0730 Orthopedic unit – surgery is delayedPatient of Dr. Smiley

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0730: Orthopedic unit – surgery is delayed Patient of Dr. Smiley CHIEF COMPLAINT: chronic osteoarthritis to the right knee Pain has worsened over the past couple of months despite meds. Pain is affecting daily activities, sitting in recliner for most of the day. Waking up from sleep. Medical: NONE Surgical: NONE Hospitalizations: NONE Grandparent : Natural causes Mother: 82 from CVA, history of HTN, HLD Father: 80 from AMI, history of CAD, HTN Child: 29, alive and well, NKMP Tabacoo: half a pack a day for 32 years , quit 1 week ago Exercise: Minimal Immunizations: Up to date per CDC guidelines Alert, oriented, and cooperative Alert and oriented x4 RLE slightly limited ROM and 3/5 strength due to pain 4/10 Full ROM and muscle strength 5/5 to all other extremities Meds: Calcium Carbonate 600 mg PO 1AM Meloxicam 15 mg PO qAM 0800: Diagnosis – Elective total right knee arthroplasty Stable Full code status Shellfish allergy – gets a rash NPO until after surgery Interventions: SCDs to bilateral lower extremities Place IV x 1 Labs: BMP, CBC, Blood type and cross, PT/INR (Done pre-op) Consult: Physical and Occupational therapy to evaluate and treat Social work for discharge planning “My knee still hurts, but this pain in my calf is new.” No tingling or numbness in calves. Constant pain. Calf pain 8/10 Deep inside pain not superficial “It’s like a bad cramp” Ibuprofen last night (treatment for pain in calves) Knee pain has been getting worse over time and constant Inflammation in right knee Pain med & recliner ease pain in the knee Knee pain 5/10, dull ache with some sharpness Knee pain was on and off Childhood illnesses: usual coughs, cold, tummy aches A few beers in the weekend Drinks coffee – almost 3 cups in morning “Normal amount” of water/fluids in a day “Can’t get around like I used to” Vitals SKIN: warm, dry 5’9 184lb(84.0 kg) Temp: 98.6 F Pulse : 70 Respiration: 25 BP: 122/76 SP02: 98% BMI 27.2 Instructions Merge and center A1 to B1 Apply percent style from B3 to B6 and B8 Merge and center A10 to H10 A10 to H10 font size 36 and purple background color Merge and center A11 to H11 A11 to H11 font size 18 and purple background color Rotate Headings B12 to H12 anticlockwise B13 to H13 apply accounting style B14 to H20 apply comma style A21 to H21 apply Total style B23 to H23 apply Currency style ...

Education

Labs:
BMP, CBC, Blood type and cross, PT/INR (Done pre-op)
Consult:
Physical and Occupational therapy to evaluate and treat
Social work for discharge planning
“My knee still hurts, but this pain in my calf is new.”
No tingling or numbness in calves.
Constant pain. Calf pain 8/10
Deep inside pain not superficial
“It’s like a bad cramp”
Ibuprofen last night (treatment for pain in calves)
Knee pain has been getting worse over time and constant
Inflammation in right knee
Pain med & recliner ease pain in the knee
Knee pain 5/10, dull ache with some sharpness
Knee pain was on and off
Childhood illnesses: usual coughs, cold, tummy aches
A few beers in the weekend
Drinks coffee – almost 3 cups in morning
“Normal amount” of water/fluids in a day
“Can’t get around like I used to”
Vitals
SKIN: warm, dry
5’9 184lb(84.0 kg)
Temp: 98.6 F
Pulse : 70
Respiration: 25
BP: 122/76
SP02: 98%
BMI 27.2

Instructions
Merge and center A1 to B1
Apply percent style from B3 to B6 and B8
Merge and center A10 to H10
A10 to H10 font size 36 and purple background color
Merge and center A11 to H11
A11 to H11 font size 18 and purple background color
Rotate Headings B12 to H12 anticlockwise
B13 to H13 apply accounting style
B14 to H20 apply comma style
A21 to H21 apply Total style
B23 to H23 apply Currency style

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1. examine three of the upstream impacts of mining. Which of these

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1. Examine Hofstede's model of national culture. Are all four dimensions still important in today's society as it relates to the success of the multinational manager? Why, or why not? Which do you think is the least important as it relates to multinational management? Why? 2. More companies are seeking to fill multinational management positions due to the influx of business growth abroad. If you were offered and accepted a position as a multinational manager, what would you do to personally prepare for the culture of a different country? Where would you seek information? What overall responsibilities would you expect of the job? How do you think the managerial responsibilities would be different from those you would face in the United States? 3. Multinational managers encounter many levels of culture. Which of the culture levels do you think might be the most difficult to manage? Why? Share an example. Which culture level do you think might be the easiest to understand? Why? Give an example of this. 4. In your own words, what is your perception of free trade? Think about the advantages of free trade; what are two benefits that result from free trade? There is also a downside to free trade; what are two disadvantages resulting from free trade? Provide reasoning for your choices. 5. What are the three major economic systems that nations utilize, and what is the role of each? How does each affect and influence individuals, multinational managers, and corporations? 6. How would you define ethical convergence? What are the four basic reasons for ethical convergence? Which might be the most difficult for multinational companies to follow, and why? 7. Describe the four major world religions. What are the impacts of each religion type on an economic environment? What do you think makes religion a concern in societies? 8. If you were a multinational manager, and you encountered an ethical dilemma within the multinational company, what heuristic questions would you use to decide between ethical relativism and ethical universalism? Of the different heuristic questions, which one do you think is most important? Explain your reasoning. 1 Week Two Instructor’s Notes PHIL 1103 Summer This week you will be learning in detail about the four different moral perspectives that we will use to analyze moral questions. Notice two things right at the start. First, because normative ethics is our main focus this term, we are not going to attempt to settle the question of whether any moral perspective at all could be correct or known to be correct—that is a task for metaethics. Our task in this second week is to learn in some detail about four different kinds of consideration or value that often seem relevant when we try to decide what is morally right or wrong in particular cases, namely: (1) Respect for the rights and autonomy of the persons involved (2) Increasing the overall well-being of the most individuals possible (3) Asking wha ...

1. Examine Hofstedes model of national culture. Are all four dime

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1. Do you think the Earth is a living organism? Why or why not? 2. Why are people in Haiti so vulnerable to major natural hazards? 3. Why did you take this environmental geology course? 4. Would an exponential negative growth of human population be a solution to many environmental problems? 5. Are there any conflicts between global environmental unity principle and regional economic development? 6. a. Look around your house or apartment and make a list of five different materials that relate to geology. For example, do you have a granite countertop? Slate floor or pool table? Salt in your kitchen? Drywall (made from gypsum)? Metal Objects? Plastic items (made from petroleum)? b. Indicate those items that can be recycled. c. If you currently do not recycle, describe what would cause you 7. Assume the Pangaea never broke up, how might today’s environments be different? 8. What are the major differences in plate tectonic settings between the U.S. eastern and western coasts? 9. Will the tectonic cycle ever stop? Why or why not? 10. Why is most seismic and volcanic energy released along the Pacific rim? 11. Does plate tectonics play a role in shaping your local environment? 12. Extremophile bacteria can live and thrive under extreme conditions. Why are they important to the search for extraterrestrial life? 13. Discuss different ways that rocks and minerals are used to benefit or to harm the environment 14. What rock property and rock structure factors should you consider for a major engineering site selection? 15. Suppose you are the superintendent of schools, what steps would you take to determine if there was an asbestos hazard, and how would you communicate with parents? 16. What factors contributed to the failure of the St. Francis Dam? 17. A town is located in the foothills of a mountain range. The rock types in the city limits and just beyond include basalt, shale, and limestone. As the town grows and expands, what advice could you give planners as to potential geologic problems related to the rocks to be aware of as new buildings and roads are sited? What additional geologic information would be necessary? 18. The rock cycle indicates how rocks can be transformed from one type to another. In other words, older rocks are recycled into new rocks. How can an older sedimentary rock be transformed into a new sedimentary rock without first becoming a metamorphic rock? 19. An ecosystem consists of both living community and its nonliving environment. Is one of two components more important? 20. Based upon the linkage between ecology and geology, what is the importance of interdisciplinary collaborations in ecological restoration? 21. What are the critical ecological challenges in your area? 22. Are there any positive impacts of land transformation on your local ecosystems? 23. How do seawalls reduce biodiversity? 24. What did you learn from the case history of wolves in Yellowstone National Park? 25. List all the nat ...

1. Do you think the Earth is a living organism Why or why not

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1. Discuss the nursing implications of the findings of the research. Consider the following questions: · Were the results statistically significant, if reported? · What is the clinical significance of the findings? · What are the risks vs. benefits to practice of the findings? · Are the findings feasible to implement? Work 57 (2017) 259–268 DOI:10.3233/WOR-172551 IOS Press 259 “I’ve never been able to stay in a job”: A qualitative study of Veterans’ experiences of maintaining employment Molly Harroda,∗, Erin M. Millerb, Jennifer Henrya and Kara Zivina,b,c,d a VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA bDepartment of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA cDepartment of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA dInstitute for Social Research, University of Michigan, Ann Arbor, MI, USA Received 5 February 2016 Accepted 4 December 2016 Abstract. BACKGROUND: Ensuring Veteran employment needs are met is a top priority for the Department of Veteran Affairs and the United States government. However, Veterans, especially those with mental health disorders, continue to encounter difficulties when employed. While many employment related programs offer numerous services aimed at helping Veterans gain employment, their ability to maintain long-term employment remains unknown. OBJECTIVE: The objective of this study was to understand factors that affect the ability of Veterans with mental health disorders to maintain long-term employment. METHODS: An exploratory, qualitative study design consisting of semi-structured interviews with 10 Veterans was performed. Inductive thematic analysis was performed to identify salient themes. RESULTS: We found that participants’ symptoms manifested themselves within the workplace affecting their ability to maintain employment, participants felt as if they had been demoted from what they did in the military, and they felt unable to relate to civilian co-workers. Strategies that helped some transition into the civilian workforce were also identified. CONCLUSIONS: A better understanding of the difficulties some Veterans face when trying to maintain employment is needed. Our findings suggest that increasing awareness of existing programs and ensuring that services provide resources and skills that help Veterans maintain long-term employment is critical. Keywords: Long-term employment, mental health, reintegration 1. Introduction Within the United States there are approximately 5.5 million Veterans who served during the Gulf War era (from August 1990 until present) [1]. These Vet- erans are younger, more likely to be of working age (18–55), and looking to secure civilian employment. ∗Address for correspondence: Molly Harrod, HSR&D (152) P.O. Box 130170 Ann Arbor, MI 48113-0170, USA. Tel.: +1 734 845 3600; Fax: +1 734 222 7503; E-mail: [email protected] Ensuring that V ...

1. Discuss the nursing implications of the findings of the researc

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1. Define the following concepts (key terms) in YOUR OWN WORDS: ◦ object permanence ◦ causality ◦ mental combinations ◦ deferred imitation 2. Using this list of behaviors, sort them into the correct sensorimotor stage in the table below. You must use them all: • Looks for hidden objects • Shakes rattle in different ways • Grasping • Repeats interesting action • Putting mom’s hands together to make her clap • Plays alone with a doll • Sits & passes toy from one hand to another • Attempting to hold a bottle to drink it • Gazes at adults • Laughs when mom starts playing • Manipulates items • Makes deliberate cry to get attention • Plays peek-a-boo • Imitates parts of an adult role • Looks in several places for lost object • Sucks on own hands • Sucking on pacifier or bottle • Feels texture of blanket • Imaginary play • Hides from dad at bedtime • Points to car and says, “car” • Reaches for bib at feeding time Sensorimotor Substage Age Range? Typical Behaviors (from the list above) Substage 1: Reflexive Substage 2: Primary Circular Reactions Substage 3: Secondary Circular Reactions Substage 4: of Secondary Circular Reactions Substage 5: Tertiary Circular Reactions Substage 6: Mental Representation C ee eBook Collection mielipiteesi ruokauhri rinnetta kukaan kysymyksia merenneuvosto joukkonsa neuvoston jumalansa huostaanvakivaltaa aitisi tuomioita naista saimme palkkaa aineetkuunnelkaa lauletaan tuollaisia pitaa tutkin allas henkilolleluulin kuolevat kuuluva varsin askel iltaan tuskanjalkelaiset kaytossa luovutan katto nimesi sydameniulkoapain poistettu neuvon poliitikot maakuntien sivuavaadit postgnostilainen jumalansa lepoon markkaamatkaansa rukoilevat serbien keskuudessaan kari otatteseisoi kestaa polttaa vanhimmat hyvinvointivaltionulkoapain kisin lahestyy seitsemas kaikkialle markkaakohteeksi lahjoista puhdistaa vahemmisto nuoremmankelvottomia maat alkutervehdys muukalaisina temppelilleerikoinen ihmisilta seurakunnat sopimusta nahdaan kaskypitempi mennessaan annoin huomiota maalia vaimokseenkahleet alati itseensa riitaa jatka rukoukseni vaatiitsetseenien porton alla vai haltuunsa hyvat pellotkansoja inhimillisyyden havittanyt viisaiden jatti siunaustiede muuttunut naiset pakenivat erikoinen aarista laskeevahainen suureen kummankin haran pilviin ruokauhriristiinnaulittu osa ahdinko sairastui todistettu kahdestiv a r m a a n o h j e l m a n k u t a k i n k y s y k a a k u u l u v ...

1. Define the following concepts (key terms) in YOUR OWN WORDS

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1. Development Plan Career Activity . Respond to the following: · What are some of the key concepts that should be included in a career plan? · What common mistakes do people make when developing a career plan? Assignment Instructions Write a one-page paper (not to exceed 250 words). You will be graded on the following: · Quality of your response. · Coherence and organization. · Mechanics. This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions. The specific course outcome associated with this assignment is: · Develop a professional development strategy that fosters career readiness skills for master's-prepared health care administrators. A guide to Social Return on Investment January 2012 in association with “For FRC Group using SROI has been a fascinating process which has fine tuned our understanding of the impacts that are achieved as we improve our performance, and exposed areas in which we can do more.” Verity Timmins, Impact Manager, FRC Group “At Impact Arts we have embraced SROI as one of our central evaluation tools, which complements our existing evaluation practice very well. SROI has clear benefits for our organisation in terms of our future funding and business development activities, as well as focusing our day to day practice on where and how we add value.” Susan Akternel, Innovation and Development Director, Impact Arts “SROI has helped us develop an ongoing relationship with our stakeholders which shows that we are listening to their needs and we can now report how our work impacts on their lives and the lives of others.” Maeve Monaghan, Director, NOW Project A guide to Social Return on Investment 3 Update to the 2009 Guide This Guide is an update to the 2009 Guide to Social Return on Investment that was published by the Cabinet Office. There are no changes to the principles or to the methodology used to apply those principles within the framework. The purpose of the update is to amend the language used so that it is more relevant for international audiences and for different sectors and types of organisations. A small number of typographical errors have also been corrected. The worked example was included as an example of how those principles are applied in practice. A supplement will be available for the worked example ‘Wheels to Meals: one year on’ which sets out how the organisation has developed its approach to SROI after completing an evaluation against the initial forecast. Supplements to the Guide will be prepared from time to time and form part of the guidance available. At the date of this update a supplement on Materiality has been released and is available from the SROI Network website. January 2012 Acknowledgements The 2009 gui ...

1. Development Plan Career Activity. Respond to the following

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1. Developing Information Technology training that can be understo

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1. Describe digital freight matchmaking in your own words.2. How

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1. Describe the ways in which governments and international bodies promote and regulate global trade (150 words) 2. Identify the questions to ask in choosing the appropriate form of ownership for a business (150 words) 3. You’re a partner in a U.S. engineering firm that’s interested in bidding on a water-treatment project in China. You know that firms from two other countries—Malaysia and Italy—will submit bids. The U.S. Foreign Corrupt Practices Act forbids you from making any payment to Chinese officials to enlist their help in getting the job. Unfortunately, the governments of Malaysia and Italy don’t prohibit local firms from offering bribes. Are you at a disadvantage? Should the Foreign Corrupt Practices Act be repealed? Why, or why not? (1page) 4. Because the United States has placed quotas on textile and apparel imports for the last thirty years, certain countries, such as China and India, have been able to export to the United States only as much clothing as their respective quotas permit. One effect of this policy was spreading textile and apparel manufacture around the world and preventing any single nation from dominating the world market. As a result, many developing countries, such as Vietnam, Cambodia, and Honduras, were able to enter the market and provide much-needed jobs for local workers. The rules, however, have changed: as of January 1, 2005, quotas on U.S. textile imports were eliminated, permitting U.S. companies to import textile supplies from any country they choose. In your opinion, what effect will the new U.S. policy have on each of the following groups: (1page) · Firms that outsource the manufacture of their apparel · Textile manufacturers and workers in the following countries: • China• Indonesia• Mexico• United States · 3. American consumers ...

1. Describe the ways in which governments and international bodi

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1. Describe the process of beta oxidation of fatty acids with FA activation and degradation? 2. Discuss the oxidation of unsaturated FAs with their three problems? 3. Explain the steps of odd chain FAs oxidation with emphasis on mutase? 4. Give the differences in peroxisomal and mitochondrial beta oxidation? 5. What are ketone bodies and write the steps of ketogenesis and metabolic degradation of ketone bodies? Firewall Security Strategies You are working with your manager on a project. You are attempting to determine the best approach for securing inbound traffic from the Internet to various application servers on the client’s local area network (LAN). You would like to select a strategy that gives the client significant control over user accessibility. You would also like to ensure that all data passing into your client’s network is properly evaluated before access is granted. Integrity of data is the top priority; however, your client has a limited budget for deployment. Using the information presented above, discuss which of the following firewall security strategies would be a good fit for your client’s network environment. Firewall Security Strategies Security through obscurity By configuring systems in a way that does not follow normal patterns and is not easily understandable, security through obscurity can be obtained. By utilizing abnormal configurations, the probability of exploitation is reduced and a level of protection is obtained. Administrators seek security through obscurity by performing one or more of the following actions: · Modification of default ports · Spoofing of banners or headers · Utilization of extraordinary long Uniform Resource Locators (URLs) · Utilizing uncommon protocols or operating systems Keep in mind that this strategy may instill a false sense of security. Because attackers have multiple methods to scan against system configurations, utilizing this as the only security mechanism is like using nothing at all. Least privilege This strategy requires that each user or group that requires access to resources be explicitly granted permission. Because all resource access would be denied by default, each individual access need would have to be individually addressed. When least privilege is employed, there is often a dramatic increase in administrative overhead as a direct result. Least privilege is preferred for administrative scenarios. Simplicity This strategy reinforces that the selected solution should remain simple. By retaining a simple solution, the potential for error in configuration, bugs, or other problems is reduced. Defense in Depth This strategy emphasizes on a layered approach. The use of multiple safeguards ensures that no system that represents a single point of failure could be breached. The characteristics of a defense-in-depth strategy are: · Public networks are separate from private networks · Multiple security controls are implemented · Redundant security controls are implemente ...

1. Describe the process of beta oxidation of fatty acids with FA a

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