J.C is an 82-year-old white man who was evaluated by GI specialist due to abdominal discomfort, loss of appetite, weight lost, weakness and occasional nausea.

Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer. 

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. You don’t need to make a presentation page.

 Identify one vulnerable population within a selected community. Explore current literature and related data to understand better the variables that place this population at risk for health concerns and health disparities. Analyze national health directives, such as Healthy People 2030 or another national initiative, to determine the correlation to the vulnerable population’s needs/risks/disparities.

1. Create a concept map, either neatly drawn by hand or using Microsoft Word, that portrays each element and its relationships. 
2. Download the Concept Map Summary templateLinks to an external site.Open this document with ReadSpeaker docReader to answer the questions related to the concept map scenario. Use of this template is required. If the template is not used, a 10% deduction will be applied. See the rubric. Save the template and include your name in the file name. 
3. Follow APA grammar, spelling, word usage, and punctuation rules consistent with formal, scholarly writing. 
4. Use APA in-text citations and complete references to support your writing.  
5. Use no more than one short direct quote (15 words or less). 
6. Refrain from using first person within this assignment. 
7. Abide by Chamberlain University’s academic integrity policy.  
8. Submit the Concept Map and the Concept Map Summary template to the Week 2 Assignment Dropbox. 

Include the Following Sections (detailed criteria listed below and in the grading rubric)

Concept Map

1. Using a concept map format, identify the following elements:
   1. vulnerable population
   2. the variables that place the population at risk
   3. the identified health risk or disparity to which the population is susceptible
   4. the relationships between the elements

Concept Map Summary

1. Describe the elements on the Concept Map and include the following.  
   1. Provide a succinct description of the vulnerable population identified.
   2. Discuss a minimum of three variables that place the population at risk.
   3. Describe the identified health risk(s) or disparity the population is at risk of experiencing.
   4. Explain how the Concept Map portrays the relationships between each element presented.
   5. Provide an in-text citation from one scholarly source to support your writing.
2. Intervention Proposal
   1. Identify one national population health goal or objective that relates to the identified risk or disparity, such as Healthy People 2030 or another national initiative
   2. Propose one strategy for the advanced practice nurse to collaborate at the local, state, or national levels to advocate for the health of the vulnerable population and advance the identified Healthy People 2030 goal or objective
   3. Identify the stakeholders with whom the advanced practice nurse could collaborate.
   4. Provide an in-text citation from two scholarly sources to support your writing. 

 Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.