Use the image in “Discussion Question Resource: Chest X-Ray” to answer the following Critical Thinking Questions. Examine the x-ray of a patient diagnosed with pneumonia due to infection with Mucor. Refer to the “Module 4 DQ Chest Xray” resource in order to complete the following questions. Critical Thinking Questions 1. Explain what Mucor is and how a patient is likely to become infected with Mucor. Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient. 2. Examine the laboratory blood test results and arterial blood gases provided in “Discussion Question Resource: Laboratory Blood Test Results.” What laboratory values are considered abnormal? Explain each abnormality and discuss the probable causes from a pathophysiologic perspective. 3. What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.

II. Observe the simulated “Home Visit With Sallie Mae Fisher” video (http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php). Refer to “Sallie Mae Fisher’s Health History and Discharge Orders” for specifics related to the case study used to inform the assignment. Using “Home Visit With Sallie Mae Fisher” and “Sallie Mae Fisher’s Health History and Discharge Orders,” complete the following components of this assignment: Essay Portion After viewing the home visit, write an essay of 500-750-words in which you do the following: 1. Identify, prioritize, and describe at least four problems. 2. Provide substantiating evidence (assessment data) for each problem identified. 3. Identify and describe at least four medical and/or nursing interventions. 4. Discuss your rationale for the interventions identified. Prepare this step of the assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Scripted Dialogue Portion Utilizing the information learned from the home visit, health histories, and discharge orders, write a scripted dialogue in which you provide Sallie Mae with education that describes her problems and the interventions identified to improve her condition. Consider Sallie Mae’s physiological, psychosocial, educational, and spiritual needs when developing your dialogue. Your dialogue should resemble a script. The following is an example of a few sentences from a scripted dialogue: Nurse: “Good morning, Salle Mae, my name is ______ and I will be your nurse today. I understand you are experiencing problems with ________.” Refer to “Home Visit With Sallie Mae Fisher Grading Criteria.” Entire Assignment You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin. NRS410V.R.HomeVisitWithSallieMaeFisherGradingCriteria_Student_02-11-13.docx NRS410V.R.SallieMaeFishersHealthHistoryandDischargeOrders_Student_02-11-13.docx

APA format MSN degree 2 pages long with 3 references 2 from walden university library Due Saturday March 23, 2018 6pm EST

Neurological Disorders

Neurological disorders affect people of all ages, every day, and everywhere in the world. Our senses stem from the neurological system, the ability to taste, smell, hear, see, and touch are the main five senses. When one of these senses is affected our body reacts to it, however there are other senses affected such as the vestibular system that tells our body where we are spatially in the universe and proprioception that helps us gage strength, and ability to do the things we do firmly, or gently. This paper will discuss migraine headaches, share how behaviors can influence the headache and affect medications for headaches, share drug treatments, measures that can decrease symptoms, and organizations available that can help give information to patients affected by the disorder.

Pathophysiology of Migraine Headaches

Headaches are common disorders of the neurological system, but they can also signal underlying disease such as tumors, meningitis, or even brain bleeds per Huether and McCance (2017). They further share migraines can last four to 72 hours and a patient must have two documented episodes of criteria such as unilateral head pain, pain that worsens with activity, and the pain must be moderate to severe in nature. Patients must also have one of these criteria such as nausea, vomiting, photophobia, or phonophobia. Migraines can be with or without perceived auras that affect the visual, sensory, or motor pathways. (Huether and McCance, 2017) They further share the trigeminal vascular system is related to migraine pain, through the release of calcitonin gene-related peptide (CGRP), and that migraines have clinical phases such as a premonitory phase where the patient may be tired, irritable, or have a stiff neck. Migraine auras can accompany just before the migraine and can be visual,sensory, or motor. Headache phase such as throbbing pain, on one side but can spread to the whole head, cause fatigue, nausea, vomiting, dizziness and the recovery phase where the patient can experience continued fatigue, irritability or depression. Migraines are wose than general headaches or tension headaches in that the symptoms are worse, last longer, and prevent the patient from doing anything besides heading to a darkened, quiet, room. When migraines become chronic, they are quite debilitating and can require medications to treat them, next we will look at treatments for migraines.

Migraine Treatments

First line treatment in migraines is the salicylates and nonsteroidal anti-inflammatory (NSAIDs) for mild to moderate migraines, with triptan type medications as first line for moderate to severe migraines. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) They further share second line treatment as over the counter caffeine compounds such as Excedrin when the salicylates and NSAIDS have not worked. If the migraine is severe the recommendation is to add Ergot derivative medications along with an antiemetic if triptan medications are not effective. Finally, is the third line medication treatments when all the above fail Butalbital or other opioids are recommended. Selecting treatment and trying medications can take months to find a combination that works and it is important to let the patient know this and assess if the patient is trying alternative or complimentary medicine practices along with medical science in the treatment of migraines as their can be drug interactions. Most of the medications used in migraine treatment require assessment of the cardiac status prior to use, and are not recommended during pregnancy. Several are affected by CYP3A4 pathways and therefore should not be used with inhibitors in that drug pathway. If a patient fails one triptan type drug another is tried as different medications can work better for some patients than others, the Butalbital and opioids are only used when all else fails due to addictability and the need to taper dosing prior to stopping these types of medications.

Behaviors Affecting Migraines and Migraine Medications

Patient behaviors can have an effect on migraines, too much sleep, too little sleep, alcohol, foods such as chocolate, and tyramine agents like red wine, stress, medications like vasodilators, hormones. Pretty much it seems life in general can be a trigger for some such as lower socioeconomical status, caffeine, smoking, and even loud noises, strong odors, weather, skipping meals, obesity. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) Often times we get busy with life and forget to slow down and take care of ourselves properly, it seems life is focused on getting ahead, or trying to fit into society rather than the health components that make life more enjoyable, and overall less costly. If one takes care of ones self, there is less expense for medical care and medication in general. Having patients keep a journal of their headaches can lead to triggers that are specific to that patient and this can help head off migraines but also help with finding medications to use specific to that patients condition. Educating on smoking and alcohol cessation, or adjusting diet if known triggers are found can help decrease symptoms and episodes of migraines.

Organizations are available to offer advice and support for patients that suffer with migraines such as the United States Headache Consortium, the Migraines.org which discusses facts and myths of migraines. Coalition for headache and migraine patients or CHAMP is a foundation to discuss migraines, find a cure and support patients and families dealing with chronic migraines.

Summary

While migraines are a disorder, and are neurologically related they can take time to diagnose, treat, and find triggers or behaviors that can affect the onset, duration, and occurrence of migraines. Working with patients to fully assess the type of headache, when it occurs, where it occurs, how long it lasts, how often it occurs, what worsens or alleviates it if anything, what kind of pain it brings such as stabbing, or throbbing, what medications or treaments they have already tried, and how it affects the patients life in that are they able to do anything when the migraine occurs. These are all questions as advanced practice nurses that will help guide diagnosis and treatment for migraine sufferers.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

This assignment is designed to help you synthesize the course material and apply the material in creating an assessment, and generating a diagnosis, as well as treatment recommendations.

Read the case study provided and write a clinical report which includes:

A summary of the major issues facing the client needing to be addressed.
A working diagnosis for the client (with diagnostic summary and rationale) utilizing the following information from the CAGE screening tool and case history information.
A Mental Status Exam which applies the information from the case history.
Detailed treatment recommendations determining which modality (family, individual, group, or couples) is most appropriate for this client. Be sure to provide the rational for your choice by integrating information from the case summary.
Recommendations on whether individual is a good candidate for treatment placement (inpatient, residential, or outpatient) and an analysis of the pros and cons for your selection based on a summary of the issues.
Your paper should be at least 4 pages long. Remember to include a cover page and reference page, and to support your arguments with information drawn from the online content, the textbook, and other credible, scholarly sources to substantiate the points you are making. Apply APA standards for writing and citations to your work.

The case information is as follow:

Case Information

Client: Joseph Blackwell

Date of Birth: July 10, 1961

Identifying Information

Gender: Male

Age: 49

Religion: Baptist

Race/Ethnicity: Caucasian

Disability: No visible disabilities

Class: Annual income under $12,000

Educational Qualification: High School Diploma

Current Family Constellation and Living Arrangements

Married currently separated

3 children, ages 20, 15, 2

Currently homeless, staying with a friend

Other Family Information

Mother gives money to him on a consistent basis

The only person who “nags” him about his drinking is his wife

Other family members have covered for him on more than one occasion, telling his wife he was working when he was really getting high.

Employment Status

Recently lost job due to failure to show up.

Employed there for 6 months

Reports having over 10 jobs in the last 5 years

Skilled as a roofer

Legal Problems

Took a Plea for Treatment in lieu of conviction for current possession of cocaine charge

License suspended for Driving Under the Influence

Currently on Probation

Past/Current Psychological Problems

Reports a diagnosis of Bipolar Manic Depression made several years ago

States “I just wants it all go away, maybe it be better if I just went away, sometimes I cry when I wake up.”

Medication history

Records indicated that the client has been treated off and on with Seroquel and Lithium. He reported that both medications helped him feel more “calm and collected.” He has been off of medication for the past 2 months.

Substance Use history

The client stated that he drinks alcohol every day, usually 1 liter of vodka and a few beers. This pattern of drinking endured for the past 10 years. He tried to stop drinking one time and the longest that he has abstained from drugs and alcohol was for a period of 3 months a few years ago. He also uses cocaine and marijuana several times per week. He stated that he has thought about stopping the substance use, but is sure that he will never be able to abstain. The patient has a history of the shakes when he has attempted to stop drinking in the past. He has tried outpatient substance abuse counseling, though would usually relapse after a few sessions. He has never participated in inpatient detox.

Records reviewed (Psychiatric ER summary dated August 6, 2010)

Patient was admitted to the X psychiatric emergency room and placed on a 72 hour observation. He was brought in by emergency medical services and a police escort after he was found in the street yelling that he wanted to die and threatening bystanders at the local bus station. His toxicology screening was positive for alcohol, marijuana, cocaine, and benzodiazepines. After the 72 hour observation the substances had cleared, the patient was administered Librium for alcohol withdrawal complications, and by day 3 he denied suicidal, as well as homicidal ideation. Thus, he was released, in good behavioral control, and referred to an outpatient chemical dependency program. Records indicated that the pt has a diagnostic history that includes, Bipolar Disorder Not Otherwise Specified, Alcohol Dependence, and Polysubstance Abuse.

Last evaluation: Wednesday, March 9, 2011

Client presented wearing a t-shirt stained with food and smelling of beer. His jeans were tattered with random holes and burn marks. His hair was long and tangled. He was malodorous. The client required multiple redirections to lower his voice and to get him back on topic as he kept changing the topic to discuss unrelated content, such as food that he wanted to eat and about a new pair of shoes that he hoped to buy. The client’s mood was unstable in that he vacillated between irritable, depressed, and euphoric states during this interview. He avoided eye contact and moving around in his chair often. He often laughed when discussing his most recent DUI and when discussing that he lost his most recent job. Client knew that he was at Agency X for a psychological evaluation, stated that it was Tuesday and that the year is 2010. He sleeps, at times, 3-4 hours per night, and sometimes does not feel the need to sleep at all. Client denied hearing voices, seeing things that others cannot, and is not paranoid. He denied any desire or plan to hurt other people. He admitted one suicide attempt by taking pain pills that were washed down with 1 liter of vodka last year because he wanted to “escape.” The client often ponders what it would be like to not be alive anymore and reported that he thought about taking a bottle of pain medication this morning in an effort to attempt suicide.

CAGE Screening Tools answers from client:

Have you ever felt you should “cut down” on your drinking?
Answer: Yes, I have tried on several occasions to drink less. The last time I tried was about 2 years ago.

Have people “annoyed” you by criticizing your drinking?
Answer: That is why I left my wife. All she did was nag about what and when I drink. I got sick of it.

Have you ever felt bad or guilty about your drinking?
Answer: Kind of sort of…

Did you ever take an “eye opener” a drink first thing in the morning to steady your nerves or get rid of a hangover?
Answer: Doesn’t everyone do this every once in a while. It takes the edge off with everything I have going on.

A supportive instructional “creative writing” easy” that points outs the many women who wear short
skirts in various work places like the office, courts, and in law enforcement duties. They are NOT hung-up
on “political correctness” and do what need to be done. THERE IS NOT CRICISM for these women. They know what
they are doing.
only support. During interviews with male employers these
women gracefully sneak in “panty flashes” by either crossing their legs to the other side, OR
sitting casually with their legs apart allowing the male employer a casual peek at their panties. They
often bend over in the office or climb ladders in short skirts to show their femininity. Policewomen,
female bailiffs and military women all over the world wear miniskirt uniforms because it allow the
agility to move quickly oppose to longer skirts. Men have more respect for women in short skirts.
Instuctions:
1. Point out the examples of the definition of “panty flashes” .
2. Point out military and policewomen in short skirts
uniforms. Put the photo in the BODY of the text please (can you resize) If not I CAN.
3. I have resized the photos and named them secretaryflash, secretaryPeek, Policewoman,
I want the photos to appear in the Body of the text Just before you start your comment on that part of
subject. For instance when you point out police and military women, the picture will appear FIRST and
you comments. Example….
“A secretaries and nurses get ahead by wearing….ect. ect so xxxxxxxxxxxxxx.
POLICEWOMEN JPEG HERE …..Also police and military women are getting ahead as short skirt appear more
often in law enforcement and military installation.

source..

Turbine engine failure
File name: project_instructions_0712
SFTY 375 Instructions for Project 2
Please review the following instructions for Project 2. If you have questions about these directions, please go to the Online Office and start a new thread with the Subject Project Directions. Post and submit your message, then check back later for answers.
Please note that Project 2 must be related to accident investigation for turbine engines.
You must address five areas for each project; each area is described in more detail below.
1. Project Selection
2. Content Focus
3. Format Options
4. Length and Size (as applicable)
5. Professional Scholarship
Project Selection
Students and instructors alike come from varied backgrounds and environments. Interests are different, as well as educational backgrounds and career experiences. For this reason, the project for this assignment can come from many areas. However, the project should be relevant to the subject matter and must be approved by the instructor.
Ideas for a project might include, but are not limited to the following:
1. Development of a Guide to turbine Engine Accident Investigation for Project 2.
2. An in depth analysis of a Case Study presented by the instructor
3. Comprehensive review of an accident related to reciprocating engines
4. Review and discussion of an NTSB accident report
5. Choose a different specific topic that is related to reciprocating engine accident investigation such as component failure analysis, component life cycle analysis, internal engine failures, component failures, bearing failures, spectrometric oil analysis programs, propeller systems, and so forth.
6. Any other specific topic that related to turbine engine accident investigation for Project 2. Keep in mind that any project approved must contain an element of research outside of the materials presented and should be of sufficient depth and scope to show a college-level understanding of the topic.
File name: project_instructions_0712
Content Focus
Focus on causes, findings, and recommendations that relate directly to engine systems, operations, components, material defects, or malfunctions.
Demonstrate an understanding of the investigative techniques and procedures presented in this course.
Show evidence and logic to support your statements and conclusions. Give citations of your sources.
Conclude with a comprehensive summary that ties the entire project together and links the project to the course goals and outcomes.
Format Options
The format of your project can be any type that you have the skills and “know how” to prepare. The format MUST be approved by the instructor. You must fully meet the content requirements and be able to upload your presentation or provide the link to it in the Assignments area of the course site. For example, if you choose to do a paper or PowerPoint, you will submit it using the activity link, but if you elect to create a video, you will need to upload the files to YouTube or some similar site if it is too large to email to the instructor. Then you will need to submit the URL using the same activity links because they link to columns in the Grade Center in Blackboard. So, you may document an application of propulsion plant investigation with a paper in PDF or DOC, html Web page, a video, PowerPoint, audio “radio” program, investigation report — any format of your choosing, as long as you can meet the content and technical requirements.
If you choose a project with demanding technical skills, you need to be “on your own” in handling the technology. The purpose of this course, as you know, is to focus on propulsion plant investigation, not on teaching you the technical requirements for various presentation formats. But if you have those skills, and you wish to use them, please do so.
For your project, no matter what format you choose, also submit a list of references that you have used, following the APA style requirements for how to list such references. For example, if you interview someone, there is a particular way to cite that person and date interviewed; if you use a report from the Web, the APA style guide shows how to list that kind of reference, too; if you use textbooks or articles, those also should be cited according to the APA style guide.
Length and Size
If you do a paper, make it 5 pages of narrative, from introduction to conclusion, with the title page, abstract, and table of contents. (Graphics, charts, tables, and the list of references are considered separately, and not part of this page count. This suggestion of 5 pages, assumes double-spaced, Times New Roman typeface with a size 12-point font.)
Professional Scholarship
While you are not held to exact standards, such as APA format on all materials, you are expected to use a professional style in your project. Do your research. Use facts, evidence, and information. Avoid unsubstantiated claims. Cite your sources. Use your own words to express ideas with language that has correct spelling and punctuation. Remember, the projects are going to be submitted to the SafeAssign database to be checked for plagiarism.
Approach your project as if you are a professional who must complete a responsible report that will shows critical thinking about accident investigation and that will inform others about how to prevent future accidents.