An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

Assignment (1- to 2-page case study analysis)

Scenario 1: 76-year-old female patient complains of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now has to sleep on two pillows in order to get enough air.

In your Case Study Analysis related to the scenario provided, explain the following

. The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
. Any racial/ethnic variables that may impact physiological functioning.
. How these processes interact to affect the patient.

What are the most common types of child labor?  In what industries are children most likely to be found working? What are the most common reasons families allow their children to work? What are the most common dangers and risks associated with child labor?  What are the most common forms of exploitation faced by child workers? What are the most effective ways to combat child labor?

Does the 4th amendment protect government employees like it does private sector employees? I believe that answer is “yes,” Justice O’Connor makes a great point thoughout her opinion relative to the words “unreasonable” in the 4th amendment.

She claims that although the 4th amendment is there to essentially protect the citizen ( even if the employer is the government ) from unreasonable search and seizures. I believe Justice Scalia nailed it on the head in his concurrance when he says that the ” Constitutional protection against unreasonable searches by government does not disappear merly because the government has the right to make reasonable intrusions in it’s capacity as employer” (Work Law Page 360) Now Justice Blackman concurs in judgement but dissents in that he thinks that there was no special need for getting a warrent.

In addition, and although I see where he is coming from, I still disagree with him as Jusice Blackman makes an arguement that it should be up to the employee to determine if they want to bring their personal life into the work place. Because by doing so it makes it harder to tell which actions and property are personal and work related. Justice blackman gave an example of an employee using a work phone to make a personal phone call.

I do find this case interesting and ironic as we see and read about former President Donald Trump’s Mar-a-lago residence being raided for national archive papers. Some of which were letters written to him by former President Barack Obama and Kim Ju Un ( Business Insider ) .

Now I do understand that the President of the United States is different than a government employee at a hospital. My over arching point in bringing this up is to echo Justice Blackman’s point in that it is hard to tell what is belongs to employee and what belongs to the employer when it is all mixed up as he writes on page 362 in Note 4 of our text. I just couldn’t help but thinkof the current news in front of us today.

The case with former President Trump, relative to these letters, could go down the rabbit hole in the court battles ahead but with obviously a different view point and different constitutional questions. But none-the-less similar. Just my food for thought.

In Justice Connor’s opinion, the case is reversed and remanded. Justice Connor concludes that searches and seizures by government employers or supervisors of the private property of their employees are subject to the Fourth Amendment restraints.

Justice O Connor goes on to state that an expectation of privacy in a place of work is based upon societal expectations that are deep rooted in the Amendment. However, the operational realities of the workplace may make some public employees’ expectations of privacy unreasonable.

In Justice Blackmunâs dissenting opinion, they agreed that the search was a violation in his Fourth Amendment rights. Ortega had an expectation of privacy in his office. The dissenting opinion was that there was â no special need to neglect obtaining a warrant and fulfilling the probable cause requirements of the Fourth Amendment.[

The Fourth Amendment protects people from unreasonable searches and seizures by the government but does not guarantee against all searches and seizures that are deemed unreasonable under the law.

I would have to agree with Justice O Connorâ’s opinion as Ortega was on a leave of absence pending an informal investigation and it would not deem unreasonable to search his office for evidence in the case. As the Fourth Amendment states it does not guarantee all searches as unlawful and in this case of a computer he acquired and the sexual harassment allegations, a search was necessary.

The bible says we should mind our own business and work with our hands just as God told us to do, so that we may respect outsiders and not be dependent on anybody per Thessalonians 4:11-12.[5]

Through the late 1990’s a number of major pharmaceutical companies, including Merck and Pfizer, began to develop a new kind of pain relief drug. At the time, the only drugs available to deal with arthritis and other similar kinds of pain were drugs like aspirin or ibuprofen. The problem with these drugs is that they had serious side-effects, including causing stomach problems such as ulcers and bleeding. Essentially these older drugs worked too indiscriminately by going after two enzymes in the body: one of these enzymes causes swelling and arthritis (COX-2), but the other one, COX-I, protects the lining of the stomach. Research was focused on finding a new drug which would attack the problematic enzyme (COX-2) without negatively affecting the beneficial properties of COX-I in protecting the stomach. The race was on to develop and patent a COX-2 inhibitor for pain relief.
By 1999, both Pfizer and Merck had independently developed separate but similar COX-2 inhibiting drugs, and had spent the millions of dollars necessary to fund the extensive serious clinical trials which had led to government approval in the U.S (and approval of the various equivalent bodies in nations around the globe, including Health Canada approval in Canada). In fact Pfizer was able to bring its COX-2 inhibitor, which it called “Celebrex” to market first. By this point, both companies had spent millions in developing their drugs, and both then began spending millions more in advertising the drug directly to the public.
(In Canada, advertising prescription drugs directly to the public is illegal; however, since Canadians watch American television broadcasts, they too see such advertisements.)
Although Pfizer had an initial head start in marketing, both Merck’s Vioxx and Pfizer’s Celebrex, have subsequently sold extremely well since. In 2003, Vioxx sold US $ 2.5 billion world-wide, representing 11% of Merck’s revenue. Similarly Celebrex sold US $2.3 billion.
Between 1999 and 2003, both drugs had been subject to a number of Adverse Drug Reaction (ADRs) reports from physicians whose patients were using these COX-2 inhibitors. Many of the reports focused on increased risk of heart-attack. Merck funded studies of these side-effects from Vioxx. It’s September 2004 and you, R. Gilmartin, have just received the results of a study of long-term side effects, specifically increased risk of heart-attack, from Vioxx use. It seems that after 18 months of use, there is substantial increase in the risk of heart attack and stroke for Vioxx users, compared to a control group. Vioxx appears to have caused up to 140,000 additional
cases of serious heart disease in the U.S. alone, of which 44% were fatal. This gives you serious concern about continuing to market the drug. After all, there are other (older) therapies for arthritis-like pain such as aspirin, and patients may well be much better off with the more benign side effects of aspirin, such as risk of damage to the stomach lining, than they are with the side effects of the COX-2 inhibitors, which includes risk of heart attack and stroke.
One consideration is the nature of the study which showed Vioxx-users with increased risk. It could be possible to argue that the increased risk of heart attack and stroke is NOT caused by Vioxx, since the study was not carefully controlled for other factors such as high blood pressure, smoking and raised cholesterol. You have the option of repeating the study with more careful controls, and this could buy you at least another profitable 18 months with Vioxx on the market. However, your own conviction is that leaving Vioxx on the market would probably lead to more heart attacks and strokes among Vioxx users during those 18 months. However you also know that Vioxx has been a much more successful pain killer for millions of arthritis victims than any other alternative, and that taking Vioxx off the market will cause great additional suffering for these
individuals. In addition, the label on Vioxx already indicated that there was a slight cardiovascular (heart) risk in taking the
medication.
Another consideration is what Pfizer will do with Celebrex. Since the study in question was specific to Vioxx, Pfizer may take
the position that there’s no evidence that Celebrex leads to increased risk of heart attacks and strokes. If you take Vioxx off
the market, and Pfizer does not follow suit with Celebrex, Pfizer will likely gain windfall profits as many of your current
customers, switch to Celebrex. You know that these two COX-2 inhibiting drugs are very similar, and that it’s very likely
Celebrex will ultimately be shown to have exactly the same side effects as Vioxx.
What will be the rations choice decision? Which will be the bounded rational decision? Provide an overall moral
judgment based on your own personal opinion.