As part of the primary health care focus, it is important to educate the young to the older population about following lifestyle practices to promote cardiopulmonary health. Can you describe how maintaining an ideal body weight, eating a low-fat, low-salt, calorie-appropriate diet, non-smoking, and engaging in regular exercise can impact a patient’s level of health in general?

Identify three major components of the Medicare and Medicaid programs and, based on these components, identify at least two patient coverage gaps for each of the programs. Be clear when you describe the coverage and the gaps as they may relate to specific ages, patient populations, or disease entities. Use primary sources to identify the components and the gaps. Additionally, discuss your stand (criticize or defend) regarding the relevance of the Social Security program to the American public. Should the program be left alone, modified, drastically changed, or eliminated? Provide the rationale and use facts to defend your position.

Describe the difference in roles between leadership and management. Explain how the goals of management and leadership overlap and provide one example. As a nurse leader, describe how you can facilitate change by taking advantage of this overlap.

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!

Robert Johnson, a 55-year-old man, is married with two adult children and five grandchildren. He is the assistant president of a large bank. In the first session, he tells you that it is becoming more difficult for him to hide his homosexuality. He has kept his homosexuality a secret his entire life. He knew he preferred men when he married his wife thirty years ago, but he thought he needed to get married to hide the fact that he was gay. During his marriage, he has had affairs with many men. Because he has been very discrete, his wife and family do not suspect that he is homosexual and that he has had several affairs.

Now he is having a relationship with a man he loves and with whom he wants to grow old.  Mr. Johnson’s lover threatens to leave him if Mr. Johnson does not get a divorce and makes their relationship public. Mr. Johnson is afraid because if he makes his homosexuality public, he may lose his job and the respect of his children.

He tells you that he is worrying so much about his over leaving that he is unable to concentrate at work. Being the vice president of the bank means a lot to him. He has worked very hard and sacrificed a lot to obtain this position. He does not want to lose it.

1. Provide a provisional DSM 5/ICD 10 diagnosis

2. Examine and discuss the psychotherapeutic modalities you would choose to use to treat this client. Choose between Psychoanalytic, Adlerian, existential, person-centered, gestalt, behavior, cognitive behavior, choice/reality, feminist, and postmodern therapy. You may combine therapies (integrative approach), but you must justify the combination. Be sure to include a list of the specific techniques (therapeutic processes and content), not just the theory you would use for this client. Be specific in how you would treat each client.