Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

Write an academic paper that analyzes the key components of a strategic planning framework, assesses the value of using a strategic planning framework, and explains the role of leadership in the strategic planning process.

Write an academic paper that analyzes the key components of a strategic planning framework, assesses the value of using a strategic planning framework, and explains the role of leadership in the strategic planning process.

Describe the type of evaluation method you might use to examine the effectiveness of your stress management workshop and justify your selection.

When developing an evaluation of your stress management workshop, identify your intention for the workshop’s overall outcome. Then consider the outcome of your workshop using the following measures:

  • How might you define or determine whether the workshop was successful?
  • Consider asking what has changed. Has the program made a difference?
  • Are behavioral changes going to occur? What behavior shifts have already occurred?
  • How are the participants’ lives changed?
  • Do they feel confident with the tools they were given?
  • Can participants envision a previous stressful experience where the application of these tools would have benefited them?
  • How well was the information relayed? Was the environment comfortable?
  • Are there wider ripples of social effect due to the resulting policy changes or institutional practice?

For the assignment, you continue to build on your Final Project. Review the “Evaluation of the Guided Imagery Workshop” handout provided. Also, conduct an Internet search for additional examples of reputable workshop evaluations. Then, consider the various evaluation methods and select an evaluation method appropriate for your stress management workshop.

  • Develop your evaluation form and include it as an appendix to the above justification.

Describe three forensic psychology professional roles that impact the outcomes of police crisis situations.

  • Briefly describe three forensic psychology professional roles that impact the outcomes of police crisis situations.
  • Analyze each role and then explain how each role impacts outcomes of police crisis situations. Focus on the contributions that the forensic psychology professionals make in each role that influence specific outcomes of a crisis situation. Be specific.
  • Support your responses with references to the Learning Resources and the research literature.

Write a paper that addresses shifts in educational paradigm (the pendulum effect).

The educational pendulum exists, and it has governed the field for decades. It creates the moving target that is nearly impossible to hit with our current practices. How do we as educators grasp this idea in order to offset it? The pendulum influences the morale of staff and students alike, so learners must find ways to manage the pendulum until the paradigm changes.

General Requirements:

Use the following information to ensure successful completion of the assignment:

  • Instructors will be using a grading rubric to grade the assignments. It is recommended that learners review the rubric prior to beginning the assignment in order to become familiar with the assignment criteria and expectations for successful completion of the assignment.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Directions:

Write a paper that addresses shifts in educational paradigm (the pendulum effect). In your paper, include the following:

  1. A research-supported discussion of educational paradigms, specifically identifying the current educational paradigm.
  2. A research-supported discussion of how the educational pendulum (shift in paradigms) influences education, including the role of the educational leader, teacher, and student.
  3. A research-supported discussion of the importance of educational paradigms, including shifting paradigms.

How would you ensure the highest level of accuracy with your simulation, and how would you go about determining accuracy?

Chapter 3 discusses methods to assess the quality of simulations. You learned about three different views of simulation quality.

Suppose you lead a task force that is developing a simulation to provide strategic planning recommendations for property use zoning for a county of 750,000 residents. The zoning board and county commissioners want a simulation that allows them to assess the impact of various zoning decisions based on a variety of dynamic factors, including age, race, education, and income status. Which of the three views discussed would provide the best quality assessment for this type of simulation? How would you ensure the highest level of accuracy with your simulation, and how would you go about determining accuracy?

As indicated above, identify which of the three views discussed in the chapter that would provide the best quality assessment for the situation described above, and explain your decision. How would you ensure the highest level of accuracy with your simulation, and how would you go about determining accuracy?

How could the Council have prevented paying for costs that were not unauthorized?

The American Recovery and Reinvestment Act of 2009 provided the Department of Agriculture with $28 billion in funding, $1.15 billion of which was allotted to the Forest Service (FS) to implement project that accomplish its mission of sustaining the nation’s forests and grasslands, creating jobs, and promoting U. economic recovery. FS’ Wildland Fire Management (WFM) program was allocated $200 million in grant funding to implement activities on State, county, and private lands. The funding was used to operate projects with State, local, and Tribal governments, and non-profit organizations that submit grant proposals to FS. FS approved 152 WFM projects on non-Federal lands from May through September 2009, including a project to perform hazardous fuels treatments on non-Federal lands. FS awarded a $3.6 million Recovery Act grant to The Council to implement this project.

Findings: The Council did not properly account for its FS Recovery Act grant funds, but, but, instead, comingled $2. 7 million of the $3.6 million in FS Recovery Act grant funds it received with funds it received from other sources. As a result, the Council may have used $2.7 million of the FS Recovery Act grant funds to pay for non-Recovery Act costs during the 2-year period we reviewed. Commingled costs cannot be charged to Federal grants because it reduces or eliminates a grant recipient’s ability to identify which portion of the commingled costs relate to authorized grant work and which do not. It also results in unallowable costs being charged to FS grants. For example, the Council received $800,188 from its $3.6 million FS Recovery Act grant in January 2011. Under 0MB rules, the Council was required to use that money solely to pay for authorized expenses incurred while performing Recovery Act grant work. However, the Council only used $95,578 of the $800,188 it received in January 2011 to reimburse legitimate grant expenses and deposited the remaining $705,611 into an account that commingled funds from both the Recovery Act grant and other Federal grants. Over a 2-year period, the Council deposited $2.7 million of the FS Recovery Act grant funds it received into the commingled account. The Council did not identify the source of the funds once they were deposited into the account; it simply lumped all the funds together. The Council then used the money in the account to pay various expenses, such as rent, utilities, and other non-FS grant costs, even though none of the costs were authorized by the FS Recovery Act grant. We further determined that the Council’s commingling activities were exacerbated by the fact that it routinely, and inappropriately, requested FS Recovery Act grant “reimbursements” for expenses it had not yet paid. The Council was subject to the requirements of 0MB Circular A-133, which specified that grant recipients can only be reimbursed for costs they have already paid. On every reimbursement request we reviewed, the Council certified that it had already paid the expenses for which it was claiming reimbursement when, in fact, it had not. Upon receiving these “reimbursements,” rather than immediately utilizing the funds to pay for authorized Recovery Act grant expenses, the Council’s executive director deposited the Recovery Act grant funds into the commingled account and used them to pay unauthorized expenses associated with other, non-FS grants.

The OIG recommended that FS:

– Recover from the Fire Safe Council the $2.7 million in Recovery Act grant  funds that were unsupported

– Withhold from the Fire Safe Council any future fund reimbursements until the internal controls and grant administration policies and procedures to properly account for all grant funds in accordance with OMB and grant requirements;

– Obtain documentations from the Fire Safe Council showing that the grants funds were adequately accounted from and used for their intended purpose; and,

– In those instances where FS determine the charges to the remaining grant were not adequately supported, disallow the costs and recover any reimbursements already made to the Fire Safe Council.

Directions 

Our focus in this course has been on foundation grants but grant management requirements of the federal government will play a role in your management experience. This case study is a true event taken from the Office of Inspector General public audit reports. Even the best grant manager will make mistakes that have to be addressed during the annual audit. When the Inspector General conducts an audit it means that something has gone wrong beyond the average management mistake. As Christians, we are called to be good stewards of the resources we are given. In a 2-3 page paper address the questions below. Based on what you have learned in this course how could this situation have been avoided?

Questions:

1. Why is the commingling of grant funds not allowable?

2. What internal controls are not in place for the WFM program?

3. How could the Council have prevented paying for costs that were not unauthorized?

4. How could this situation have been avoided?

OIG Audit Reports: https://www2.ed.gov/about/offices/list/oig/rpauditinvestmainpage.html