Ethical Dilemma Case Stuy - A Jehovahs Witness refuses a blood tran.docx
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Ethical Dilemma Case Stuy - A Jehovah's Witness refuses a blood transfusion Submit Assignment Due Friday by 11:59pm Points 50 Submitting a file upload Objective Demonstrate understanding of professional and ethical responsibility Demonstrate critical thinking in the application of ethical principles to ethical decision making when presented with an ethical dilemma. Instructions Answer the questions at the end of this case study. Write a paper that is 3 to 6 pages in length, created using APA format. Use 1-inch margins, double spaced text, 12-point font, and Times New Roma font. Include a reference page with a minimum of 3 relevant citations or quotations. Create a cover page with student name, title of the course, title of assignment, date, and name/title of instructor. Submit your paper response to the assignment box on or before the due date. Late responses will not be accepted. Refer to the grading rubric provided for this assignment Case Study "Juana" (fictitious name) a 20-year-old, Black Hispanic female, 32 weeks pregnant, was brought to the emergency department (ED) by the paramedics. She arrived in the ED immobilized on a flat board with a hard cervical collar in place. Juana was the driver of a sedan involved in a single-vehicle collision. She stated she was driving at approximately 60 miles per hour on the highway and suddenly lost control of the vehicle and crashed into a light pole. She also stated her head hit the windshield and shattered the glass. She denied loss of consciousness. Upon her arrival in the ED, Juana was alert and oriented to person, place, and time and had a Glasgow Coma Scale of 15/15. Her initial complaints were lightheadedness, weakness, left shoulder pain, and severe abdominal cramping that started immediately following the car accident. She had a past medical history of sickle cell disease and no previous pregnancies. Her lungs were clear bilaterally. Juana's heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her initial blood pressure (BP) was 130/80, and fetal pulse rate was 90. Once the cervical spine films were taken and the flat board was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm. Juana was placed on a 100% nonrebreather mask. Peripheral intravenous lines were started bilaterally to replace fluid loss that was indicated by the change in vital signs. It was suspected that she was bleeding internally into her thoracic or abdominal cavity. Blood specimens were drawn and sent to the laboratory. A hemoglobin of 6 g/dl and hematocrit of 21% indicated internal bleeding. Ultrasound showed blood in the amniotic cavity and Doppler confirmed a fetal heart rate of 90 bpm indicating fetal distress. The patient was informed by the medical team of the critical nature of her condition. The plan of care for her was an immediate blood transfusion and an emergency cesarean section. Matters became complicated when Juana informed the.
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59058785 case-study
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Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docx
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Surgical and Anaesthetic management of a patient with diseased heart is always challenging. Specially it sweats more when the issue is PREGNANCY. It demands skillful and sophisticated handling of the patient. Moreover, when the finding is incidental, a single break of concentration can be fatal.
A ) Society perspective90 year old female, Mrs. Ruth, from h.docx
A ) Society perspective
90 year old female, Mrs. Ruth, from home with her daughter, is admitted to hospital after sustaining a hip fracture. She has a history of chronic obstructive pulmonary disease on home oxygen and moderate to severe aortic stenosis. (Obstruction of blood flow through part of the heart) She undergoes urgent hemiarthroplasty (hip surgery) with an uneventful operative course.
The patient and her family are of Jewish background. The patient’s daughter is her primary caregiver and has financial power-of-attorney, but it is not known whether she has formal power of attorney for personal care. Concerns have been raised to the ICU team about the possibility of elder abuse in the home by the patient’s daughter.
Unfortunately, on postoperative day 4, the patient develops delirium with respiratory failure secondary to hospital acquired pneumonia and pulmonary edema. (Fluid in the lungs) Her goals of care were not assessed pre-operatively. She is admitted to the ICU for non-invasive positive pressure ventilation for 48 hours, and then deteriorates and is intubated. After 48 hours of ventilation, it was determined that due to the severity of her underlying cardio-pulmonary status (COPD and aortic stenosis), ventilator weaning would be difficult and further ventilation would be futile.
The patient’s daughter is insistent on continuing all forms of life support, including mechanical ventilation and even extracorporeal membranous oxygenation (does the work of the lungs) if indicated. However, the Mrs Ruth’s delirium clears within the next 24 hours of intubation, and she is now competent, although still mechanically ventilated. She communicated to the ICU team that she preferred 1-way extubation (removal of the ventilator) and comfort care. This was communicated in writing to the ICU team, and was consistent over time with other care providers. The patient went as far to demand the extubation over the next hour, which was felt to be reasonable by the ICU team.
The patient’s daughter was informed of this decision, and stated that she could not come to the hospital for 2 hours, and in the meantime, that the patient must remain intubated.
At this point, the ICU team concurred with the patient’s wishes, and extubated her before her daughter was able to come to the hospital.
The daughter was angry at the team’s decision, and requested that the patient be re-intubated if she deteriorated. When the daughter arrived at the hospital, the patient and daughter were able to converse, and the patient then agreed to re-intubation if she deteriorated.
(1) What are the ethical issues emerging in this case? State why? (
KRISTINA)
(2) What decision model(s) would be ideal for application in this case? State your justification.
(Lacey Powell
)
(3) Who should make decisions in this situation? Should the ICU team have extubated the patient?
State if additional information was necessary for you to arrive at a better decision(s) in your case.
Chapter 19 Nursing Management of Pregnancy at Risk Pregnancy.docx
Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
Case 1
Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared
1. Why is Teresa’s pregnancy considered a high-risk pregnancy
Incorrect answer.
Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section.
Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor
IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing.
2. Discuss potential pregnancy-related complications for Teresa.
What else?
Some of the potential pregnancy –related complications for Teresa are late miscarriage, She is 26 weeks pregnant.. this is no longer a complication.
ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.
This is for IVF not the pregnancy
high blood pressure, pre-eclampsia, premature delivery, low birth weight,
birth defects, Fetal not maternal
and stress.
3. Discuss the potential risks to the babies.
You only discuss problems of prematurity.. what else?
The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis.
Case 2
Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)
1. Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.
this is a definition not a care plan
The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this c.
Group Project Assignment Legal Malpractice Case Description.docx
Group Project: Assignment Legal Malpractice Case Description
Outcomes addressed in this Assignment:
MN506-2:
Critique ethical-legal concepts, principles, and dilemmas related to the provision of health care.
The group will write a10–15-page APA formatted paper (title page and references list do not count towards the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must have minimum of eight references. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case.
Liability issues
Parties involved and who should be sued
Defenses of the parties
Standards of care
Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased
People Involved in Case:
Mrs. Wilma Carpenter — patient, deceased
Mr. Howard Carpenter — husband and plaintiff in wrongful death suit
Mrs. Scale, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
Richard Washington, MD — orthopedic surgeon
Judy Gouda, RN, NP
Joseph Alsoff, LPN — post-surgical unit nurse
Kelly Wheeler, RN — post-surgical unit nurse
David Casler, LRT
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
Caring Memorial Hospital
Facts:
The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.
The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse's assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.
Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.
The lice.
Recommended
59058785 case-study
homework help,online homework help,online tutors,online tutoring,research paper help,do my homework,
Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docx
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
Preoperative Incidental Detection & Anaesthetic Management of Valvular Heart ...
Surgical and Anaesthetic management of a patient with diseased heart is always challenging. Specially it sweats more when the issue is PREGNANCY. It demands skillful and sophisticated handling of the patient. Moreover, when the finding is incidental, a single break of concentration can be fatal.
A ) Society perspective90 year old female, Mrs. Ruth, from h.docx
A ) Society perspective
90 year old female, Mrs. Ruth, from home with her daughter, is admitted to hospital after sustaining a hip fracture. She has a history of chronic obstructive pulmonary disease on home oxygen and moderate to severe aortic stenosis. (Obstruction of blood flow through part of the heart) She undergoes urgent hemiarthroplasty (hip surgery) with an uneventful operative course.
The patient and her family are of Jewish background. The patient’s daughter is her primary caregiver and has financial power-of-attorney, but it is not known whether she has formal power of attorney for personal care. Concerns have been raised to the ICU team about the possibility of elder abuse in the home by the patient’s daughter.
Unfortunately, on postoperative day 4, the patient develops delirium with respiratory failure secondary to hospital acquired pneumonia and pulmonary edema. (Fluid in the lungs) Her goals of care were not assessed pre-operatively. She is admitted to the ICU for non-invasive positive pressure ventilation for 48 hours, and then deteriorates and is intubated. After 48 hours of ventilation, it was determined that due to the severity of her underlying cardio-pulmonary status (COPD and aortic stenosis), ventilator weaning would be difficult and further ventilation would be futile.
The patient’s daughter is insistent on continuing all forms of life support, including mechanical ventilation and even extracorporeal membranous oxygenation (does the work of the lungs) if indicated. However, the Mrs Ruth’s delirium clears within the next 24 hours of intubation, and she is now competent, although still mechanically ventilated. She communicated to the ICU team that she preferred 1-way extubation (removal of the ventilator) and comfort care. This was communicated in writing to the ICU team, and was consistent over time with other care providers. The patient went as far to demand the extubation over the next hour, which was felt to be reasonable by the ICU team.
The patient’s daughter was informed of this decision, and stated that she could not come to the hospital for 2 hours, and in the meantime, that the patient must remain intubated.
At this point, the ICU team concurred with the patient’s wishes, and extubated her before her daughter was able to come to the hospital.
The daughter was angry at the team’s decision, and requested that the patient be re-intubated if she deteriorated. When the daughter arrived at the hospital, the patient and daughter were able to converse, and the patient then agreed to re-intubation if she deteriorated.
(1) What are the ethical issues emerging in this case? State why? (
KRISTINA)
(2) What decision model(s) would be ideal for application in this case? State your justification.
(Lacey Powell
)
(3) Who should make decisions in this situation? Should the ICU team have extubated the patient?
State if additional information was necessary for you to arrive at a better decision(s) in your case.
Chapter 19 Nursing Management of Pregnancy at Risk Pregnancy.docx
Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
Case 1
Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared
1. Why is Teresa’s pregnancy considered a high-risk pregnancy
Incorrect answer.
Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section.
Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor
IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing.
2. Discuss potential pregnancy-related complications for Teresa.
What else?
Some of the potential pregnancy –related complications for Teresa are late miscarriage, She is 26 weeks pregnant.. this is no longer a complication.
ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.
This is for IVF not the pregnancy
high blood pressure, pre-eclampsia, premature delivery, low birth weight,
birth defects, Fetal not maternal
and stress.
3. Discuss the potential risks to the babies.
You only discuss problems of prematurity.. what else?
The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis.
Case 2
Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)
1. Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.
this is a definition not a care plan
The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this c.
Group Project Assignment Legal Malpractice Case Description.docx
Group Project: Assignment Legal Malpractice Case Description
Outcomes addressed in this Assignment:
MN506-2:
Critique ethical-legal concepts, principles, and dilemmas related to the provision of health care.
The group will write a10–15-page APA formatted paper (title page and references list do not count towards the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must have minimum of eight references. You may have an appendix that has samples of documents that support your positions or expands on the facts of the case.
Liability issues
Parties involved and who should be sued
Defenses of the parties
Standards of care
Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma Carpenter, Deceased
People Involved in Case:
Mrs. Wilma Carpenter — patient, deceased
Mr. Howard Carpenter — husband and plaintiff in wrongful death suit
Mrs. Scale, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
Richard Washington, MD — orthopedic surgeon
Judy Gouda, RN, NP
Joseph Alsoff, LPN — post-surgical unit nurse
Kelly Wheeler, RN — post-surgical unit nurse
David Casler, LRT
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
Caring Memorial Hospital
Facts:
The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.
The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse's assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.
Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.
The lice.
Chapter 19 Nursing Management of Pregnancy at Risk Pregnancy
Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
Case 1
Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared
1. Why is Teresa’s pregnancy considered a high-risk pregnancy
Incorrect answer.
Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section.
Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor
IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing.
2. Discuss potential pregnancy-related complications for Teresa.
What else?
Some of the potential pregnancy –related complications for Teresa are late miscarriage, She is 26 weeks pregnant.. this is no longer a complication.
ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.
This is for IVF not the pregnancy
high blood pressure, pre-eclampsia, premature delivery, low birth weight,
birth defects, Fetal not maternal
and stress.
3. Discuss the potential risks to the babies.
You only discuss problems of prematurity.. what else?
The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis.
Case 2
Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)
1. Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.
this is a definition not a care plan
The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this c ...
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Case#1A 24-year-old male graduate student without prior medical .docx
Case#1
A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder.
Qu.
For this homework assignment, you will continue coding for Reports 2.docx
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
MN506 Unit 7 Assignment Description You will constr.docx
MN506 Unit 7 Assignment
Description:
You will construct a group contract in Unit 2. In the contract, you will determine how your group will
communicate and share documents. Roles of the group will be delineated. You will work from Unit 3 to Unit 7
on a malpractice case.
There are two malpractice cases. Your instructor will assign your group either Case Study 1: Malpractice Action
brought by Yolanda Pinnelas or Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma
Carpenter, Deceased. The group will construct a 10–15-page paper about the legal constructs involved in one
of the cases.
Directions:
The group will write a10–15-page APA formatted paper (title page and references list do not count towards
the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must
have minimum of eight references. You may have an appendix that has samples of documents that support
your positions or expands on the facts of the case.
You will post a draft of the group paper in the Discussion Board of Unit 7. This will give you an opportunity to
get peer feedback and to learn from others.
You may use Goggle Hangouts™, SKYPE®, or other conferencing tools. Additionally, you may want to use a
document-sharing tool such as Google Drive®. The paper should discuss the following issues:
• Liability issues
• Parties involved and who should be sued
• Defenses of the parties
• Documents that the plaintiff’s side will ask for and how they will be used
• Standards of care
• Duty, breach, damages, and proximate cause
• Insurance issues
• Risk management issues before and after the incident
• Documentation and mandatory reporting
• Who should write the incident report and what should it say?
• The doctrine of Respondeat Superior and how it would apply the issues surrounding informed consent
Preparation for court of the parties.
Due: Day 7 by 11:59 p.m. (ET)
Case Study 1: Malpractice Action Brought by Yolanda Pinnelas
People involved in case:
Yolanda Pinnelas — patient
Betty DePalma, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
William Brady, M.D. — plastic surgeon
Mary Jones, RN — IV insertion
Carol Price, LPN
Jeffery Chambers, RN — staff nurse
Patricia Peters, PharmD — pharmacy
Diana Smith, RN
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
SAFE-INFUSE — pump
Brand X infusion — pump
Caring Memorial Hospital
Facts:
The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy.
Caring Memorial is a hospital in upstate New York. Yolanda was a student at Ithaca College and studying to be
a music conductor.
Yolanda was diagnosed with anal cancer and was to receive Mitomycin for her chemotherapy. Mary Jones, RN,
inserted the IV on the day shift around 1300, and the p ...
Child abuseProtestRally HandoutChild abuseI have written a p
Child abuse:Protest/Rally Handout
Child abuse
I have written a paper, which is about the Child Abuse, and it includes the following points:
• Child abuse.
• Physical Abuse.
• Sexual Violence.
• Negligence.
• Emotional Exploitation.
For this reason, I need a Protest/Rally Handout about my paper, which I wrote, and it has to be:
· 300 words minimum.
· Opening: headline.
· Action/Organization/Cause Introduction: two to three sentences maximum. Strong, direct writing.
· Bulleted list of statistics (with sources); quotes; and action needed. Practice parallelism by matching first words in bulleted list; use active verbs to introduce bulleted items, when possible; and, highlight necessary stats and quotes with bold and/or italics.
· Closing: Call to Action and ways to reach you/org.
Note: the Protest/Rally Handout should include all of the points which were included in my paper. Child abuse, Physical Abuse, Sexual Violence, Negligence and Emotional Exploitation.
Example
Protest/Rally has to be the same of this example.
SUBDOMAIN 734.3 ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP
Competencies: 734.3.1: Principles of Leadership The graduate applies principles of leadership to promote highquality
healthcare in a variety of settings through the application of sound leadership principles.
734.3.2: Interdisciplinary Collaboration The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
734.3.3: Quality and Patient Safety The graduate applies quality improvement processes intended to achieve optimal healthcare
outcomes, contributing to and supporting a culture of safety.
734.3.4: Healthcare Utilization and Finance The graduate analyzes financial implications related to healthcare delivery,
reimbursement, access, and national initiatives
Introduction:
Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any
sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a
failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the
hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67yearold patient, arrives at the sixroom emergency department (ED) of a sixtybed
rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe
pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR88 (regular), T98.6, R32, and his weight was
recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area ...
Child abuse protestrally handoutchild abusei have written a p
Child abuse protestrally handoutchild abusei have written a p
Case study of TOF
This is our first case study as a trainee in a hospital, its not the best case study hehe but try to keep it confidential
Explain in your own words why it is important to read a statistical .docx
Explain in your own words why it is important to read a statistical study carefully. Can you think of circumstance where it might be okay to misrepresent data?
Video Reflection 12 -
Do you think it is possible to create a study where there really is no bias sampling done? How would you manage to create one?
Video Reflection 13 -
What are your thoughts on statistics being misrepresented/ how does it make you feel? Why do you think the statistic are often presented in this way?
.
Explain how Matthew editedchanged Marks Gospel for each of the fol.docx
Explain how Matthew edited/changed Mark's Gospel for each of the following passages, and what reasons would he have had for doing that? What in Mk’s version was Mt trying to avoid – i.e., why he might have viewed Mk’s material as misleading, incorrect, or problematic? How did those changes contribute to Matthew’s overall message? How did that link up with other parts of Mt’s message?
Use both the following two sets of passages to support your claim, making use ONLY of the resources below, the Bible, textbooks and Module resources.
1. How did Matthew edit/change Mark 6:45-52 to produce Matthew 14:22-33 – and why?
2. How did Matthew edit/change Mark 9:2-10 to produce Matthew 17:1-13 – and why?
The paper should 350-750 words in length, double-spaced, and using MLA formatting for reference citations and bibliography. Submit the completed assignment to the appropriate Dropbox by
no later than Sunday 11:59 PM Eastern.
Resources for this paper:
See the ebook via SLU library:
New Testament History and Literature
by Martin (2012), pp. 83-88,105-108.
See the ebook via SLU library:
The Gospels
by Barton and Muddiman (2010), p. 53,56-57,102,109.
.
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Similar to Ethical Dilemma Case Stuy - A Jehovahs Witness refuses a blood tran.docx
Chapter 19 Nursing Management of Pregnancy at Risk Pregnancy
Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
Case 1
Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared
1. Why is Teresa’s pregnancy considered a high-risk pregnancy
Incorrect answer.
Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section.
Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor
IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing.
2. Discuss potential pregnancy-related complications for Teresa.
What else?
Some of the potential pregnancy –related complications for Teresa are late miscarriage, She is 26 weeks pregnant.. this is no longer a complication.
ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.
This is for IVF not the pregnancy
high blood pressure, pre-eclampsia, premature delivery, low birth weight,
birth defects, Fetal not maternal
and stress.
3. Discuss the potential risks to the babies.
You only discuss problems of prematurity.. what else?
The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis.
Case 2
Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)
1. Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.
this is a definition not a care plan
The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this c ...
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Case#1A 24-year-old male graduate student without prior medical .docx
Case#1
A 24-year-old male graduate student without prior medical or psychiatric history is reported by his mother to have been very anxious over the past 6 months, with increasing concern that people are watching him. He now claims to “hearing voices,” telling him what must be done to “ fix the country.” Important workup ? thyroid-stimulating hormone TSH, rapid plasma reagain (RPR), and brain imaging.
Questions:
1. What is the diagnosis of this patient?
2. What is the age onset of this disorder?
3. What socioeconomic group suffers from this disorder?
4. What is the subtype of this disorder in this patient ?
5. List five positive and negative symptoms that we can find in schizophrenia disorder>
6. What is the treatment?
7. What are five characteristics associated with better prognosis?
Case#2
Ms. Torrez is a 17-year-old Caucasian woman without prior psychiatric history who is brought to the Emergency room by ambulance after her parents called 911 when they found her having a seizure in their living room. She was admitted to the medical intensive care units in status epilepticus and was quickly stabilized with intramuscular lorazepam and fosphenytoin loading. Her heigh is 5 feet 6 inches, she is of medium build, and her weight is 101 lbs. (BMI16.3kg/m2). She does not suffer any medical conditions, and this is her first seizure. Laboratory workup shows an electrolyte imbalance as the most likely cause of the seizures. Although initially reluctant, she admits to purging with the use of ipecac several times this week. She reports that although she normally restricts her daily caloric intake to 500 calories, she regularly induces vomiting if her weight is above 100 lbs. Her last menstrual cycle was 1 year ago. Psychiatric consultation is requested in order to confirm the diagnosis
The on-call psychiatry notes in Terry’s chart
Patient appears underweight and younger than her stated age. She is mild distress, has a nasogastric tube in place, and exhibits poor eye contact. She reports feeling “sad” and admitted to experiencing constant preoccupation about her physical appearance and says, “I am fat; I hate my body.” She also reports insomnia, low energy levels, and history of self-harm behavior by cutting her forearms. She reports that she is careful hiding her symptoms from her parents, whom she describes as strict disciplinarians. She also expresses concerns that she will disappoint them.
Ms. Torrez’ parents describe her as a perfectionist. They say that she is involve in multiple school activities, takes advanced placement classes, and has been recently concerned about being accepted at her college of choice. They report that she maintains a 4.0 grade point average in high school, and they are expecting her to become a lawyer. Her parents have noticed that she is underweight and rarely see her eat but attributed this to stress from her many academic pursuits. Ms. Torrez’ mom was diagnosed with obsessive-compulsive disorder.
Qu.
For this homework assignment, you will continue coding for Reports 2.docx
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
MN506 Unit 7 Assignment Description You will constr.docx
MN506 Unit 7 Assignment
Description:
You will construct a group contract in Unit 2. In the contract, you will determine how your group will
communicate and share documents. Roles of the group will be delineated. You will work from Unit 3 to Unit 7
on a malpractice case.
There are two malpractice cases. Your instructor will assign your group either Case Study 1: Malpractice Action
brought by Yolanda Pinnelas or Case Study 2: Wrongful Death by Howard Carpenter on Behalf of Wilma
Carpenter, Deceased. The group will construct a 10–15-page paper about the legal constructs involved in one
of the cases.
Directions:
The group will write a10–15-page APA formatted paper (title page and references list do not count towards
the 10–15 pages). Support the paper with peer reviewed articles and case law where applicable. You must
have minimum of eight references. You may have an appendix that has samples of documents that support
your positions or expands on the facts of the case.
You will post a draft of the group paper in the Discussion Board of Unit 7. This will give you an opportunity to
get peer feedback and to learn from others.
You may use Goggle Hangouts™, SKYPE®, or other conferencing tools. Additionally, you may want to use a
document-sharing tool such as Google Drive®. The paper should discuss the following issues:
• Liability issues
• Parties involved and who should be sued
• Defenses of the parties
• Documents that the plaintiff’s side will ask for and how they will be used
• Standards of care
• Duty, breach, damages, and proximate cause
• Insurance issues
• Risk management issues before and after the incident
• Documentation and mandatory reporting
• Who should write the incident report and what should it say?
• The doctrine of Respondeat Superior and how it would apply the issues surrounding informed consent
Preparation for court of the parties.
Due: Day 7 by 11:59 p.m. (ET)
Case Study 1: Malpractice Action Brought by Yolanda Pinnelas
People involved in case:
Yolanda Pinnelas — patient
Betty DePalma, RN, MS — nursing supervisor
Elizabeth Adelman, RN — recovery room nurse
William Brady, M.D. — plastic surgeon
Mary Jones, RN — IV insertion
Carol Price, LPN
Jeffery Chambers, RN — staff nurse
Patricia Peters, PharmD — pharmacy
Diana Smith, RN
Susan Post, JD — risk manager
Amy Green — quality assurance
Michael Parks, RN, MS, CNS — education coordinator
SAFE-INFUSE — pump
Brand X infusion — pump
Caring Memorial Hospital
Facts:
The patient, Yolanda Pinellas, is a 21-year-old female admitted to Caring Memorial Hospital for chemotherapy.
Caring Memorial is a hospital in upstate New York. Yolanda was a student at Ithaca College and studying to be
a music conductor.
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inserted the IV on the day shift around 1300, and the p ...
Child abuseProtestRally HandoutChild abuseI have written a p
Child abuse:Protest/Rally Handout
Child abuse
I have written a paper, which is about the Child Abuse, and it includes the following points:
• Child abuse.
• Physical Abuse.
• Sexual Violence.
• Negligence.
• Emotional Exploitation.
For this reason, I need a Protest/Rally Handout about my paper, which I wrote, and it has to be:
· 300 words minimum.
· Opening: headline.
· Action/Organization/Cause Introduction: two to three sentences maximum. Strong, direct writing.
· Bulleted list of statistics (with sources); quotes; and action needed. Practice parallelism by matching first words in bulleted list; use active verbs to introduce bulleted items, when possible; and, highlight necessary stats and quotes with bold and/or italics.
· Closing: Call to Action and ways to reach you/org.
Note: the Protest/Rally Handout should include all of the points which were included in my paper. Child abuse, Physical Abuse, Sexual Violence, Negligence and Emotional Exploitation.
Example
Protest/Rally has to be the same of this example.
SUBDOMAIN 734.3 ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP
Competencies: 734.3.1: Principles of Leadership The graduate applies principles of leadership to promote highquality
healthcare in a variety of settings through the application of sound leadership principles.
734.3.2: Interdisciplinary Collaboration The graduate applies theoretical principles necessary for effective participation in an
interdisciplinary team.
734.3.3: Quality and Patient Safety The graduate applies quality improvement processes intended to achieve optimal healthcare
outcomes, contributing to and supporting a culture of safety.
734.3.4: Healthcare Utilization and Finance The graduate analyzes financial implications related to healthcare delivery,
reimbursement, access, and national initiatives
Introduction:
Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any
sentinel event such as the one described below. Once the cause is identified and a plan of action established, it is useful to conduct a
failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the
hospital described in this scenario, you have been selected as a member of the team investigating the incident.
Scenario:
It is 3:30 p.m. on a Thursday and Mr. B, a 67yearold patient, arrives at the sixroom emergency department (ED) of a sixtybed
rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe
pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.
Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR88 (regular), T98.6, R32, and his weight was
recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area ...
Child abuse protestrally handoutchild abusei have written a p
Child abuse protestrally handoutchild abusei have written a p
Case study of TOF
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1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
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MN506 Unit 7 Assignment Description You will constr.docx
MN506 Unit 7 Assignment Description You will constr.docx
Child abuseProtestRally HandoutChild abuseI have written a p
Child abuseProtestRally HandoutChild abuseI have written a p
Child abuse protestrally handoutchild abusei have written a p
Child abuse protestrally handoutchild abusei have written a p
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Invitations
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Experimental Design Assignment
You were given an
Aedes
aegypti
gene of unknown function. Using Blast you were able to find the homologs of your gene. You have done research regarding the function of the homologs. Using this information:
A.Construct
a hypothesis
Give a hypothesis on the function of your gene SHAKER is in Aedesaegypti.
B.Design
an experiment to test your hypothesis.
Include a
labeled
sketch and written summary of experiment. (
include drawing of all conditions
, negative/positive etc)
C. Variables
List the Dependent and Independent
List Control variable
List a Positive and /or Negative controls
D.
Create a
data
set
and figure
Create a graph that clearly conveys to the reader what your experiment is about.
F.Interpretation
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G.Self-critique
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Why might your conclusion be wrong, what other questions do you have.
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Expand
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Select
at least three interactive features that could be added to your site.
Identify
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What purpose would each feature serve for your site and its visitors?
How would you construct these features?
Note
: The form created in the next individual activity, "Individual: Refine and Finalize Website" can be included as one of the interactive features.
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Exercise 7 Use el pronombre y la forma correcta del verbo._.docx
Exercise 7: Use el pronombre y la forma correcta del verbo.
____________________________
gustar faltar quedar molestar
encantar fascinar interesar
____________________________
1. A mi ______ __________ la poesía romántica.
2. A nosotros ______ ________ estudiar lenguas extranjeras.
3. A las muchachas ______ _______ la música de Julio Iglesias.
4. A Juan y a Ramón ______ ___________ practicar los deportes.
5. A ti no _____ _________ el café.
6. A la profesora no ______ ________ preparar los exámenes.
7. Al consejero _____ ____________ los estudiantes.
8. A los atletas ____ ___________ el gimnasio.
9. Tenemos $500 y pagamos $350 por la matricula. ___ ___________ $150.
10. A los doctores ____ ________ la medicina.
11. A nosotros ____ ________ las pizzas.
12. A ellos ____ __________ la violencia.
13. En la Argentina bailan mucho. A ellos ____ ______ el tango.
14. Nosotros deseamos buscar el vocabulario. ____ __________ un diccionario.
15. Uds. desean llamar a los amigos. ____ ________ un teléfono.
16. A los estudiantes ________ ________ las vacaciones.
17. A mí ________ _________ los actores.
18. A Ud. _________ ____________ solamente diez dólares.
19. A Alberto y a Juan _______ ____________ el béisbol.
20. A ti _______ ____________ trabajar.
21. A Marisa _____ _____________ la música popular.
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Exercise 21-8 (Part Level Submission)The following facts pertain.docx
Exercise 21-8 (Part Level Submission)
The following facts pertain to a noncancelable lease agreement between Windsor Leasing Company and Sheridan Company, a lessee.
Inception date:
May 1, 2017
Annual lease payment due at the beginning of
each year, beginning with May 1, 2017
$21,737.01
Bargain-purchase option price at end of lease term
$3,800
Lease term
5
years
Economic life of leased equipment
10
years
Lessor’s cost
$68,000
Fair value of asset at May 1, 2017
$93,000
Lessor’s implicit rate
10
%
Lessee’s incremental borrowing rate
10
%
The collectibility of the lease payments is reasonably predictable, and there are no important uncertainties surrounding the costs yet to be incurred by the lessor. The lessee assumes responsibility for all executory costs.
Click here to view factor tables
(c)
Your answer is partially correct. Try again.
Prepare a lease amortization schedule for Sheridan Company for the 5-year lease term.
(Round present value factor calculations to 5 decimal places, e.g. 1.25125 and Round answers to 2 decimal places, e.g. 15.25.)
SHERIDAN COMPANY (Lessee)
Lease Amortization Schedule
Date
Annual Lease Payment Plus
BPO
Interest on
Liability
Reduction of Lease
Liability
Lease Liability
5/1/17
$
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record depreciation.)
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record interest.)
1/1/18
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record second payament.)
Question 27
Pearl Corporation manufactures replicators. On January 1, 2017, it leased to Althaus Company a replicator that had cost $100,000 to manufacture. The lease agreement covers the 5-year useful life of the replicator and requires 5 equal annual rentals of $40,200 payable each January 1, beginning January 1, 2017. An interest rate of 12% is implicit in the lease agreement. Collectibility of the rentals is reasonably assured, and there are no important uncertainties concerning costs.
Prepare Pearl’s January 1, 2017, journal entries.
(Credit account titles are automatically indented when amount is entered. Do not indent manually. If no entry is required, select "No Entry" for the account titles and enter 0 for the amounts. Round present value factor calculations to 5 decimal places, e.g. 1.25124 and the final answer to 0 decimal places e.g. 58,971
.
)
Click here to view factor tables
Date
Account Titles and Explanation
Debit
Credit
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record the lease.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record cost.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record first lease payment.)
6 years ago
16.01.2017
8
Report Issue
Answer
(
0
)
Bids
(
0
)
other Questions
(
10
)
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Ethical Dilemma Case Stuy - A Jehovahs Witness refuses a blood tran.docx
- 1. Ethical Dilemma Case Stuy - A Jehovah's Witness refuses a blood transfusion Submit Assignment Due Friday by 11:59pm Points 50 Submitting a file upload Objective Demonstrate understanding of professional and ethical responsibility Demonstrate critical thinking in the application of ethical principles to ethical decision making when presented with an ethical dilemma. Instructions Answer the questions at the end of this case study. Write a paper that is 3 to 6 pages in length, created using APA format. Use 1-inch margins, double spaced text, 12-point font, and Times New Roma font. Include a reference page with a minimum of 3 relevant citations or quotations. Create a cover page with student name, title of the course, title of assignment, date, and name/title of instructor.
- 2. Submit your paper response to the assignment box on or before the due date. Late responses will not be accepted. Refer to the grading rubric provided for this assignment Case Study "Juana" (fictitious name) a 20-year-old, Black Hispanic female, 32 weeks pregnant, was brought to the emergency department (ED) by the paramedics. She arrived in the ED immobilized on a flat board with a hard cervical collar in place. Juana was the driver of a sedan involved in a single-vehicle collision. She stated she was driving at approximately 60 miles per hour on the highway and suddenly lost control of the vehicle and crashed into a light pole. She also stated her head hit the windshield and shattered the glass. She denied loss of consciousness. Upon her arrival in the ED, Juana was alert and oriented to person, place, and time and had a Glasgow Coma Scale of 15/15. Her initial complaints were lightheadedness, weakness, left shoulder pain, and severe abdominal cramping that started immediately following the car accident. She had a past medical history of sickle cell disease and no previous pregnancies. Her lungs were clear bilaterally. Juana's heart rate was 90 beats per minute (bpm), her respiratory rate was 28, and her initial blood pressure (BP) was 130/80, and fetal pulse rate was 90. Once the cervical spine films were taken and the flat board was removed, her BP reflected orthostatic changes of 100/60 and pulse of 120 bpm. Juana was placed on a 100% nonrebreather mask. Peripheral intravenous lines were started bilaterally to replace fluid loss that was indicated by the change in vital signs. It was suspected that she was bleeding internally into her thoracic or abdominal cavity. Blood specimens were drawn and sent to the laboratory. A hemoglobin of 6 g/dl and hematocrit of 21% indicated internal bleeding. Ultrasound showed blood in the amniotic cavity and Doppler confirmed a fetal heart rate of 90 bpm indicating fetal distress. The patient was informed by the medical team of the critical nature of her condition.
- 3. The plan of care for her was an immediate blood transfusion and an emergency cesarean section. Matters became complicated when Juana informed the medical team that she was a Jehovah's Witness and refused the proposed plan of care. The physician then recommended the use of alternative blood products. Juana insisted that this was also against her religion and she refused the alternative treatments being offered. The medical team advised her that Jehovah's Witnesses could choose certain blood byproducts, such as albumin, cryoprecipitate, and globulin (Watchtower Bible and Tract Society, 2004). According to Juana and her husband, both believed that if she accepted the blood transfusion or blood products she would no longer be a Jehovah's Witness and would be condemned to hell. The husband then presented the physician with Juana's blood card, created by the Watchtower Bible and Tract Society, the governing organization of Jehovah's Witnesses. The card stated her advance directives, including the prohibition of blood and blood products. Juana's condition worsened within 2 hours of admission to the ED. She went into labor and delivered a stillborn baby boy. She was immediately transferred to the intensive care unit where, despite continued aggressive attempts to stabilize her, she went into cardiac arrest and died. Questions What is the ethical/legal dilemma presented in this case? Do you support/oppose Juana's decision to refuse the blood transfusion? What ethical principles are involved in this case? What are the obligations or duties involved in this case? What are the consequences of each possible action? What are the proper ethical actions? Support your arguments. What can you do to assist the patient and family during this difficult time? Rubric
- 4. Ethical Dilemma Jehovah's Witness refuses blood transfusion Ethical Dilemma Jehovah's Witness refuses blood transfusion Criteria Ratings Pts This criterion is linked to a Learning Outcome Defines the ethical dilemma Excellent 20.0 pts Good 16.0 pts Needs improvement 12.0 pts Unacceptable 0.0 pts 20.0 pts This criterion is linked to a Learning Outcome Identifies stakeholders Excellent 10.0 pts Good 6.0 pts Needs improvement 4.0 pts Unacceptable 0.0 pts 10.0
- 5. pts This criterion is linked to a Learning Outcome Identifies solutions or alternatives Excellent 25.0 pts Good 15.0 pts Needs improvement 10.0 pts Unacceptable 0.0 pts 25.0 pts This criterion is linked to a Learning Outcome Compares and evaluates the ethical arguments Excellent 20.0 pts Good 12.0 pts Needs improvement 8.0 pts Unacceptable 0.0 pts 20.0 pts This criterion is linked to a Learning Outcome Problem solving, critical thining Excellent
- 6. 20.0 pts Good 12.0 pts Needs improvement 8.0 pts Unacceptable 0.0 pts 20.0 pts This criterion is linked to a Learning Outcome APA format Excellent