As you have discovered through this course, nurses are influential members of the community and the political system. Therefore, for the purposes of this assignment you will identify a problem or conc

As you have discovered through this course, nurses are influential members of the community and the political system. Therefore, for the purposes of this assignment you will identify a problem or concern in your community, organization, etc. that has the capacity to be legislated. You will conduct research and state a proposal. Through the legislative process, your proposal for the problem or concern may influence an idea for change into a law.

First, refer to the “How a Bill Becomes a Law” media.

Then, view the “Bill to Law Process” to watch the scenario.

After viewing the scenario, refer to the “Legislative Assignment.” You will need to save the document first in order to use it.

Submit the assignment to the instructor. You also reserve the right to submit your completed proposal to the respective government official. However, this is optional. If you select to submit your proposal as a part of the legislative process, refer to “Find Your Representative” or research the contact information on your own.

APA format is not required, but solid academic writing is expected.

Case Study 3 & 4 (10 Points) Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same

Case Study 3 & 4 (10 Points) 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Inflammatory Bowel Disease

 Case Study

 The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine Diagnostic Analysis The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy?

 2. Why was the Meckel scan ordered for this patient?

 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease?  

 Urinary Obstruction

 Case Studies

 The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle Normal resting bladder with a positive tonus limb Cystoscopy Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL) Prostate ultrasound Diffusely enlarged prostate; no localized tumor Diagnostic Analysis Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. 

Critical Thinking Questions

 1. Does BPH predispose this patient to cancer?

 2. Why are patients with BPH at increased risk for urinary tract infections?

 3. What would you expect the patient’s PSA level to be after surgery?

 4. What is the recommended screening guidelines and treatment for BPH?

 5. What are some alternative treatments / natural homeopathic options for treatment?  

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with m

L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.

Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.

Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.

One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.

Questions

1. What are the effects of controlling BP in people with diabetes?
2. What is the target BP for patients with diabetes and hypertension?
3. Which antihypertensive agents are recommended for patients with diabetes?

I need a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address

I need a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

• Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
• Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations. 
• Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples. 

Has to be submitted to safe assign and have a low score. Due on Sunday.

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Co

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

This assignment consists of both an interview and a PowerPoint (PPT) presentation.

Assessment/Interview

Select a community of interest in your region. Perform a physical assessment of the community.

1. Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
2. Interview a community health and public health provider regarding that person’s role and experiences within the community.

Interview Guidelines

Interviews can take place in-person, by phone, or by Skype.

Develop interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.

Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.

Compile key findings from the interview, including the interview questions used, and submit these with the presentation.

PowerPoint Presentation

Create a PowerPoint presentation of 15-20 slides (slide count does not include title and references slide) describing the chosen community interest.

Include the following in your presentation:

1. Description of community and community boundaries: the people and the geographic, geopolitical, financial, educational level; ethnic and phenomenological features of the community, as well as types of social interactions; common goals and interests; and barriers, and challenges, including any identified social determinates of health.
2. Summary of community assessment: (a) funding sources and (b) partnerships.
3. Summary of interview with community health/public health provider.
4. Identification of an issue that is lacking or an opportunity for health promotion.
5. A conclusion summarizing your key findings and a discussion of your impressions of the general health of the community.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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