Vitamins

Discussion 4 (Vitamins)

Vitamins are energy building nutrients that contribute to sound nutritional health. Water, on the other hand, is responsible for carrying necessary nutrients and removing waste products throughout our body. A human body is made out of mostly water and is critical to our health. Similarly, minerals and electrolytes are essential to human health and can be obtained in our diet from different foods. When humans are too sick to consume a regular diet, digestion and absorption may impact the supply of necessary nutrients, requiring specialized nutritional support to meet their nutritional needs.

After studying 

Module 4: Lecture Materials & Resources
, read the case study and answer the prompts:

Sharyn Bartell is a 24-year-old student who suffered multiple fractures when she fell from a cliff when hiking. As a result of the accident, she is immobile, in traction, and had a small bowel resection. She is able to keep her head up to 45 degrees. Sharyn used to weigh 140 pounds but has lost 8 pounds since the accident. The healthcare team agrees that Sharyn will need a feeding tube before her nutritional status deteriorates any further.

1. Navigate the web, research a high protein formula that can be administered via feeding tube and share 1) name of formula, 2) nutrient composition, and 3) indications for use.

2. Navigate to the Oley Foundation: 

Dietary Recommendations for Patients with Intestinal Failure – Oley FoundationLinks to an external site.
, read “Physiological Considerations” and discuss in at least one paragraph with two (2) effects of the small bowel resection on Sharyn’s fluid and electrolyte balance.

3. Navigate to the Oley Foundation: 

Living with Enteral Feeds – Oley FoundationLinks to an external site.
 and provide two (2) physical or psychosocial adjustments Sharyn will have to make when living with a feeding tube.

Discussion 5 (Nutrients)

All people need the same nutrients, but the amounts will vary depending on their stage in life such as infants, children, adolescents, pregnancy, adults, and older adults. For example, a pregnant woman will need to make sure she has a proper diet before, during, and after the pregnancy. A poor diet before and during the pregnancy may affect the health and development of her infant. She will also need to make sure and maintain a nutritionally balanced diet after the pregnancy, especially if she plans to breastfeed her infant.

After studying 

Module 5: Lecture Materials & Resources
, answer the following:

1. Review figure 10-3 Comparison of Selected Nutrient Recommendations for Nonpregnant, Pregnant, and Lactating Women in text and compare the recommended percent allowances for:

A. Iron – Who (nonpregnant, pregnant, lactating) needs it more and why?

2. Ellen is an 18-year-old single mother of a six-month infant; she works at a convenience store and makes minimum wage. Ellen has limited financial means and needs assistance. Navigate to Floridahealth.gov: 

https://www.floridahealth.gov/programs-and-services/wic/wic-program-info.htmlLinks to an external site.
 and share at least two (3) examples of how food assistance programs can help Ellen’s infant and one (1) example of why nutrition is important for an infant – provide a full paragraph.

3. Miguel is a 75-year older adult and has been diagnosed with early macular degeneration. Explain what macular degeneration is and share 2 vitamins or minerals that help reduce progression of the disease.

 

Discussion 6 (Chronic Disease)

 According to the Centers of Disease Control and Prevention (CDC, 2023), six out of ten adults in the United States have at least one chronic disease, and about four in ten have two or more chronic diseases. Chronic diseases include cardiovascular conditions, cancers, diabetes mellitus, and Alzheimer’s. Diet is a lifestyle factor that affects the development of many chronic conditions and even some neurological diseases.

After studying 

Module 6: Lecture Materials & Resources
, read the case study and answer the following:

Lenora is a 57-year-old Jamaican American female who works as a desk clerk. Her job requires her to sit all day from 9 a.m. to 5 p.m., then she drives for one hour to go home. She lives alone in a studio apartment. By the time she gets home, she is tired and barely has time to pick up some fast food. She was recently diagnosed with hypertension and diabetes type 2. She is 5’ 5” tall and weighs 180 pounds with a BMI of 30.1. Her blood pressure was 150/105 and her HbA1C of 7.5%. The healthcare team starts Lenora on atenolol (Tenormin) for her hypertension and metformin (Glucophage) for her diabetes.

References: Centers of Disease Control and Prevention. (2023). 
About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm#risks

In paragraph form:

1. Provide at least two (2) complications of uncontrolled hypertension and diabetes.

2. Provide at least two (2) risk factors that may contribute to Lenora’s development of hypertension (see Appendix J: Body Mass Index (BMI) of your textbook)

3. Describe what is HbA1C and how is it used to monitor diabetes? (see Chapter 20, page 564 of your textbook).

4. Discuss what dietary counseling will Lenora need to control her hypertension and diabetes? Provide at least two (2) examples.

 

Discussion 7 (Cancers & HIV)

While cancers and human immunodeficiency virus (HIV) are different diseases, they both have debilitating effects that influence nutritional needs – and if nutritional needs are not met, both advanced stages of cancer and HIV can lead to severe body wasting. Cancer and HIV require highly individualized nutrition therapy.

After studying 

Module 7: Lecture Materials & Resources
, answer the following:

Navigate to HIVinfo by the NIH.gov: 

https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-nutrition-and-food-safetyLinks to an external site.
 – read the webpage and scroll to Healthy Living with HIV.

1. Describe how foods may affect HIV treatment (provide at least 2 examples).

2. Explain how to prevent opportunistic infections through their diet in people living with HIV.

3. Describe the type of cancer frequently associated with HIV and explain how this cancer’s symptoms may cause anorexia on those with HIV (see page 663 in your textbook).

5 cl

 

discuss a very brief description (one paragraph for the group session– do NOT include the actual 12-steps) to include the following: 

Official name of the program or group you observed.

laura

 From a financial standpoint, what impact would this scholarship have on your education? 

  Discuss how your interest in your field or major developed. Describe your experience in the field and what you gained from this involvement. Please provide a minimum of 200 words. 

 When did you know that you wanted to pursue this degree? What makes now the time to pursue or continue your pursuit of your degree? Please provide a minimum of 200 words. 

  What are your short- and long-term career goals, and how will earning this degree contribute to achieving those goals? Please provide a minimum of 200 words. 

 Describe the skills and traits you possess that help you overcome obstacles. Please describe an experience or accomplishment that you are proud of. Please provide a minimum of 200 words. 

bkg

Please provide a personal statement that addresses your background, reasons for transferring, and the personal, academic and professional objectives you hope to achieve if admitted into University. (Maximum 1500 characters)*

0 word 0/1500

Diversity of all kinds is important to enriching the educational experience at University. Please share with us anything in your background or lived experience that has shaped your perspectives and how that would contribute to the classroom and community at Howard. (500 words maximum)

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Gas Exchange

Comparison of Gas Exchange Exemplars

Pneumothorax

Tension Pneumothorax

Flail Chest

Hemothorax

Acute Respiratory Failure

Pathophysiology

Etiology

Clinical Manifestations

Interventions

soap for brilliant

Week 6: Problem-Focused SOAP Note

USE the template that I gave you before. Needs the 1st blank paper for cover sheet.

Some Rubric

Some Rubric

Criteria Ratings Pts

This criterion is linked to a
Learning Outcomes (Subjective)

10 pts
Accomplished

Symptom analysis is well organized, with C/C, OLD

CART, pertinent negatives, and pertinent positives. All

data needed to support the diagnosis & differential

are present. Is complete, concise, and relevant with

no extraneous data.

10 pts

This criterion is linked to a
Learning Outcome (Objective)

10 pts
Accomplished

Complete, concise, well organized, well written, and

includes pertinent positive and pertinent negative

physical findings. Organized by body system in list

format. No extraneous data.

10 pts

This criterion is linked to a
Learning Outcome
(Assessment)

10 pts
Accomplished

Diagnosis and differential dx are correct, include ICD

code, and are supported by subjective and objective

data.

10 pts

This criterion is linked to a
Learning Outcome (Plan) 10 pts

Accomplished

Plan is organized, complete and supported with 2

evidence-based references. Addresses each diagnosis

and is individualized to the specific patient and

includes medication teaching and all 5 components:

(Dx plan, Tx plan, patient education, referral/follow-

up, health maintenance).

10 pts

Total Points: 40

Patient initial: R. R

DOB: June/1991 Sex: F

Encounter Date: 08/08/2023

SUBJECTIVE:

Chief Complaint:

History Of Present Illness:

appt is requested for URI

Medical History:

#. COVID 1/2022

#. hemorrhoids

#. Postpartum Depression, Anxiety, panic attacks

#. ADD

#. Insomnia

#. Allergic rhinitis

#. Psoriasis

#. Onychymycosis

Surgical History:

none

Gynecological History:

G2 P2 A0

Family History:

M: living, arrhythmia, palpitations

F: living, healthy

S: asthma

Social History:

-Married

-Lives with husband, 2 kids, and grandparents

-Authorization coordiinator at USC Keck, also student in digital marketing

-Denies tobacco use

-etoh use: Socially

-Denies illicit drug use

Smoking Status: Never Smoked

Allergies:

No known allergies

Current Medications:

———————————-

Paxil 10 mg po qd

xanax 0.25 mg prn panic attacks

Adderall 20mg bid prn

———————————

Review of System:

Constitutional: Patient denies weight change, fever, chills, weakness, fatigue, sleep

changes, appetite changes.

Head: Patient denies headache.

Neck: Patient denies abnormal masses, neck stiffness.

Eyes: Patient denies vision loss, blurring, discharge, excessive tearing, dryness.

Ears: Patient denies hearing loss, tinnitus, vertigo, discharge, pain

Nose: #sinus congestion#

Mouth: Patient denies ulcers, bleeding gums, taste problems.

Throat: #sore throat#

Cardiovascular: Patient denies chest pain, chest pressure, palpitations, DOE,

orthopnea.

Respiratory: #dry cough#

Patient denies shortness of breath, increased sputum, hemoptysis.

Gastrointestinal: #looser stools, frequency, occ incontinence#

Patient denies nausea, vomiting, heartburn, dysphagia, constipation, melena,

abdominal pain, jaundice, hemorrhoids.

Genitourinary: #urinary urgency and frequency, occasional incontinence#

Patient denies abnormal hesitancy, hematuria, dysuria, nocturia, stones.

Musculoskeletal: Patient denies arthralgias, joint stiffness, myalgias, muscle

weakness, instability and abnormal range of motion

Integumentary (Skin and/or Breast): Patient denies rash, lesions, changes in hair,

changes in nail, pruritus

Neurological: Patient denies headache, syncope, seizures, vertigo, ataxia, diplopia,

tremor, numbness, tingling.

Psychiatric: #depression, anxiety, ADD#

Patient denies mood abnormalities, memory loss, difficulty sleeping, appetite

changes

Endocrine: Patient denies sensitivity to cold or heat, polyuria, polydipsia.

Hematologic/Lymphatic: Patient denies bleeding, bruising, lymphadenopathy.

GYN: #menorrhagia#

Patient denies changes in menstrual cycle, hot flashes.

OBJECTIVE:

Physical Exam:

Constitutional: #last exam done on 7/10/23 showed#

WD, WN, Alert, Oriented X3 in NAD. Affect appropriate. Gait normal.

Eye: PERRLA, EOMI, nl conjunctiva

Ear: No pinnea/tragal tenderness. Drums are visualized, no wax in canals

Nose: N1 mucosa. N1 Nasal septal walls and turbinates.

Mouth: N1 bucal mucosa, no lesions noted.

Throat: Clear, no erythema or exudates.

Neck: #thyroid fullness R#

supple, no masses. Trachea is midline. N1 carotid auscultation. No JVD

Cardiovascular: RRR, N1 S1 and S2, No cardiac murmurs, rubs or gallops.

Lungs: ctab, no wheezes, rhonchi or crackles

Chest/Breasts: deferred

Gastrointestinal (Abdomen): soft, nt, nd, bs(+). No palpable masses.

Genitourinary: #negative CVAT#

deferred

Lymphatic: -No LAN noted

Musculoskeletal: good ROM. Strength symmetrical and wnl. No muscle weakness or

stiffness. No joint effusion or ttp.

Skin: Normal color and texture. No lesions seen.

Extremities: Warm, no clubbing, cyanosis or edema. N1 DP/PT pulses bilaterally

Neurological/Psychiatric: CN I-XII intact, neurosensory wnl, strength (5/5), (2+) DTR

UE/LE bilaterally -Judgment and insight intact

ASSESSMENT:

Diagnosis:

ICD-10 Codes:

1)J069; Upper respiratory infection, unspecified

PLAN:

Procedures (CPT code):

1) 99213; Detailed

2) 99401; 15 min

Medications:

Promethazine-DM 6.25-15 MG/5ML Oral Syrup; Take 5 ml orally every 4 hours Take

as needed for dry cough; Qty: 120; Refills: 0

Care Plan:

.***URI- x4 days, sore throat, sinus congestion, dry cough, headache. took

tylenol/cough syrup, claritin with not much relief. sent home today from work, COVID

test today from work pending results. sisters also similar sxs, but has tested

negative for COVID.

-off work this week

-Rx promethazine/DM 5mL prn cough, r/b d/w pt

-sudafed and tylenol prn

-f/u 1 week, if no improvement and covid neg, come back in office for exam

***urinary incontinence- h/o occasional stress incontinence, however over last 1 mo,

c/o increasing urengency, frequency and 2 episodes of incontinence, which occured

with only minimal alcohol use. denies hematuria, dysuria. c/o menorrhagia

worsening after delivering her 2 yo. denies LBP/trauma/saddle paresthesia

-pelvic floor PT ordered

-UA/UCx ordered

-referred to uro gyn

-ordered transvaginal u/s r/o uterine fibroids

-counseled on wt loss. keep voiding journal

-avoid irritants such as caffeine/ETOH

***diarrhea- c/o looser stools, 4-5xd and few episodes of incontinence. c/o abd

cramping after bm, othewise no abd pain, fever, melena, wt loss. has had h/o abd

pain and cramping which we ordered stool studies, CRP, ESR but pt never did.

denies LBP/trauma/saddle paresthesia. abd exam normal today

-ordered stool studies, ESR, CRP

-referred to GI

-ER precautions

***Hyperlipidemia, lipoprotein deficiency- On 1/16/23, FLP showed 237/47/182/156.

Has lost 6 lbs intentionally since last visit.

-Rec low fat, low carb diet

-FLP with next annual

***obesity- BMI 31.37, wt 221 lbs, Has lost 6 lbs intentionally since last visit.

-counseled

***thyroid fullness- noted on exam. 1/16/23, TSH wnl.

-ordered thyroid u/s 11/8/22, pt has not done yet

Plan Notes Continued: .

***trigger finger- unsure of duration, ono/off. R ring finger locks. Pt has seen hand

specialist in the past for another issue

-Rx ibuprofen as noted above, r/b d/w pt

-pt rec to f/u with hand specialist

***Vitamin D deficiency- On 1/16/23, Vitamin D level was 24. not supplementing.

-Rec Vitamin D 4000 IU qd

-Vitamin D level with next annual

***Onychymycosis- b/l feet on PEX on 2/1/23. pt is interested in tx.

-given the interactions between terbinafine and her psychiatric meds, I rec she

checked with them first before we start

***Depression, Anxiety- F/b psychiatrist, Dr. Askins and psychologist, Dr. Tricia

Duncan Hassle. Takes Paxil 10 mg po qd and xanax 0.25 mg prn panic attacks.

Denies SI/HI.

-mgmt per psych

***ADD- F/b psychiatrist, Dr. Askins. Takes Adderall 20mg bid prn.

-mgmt per psych

Patient Instructions: .

.

-Pt has been instructed to take medications as prescribed

-Pt received education on compliance with medications and recommendations

-Pt received counseling regarding Medication Side Effects

-Pt received counseling on following a well-balanced healthy diet with veg, fruit and

fiber.

-Pt was instructed to do CV exercise at least 3-4 times every week for 30 minutes.

PHCM: .

.

31 y/o F:

-Annual physical: done 2/1/23- next due 2/1/24

-Annual labs: done 1/16/23- next due 1/16/24

-Cervical CA screening: managed by GYN

-Skin CA screening; Referred to derm on 3/30/22

Immunizations:

Tetanus: doen 2021- next due 2031

Influenza: Fall 2022

COVID19: Pfizer in 7/1/21, bivalent booster Pfizer 1/14/23

HPV: will check records

  • Week 6: Problem-Focused SOAP Note

Assigment .Apa seven . All instructions attached.

 

Identifying and justifying appropriate Study Designs · 

Step 1:  A not-for-profit organization called Epidemiologists Without Borders has reached out to student researchers studying epidemiology at Florida National University. The organization has asked for support in the design of three research projects they plan to carry-out in several of the communities where they currently work. Read these three case studies summarized below.

NOTE: You may substitute one of the case-studies outlined below for a case study that is relevant to your own community. If you choose to do so, generate a case-study regarding a public health problem that is relevant and requires epidemiological research. Include the case study when you submit your assignment.

Case study 1:

Vaginal cancer is a rare disease that can often be cured when detected in its early stages. Vaginal cancer occurs more often in women over the age of 50 but can occur at any age. There are usually no symptoms for vaginal cancer. Epidemiologists Without Borders has been awarded a large grant to study the relationship between vaginal cancer and prior exposures to any risk factor among women in a South African city.  

Case study 2:

Epidemiologists Without Borders has learned that a large group of employees who have worked in a specific building (building A) of a very large corporation for more than 25 years appear to have high cancer incidence rates. The corporation has a total of 3 office buildings (buildings A, B, and C). Epidemiologists Without Borders would like to conduct research to determine if the rates of cancer incidence among those workers from building A are in fact higher than expected.

Case study 3:

Epidemiologists Without Borders supports the rights to life, health, and dignity for people who use illicit drugs. The organization is concerned about the high rates of HIV infection it has observed in one particular community and suspects that there are many risk factors possibly contributing to this high HIV risk. Currently, the data in this community with respect to the exact HIV incidence rate among injection drug users is of poor quality but estimates indicate that the prevalence is as high as 10-20%. Access to HIV testing is also low in this population. Additional challenges include limited resources, and the difficulty in recruiting people for testing due to their high mobility and hidden social networks. 

Epidemiologists without Borders would like to identify potential risk factors for contracting HIV among injection drug users in this community so that it can develop appropriate interventions.

Step 2: Select the most appropriate study design for each of the three case-studies proposed by Epidemiologists Without Borders (or for the one relevant in your community) based on what you have learned in this Week’s Lectures, Readings, PPT’s and modules. 

Step 3: Write a letter responding to Epidemiologists Without Borders outlining the study designs that you recommend. Justify why the study designs you selected are appropriate for each of the three case-studies. Your response must also outline at least one benefit and one limitation for each of the study designs you have recommended for each case-study. Your letter to Epidemiologist Without Borders should be clear and concise and contain no more than 450-550 words.  

Please be sure to adhere to the following when posting your weekly discussions:

1. Students are to write their name and the appropriate discussion number/discussion title in the title bar for each discussion. For example, Discussion 1: Micheal Cabrera or Discussion 3: Sheila Smith. This is important in identifying that students are submitting original posts as well as response posts as required.

2. Students are to submit their discussions directly onto Blackboard Discussion Board Attachments submitted as discussion board posts will not be graded.

3.  As a reminder, all discussion posts must be minimum 350-550 words, references must be cited in APA format 7th Edition, and must include minimum of 3 scholarly resources published within the past 5-7 years (not part of the classroom coursework).  

project

Part II: How the Courts Address or Respect Our Rights as Citizens – Presentation

Assignment

Required Resources

Read/review the following resources for this activity:

· Textbook: Chapter 17. Also, Chapter 11 and 12 from Week 6 might still be relevant.

· Lesson

· Minimum of 2 scholarly sources in addition to the textbook.

Instructions

This is Part II of the assignment you submitted in Week 6.

Using the case outline (Part I: How the Courts Address or Respect Our Rights as Citizens) you submitted in Week 6, prepare and submit a presentation, which will either be a narrated PowerPoint, a Kaltura Video, or some other format as approved by your instructor.
Be sure to verify the presentation format with your instructor before starting work on this assignment.

The presentation Point presentation will need to include:

· Name the case

· Discuss the facts of the case

· Discuss the history of the case (what laws or legal action was taken)

· Discuss the issues or the facts of the case and legal questions the court must decide

· Discuss if the court's decision or holdings was for the plaintiff or for the defendant and what were the reasons for the decision?

· Discuss the concurring and dissenting opinions from the judge or if a jury trial, the jury.

Important: In this assignment, you are expected to elaborate the points you made in the prior assignment in Week 6. This assignment will be graded on your strength to elaborate and explain the facts of the case and proper use of visual aids, good narration, and presenting to the case and how well you stick to the case. For example, if you are using the PowerPoint, you are also expected to include proper visuals that are relevant to the case. Do not copy-paste the outline into this and call it complete.

Requirements

· Length: The presentation must be 10-15 slides long if using PowerPoint (excluding cover and reference pages) or 3-5 minute long if using a video presentation.

· Font should not be smaller than size 16-point  

· Parenthetical in-text citations included and formatted in APA style  

· Title/Introduction slide required

· References slide minimum of 2 scholarly sources in addition to textbook if cited)

· Use the speaker notes to elaborate on the content on the slides

· Ebook:
https://bookshelf.vitalsource.com/reader/books/9780135246849/pageid/11

· The Struggle for Democracy, 2018 Elections and Updates Edition

· Or
[email protected]

· PWD: Bryanthierry@09

Research Problem

  proposed research problem statement, ( Psychiatry) including your study variables and hypothesis to make your problem statement clear. Explain any ethical considerations you should keep in mind in relation to your research problem statement. Then, explain how addressing this research problem may bring about positive nursing practice changes.  

Please Reply to the following 2 Discussion posts:

Please see the attachment for the instructions