Discuss what is happening on a cellular level with the disease process. Be careful to realize that patients have co-morbidities, and you may need to discuss the other diseases impact on the pathophysiology and care of the patient.  Three (3) resources after 2008 are required along with APA format. Add questions to paper

CASE STUDY: 
Asthma

 

Patient Profile:

    Miss Winters, age 25, comes to the emergency department with severe wheezing, dyspnea, and anxiety. She was in the ED only 6 hours ago with an acute asthma attack, which resolved with nebulized albuteral treatments.

 

Subjective Data:

-Admits to use of albuterol inhaler several times weekly for the last few months 

-Asthma symptoms occasionally awaken her at night (about 3 times a week), and she has cancelled several outings with her family due to her symptoms

          -Can now only speak in one to three word sentences

          -Is allergic to cigarette smoke

-Began to experience increased shortness of breath and chest tightness when she returned home

-Used albuterol inhaler repeatedly at home without relief

-History of pruritic skin lesions that have come and gone since childhood.

 

Objective Data:

            Physical Examination:

                -Using accessory muscles to breath

             -Audible inspiratory and expiratory wheezing to auscultation with no air movement in lower lobes of l

                     lungs

             -HR = 126/min; Resp = 40/min

             -Areas of dry, scaling skin in antecubital areas bilaterally with evidence of scratching

            
Diagnostic Studies:

                        ABGs: PO2  = 80 mm Hg

                                    PCO2  = 35mm Hg

                                    HCO3  = 24 mEq/L

                                    pH = 7.48

                        PEFR: 150 L/min (Personal best: 400 L/min)

                        Continuous pulse oximetry: 82-85

 

CRITICAL THINKING QUESTIONS:

 

1. Why did Ms. W. return to the ED? Explain the pathophysiology of this second exacerbation of asthma.

 

2. Describe the progression of breath sounds auscultated from early in an asthma attack through very severe respiratory impairment. How do the sounds change as the patient improves?

 

3. What is the significance of her dry, scaling, pruritic skin lesions? What is your diagnosis (no nursing dx please)? How do these types of lesions relate to asthma? What is their physiologic cause ?

 

4. Analyze the ABG. What type of acid-base disorder is present? Why? Is there any compensation?

 

5. Discuss the four categories of asthma diagnosis advocated in the 
Guidelines for the Diagnosis and Management of Asthma from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Which classification best describes Ms. W.'s asthma?

 

6. According to the asthma treatment guidelines from #5: the “Step up-Step down” approach, what is the recommended treatment strategy for a patient currently at Ms. W.’s classification level once this current exacerbation is controlled? When would it be appropriate to reevaluate the interventions and possibly adjust the medications?

 

7. She lost her Peak Flow meter during a recent house move. Why would you want to order a new one for her? How is it used and how can it help increase her ability to control her asthma? Explain the red, yellow, and green zones. What is the significance of her PEFR level on her return to the Emergency Room?

 

 Many of us can think of leaders we have come to admire, be they historical figures, pillars of the industry we work in, or leaders we know personally. The leadership of individuals such as Abraham Lincoln and Margaret Thatcher has been studied and discussed repeatedly. However, you may have interacted with leaders you feel demonstrated equally competent leadership without ever having a book written about their approaches.

What makes great leaders great? Every leader is different, of course, but one area of commonality is the leadership philosophy that great leaders develop and practice. A leadership philosophy is basically an attitude held by leaders that acts as a guiding principle for their behavior. While formal theories on leadership continue to evolve over time, great leaders seem to adhere to an overarching philosophy that steers their actions.

What is your leadership philosophy? In this Assignment, you will explore what guides your own leadership. 

To Prepare:

• Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
• Reflect on the leadership behaviors presented in the three resources that you selected for review.
• Reflect on your results of the CliftonStrengths Assessment*, and consider how the results relate to your leadership traits.

*not required to submit CliftonStrengths Assessment

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

• A description of your core values.
• A personal mission and vision statement.
• An analysis of your CliftonStrengths Assessment summarizing the results of your profile
• A description of two key behaviors that you wish to strengthen.
• A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
• Be sure to incorporate your colleagues’ feedback on your CliftonStrengths Assessment from this Module’s Discussion 2.

What is risk

Hum Ecology & Environment

Peers response

Your responses should consist of your informed input. One or two-sentence peer responses will not fetch full points. Do not merely recite the content you read in the unit; don’t simply give your opinion.

Your input should be in your own words (to avoid plagiarism), demonstrating your understanding and comprehension of the topic. Be sure to support all your posts (initial post + responses) with specific references to the assigned readings, lecture material, and other relevant research you find appropriate in APA format.

1st peees response

Octavia Dykes

Food insecurity and food scarcity by definition are different. Food Insecurity is caused by a lack of means to obtain food with the leading cause being income. Food scarcity is the lack of food available this could be caused by location or production. Both situations create hunger.  A person with food insecurity could be near a market with available goods but have limited or no money to buy food.  A person with food scarcity may have the money for goods at the market but the closest market with goods available is an hour's drive away or the market close by has limited goods available for sale. 
 These would be densely populated areas without an adequate grocery source or areas of very low population where there are no grocery stores until the next major city (The Annie E. Casey Foundation, 2021).  “
It is not confined to one single sector, sub-system (e.g. value chain, market) or discipline, and thus broadens the framing and analysis of a particular issue as the result of an intricate web of interlinked activities and feedbacks. It considers all relevant causal variables of a problem and all social, environmental, and economic impacts of the solutions to achieve transformational systemic changes” (Food and Agricultural Organization of the United Nations. (2018). Sustainable food systems.).

As nurses, we can assess our patients for having signs of being malnourished, and be observant of those that tend to hoard every scrap left on their tray for “later”, these are in my experience the patients having food security issues outside of the hospital. We can provide resources before they discharge, such as their closest food banks and food drive locations so that they may receive these resources. The hospital I work for does monthly community service events, it’s usually a food bank so that we can collect and give food out to those in need. As nurses, we can get involved within these communities. I’m not saying use all your free time but a few hours one weekend a month is such a great help with soap kitchens, food drives, food banks, etc.

 

References: 

Food and Agricultural Organization of the United Nations. (2018). 
Sustainable food systems. 

http://www.fao.org/3/ca2079en/CA2079EN.pdf

The Annie E. Casey Foundation. (2021). 
Food Deserts in the United States. 


https://www.aecf.org/blog/exploring-americas-food-deserts

2nd peer response

Zoe Snider

Food insecurity refers to the lack of consistent access to food. Chronic food insecurity can lead to various health problems among vulnerable populations such as children, the elderly, and those with pre-existing health conditions (Nord, Coleman-Jensen, Andrews, & Carlson, 2020, p. 1). Food insecurity can be on the individual level or the community level. Food scarcity on the other hand is more of a systemic issue, affecting the population. Multiple factors can cause food scarcity including adverse weather conditions, population growth, and political climate (Kanter, Redmond, & Wansink, 2013). When looking at what impacts food security the most I quickly thought consumption would play the largest role. Food production cannot keep up with the amount of food that humans are consuming. This could be from overpopulation. The relationship between food and race takes a look at the community's access to healthy, sustainable food. These communities may only have convenience stores and fast food supplying them with their weekly food intake. Not only would they have to travel farther for healthy food, but it also is much more expensive than a fast food dinner. Nurses can detect food insecurities in a multitude of ways. A basic assessment would tell a nurse a lot. Direct questioning can go a long way! This is why rapport with patients is important. 

 

Kanter, D. R., Redmond, L., & Wansink, B. (2013). Food scarcity and obesity: A view from behavioral economics. American Journal of Preventive Medicine, 45(5), 651-658.

Nord, M., Coleman-Jensen, A., Andrews, M., & Carlson, S. (2020). Household Food Security in the United States in 2019. U.S. Department of Agriculture, Economic Research Service. 

 

A nurse at the local Senior Center made the following notation about a client: A 74-year-old female client wearing eyeglasses with bifocal lenses and hearing aid in her left ear. Walks with a shuffling gait, using a cane for support. Wearing house slippers and housedress. States, “My other doctor says I should have my eyes looked at by an expert. It’s been a while, and my eyes seem to be acting up lately. I can’t see so good anymore.” The client states that she takes medication for “sugar” and her blood pressure and has worn glasses for years with the last prescription changed about 3 years ago. “I was a seamstress for many years and quit when I couldn’t see to thread the needles anymore-just in time too. These new materials are too hard to work with!” Denies using any eye drops. Describes vision changes as difficulty seeing well at night, especially if trying to read. Uses a magnifying glass to help when reading. No eye pain or discharge, although eyes sometimes feel “dry and scratchy,” with the left eye being worse than the right. Admits to rubbing eyes but without relief.

Develop a Plan of Care for this patient that includes:

• 2 Nursing Diagnosis
• 2 goals for each Nursing Diagnosis
• Interventions with rationales