I have to write a reply to each of the texts in the document attached below, they must be 200 words each and include references.

Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
3. What are three things the nurse can do to speed up the time between admission and intervention? 
4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
6. Why is morphine the drug of choice for cardiac pain?
7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
8. What are three differences between CKMB’s and Troponin blood tests?
9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

Assessment 3

Applying Ethical Principles

Competency 3

Apply ethical principles and academic standards to the study of health care.

Criterion

Summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.

Your Result: NON_PERFORMANCE

Does not summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.

Your Result: NON_PERFORMANCE

Does not discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Apply ethical principles to a possible solution to the proposed problem or issue from a case study.

Your Result: NON_PERFORMANCE

Does not identify ethical principles related to the possible solution to the proposed problem or issue from the case study.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Competency 4

Write for a specific audience, in appropriate tone and style, in accordance with Capella's writing standards.

Criterion

Discuss the effectiveness of the communication approaches present in a case study.

Your Result: NON_PERFORMANCE

Does not discuss the effectiveness of the communication approaches present in a case study.

Faculty Comments:

While you mention that the case study is one provided by Capella; unfortunately, you did not select one of the provided case studies that were listed in your instructions. Please review the written instructions and let me know if you have any questions.

Criterion

Produce text with minimal grammatical, usage, spelling, and mechanical errors.

Your Result: BASIC

Produces text with some grammatical, usage, spelling, and mechanical errors, making text difficult to follow at times.

Faculty Comments:

Again, as mentioned in your previous assessment – your focus gets lost in your extravigant vocabulary. Please take a look at the example paper for ideas as to how your paper should look and sound.

Criterion

Integrate into text appropriate use of scholarly sources, evidence, and citation style.

Your Result: NON_PERFORMANCE

Does not integrate into text appropriate use of scholarly sources, evidence, and citation style.

Faculty Comments:

Your paper does not appear to be in APA format as discussed in the scoring guide of your previous assessment. Please utilize the resources provided to assist you with APA formatting. Additionally, you need to use literature that is recent and peer-reviewed. Resources should be 5 years old or less.

You should check two places for feedback from faculty: in the comments for each criterion above, and within the document itself, either as attached comments or within tracked changes.

Assessment 3 instructions

Introduction

Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.

Instructions

Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum, be sure to address each point. In addition, you are encouraged to review the performance-level descriptions for each criterion to see how your work will be assessed.

For this assessment, develop a solution to a specific ethical dilemma faced by a health care professional. In your assessment:

Access the Ethical Case Studies media piece to review the case studies you will be using for this assessment.

Select the case most closely related to your area of interest and use it to complete the assessment.

Note: The case study may not supply all of the information you need. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any assumptions or speculations you make.

Include the selected case study in your reference list, using proper APA style and format. Refer to the Evidence and APA section of the Writing Center for guidance.

Summarize the facts in a case study and use the three components of an ethical decision-making model to analyze an ethical problem or issue and the factors that contributed to it.

Identify which case study you selected and briefly summarize the facts surrounding it. Identify the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or challenge.

Identify who is involved or affected by the ethical problem or issue.

Access the Ethical Decision-Making Model media piece and use the three components of the ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to analyze the ethical issues.

Apply the three components outlined in the Ethical Decision-Making Model media.

Analyze the factors that contributed to the ethical problem or issue identified in the case study.

Describe the factors that contributed to the problem or issue and explain how they contributed.

Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as evidence to support an analysis of the case.

In addition to the readings provided, use the Capella library to locate at least one academic peer-reviewed journal article relevant to the problem or issue that you can use to support your analysis of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guide will help you locate appropriate references.

Cite and apply key principles from the journal article as evidence to support your critical thinking and analysis of the ethical problem or issue.

Review the Think Critically About Source Quality resource.

Assess the credibility of the information source.

Assess the relevance of the information source.

Discuss the effectiveness of the communication approaches present in a case study.

Describe how the health care professional in the case study communicated with others.

Assess instances where the professional communicated effectively or ineffectively.

Explain which communication approaches should be used and which ones should be avoided.

Describe the consequences of using effective and non-effective communication approaches.

Discuss the effectiveness of the approach used by a professional to deal with problems or issues involving ethical practice in a case study.

Describe the actions taken in response to the ethical dilemma or issue presented in the case study.

Summarize how well the professional managed professional responsibilities and priorities to resolve the problem or issue in the case.

Discuss the key lessons this case provides for health care professionals.

Apply ethical principles to a possible solution to an ethical problem or issue described in a case study.

Describe the proposed solution.

Discuss how the approach makes this professional more effective or less effective in building relationships across disciplines within his or her organization.

Discuss how likely it is the proposed solution will foster professional collaboration.

Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

Apply the principles of effective composition.

Determine the proper application of the rules of grammar and mechanics.

Write using APA style for in-text citations, quotes, and references.

Determine the proper application of APA formatting requirements and scholarly writing standards.

Integrate information from outside sources into academic writing by appropriately quoting, paraphrasing, and summarizing, following APA style.

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Ethical Case Studies to use for this assignment

Consider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).

Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.

Case Study topic is the missing needle protector.

E. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.

Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.

The operating room supervisor appeared at Straight's office one Monday afternoon. “We've got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I'm almost sure we left a plastic needle protector from a disposable syringe in a patient's belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They'd be almost impossible to see if they were in a wound.”

“Where did it come from?” asked Straight.

“I'm not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn't think about the protective sheath, which must have been on it.

“Let's get Mrs. Jameson back into surgery.” said Straight. “We'll tell her it's necessary to check her incision and deep sutures. She'll never know we're really looking for the needle cover.”

“Too late,” responded the supervisor, “she went home day before yesterday.”

Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”

The supervisor nodded affirmatively. “He won't consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she'll never know it's there.”

Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient's belly. The chief knew something was amiss but didn't pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”

Straight liked working at Hopewell Hospital and didn't relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.

Mark and Jacqueline have been married for 30 years. They have grown children who live in another state. Jacqueline’s mother has moved in with the couple because she has Alzheimer’s disease. Jacqueline is an only child and always promised her mother that she would care for her in her old age. Her mother is unaware of her surroundings and often calls out for her daughter Jackie when Jacqueline is in the room. Jacqueline reassures her mother that she is there to help, but to no avail. 

Jacqueline is unable to visit her children on holidays because she must attend to her mother’s daily needs. She is reluctant to visit friends or even go out to a movie because of her mother’s care needs or because she is too tired. Even though she has eliminated most leisure activities with Mark, Jacqueline goes to bed at night with many of her caregiving tasks unfinished. She tries to visit with her mother during the day, but her mother rejects any contact with her daughter. Planning for the upcoming holidays seems impossible to Mark, because of his wife’s inability to focus on anything except her mother’s care. 

Jacqueline has difficulty sleeping at night and is unable to discuss plans even a few days in advance. She is unable to visit friends and is reluctant to have friends visit because of the unpredictable behavior of her mother and her need to attend to the daily care. 

Reflective Questions 

1. How do you think this situation reflects Jacqueline’s sense of role performance? 

2. How do you think that Jacqueline may be contributing to her own health?

Please provide rationales for your answers. Please provide a citation for your answers.