This task requires you to work with your classmates in the simulated community services environment within the classroom while basing this task on your own personal work placement organization. You will not actually be implementing this program within your work placement organization – but will be implementing it during class time using your classmates and assessor, who will role play your colleagues as and when appropriate.

Basing it on your real work placement in the community services sector will enable you to further study the organization and its goals, practices and policies and make it relevant to you. Ideas for a service program within your organization’s setting could include: .

A volunteer program (e.g. companionship) A wellness program (e.g. leisure, nutrition or interest-based) . A mentoring program (e.g. buddy or big brother/sister program) or any other service program you feel may suit the goals of the organization and meet the needs of those it has been set up to assist.

Your assessor can discuss other ideas with you before begin if you have any doubts or questions. The guidelines for the program are as follows: It must run for at least four weeks and not be a once-off event. There is a budget of $5,000.

Ment ardi to ating ite sislamno You are restricted to using two existing staff members (these can be existing positions within your work placement organization) and new staff cannot be recruited.

You can make use of volunteers if necessary but you would be responsible for recruiting these people. Approvals must be obtained after the planning stage is completed and then again after the program development has taken place prior to implementation.

In order to complete this activity you need to be familiar with, and have access to, your work placement organisation’s policies and procedures on risk management.

What are the criteria for a substance use disorder? If your client asked you “What is the difference between substance abuse and substance dependence? ”  How would you explain (teach)

3.  Many people are described as having duel diagnosis.  What does that mean?

and how would that impact your nursing treatment of that person?

How would you go about prioritizing what issue you would treat first?

4.  Many people have a substance abuse disorder yet so many people are not identified or treated for this disorder.  What are some reasons cited in the text regarding failure to detect substance abuse disorders and failure to provide treatment?

5. Review some methods used to screen for substance abuse disorders?  What is CAGE?

6.  What is the legal limit of blood alcohol content with a breathe device?  What is the level that could cause death?  Is that true for everyone?  can the levels change?  why or why not?

7.  Explain briefly what is alcohol withdrawal?  what happens in the body?

What is the treatment course for alcohol withdrawal?  is it life threatening?  What is the most significant concern with alcohol withdrawal?

8.  What medications are used when a person is going thru  active withdrawal from alcohol?

How long does withdrawal typically last?

What are the common symptoms of alcohol withdrawal?

Case study • Orla Ramos is 43-year old female admitted to the hospital due to increasing fatigue, weakness, chest pain, dyspnea, and shortness of breath (SOB). The chest pain as substernal, sharp, and radiating to both shoulders. The chest pain had been present for 2 days, but became progressively worse and was associated with dyspnea which prompted her to seek care. She reported a viral upper respiratory infection starting 1 week before the current symptoms began.

• She reports a personal history of smoking half a pack per day since her teens. She has no known allergies and no significant health issues. The only time she was hospitalized was for delivery of two children with no complications. She has a family history of Hashimoto thyroiditis. Physical examination and diagnostic test results

• General, neuromuscular: Mild obesity. Alert, oriented, cooperative, and anxious. Full ROM and strength 5/5 in all extremities • Vital signs: Temperature = 100.8 degrees Fahrenheit (oral); heart rate = 126 beats/min, sinus tachycardia; respiratory rate = 30 breaths/min, labored; blood pressure = 100/60 mmHg; oxygen saturation = 92% on a venturi mask with a flow rate equal to 40% fraction of inspired oxygen; pain = 7/10. Pain is substernal, radiating, and constant; but slight relief when she is upright and leans forward. Pain is worse with coughing and deep inspiration. She is unable to recline due to significantly increased SOB, dyspnea, and pain.

• Ears, nose, throat: Left tympanic membrane red, but not bulging. Posterior pharynx red and edematous, but no exudate noted. Tonsils reddened and 2+. • Cardiopulmonary: Bilateral chest expansion symmetrical. Breath sounds clear, but diminished at bases. S1 and S2 muffled with grating friction rub auscultated. Pedal pulses 1+ and slight pedal edema noted. Bilateral jugular venous distention noted. Extremities slightly cool and pale with capillary refill 3 seconds.
• Abdomen: Soft, non-tender, no masses, and normoactive bowel sounds in all quadrants. Voided 200 cc of clear, yellow urine. • Serum results: Abnormal serum results include total white blood cell count = 17 cells/mcL; c-reactive protein = 15 mg/L; creatinine = 1.5 mg/dl; blood urea nitrogen = 25 mg/dL. Troponin and brain natriuretic peptide levels within normal ranges.

• Other results: Chest x-ray positive for cardiomegaly, but lungs clear. Echocardiogram showed moderate pericardial effusion, reduced right ventricle wall motion, and reduced ejection fraction. Electrocardiogram showed sinus tachycardia with non-specific ST segment changes. Summer To answer questions 1-3, use the scenario above

1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes), and relate the changes to abnormal findings to support your interpretation. (20 points) Hint: We are in the cardiovascular system ☺ !

2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis label, explain the nursing interventions to address the identified problem. Provide evidence-based rationale to explain the need and/or benefit of each intervention. For interventions, include what the nurse should “monitor/assess”, “do”, and “teach” to the client. (20 points)

3. Describe medical therapies used to treat the disorder and explain their specific mechanism of action and intended impact at the cellular and/or tissue level. (15 points)

To answer questions 4-5, choose ONE disorder from this week’s reading

4. For the chosen disorder, identify the disorder and describe the impact on the United States population including incidence, prevalence, costs, morbidity, mortality, and/or other appropriate issues. Be sure to identify the disorder, the population associated with the data, and the year(s) of data. (15 points)

5. For the chosen disorder, locate recommendations in a nursing journal article or professional nursing organization. Provide a brief summary of the information and specific recommendations for nursing actions to improve care for patients. (15 points) Hint: To increase the likelihood of locating a nursing journal or organization, look for some form of the word “nurse” in the journal or organizational name!