Intracranial Regulation Case Study Mr James Hobson is a 69.pdf
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Intracranial Regulation Case Study Mr. James Hobson is a 69-year-old male with a history of hypertension that is well controlled on medication. He has been smoking 1 or 2 packs of cigarettes a day for the past 52 years and has a body mass index of 37.3. He awoke yesterday morning complaining of blurry vision and some weakness on the left side of his body. He thought he had just slept wrong, so he was not concerned. Later in the morning he was having trouble walking and his wife convinced him to call his physician. The physician's office called 911, and Mr. Hobson was transported to the nearest hospital. Upon arrival to the emergency department the physical etam findings were- HR 112 beats/min, BP 172/90 mm Hg, RR 24 breaths/min, O2 Sat 90%, leg arm and leg weakness (3/5), and somewhat decreased sensation. He was awake and responding to questions appropriately, though slowly. The following diagnostics tests were ordered: noncontract CT (NCCT) of the head; ECG; CBC with platelets, cardiac enzymes, and troponin; electrolytes; BUN; creatinine; glucose; PT/INR; and PTT. This patient's CT scan did not show any signs of hemorrhage. Note: Currently, thrombolytics are administered to treat an ischemic stroke within 3 hours of symptom onset. Studies are underway to evaluate the safety and efficacy of extending this window to 4 hours. Because it was unclear exactly when the symptoms began, the decision was made not to administer a thrombolytic. Question: Discuss the nursing assessments for Mr. Hobson..
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ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITALThe followi.docx
ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITAL
The following information should be included daily as it applies to your patient.
Demographic DataDate of AdmissionVital Signs
39 y/o African American male
10/28/18
BP: 115/60. Pain: 2
P: 91
T: 98.2.
RR: 22
SP02: 95
Significant Past Medical HistoryAllergies/Reactions
HTN, Hyperlipemia, Diabetes
NKA
Reason for Hospitalization and Current Diagnosis
Current Diagnosis: Acute Embolic Stroke, Cerebral Edema, R Hemiparesis, Pneumonia
Reason for hospitalization: 38 y/o male with a history of HTN presented with onset Right Sided Weakness and confusion at 11pm on 10-27-18 when he went to sleep. He woke up at 3am and he was talking gibberish to his fiancé. He went back to sleep and 2 hours later his symptoms had worsened. On 10-28-18, EMS was called by his fiancé and he was taken to the ER. His fiancé said he had taken “something” possibly cocaine. Patient was diagnosed with Acute Embolic Stroke, Cerebral Edema, R Hemiparesis and recently Pnuemonia.
Describe thepathophysiologyincluding signs, symptoms and incidence; and compare with patient findings:
· Acute Embolic Stroke:
Pathophysiology: Occurs when a blood clot that forms somewhere elsewhere in the body breaks loose and then travels to the brain through the bloodstream. The clot can lodge in an artery and blocks the flow of blood.
Common symptoms:Difficulty speaking or understanding words, numbness and tingling, temporary paralysis, blurred vision or blindness, slurred speech, dizziness, feeling faint, difficulty swallowing, nausea, sleepiness. Embolic stroke doesn’t cause any unique symptoms
Muscular symptoms: Difficulty with coordination, stiff muscles, feelings of weakness on one side or all of the body.
Cognitive symptoms: Mental confusion, an altered level of consciousness, visual agnosia
Patient Findings: Patient presented with R hemiparesis, facial drooping, slurred speech, difficulty swallowing.
· Cerebral Edema
Pathophysiology: It’s a life threatening condition that causes fluid to develop in the brain.
This fluid increases the pressure inside of the skull causing intracranial pressure (ICP). Increased ICP can reduce brain blood flow and decrease the oxygen your brain receives. The brain needs an uninterrupted flow of oxygen to function properly.
Symptoms: Headache, dizziness, nausea, lack of coordination, numbness, mood changes, memory loss, difficulty speaking, incontinence, change in consciousness, seizures, weakness in extremities
Patient Findings: Patient presented with difficulty speaking, incontinence, change in consciousness, weakness in extremities
· Hemiparesis
Pathophysiology: Hemiparesis is weakness on one side of the body. One side can still move but with reduced muscular strength.
Symptoms: Difficulty walking, standing, and maintaining your balance. You may also have numbness or tingling on your weaker side.
Patient findings: Patient has right sided weakness.
· Pneumonia
.
Parkinsons disease Fi.docx
Parkinson's
disease
Final presentation:
Laboratory for Diagnosis, Symptom and \
Illness Management.
1
Yisel Castro
Lianne Blanco
Patient information
Name: Luis Morel
Age: 62 years
Gender: Male
RACE: HISPANIC
MARITAL Status: Married
Medication Intolerance: Denied
Allergies: Seafood.
Chronic Illnesses/Major traumas: Controlled Hypertension
Hospitalizations/Surgeries: Inguinal Hernia (2 years ago).
Immunization: Updated (PCV13, Influenza, RZV,).
Hospitalizations/Surgeries: Denied
2
Epidemiology of Parkinson Disease
First symptoms appear usually after age of 40 years but have been reported cases in children’s and is called Juvenile Parkinsonism.
Aged 50 years and over are affected in 1 %, this number increased in 10 % in person 60 years and over about 1½ times more common in men than in women.
The causes of Parkinson's disease (PD), the second most common neurodegenerative disorder, are still largely unknown. Current thinking is that major gene mutations cause only a small proportion of all cases and that in most cases, non-genetic factors play a part, probably in interaction with susceptibility genes. Numerous epidemiological studies have been done to identify such non-genetic risk factors, but most were small and methodologically limited. Larger, well-designed prospective cohort studies have only recently reached a stage at which they have enough incident patients and person-years of follow-up to investigate possible risk factors and their interactions.
3
Etiology
Primary (idiopathic- most common):
unknown origin but not induced by obvious stimulus.
Secondary (parkinsonism): related to drugs, stroke, or trauma, other stimuli
Familial: Genetics related, are included 20 % of the existing cases diagnosed
4
Risk Factors
Heredity.
Age. (60 or older)
Sex.
Autoimmune factors
Exposure to toxins
5
Thinking difficulties
Depression and emotional changes
Swallowing problems
Chewing and eating problems
Sleep problems and sleep disorders
Bladder problems
Constipation
Blood pressure changes
Smell dysfunction
Sexual dysfunction
fatigue
Associated conditions
6
PATIENT history
Patient is 62 years old, male, Hispanic descendent, recently discharged from US Army after 25 years of service. He is today looking for medical advice after has been notice a little resting tremor in both hands more marked in right hand, also noted slow motion in some movement mainly with changes of position and some incoordination when he walks. He is concerned because his paternal Grandfather died after suffering for many years with Parkinson’ s disease related disabilities, his father died at 43 years old in a motor vehicle accident and no time to development the disease and he hears that Parkinson’s Disease has some genetics implication. His medical history is only remarkable for a 10 years history of well cont.
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light-headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduates married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crep.
Cardiovascular systemA 70 year old black American female who.docx
Cardiovascular system
A 70 year old black American female who has the following
preexisting conditions
;
Hypertension (HTN): longterm
Heart failure (CHF) : 2 months
Coronary artery disease (CAD) : longterm
Myocardial infarction (MI) : five years ago
Ejection (EF) of 55% : 2 months ago
Socioeconomic data:
Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker
Pharmacologic data:
Aspirin (acetylsalicylic acid, ASA)
Clopidogrel bisulfate (Plavix)
Lisinopril (Prinivil, Zestril)
Carvedilol (Coreg)
Furosemide (Lasix)
Potassium chloride (KCL)
Client Profile:
70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.
Assessment:
At the office the following subjective and objective data was supplied:
“I noticed my legs were getting a bit bigger and they are achy, too.”
She has gained 10 pounds over the last 5 days.
She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath.
Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds.
She denies any chest, arm, or jaw pain or nausea.
She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint.
She admits only to feeling a little more tired than usual.
Eats Southern Cooking when at home.
Vital signs :
T= 97.6 F (36.4C), BP 140/70, P 93, R 22.
Labs ordered:
complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.
Questions
1. Which assessment findings during this visit are consistent with heart failure?
2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?
3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.
5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.
6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patie.
NEUROLOGICAL DISORDERS DUE TO METABOLIC DERANGEMENTS
Metabolic and endocrine disorders can present with neurological signs and symptoms. It is important to recognise them so that can be promptly treated. Majority of symptoms fully reverse if treatment is started on time. This presentation looks at some common metabolic/endocrine disorders with neurological manifestations. The description is in the form of case series.
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ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITALThe followi.docx
ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITAL
The following information should be included daily as it applies to your patient.
Demographic DataDate of AdmissionVital Signs
39 y/o African American male
10/28/18
BP: 115/60. Pain: 2
P: 91
T: 98.2.
RR: 22
SP02: 95
Significant Past Medical HistoryAllergies/Reactions
HTN, Hyperlipemia, Diabetes
NKA
Reason for Hospitalization and Current Diagnosis
Current Diagnosis: Acute Embolic Stroke, Cerebral Edema, R Hemiparesis, Pneumonia
Reason for hospitalization: 38 y/o male with a history of HTN presented with onset Right Sided Weakness and confusion at 11pm on 10-27-18 when he went to sleep. He woke up at 3am and he was talking gibberish to his fiancé. He went back to sleep and 2 hours later his symptoms had worsened. On 10-28-18, EMS was called by his fiancé and he was taken to the ER. His fiancé said he had taken “something” possibly cocaine. Patient was diagnosed with Acute Embolic Stroke, Cerebral Edema, R Hemiparesis and recently Pnuemonia.
Describe thepathophysiologyincluding signs, symptoms and incidence; and compare with patient findings:
· Acute Embolic Stroke:
Pathophysiology: Occurs when a blood clot that forms somewhere elsewhere in the body breaks loose and then travels to the brain through the bloodstream. The clot can lodge in an artery and blocks the flow of blood.
Common symptoms:Difficulty speaking or understanding words, numbness and tingling, temporary paralysis, blurred vision or blindness, slurred speech, dizziness, feeling faint, difficulty swallowing, nausea, sleepiness. Embolic stroke doesn’t cause any unique symptoms
Muscular symptoms: Difficulty with coordination, stiff muscles, feelings of weakness on one side or all of the body.
Cognitive symptoms: Mental confusion, an altered level of consciousness, visual agnosia
Patient Findings: Patient presented with R hemiparesis, facial drooping, slurred speech, difficulty swallowing.
· Cerebral Edema
Pathophysiology: It’s a life threatening condition that causes fluid to develop in the brain.
This fluid increases the pressure inside of the skull causing intracranial pressure (ICP). Increased ICP can reduce brain blood flow and decrease the oxygen your brain receives. The brain needs an uninterrupted flow of oxygen to function properly.
Symptoms: Headache, dizziness, nausea, lack of coordination, numbness, mood changes, memory loss, difficulty speaking, incontinence, change in consciousness, seizures, weakness in extremities
Patient Findings: Patient presented with difficulty speaking, incontinence, change in consciousness, weakness in extremities
· Hemiparesis
Pathophysiology: Hemiparesis is weakness on one side of the body. One side can still move but with reduced muscular strength.
Symptoms: Difficulty walking, standing, and maintaining your balance. You may also have numbness or tingling on your weaker side.
Patient findings: Patient has right sided weakness.
· Pneumonia
.
Parkinsons disease Fi.docx
Parkinson's
disease
Final presentation:
Laboratory for Diagnosis, Symptom and \
Illness Management.
1
Yisel Castro
Lianne Blanco
Patient information
Name: Luis Morel
Age: 62 years
Gender: Male
RACE: HISPANIC
MARITAL Status: Married
Medication Intolerance: Denied
Allergies: Seafood.
Chronic Illnesses/Major traumas: Controlled Hypertension
Hospitalizations/Surgeries: Inguinal Hernia (2 years ago).
Immunization: Updated (PCV13, Influenza, RZV,).
Hospitalizations/Surgeries: Denied
2
Epidemiology of Parkinson Disease
First symptoms appear usually after age of 40 years but have been reported cases in children’s and is called Juvenile Parkinsonism.
Aged 50 years and over are affected in 1 %, this number increased in 10 % in person 60 years and over about 1½ times more common in men than in women.
The causes of Parkinson's disease (PD), the second most common neurodegenerative disorder, are still largely unknown. Current thinking is that major gene mutations cause only a small proportion of all cases and that in most cases, non-genetic factors play a part, probably in interaction with susceptibility genes. Numerous epidemiological studies have been done to identify such non-genetic risk factors, but most were small and methodologically limited. Larger, well-designed prospective cohort studies have only recently reached a stage at which they have enough incident patients and person-years of follow-up to investigate possible risk factors and their interactions.
3
Etiology
Primary (idiopathic- most common):
unknown origin but not induced by obvious stimulus.
Secondary (parkinsonism): related to drugs, stroke, or trauma, other stimuli
Familial: Genetics related, are included 20 % of the existing cases diagnosed
4
Risk Factors
Heredity.
Age. (60 or older)
Sex.
Autoimmune factors
Exposure to toxins
5
Thinking difficulties
Depression and emotional changes
Swallowing problems
Chewing and eating problems
Sleep problems and sleep disorders
Bladder problems
Constipation
Blood pressure changes
Smell dysfunction
Sexual dysfunction
fatigue
Associated conditions
6
PATIENT history
Patient is 62 years old, male, Hispanic descendent, recently discharged from US Army after 25 years of service. He is today looking for medical advice after has been notice a little resting tremor in both hands more marked in right hand, also noted slow motion in some movement mainly with changes of position and some incoordination when he walks. He is concerned because his paternal Grandfather died after suffering for many years with Parkinson’ s disease related disabilities, his father died at 43 years old in a motor vehicle accident and no time to development the disease and he hears that Parkinson’s Disease has some genetics implication. His medical history is only remarkable for a 10 years history of well cont.
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light-headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduates married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crep.
Cardiovascular systemA 70 year old black American female who.docx
Cardiovascular system
A 70 year old black American female who has the following
preexisting conditions
;
Hypertension (HTN): longterm
Heart failure (CHF) : 2 months
Coronary artery disease (CAD) : longterm
Myocardial infarction (MI) : five years ago
Ejection (EF) of 55% : 2 months ago
Socioeconomic data:
Widow, Lives alone, independent ADL’s, Nonsmoker, Nondrinker
Pharmacologic data:
Aspirin (acetylsalicylic acid, ASA)
Clopidogrel bisulfate (Plavix)
Lisinopril (Prinivil, Zestril)
Carvedilol (Coreg)
Furosemide (Lasix)
Potassium chloride (KCL)
Client Profile:
70 year old woman originally from Alabama. She lives alone and is able to manage herself independently. She is active in her community and church. Diagnosed with heart failure 2 months age and is followed up at home with a visiting nurse every other week for to assist is managing her heart failure symptoms. She is being referred to the nurse practitioner for follow up of changes in her symptoms.
Assessment:
At the office the following subjective and objective data was supplied:
“I noticed my legs were getting a bit bigger and they are achy, too.”
She has gained 10 pounds over the last 5 days.
She gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down to catch her breath.
Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds.
She denies any chest, arm, or jaw pain or nausea.
She denies any back pain, stomach pain, confusion, dizziness, or a feeling faint.
She admits only to feeling a little more tired than usual.
Eats Southern Cooking when at home.
Vital signs :
T= 97.6 F (36.4C), BP 140/70, P 93, R 22.
Labs ordered:
complete blood count (CBC), basic metabolic panel (BMP), brain natriuretic peptide (B-type natriuretic peptide assay or BNP), troponin, creatine kinase (CPK), creatine kinase-MB (CKMB), and albumin. The APN also prescribes oral (PO) Furosemide and arranges an outpatient electrocardiogram (ECG, EKG), chest X-ray, and echocardiogram.
Questions
1. Which assessment findings during this visit are consistent with heart failure?
2. Why did the APN ask about back pain, stomach pain, confusion, dizziness or a feeling that she might faint?
3. Explain what the following terms indicate and include the normal values: cardiac output, stroke volume, afterload, preload, ejection fraction and central venous pressure. Is an ejection fraction of 55% significant. Provide rationale.
5. Discuss the body’s compensatory mechanisms during hear failure. Include an explanation of the Frank-Starling law in your discussion.
6. Heart failure can be classified as left or right ventricular failure, systolic versus diastolic, according to the New York Heart Association (NYHA) and using the ACC/AHA (American Heart Association) guidelines. Explain these four classification systems and the signs and symptoms that characterize each. Which Classification fits this patie.
NEUROLOGICAL DISORDERS DUE TO METABOLIC DERANGEMENTS
Metabolic and endocrine disorders can present with neurological signs and symptoms. It is important to recognise them so that can be promptly treated. Majority of symptoms fully reverse if treatment is started on time. This presentation looks at some common metabolic/endocrine disorders with neurological manifestations. The description is in the form of case series.
Similar to Intracranial Regulation Case Study Mr James Hobson is a 69.pdf (20)
ASSESSMENT AND PLANNING GUIDE FOR USE IN THE HOSPITALThe followi.docx
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Case StudyChief complaint I’m here for a medication refi.docx
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Cardiovascular systemA 70 year old black American female who.docx
NEUROLOGICAL DISORDERS DUE TO METABOLIC DERANGEMENTS
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gelato at Giovanni's is so delightful that customers are willing to wait regardless of how long the
line is. The interarrival and service times are distributed as shown in the table. The stream of
random numbers for a Monte Carlo simulation appears in this table: Giovanni sells his gelato at a
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Dr Rogers is a new general practitioner at Pritter City Hos.pdf
Dr. Rogers is a new general practitioner at Pritter City Hospital, with a
specialty in geriatric care. On October 15, he has a scheduled
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little late and on entry to the examination room greets Ethel, and then
scans the patients medical history but does not notice that the Ethel
Mertz in the record is 27 years old and has an address in another
city. He chats with Ethel and examines her. He has some problems in
communicating with her because of her dementia and the
examination takes much longer than the 20 minutes allocated on his
schedule. The nursing assistant has limited English and cannot
provide much information on Ethels condition.
He notes that she has a serious eye infection and decides to
prescribe Norfloxacin The physician order entry software provides the
capability for default self-selection of medications upon entering the
first three letters of the drug. As soon as Nor was entered, the
software selects Norflex, which was inadvertently accepted by Dr.
Rogers as he hurried to get to his next appointment. The order was
signed electronically. The prescription order was sent in the hospital
pharmacy where it was correctly filled for Norflex, a muscle relaxant
rather than an antibiotic. Both are oral medications, although muscle
tightening or spasms could result from Norflex. The medication was
made available for the nursing assistant to pick up, and the patient
was returned to the nursing facility.
Ethel began taking Norflex but was admitted to the emergency room
later the same week with septic shock due to a very serious bacterial
infection. When the emergency room staff accessed her health
record on the hospital EMR, there was no entry for a geriatric clinic
visit on October 15, so the findings from he.
4 and CAM plants use a cifferentstrategy then C 3 plantslin .pdf
4 and CAM plants use a cifferentstrategy then C 3 plantslin order to.. avoid tosing CO2 and O2
through the stomata when they must be kept open ail the time. return to a fully aquatic lifestyle.
avoid excessive predation in areas with many herblvores. avoid losing too much waser through the
stomats in hot, dry climates. be able to do photosynthesis in areas where there is no direct
sunlight..
American International Group AIG stood at the centre of th.pdf
American International Group (AIG) stood at the centre of the financial crisis of 2008. It was one
of the main institutions issuing credit default swaps. With default rates increasing and the
economic climate worsening, it found itself in liquidity problems. AIG was forced to seek a
government rescue and was effectively nationalised. Shortly after the bailout in 2009, it also
become the centre of a media firestorm in the so-called AIG bonus payments controversy.
Questions:
Critically evaluate the factors leading to AIGs liquidity problems, bailout, and nationalisation.
Critically assess the reasons and judgment behind the AIG bonus payments controversy.
Write a short essay imagining what would have happened if AIG hadnt been saved..
AFN Required additional assets Increase in Spontaneous Li.pdf
AFN= Required additional assets - Increase in Spontaneous Liabilities - Increased Retained
Earnings AFN=(S0A0)S(S0L0)SMS1(1PayoutRatio)AFN=$114.00$10.40$159.98=$56.38 No,
ERSC does not require additional financing to support this growth..
Australia In February Uber lost a court challenge against a.pdf
Australia In February, Uber lost a court challenge against a 2015 Australian Taxation Office
decision that forced drivers to be registered to pay goods and services tax. The company argued
its drivers didn't need to be registered because they weren' t taxi operators. However, the court
found Uber could be designated as a taxi service. Last year, Northern Territory banned Uber after
refusing to change the law to accommodate the app's legality. United States In June 2015,
California's Labour Commission ruled Uber driver Barbara Berwick was an employee and not an
independent contractor. The company had argued it did not dictate driver hours and only provided
the app to connect drivers and passengers. In 2016. Uber agreed to pay up to US $100 million to
settle a class-action lawsuit, allowing it to keep its Californian and Massachusetts drivers as
independent contractors. The company pulled out of Austin, Texas, last year after being told to
fingerprint and background-check all drivers. Canada In March 2017, Uber drivers in Ontario
launched a class-action lawsuit against the company asking the court to find they are employees,
not independent contractors. Ride-share apps are not legal in Vancouver. United Kingdom In
October 2016, the Central London Employment Tribunal ruled Uber drivers were employees. not
contractors, meaning they would qualify for the minimum wage, paid time off and other conditions.
In April, Uber was granted the right to appeal. France In June 2016, a French court fined Uber and
two of its executives for running an illegal transport service with non-professional drivers in the first
such criminal case in Europe. Uber was ordered to pay 800,000, but half the fine was suspended.
Complete the following Reading Assignment (Maximum 500 words) 1. Update to the Legal
Challenges for Uber. 2. Compare it to the situation in the UAE and the GCC..
ACME Corp 205110014302001DB8CAFE11564 2051.pdf
ACME Corp. 205.1.100.14/302001:DB8:CAFE:1:.15/64 205.1.100.13/302001:DB8:CAFE:1:1/64
Corporate LAN ISP - Management VLAN 100: 172.16.100.0/24 - RnD VLAN 10: 10.10.0.0/16 -
Finance VLAN 20: 10.20.0.0/16 - Staff VLAN 30: 10.30.0.0/16 RnD's Experimental PVv Network:
2001:DB8:ACAD:1::64 On the Corporate LAN - VLAN 900 has been assigned the Native VLAN
and is not routable.Addressing Table To assist with connectivity te:SW-1 and SW-2 VLAN
Assignment Table EtherChannel Port Assignment Table The IEEE 802. 3ad open standard, Link
Aggregation Control Protocol (LACP) will be used for the EtherChannel between SW-1 and SW-
2.Router Pre-configurations The following pre-configurations have been applied to the Core router
- Hostname: Core - The router is protected from unauthorized access using a privileged exec
password of cisco - The assigned console password is class. - The VTY lines of the router have
been configured to only accept $SH type connections. - The SSH service has been configured to
use acme.com as the IP domain name and 1024 is the selected Modulus bit value. - For
authenticating SSH connections, locally configured credentials with the highest administrative
privileges available, have been set. Username: netadmin Secret Password: cisco - All service
passwords have been encrypted. - The banner MOTD message has been configured. - Interface
GO/O/1, has already been configured and enabled for IPv4 and IPv6 communication with the ISP
router. Instructions Part 1: On the Core router, complete the following configurations Step 1: On
interface Govov of the Core router, complete the remaining interface and sub-interface
configuration to support inter-VLAN routing. a. Using the Address information provided in the
Addressing Table configure and enable, on the Core router, interface Gorovo and all of its
corresponding subinterlaces. b. The sub-interface on GONar that corresponds with VLAN 900
should be configured as native, but it should NOT be routable. Step 2: Enable IPv6 Stateless
Address Autoconfiguration (SLAAC) for the RnD Experimental Network on the Core router. Step 3:
Configure DHCP pools for both the Finance and the Staff VLANs. a. Configure separate DHCP
pools for the Finance and Staff VLANs: 1) DHCP pool names: Finance and Staff 2) Using the
network address information identified in the VLAN Assignment Table configure both DHCP pools.
3) Exclude from the DHCP pool the router interface address for each corresponding VLAN. 3)
Setup each pool to also provide hosts with their corresponding default gateway address.Note: To
expedite successful completion of the Skills Assessment, all necessary configuration tasks have
already been applied on SW-2. Thus, the following onfiguration tasks need only to be completed
on SW-1. Step 1: Configure VLANs on SW-1 Using the information provided in the SW-1 and SW-
2 VLAN Assignment Table, create and name the identified VLANs on SW-1. Step 2: Assign
Access Ports to VLANs. For each host on SW-1, assign the connect.
Under standards you may include areas such as the following.pdf
Under standards, you may include areas such as the following: IC: Surveillance, Prevention, and
Control of Infection HR: Management of Human Resources EC: Management of the Environment
of Care IM: Management of Information MM: Medication Management LD: Leadership NPSG:
National Patient Safety Goals PI: Improving Organizational Performance PC: Provision of Care,
Treatment, and Services RI: Ethics, Rights, and Responsibilities Severity of risk may be
designated as follows: H: High risk M: Medium risk Ledium/high risk Low risk Compliance (in
percent) may be entered on a monthly, quarterly, bi-annual, or annual schedule. The matrix here
shows quarterly compliance schedule. Adjust it as necessary. To support your work, use your
course and textbook readings and also use the South University Online Library. As in all
assignments, cite your sources in your work and provide references for the citations in APA
format. Submission Detail:.
This assignment is intended to help you learn to do the foll.pdf
This assignment is intended to help you learn to do the following:
Identify the advantages, disadvantages, and tax treatments of different wealth transfer vehicles.
Select appropriate trusts used in estate planning. Apply appropriate transfer vehicles to minimize
taxes in given cases. Compare the characteristics of different trust arrangements. Select
appropriate charitable contribution method for clients.
1.refer to cody & Reeses case in chapter 6 of estate planning
2. Providing the following estate objectives of cody and Reese:To maximize their estate tax
savings -to provide the surviving spouse with a stream of income -to pass all their assets to their
daughter after the surviving spouse does or remarries -to start a college savings plan for their
daughter -to donate some of their assets to charity
3. Write a 2 page recommendation report in which you need to:
-. Apply proper estate planning techniques to help them reach their goals
- provide detailed rationale that supports your recommendation
cey a fios wort mariad yeas ago and had oae child, Amber. Cody and his longtime friend. cost reet
menty thing in Kandis sew plane. For a brief period, Kandi was distracted and lay consisl of te
plane Unformately, the plane crashed and Kandi died instantly and Cody dief . - Tenunal noidence
viluad at $500.000 held tenancy by the entirety. The home had an eein mad the followias prsperty
. Manding mortsys of $200,000. - Cat 1 raloed at $10,000 held fee simple by Cody. - Cr 2 ralued at
$15,000 beld joint tenancy with rights of survivoship by Cody ans - Diamond ring valued ar $50,
000 held fee cimple by Reese. Artier: - Bour valued at $20,000 held tenancy in common by Cody
and Amber (equal contuites - Life launnoe Policy 1 on Recie's life owned by Cody. The fair market
value of the poly ion). was $100,000 and the death bencfit was $200,000. The beneficiary is
Amber. - Lift Inarance Policy 2 on Cody's life, awned by Cody. The fair market value of the poling
wa 585,000 and the death benefit was $500,000. The only beneficiary is Kandi. - IRA acoount
valued at $4,500,000 owned by Cody with Amber as the beneficiary. - Inewable Trest by Cody for
the benefit of Amber created five years ago. The tratin wi. ued at $500,060, and Amber is the
beneficiary ar Cody's death. There were no tatatle ifo on the initial or absequent transfers to the
trust. Nsee Ueles obtenvis rated, assume equal contributions were made by all parties for joilte
onand properry. The acoileet was found to be the fast of the plane manufacturer, therefore, Cody's
heirs retevid $100.000 for wrongful death and $500,000 for his pain and suffering. Cody's last
medical expento wete $40000, hin funeril expenses were $30,000, the administrative fees for the
extare weft $100000, and he had miating debts of $100,000. Cody's will left $100,000 to a
qualifying chatip? ad the remaining pecbate asets to Rese. His will states that debts and expenser
will reduse the.
Theffamous iris dataset the first sheet of the spreadsheet .pdf
Theffamous iris dataset (the first sheet of the spreadsheet linked above) was first published in
1936 by Ronald Fister. The dataset contains 50 samples from 3 iris species: setosa, virginia, and
versicolor. Four features are measured, all in cm: sepal length, sepal width, petal length, and petal
width. What is the equation for the least square regression line where the independent or predictor
variable is petal length and the dependent or response variable is petal width for iris virginica? y^=
x+ What is the predicted petal width for iris virginica for a flower with a petal length of 6.27 ? cm.
5 Let Y1Y2Yn be independent exponentially distributed .pdf
5. Let Y1,Y2,,Yn be independent, exponentially distributed random variables with mean =/2. Show
that the mean and variance of the minimum, Y(1)=min(Y1,Y2,,Yn), are E(Y(1))=2n and Var(Y(1))=
4n22. (4).
STEP 3 Create the May 31 Unadjusted Trial Balance from the .pdf
STEP 3 Create the May 31, Unadjusted Trial Balance from the General Ledger STEP 4 Prepare
the Adjusting Journal Entries on Tab 4 and enter into the Adjustments column Then calculate the
Adjusted Trial Balance Step 5 Identify which accounts are Asset,Liabilities, Owners Equity,
Revenue, Expense Step 6 Use the balances in the Adjusted Trial Balance to create Financial
Statements STEP 3 STEP 4 Emerson Company tHIS ACCRUAL Emerson Company Unadjusted
Trial Balance bASIS Adjusted Trial Balance ASSET?/ Liability/ OW/Revenue/Expense? Income
Statement Accounts Balance Sheet Accounts May 31, 20Y5 Adjustments May 31, 20Y5 Debit
Credit Debit Credit A B C D = A+C-D = B+D-C Debit Credit Debit Credit Debit Credit Cash
Accounts Receivable Supplies Prepaid Rent Prepaid Insurance Equipment Acc. Depreciation -
Equipment Accounts Payable Salaries Payable Unearned Fee Kelly Pitney, Capital.
Problem 2 Features grow on branches Filtercpp program can .pdf
Problem 2: Features grow on branches Filter.cpp program can filter lines that contain whitespace
(tabs and spaces) before a Instead of hardcoding the comment character as , we want to have it
take a user input that specifies a comment character. 1. Make a new branch to develop your
feature on. 2. Modify to support your new feature, add it to the repository, and commit. 3. Write
your code, add it to the repository, and commit. 4. Push your branch to the remote repository. (You
can check git-classes.mst.edu to make sure it's up there.) The first time you a new branch, you
have to tell git to make a new branch on the remote repo. will tell you the right command to run.
Now, you'd like to merge your feature into too! 1. Okay so merge it already. 2. Don't forget to push
after you've merged!.
5 10 pts We assume that following MIPS code is executed o.pdf
5. (10 pts) We assume that following MIPS code is executed on a processor with a 5-stage
pipeline, full forwarding, and an always-taken branch predictor: Fill the pipeline execution diagram
(below) for this code, assuming that branch outcome is available in the EX stage (1st branch is
actually not taken, 2nd is taken)..
51 Using the annual financial report obtained for Exercise.pdf
5-1. Using the annual financial report obtained for Exercise 11, answer the following questions: a.
Examine the governmental fund financial statements. Are any major capital projects funds
included? If so, list them. Attempt to find out the nature and purpose of the projects from the letter
of transmittal, the notes, or MD&A. What are the major sources of funding, such as bond sales,
intergovernmental grants, and transfers from other funds? Were the projects completed during the
year? b. Again looking at the governmental fund financial statements, are any major debt service
funds included? If so, list them. What are the sources of funding for these debt service payments?
c. Does your report include supplemental information including combining statements for nonmajor
funds? If so, are any capital projects and debt service funds included? If so, list them. Indicate the
major revenue and other financing source categories for these funds.d. Review the governmental
fund Statement of Revenues, Expenditures, and Changes in Fund Balances, specifically the
expenditure classification. Compute a ratio of capital outlay/total expenditures. Again, compute a
ratio of debt service/total expenditures. Compare those with your classmates' ratios. Comment on
the possible meaning of these ratios. e. Review the notes to the financial statements, specifically
the note (in the summary of significant accounting policies) regarding the definition of modified
accrual accounting. Does the note specifically indicate that modified accrual accounting is used for
capital projects and debt service funds? Does the note indicate that debt service payments, both
principal and interest, are recorded as an expenditure when due? f. Does your government report
capital leases payable in the government-wide Statement of Net Position? If so, can you
determine if new capital leases were initiated during the year? Can you trace the payments related
to capital leases? g. Does your government report any permanent funds, either major or
nonmajor? If so, list them. What are the amounts of the permanent resources available for
governmental purposes? What is/are the governmental purpose(s)?.
Identify potential strategies nurses might use to navigate c.pdf
Identify potential strategies nurses might use to navigate communication challenges when
discussing patient care with surgical patients from the following group:
Patients who identify as Aboriginal and Torres Strait Islander
The goal is to demonstrate, an understanding of the importance of placing effective
communication at the centre of patient care for marginalised surgical patients, and to underpin
that understanding with current research evidence (<10 years)..
Myca Corpun nakit aklar aadaki gibi olan bir projesi vardr.pdf
Myca Corp.'un nakit aklar aadaki gibi olan bir projesi vardr. Yllk yzde 10,2'lik bir faiz oran
varsaymyla bugn nakit aklarnn deeri nedir?
Yl Nakit akm
1 $ 1.860
2 2.360
3 2.710
4 2.720
Myca Corp.'un nakit aklar aadaki gibi olan bir projesi vardr. Yllk yzde 10,2'lik bir faiz oran
varsaymyla bugn nakit aklarnn deeri nedir?
Yl Nakit akm
1 $ 1.860
2 2.360
3 2.710
4 2.720.
Hester is configuring syslog on her companys network She s.pdf
Hester is configuring syslog on her company's network. She sees three types of elements that
make up the system. Which of the following is not one of the elements she might see in syslog?
Hester is configuring syslog on her company's network. She sees three types of elements that
make up the system. Which of the following is not one of the elements she might see in syslog?
Soren, a cybersecurity analyst, wants to deploy a monitoring system that will alert him if there is a
breach of the company's network by an attacker. However, he doesn't want the system to
automatically shut down all traffic and block legitimate traffic as well. Which of the following might
he choose to deploy?
Kalindi, a cybersecurity administrator for a large organization, wants to implement a new antivirus
system. After researching the different methods of detection, she wants an option that should
increase the chances of identifying a zero-day attack but that requires constant updates from the
manufacturer. Which of the following types of analysis is performed by the software she wants?
A friend of yours wants to get into the cybersecurity field. He has just learned about packet
analysis in class and wants to get some hands-on experience with it using his home network.
Which of the following tools would not be a good recommendation for him to consider?
a. MSG
b. ID
c. HEADER
d. PRI.
I need sir very urgently please do as soon as first Three w.pdf
I need sir very urgently please do as soon as first
Three women are set to have their babies on the same day. We say A as the event of receiving at
least 2 boys. Likewise, B is the event of getting 2 girls and C is the event of the second lady
getting a girl baby. Work out the probability for event A,B and C (6 marks) Hint: There are 4
possible set of outcomes eg: {HHT,HTH,THH,HHH}..
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KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
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- 1. Intracranial Regulation Case Study Mr. James Hobson is a 69-year-old male with a history of hypertension that is well controlled on medication. He has been smoking 1 or 2 packs of cigarettes a day for the past 52 years and has a body mass index of 37.3. He awoke yesterday morning complaining of blurry vision and some weakness on the left side of his body. He thought he had just slept wrong, so he was not concerned. Later in the morning he was having trouble walking and his wife convinced him to call his physician. The physician's office called 911, and Mr. Hobson was transported to the nearest hospital. Upon arrival to the emergency department the physical etam findings were- HR 112 beats/min, BP 172/90 mm Hg, RR 24 breaths/min, O2 Sat 90%, leg arm and leg weakness (3/5), and somewhat decreased sensation. He was awake and responding to questions appropriately, though slowly. The following diagnostics tests were ordered: noncontract CT (NCCT) of the head; ECG; CBC with platelets, cardiac enzymes, and troponin; electrolytes; BUN; creatinine; glucose; PT/INR; and PTT. This patient's CT scan did not show any signs of hemorrhage. Note: Currently, thrombolytics are administered to treat an ischemic stroke within 3 hours of symptom onset. Studies are underway to evaluate the safety and efficacy of extending this window to 4 hours. Because it was unclear exactly when the symptoms began, the decision was made not to administer a thrombolytic. Question: Discuss the nursing assessments for Mr. Hobson.