The Biased Care Model offers different routes to improve clinical care that can be utilized. Provide an example of a biased perception in minority healthcare that may impact patient outcomes and how the use of the Biased Care Model can help to facilitate change and improve clinical care.

You are called to the delivery room at 2:00 a.m. for a laboring gravida 1 para 0 mother at 28 weeks gestation. The mother had good antenatal care and had a normal integrated prenatal screening (IPS), normal 20-week ultrasound, and protective serology, including rubella immune, human immunodeficiency virus (HIV) negative, venereal disease research laboratory (VDRL) negative, and hepatitis negative. Group B Streptococcus (GBS) status is unknown as the woman had not yet had swabs done. Social history was negative for tobacco, alcohol, or recreational drug use during the pregnancy. She has gestational diabetes mellitus, which was reasonably controlled by diet and exercise
alone. You arrive to the delivery room moments before the baby is born and prepare equipment for a potential resuscitation, which includes oxygen, bag and mask, suction, towels to dry, and intubation equipment. At birth, the newborn cries spontaneously. She is placed on the warmer to be dried and stimulated; her heart rate is 120 beats per minute and her respiratory rate is 60 breaths per minute. The infant grunts intermittently. At 4 minutes of age, the newborn has both subcostal and intercostal retractions, nasal flaring, and continuous grunting. Her respiratory rate is now 82 breaths per minute and her heart rate is 190 beats per minute. Oxygen saturation by pulse oximetry is 84% with blow-by oxygen. You begin providing CPAP at 6 cm H2O by mask with a t-piece resuscitator. A systolic murmur gr 2/6 is auscultated loudest at the left upper sternal border (LUSB). The infant is transferred to the NICU where she continues to receive nasal CPAP at 6 cm H2O and a FiO2 of 0.45. The chest X-ray shows a diffuse ground-glass appearance with air bronchograms. An arterial umbilical catheter (UAC) is inserted. Arterial blood gas reveals the following: pH 7.23, CO2 60, PaO2 40, HCO3 27, BE +1, and lactate 4.8.
Blood work shows white blood cell count 20.3, neutrophils 12.3, no left shift, hemoglobin 16.5, platelets 260.

1. What is the first line of therapy for this premature infant considering her presentation?
2. What are the chemical components that makeup surfactants?
3. How does surfactant work in the lung?

A term (41 weeks) female weighing 3100 g was born to a 30-year-old healthy gravida 2 para 1 mother by cesarean. Apgar scores were 9 and 9 at 1 and 5 minutes. The infant was initially well until day 3 of life, when she presented with tachypnea and increased work of breathing, including retractions and nasal flaring. The infant was transferred to the NICU. A complete sepsis workup was done and antibiotics were given as protocol. The infant was placed on a nasal cannula for oxygen saturation which ranged from 89-91%. Capillary blood gas was performed and revealed the following: pH 7.30, PaCO2 56 mm Hg, PaO2 45 mm Hg, HCO3 27 mEq/L, and BE 1. A chest radiograph showed mild hyperinflated lungs and mild perihilar interstitial markings. An echocardiogram was also ordered at this time, which showed an anatomically normal heart with no structural malformation. During the next 24 hours, the infant’s respiratory status worsened,
with progressive increases in work of breathing with increasing oxygen requirement. Continuous positive airway pressure was initiated by a nasal mask at 6 cm H2O and an FIO2 of 0.50. A follow-up chest radiograph was performed, which showed increasing haziness of both lung fields with air bronchograms. Capillary blood gases obtained 12 hours after nasal CPAP therapy revealed the following: pH 7.19, PaCO2 80 mm Hg, PO2 40 mm Hg, HCO3 29.5 mEQ/L, BE 1.8, and oxygen saturation 88%. Physical assessment revealed the following: temperature 37.1°C, heart rate 175 beats per minute, respiratory rate 90 breaths per minute, and blood pressure 70/40 mm Hg. The infant was
intubated and mechanically ventilated with an inspiratory pressure of 20 cm H2O, PEEP 6 cm H2O, set rate of 60 breaths per minute, and FIO2 of 0.80. Systemic examination was unremarkable except for respiratory distress. There was no clinical evidence of pulmonary hypertension. A complete sepsis workup was repeated. The white blood cell count was unremarkable. Chest radiograph following intubation
revealed a diffuse ground-glass appearance with air bronchograms. The endotracheal tube was 2 cm above the carina.

1. What therapeutic recommendation would you make based on the infant’s clinical presentation and chest radiograph?
2. Given this presentation, what diagnosis should be considered for this infant?
3. What information obtained by chest radiograph would indicate that this infant may benefit from
surfactant replacement
therapy?

Which of the following directs legislative requirements for the advanced practice registered nurse (APRN) credentialing process? Educational institutions Nursing licensing boards

A patient being treated for acute myeloid leukemia asks the nurse about the future treatment options the nurse explains the patient might be a candidate for an allogeneic stem cell transplant an allogeneic transplant involves the patient receiving