form of obstructive airway disease. 4 Chronic bronchitis is a clinical diagnosis characterized by a cough productive of sputum for over three months’

http://www.aafp.org/afp/1998/0515/p2365.html

duration during two consecutive years and the presence of airflow obstruction.

http://www.aafp.org/afp/1998/0515/p2365.html

Pulmonary function testing aids in the diagnosis of chronic bronchitis by documenting the extent of reversibility of airflow obstruction.

http://www.aafp.org/afp/1998/0515/p2365.html

The following treatments and recommendations would be appropriate.

4 Documentation of airflow obstruction by pulmonary function testing is critical for the diagnosis of chronic bronchitis and provides valuable therapeutic information about the patient’s responsiveness to inhaled bronchodilator therapy.

http://www.aafp.org/afp/1998/0515/p2365.html

A measured forced expiratory volume in one second (FEV1) of less than 70 percent of the total forced vital capacity (FVC)—the FEV1/FVC ratio—defines obstructive airway disease.

http://www.aafp.org/afp/1998/0515/p2365.html

An FEV1/FVC ratio of less than 50 percent indicates end-stage obstructive airway disease.

http://www.aafp.org/afp/1998/0515/p2365.html

Hypoxemia is a common finding on arterial blood gas sampling in patients with advanced chronic bronchitis and ventilatory failure secondary to bronchospasm and inflammation.

http://www.aafp.org/afp/1998/0515/p2365.html

Radiographic findings correlate poorly with symptoms in most patients with chronic bronchitis.

http://www.aafp.org/afp/1998/0515/p2365.html

Common, but nonspecific, findings include hyperinflation, bullae, blebs, diaphragmatic flattening and peribronchial markings.

http://www.aafp.org/afp/1998/0515/p2365.html

A better understanding of the role of inflammatory mediators in chronic bronchitis has led to greater emphasis on management of airway inflammation and relief of bronchospasm.

http://www.aafp.org/afp/1998/0515/p2365.html

Inhaled ipratropium bromide and sympathomimetic agents are the current mainstays of management.

http://www.aafp.org/afp/1998/0515/p2365.html

While theophylline has long been an important therapy, its use is limited by a narrow therapeutic range and interaction with other agents.

http://www.aafp.org/afp/1998/0515/p2365.html

Oral steroid therapy should be reserved for use in patients with demonstrated improvement in airflow not achievable with inhaled agents.

http://www.aafp.org/afp/1998/0515/p2365.html

Antibiotics play a role in acute exacerbations but have been shown to lead to only modest airflow improvement.

http://www.aafp.org/afp/1998/0515/p2365.html

Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration and nutritional support also play key roles in long-term management of chronic bronchitis.

http://www.aafp.org/afp/1998/0515/p2365.html

Proper treatment and management of chronic bronchitis is needed in order to prevent right-sided heart failure which is suspected in this case. 2 This can be in response to abnormally low oxygen levels in the vessels inside the lungs as a result of COPD.

The excess strain from pulmonary hypertension on the right ventricle can result in heart failure.

5 Right-sided heart failure causes fluid to accumulate in the legs, ankles and abdomen as well as the lungs.

6 Right-sided heart failure means that the right side of the heart is not pumping blood to the lungs as well as normal.

http://www.genesishcs.org/patients-visitors/health-library/healthwise-document-viewer/?id=tx4093abc

7 Most people develop heart failure because of a problem with the left ventricle.

But reduced function of the right ventricle can also occur in heart failure.

8 As blood begins to back up behind the failing left ventricle and into the lungs, it will become harder for the right ventricle to pump returning blood through the lungs.

7 Like the left ventricle, the right ventricle will weaken with time and start to fail.

In right-sided heart failure, the right ventricle loses its pumping function, and blood may back up into other areas of the body, producing congestion.

In addition to her chronic bronchitis and suspected heart failure, patient has stage I hypertension with a blood pressure of 158/98. 9 Readings between 140/90 and 159/99 usually indicate Stage I Hypertension, which means the force of the blood pressure in your arteries is higher than normal, putting you at increased risk of life-threatening problems such as heart attacks and stroke.

/orders/www.caring.com/charts/blood-pressure-158-95

Blood pressure in this range can also damage organs such as the heart and the kidneys, especially in people who already have chronic medical problems affecting these parts of the body.

/orders/www.caring.com/charts/blood-pressure-158-95

As she is already on Lasix and Lotensin, the diuretics will help to reduce blood pressure by increasing the removal of sodium and fluid from the blood into the urine by the kidneys. Diuretics also lower blood pressure by promoting dilation of small blood vessels. The ACE inhibitors will decrease blood pressure by reducing the production of angiotensin II, a potent constrictor of blood vessels. They are often prescribed for people with hypertension who also have kidney damage, heart failure or diabetes.

Having high blood pressure puts you at risk for heart disease and stroke, which are leading causes of death in the United States. 10 About 75 million American adults (32%) have high blood pressure—that’s 1 in every 3 adults.

5 High blood pressure costs the nation $46 billion each year.

This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work.

11 With her abnormal lipid panel, patient is also at risk for coronary heart disease.

1 Cholesterol is required for the synthesis of steroid hormones and bile.

12 It is a necessary component of cell membranes.

If we don’t get cholesterol from our diet, the liver will make it.

However, most people do receive plenty of cholesterol from their diet resulting in high cholesterol levels (greater than 200 mg/dL).

The total cholesterol measurement is a sum of High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL).

13 Low levels of HDL significantly increase the risk of heart disease and are associated with diets high in saturated fats, refined carbohydrates, and refined sugars, especially high fructose corn syrup.

Inactivity, obesity and cigarette smoking also reduce HDL levels.

12 Elevated LDL levels are the result of inactivity, obesity, and type II diabetes.

13 LDL levels also increase from diets high in refined carbohydrates, sugar, saturated animal, trans, and hydrogenated fats.

14 Conditions that can cause high triglycerides include hypothyroidism, diabetes, liver and kidney disease, corticosteroids, and diets high in refined carbohydrates and sweets as well as excess fat intake.

Other medications may need to be prescribe such as beta blockers which will slow heart rate and decrease blood pressure, which decreases the heart’s demand for oxygen. Aspirin can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. Cholesterol-modifying medications can decrease the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Possible medications including statins, niacin, fibrates and bile acid sequestrants.

Another of patient’s abnormal labs is her HbA1c of 7.3%. In patients with HbA1c < 7.3%, postprandial glucose makes the major contribution to the overall hyperglycemia, whereas the contribution of fasting glucose becomes progressively predominant in patients with HbA1c > 7.3%. As a consequence of these observations, initiation of anti-diabetic treatments or implementation of second-line therapies should be aimed at reducing either postprandial excursions or fasting hyperglycemia according to whether HbA1c levels are found respectively below or above a cut-off value of 7.3%.

8 Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%.

People with diabetes with poor glucose control have hemoglobin A1c levels above 7%.

The goal for people with diabetes, with their doctor’s help, is to establish stable blood glucose levels resulting in hemoglobin A1c levels that are at least below 7% to reduce or stop complications of diabetes (for example, diabetic nerve, eye, and kidney disease).

In summary, Chronic obstructive pulmonary disease is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalizations. Appropriate treatment plans should be aimed towards progression and prevention of these diseases.

References

4 American Thoracic Society.

http://www.aafp.org/afp/1998/0515/p2365.html

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.

http://www.aafp.org/afp/1998/0515/p2365.html

Am J Respir Crit Care Med.

http://www.aafp.org/afp/1998/0515/p2365.html

1995;152(5 Pt 2)

http://www.aafp.org/afp/1998/0515/p2365.html

14 American Diabetes Association.

“Diagnosing Diabetes and Learning About Prediabetes.”

15 www.cdc.gov/bloodpressure/facts

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NR 103 Week 6 Required Uniform Assignment (RUA): Transitions Paper

•   NR 103 Week 6 Transitions Paper – Delegation in Professional Nursing Paper (Delegation)
•   NR-103 Week 6 Transitions Paper – Rewarding Employees for Safety (Safety)
•   NR 103 Week 6 Transitions Paper – The Importance of Prioritizing Nurses (Prioritization)

Purpose

The purpose of this assignment is to explore a critical concept in nursing. The student will be able to demonstrate application of information literacy and ability to utilize resources (library, writing center, SmartThinking, APA resources, Turn-It-In, and others) through literature search and writing the paper.

Requirements and Guidelines

Pick one of the following topics and find a scholarly nursing journal article that discusses this
nursing topic. The topics are:

•   Safety
•   Delegation
•   Prioritization
•   Caring

After you find a scholarly nursing journal article using the Chamberlain library resources, you will
complete a 1-page summary and reflection on the article. The paper should be completed in APA
format and include the following:

•   A cover page (not included in the page number requirement).
•   A reference page (not included in the page number requirement).
•   One direct quote from one of your references, appropriately cited in the body of your paper.
•   One indirect quote (or paraphrased reference) appropriately cited in the body of your paper.
•   Citations and references in APA format.

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PSYCHOPHARMACOLOGY. Respond To This Discussion Post

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

• Metformin 500mg BID 

• Januvia 100mg daily 

• Losartan 100mg daily 

• HCTZ 25mg daily 

• Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

By Day 3 of Week 7

Post a response to each of the following:

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Respond to the these discussions. All questions need to be addressed.

Discussion 2 Me

Treatment of a Patient with Insomnia       

The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: Metformin 500mg BID, Januvia 100mg daily, Losartan 100mg daily, HCTZ 25mg daily, and Sertraline 100mg daily. Current weight: 88 kg. Current height: 64 inches. Temp: 98.6 degrees F. BP: 132/86 (Walden University).

Question number one, what brings you in today? By asking an open-ended question, the patient is more willing to share information with the provider (Stern, 2016). Another question that would be of beneficial knowledge during the interview is, do you consume caffeine? If so, how much caffeine do you consume in a day? Caffeine consumption close to bedtime contributes greatly to insomnia (Farazdaq et al., 2018). Lastly, the third question that should be asked is, do you suffer from Gastro Esophageal Reflux Disease (GERD). According to Farazdaq, Andrades, and Nanji, (2018) GERD is a contributing factor to insomnia in elderly patients. By asking the above questions, the provider can rule out environmental factors while assessing the patients concerns with open-ended questions.

People in the patient’s life that could provide further information is children or caretakers. Questions that would be appropriate to ask the patient’s children or caretaker would be if there is a recent decrease in her appetite, energy, mood, or interests. By asking about these areas of the patient’s life will provide external information that the patient might be withholding or may be unaware of.

Insomnia relies heavily on self-report for a diagnosis (Levenson et al., 2015). Also, a physical exam could be performed with the order of blood testing to rule out thyroid problems. According to Dr. Abhinav Singh (2021), hyperthyroidism results in nervousness from overactivity of this hormone, and insomnia is often a symptom. Administering the Hamilton Anxiety Rating Scale (HAM-A) would assess the severity of the patient’s anxiety. The HAM-A results would aid with further treatment of the patient’s insomnia, if related to anxiety (Psychiatry & Behavioral Health Learning Network, 2021). Another appropriate scale to administer to this patient is the Hamilton Depression Rating Scale (HDRS). HDRS is an assessment that focuses on feelings of guilt, mood, suicidal ideation, activities, weight, various stages of insomnia, and many more important areas (Hamilton, 1960).

The patient presents with a previous diagnosis of depression. The differential diagnosis for this patient is Generalized Anxiety Disorder (GAD), secondary to husband’s death. There are many possible changes within the living dynamics, such as financial burdens, fear of her own death, and suddenly sleeping alone.  Changes within this patient’s routine may be a cause of reported insomnia.

Temazepam is FDA approved for insomnia, and used off-label for anxiety disorders, acute mania, psychosis, and catatonia (Puzantian & Carlat, 2020). Temazepam is generally effective in the treatment of insomnia, by enhancing widespread inhibitory activity of GABA (Levenson et al., 2015). Temazepam is metabolized through the liver without CYP450 (Puzantian & Carlat, 2020). Another good sleep aid choice is Trazodone. Trazodone is widely used for insomnia (Levenson et al., 2015). Trazodone is FDA approved for the treatment of major depression and used off-label for insomnia and anxiety (Puzantian & Carlat, 2020). Trazodone inhibits serotonin reuptake, alpha-1 adrenergic receptor antagonist, and serotonin 5-HT2A and 5-HT2C receptor antagonist (Puzantian & Carlat, 2020). And Trazodone is metabolized primarily through CYP3A4 to active metabolite mCPP, that is metabolized by 2D6, inducing P-glycoprotein (Puzantian & Carlat, 2020). Trazodone, however, carries the side effect of daytime somnolence and dizziness (Puzantian & Carlat, 2020).

The favorable medication for this patient, is Temazepam. Temazepam is a safer medication to use in elderly patients because of the lack of active metabolites, its short half-life and absence of drug interactions (Puzantian & Carlat, 2020). The patient is currently taking Metformin, Januvia, Losartan, HCTZ, and Sertraline. Based on the current medications, the patient is being treated for diabetes mellitus, hypertension, and depression. Adding Temazepam to the patient’s medication regimen would not result in toxicity of other medications. Sleep is heritable and regulated by numerous genes. A genome wide association study found numerous single-nucleotide polymorphisms (SNPs) significantly associated with insomnia symptoms. The most significant SNPs occurred within genes involved in neuroplasticity, stress reactivity neuronal excitability, and mental health (Rajib, 2020).

The starting dose of Temazepam is lower in the elderly population (Puzantian & Carlat, 2020). The proper dose to begin with this patient, is Temazepam 7.5mg tab PO QHS. At the 4-week checkup, the expected outcome would be an increased ability to sleep, and reduced anxiety. If these results have not been achieved, Temazepam 15mg tab PO Q HS would be ordered. Temazepam does have the risk of weakness and dizziness, so great care and caution would need to be taken when increasing the dose. There needs to be an evaluation of the effects at week 8, or sooner if needed. The maximum dose of Temazepam is 30mg PO Q HS, and even lower in the elderly (Puzantian & Carlat, 2020).

References

Farazdaq, H., Andrades, M., & Nanji, K. (2018, December 31). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia. /orders/www.ncbi.nlm.nih.gov/pmc/articles/PMC6382090/.

Hamilton, M. (1960). Hamilton Rating Scale for Depression. PsycTESTS Dataset, 23, 56–62. /orders/doi.org/10.1037/t04100-000

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The Pathophysiology of Insomnia. Chest, 147(4), 1179–1192. /orders/doi.org/10.1378/chest.14-1617

Puzantian, T., & Carlat, D. J. (2020). Medication fact book for psychiatric practice. Carlat Publishing, LLC.

Rajib, D. (2020). Do genes matter in sleep? -A comprehensive update. Journal of Neuroscience and Neurological Disorders, 4(1), 014–023. /orders/doi.org/10.29328/journal.jnnd.1001029

Singh, A. (2021, March 8). Could Your Thyroid be Causing Sleep Problems? Sleep Foundation. /orders/www.sleepfoundation.org/physical-health/thyroid-issues-and-sleep.

Stern, T. A. (2016). Massachusetts General Hospital: psychopharmacology and neurotherapeutics (1st ed.). Elsevier.

Walden University. (n.d.). Treatment for a Patient with a Common Condition. /orders/class.content.laureate.net/14884e77402afe219224c67c4f0463b3.html.

Assignment 1: Differential Diagnosis For Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To prepare:

· Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.

· Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

· Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

· Consider which of the conditions is most likely to be the correct diagnosis, and why.

· Download the SOAP Template found in this week’s Learning Resources.

To complete:

· Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style.  Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

· Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least 3 different references from current evidence based literature.

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Health Promotion And Wellness Assessment

Open the assignment Health Promotion and Wellness Assessment for details.

• The major assignment for this course is an interview of a Family and an assessment of Family characteristics which is due in Module 5/Week 5.
• Module 2-1 assignment information will be summarized and included in your Assignment Module 5-1 Family Health Assessment. Please use your interview family for this assignment.
• Identify areas needing intervention by using the using the modified Love to Live Well Assessment below to highlight suggestions you may make for your interview family
• Use your interview family and identify areas for making health and wellness promotion.
• Describe these recommendations for health promotion in detail.
• Complete and submit your assignment by 2359 Saturday of Module 2.
   

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Case Study

Case Study

Case Study

please follow the instructions.

Don’t do the Conceptual Debriefing &Case Reflection. that is the second to the last page (Page 9 I think)

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Health Insurance Pt 2

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Develop A Solution To A Specific Ethical Dilemma Faced By A Health Care Professional By Applying Ethical Principles. Describe The Issues And A Possible Solution In A 3-5 Page Paper.

Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Discuss the effectiveness of the communication approaches present in a case study.

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.Write following APA style for in-text citations, quotes, and references.

For this assessment, you will develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

Access the Ethical Case Studies media piece linked in the Resources to review the case studies you may use for this assessment and select the case most closely related to your area of interest and use that case study to complete the assessment.

Note: The case study may not supply all of the information you may need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.

Identify which case study you selected, briefly summarize the facts surrounding the case study, and identify the problem or issue in the case study that presents an ethical dilemma or challenge and describe that dilemma or challenge.

Use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) found in the Ethical Decision-Making Model media piece in the Resources to analyze the ethical issues.

Analyze the factors that contributed to the problem or issue.

Identify who is involved or affected by the problem or issue.

Describe the factors that contributed to the problem or issue and explain how they contributed.

Cite and apply the journal article as evidence to support your critical thinking and analysis of the case.

Assess the credibility of the information source.

Assess the relevance of the information source.

Discuss the effectiveness of the communication approaches present in the case study.

Describe how the health care professional communicated with others.

Describe the communication and communication strategies that were applied, both in creating and in resolving the problems or issues presented.

Assess instances where the professional communicated effectively or ineffectively.

Discuss the effectiveness of the approach used by the professional related to any problems or issues involving ethical practice in the case.

Describe the actions taken in response to the ethical dilemma or challenge presented in the case study.

Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.

Discuss the key lessons this case provides for health care professionals.

Apply ethical principles to a possible solution to the proposed problem or issue from the case study.

Describe the proposed solution.

Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.

Discuss how likely it is the proposed solution will foster professional collaboration.

Needs to be original; no plagiarism.

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Terri Schiavo Case Through The Lens Of The Bioethical Issue(S) Related To The Case.

Terri Schiavo Case Through The Lens

Terri Schiavo Case Through The Lens

Overview

Healthcare professionals provide support throughout the cycle of life, from birth to death. They have an obligation to provide humane and compassionate care to patients while adhering to their specific field’s code of ethics. Sometimes, healthcare professionals are privy to discussions between family members regarding end-of-life issues. In some instances, a healthcare facility may be in charge of providing information about advance directives to patients. Healthcare professionals should calibrate their own moral beliefs to align with their ethical and legal obligations. By studying issues contained within real-life cases, healthcare professionals can come to terms with their beliefs and obligations relative to end-of-life issues.

For Final Project II, you will submit a draft of your essay for your Milestone Three assignment, which will be submitted to scaffold learning and ensure quality final submissions. This milestone draft will be submitted in Module Six. The final product will be submitted in Module Eight.

In this assignment, you will demonstrate your mastery of the following course outcomes:

 Analyze bioethical issues faced by various healthcare professionals for their impact on decision making

Prompt

In this project, you will analyze the Terri Schiavo case through the lens of the bioethical issue(s) related to the case. You will analyze the case to address what the bioethical issue is and what role end-of-life issues, such as self-determination and advanced directives, played in the case. Using your analysis, you will determine how this bioethical issue impacted the decisions made by the healthcare professionals involved in the case.

Your essay must address the following critical elements:

I. Introduction: Describe the provided case, including information on the stakeholders involved, the bioethical issue, and the time period of the incident that occurred.

II. Bioethical Analysis: Analyze the bioethical issue for the role end-of-life issues played in the case. Be sure to use appropriate terminology and support with secondary research.

III. Conclusion: Describe how the bioethical issue influenced the decisions of healthcare professionals involved in the case. Be sure to use specific examples.

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Discussion: Alterations In Cellular Processes

Alterations In Cellular Processes

Alterations In Cellular Processes

Alterations In Cellular Processes

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

For this Discussion, you will examine the above case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.

For this Discussion, you will examine the above case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

• The role genetics plays in the disease.
• Why the patient is presenting with the specific symptoms described.
• The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
• The cells that are involved in this process.
• How another characteristic (e.g., gender, genetics) would change your response.

REQUIRED READINGS

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Chapter 1: Cellular Biology; Summary Review
Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases
Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
Chapter 7: Innate Immunity: Inflammation and Wound Healing
Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review
Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
Chapter 12: Cancer Biology (stop at Resistance to destruction); Summary Review
Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review

Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from /orders/www.ncbi.nlm.nih.gov/books/NBK513315/
Credit Line: Immediate Hypersensitivity Reactions – StatPearls – NCBI Bookshelf. (2019, June 18). Retrieved from /orders/www.ncbi.nlm.nih.gov/books/NBK513315/. Used with permission of Stat Pearls

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