Review the Healthy People 2030 objectives for Access to Care. Of all the objectives listed under this topic, which do you think would be most beneficial to the patients with chronic illness?

• Provide rationales for your selection and support responses with examples from references.
• Please provide a new answer, not the one established in the course hero.

Mrs. Martin is hospitalized for an exacerbation of her multiple sclerosis. She tells the nurse she is tired of being ill and is not getting any better. She says, “When I am in the hospital, I cannot attend church, which is my only enjoyment.” Later in the day, Mrs. Martin is tearful and withdrawn when the nurse makes rounds.

1. What further data collection should the nurse obtain to identify Mrs. Martin’s patient-centered needs?
2. What possible nursing diagnoses would be appropriate for Mrs. Martin?
3. What patient-centered care interventions could the nurse use to assist Mrs. Martin in meeting her wish to attend church?
4. How would the nurse know that Mrs. Martin’s goal has been met?

Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs.

It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations.

He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF).

Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy.

He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR’s physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally.

He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits.

Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND).

Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?

Discussion Question #2

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat?

How often the medication is given? What labs should get monitored while the patient is taking this medication?

Topics discussed (20-50 words): Interview notes (50-100 words) include notes about the verbal and non-verbal communication skills you used during the interview: Interview 2 Date of interview: Interview conducted with a colleague/client (delete as necessary)

Topics discussed (20-50 words): Interview notes (50-100 words) include notes about the communication skills (verbal and non-verbal) you used during the interview:

Describe the alternation of generations in plants, distinguishing between the gametophyte generation and sporophyte generation.

-How many chromosomes (haploid or diploid) is in each generation?
-What structures (spores or gametes) are made by each generation?
-How are spores made (meiosis or mitosis)? How are gametes made (meiosis or mitosis)?Learning Objective 2: Explain why or how each of the following adaptations allowed plants to successfully evolve from aquatic (the ancestor to plants was an aquatic alga) to terrestrial.

-Structural and physiological adaptations include roots and shoots, mycorrhizae, cuticles, vascular tissue; explain why each of these was a beneficial adaptation.
-Reproductive adaptations include structures to keep gametes and embryos from drying out as well as mechanisms to disperse their gametes (getting the sperm to the eggs)Learning Objective 3: Relate the evolution of plants to green algae.

-Which green alga is related to the protist ancestor of land plants?
-What characteristics do green algae and land plants have in common? Which characteristics are different?Learning Objective 4: Identify the four major groups of plants [bryophytes (such as mosses), seedless vascular plants (such as ferns), gymnosperms (such as conifers and most evergreens), and angiosperms (most plants)] including:

-their structural and physiological adaptations (see #5 below)- how is each group different from the others?

-their evolutionary history- when and why did they evolve?
-and their ecological significance- what role do they play in their environment?Pick one of the four groups of plants listed above and explain the three points listed.

Learning Objective 5: Compare and contrast each group of plants (nonvascular plants through angiosperms) based on the following characteristics:

–
-Which is the dominant generation?
-Does the plants of that group have vascular tissue?
-How does each group get sperm to the egg?
-Does the group make seeds?
-Does the group make flowers?
-Does the group make fruits?
-How does each group disperse its “offspring” from the dominant generation?
-How do they reproduce sexually?  Do they reproduce asexually?  What is the significance of each method?Pick one of the four groups of plants and explain each of the eight points listed.

Learning Objective 6: Describe the change in environmental conditions around 360 million years ago and how that change promoted the evolution of seed plants. Why were non-seed plants so prevalent prior to this environmental change?

Learning Objective 7: Distinguish among the three groups of fungi (zygote, sac, and club fungi), including the name of the fruiting bodies, sporangia, and spores of each. Be able to visually identify members of the groups of fungi.

Learning Objective 8: Describe the symbiotic relationship between fungi and algae in a lichen.  Be able to visually identify the types of lichens: foliose, crustose, and fruticose.

Choose one of the statements to explain: either the symbiotic relationship between an alga and fungus in a lichen, OR the three shapes of lichens (foliose, crustose, fruticose).

Learning Objective 9: Describe the feeding mechanisms, structure, reproduction, ecological importance and commercial uses of fungi.

-Feeding mechanisms: saprotrophy, parasitism
-Structure: hyphae, mycelium, fruiting body, spores, sporangia
-Ecological importance: decomposition, parasites, mycorrhizae
-Commercial importance: food (and food production), anitibiotics, medicationPick one of the four points above to explain.