Describe two external stressors that are unique to adolescents. Discuss what risk-taking behaviors may result from the external stressors and what support or coping mechanism can be introduced.

Leonard Mays is a 43-year-old Caucasian, homeless man with long-standing insulin-treated type 2 diabetes.  He has now been diagnosed with right lower extremity cellulitis. He has taken a prescribed oral antibiotic for the past week but has not noticed much improvement.

 For the last 2 days, he has complained of intermittent fevers and chills, nausea with poor oral intake, and proximally spreading erythema over his right leg.

On the evening of admission, a worker at the homeless shelter notices that he is markedly confused and calls 911. In the emergency room, he is oriented only to his name.

The patient is tachypneic, breathing deeply at a rate of 24/min. He is febrile at 38.8°C. He is normotensive, but his heart rate is elevated at 112 bpm.

On examination, this patient is a delirious, unkempt man with a fruity breath odor. His right lower extremity is markedly erythematous and exquisitely tender to palpation. Serum chemistries reveal glucose of 488 mg/dL, potassium of 3.7 mg/dL, and sodium of 132 m/dL. Urine dipstick is grossly positive for ketones.

In this discussion:

1. Describe and discuss with your colleagues the pathophysiology of ketoacidosis in this diabetic patient. What is causing his altered mental status?
2. Describe the pathogenetic mechanism of his respiratory pattern.
3. Describe and discuss a plan of care for this patient during his first few days in the hospital.
4. Describe a plan of care for him at discharge (he will likely be admitted to the “medical floor” of the homeless shelter, which has the services of a Nurse Practitioner three times per week and a registered nurse four times per week).  Include plans for at least one population-focused intervention.
5. Discuss his long-term prognosis.  What are the community resources he will need across his lifespan?

Did the British Empire benefit India? Examines both sides –  the pros and cons.

Ms. Jenny Katigbak is an 83-year-old retired nurse with a long history of hypertension. During her final checkup, the physician gave a prescription where Ms. Jenny must take one $$25\mathrm{mg}$$therabloc tablet per day. Give the format of the bizbox under the department where Ms. Jenny can claim her prescription (Place your answer on a separate page). Briefly discuss the flow of the Outpatient department prior to the department where Ms. Jenny will claim her prescription.

Explain how functional groups of chlorpromazine used to treat psychosis and describe the kinetic of elimination of phenytoin at high dose. Describe the interaction of phenytoin and valproate that can cause idiosyncratic effect and describe the rationale use of methadone in treating methadone addiction including the mechanism of action.