In anticipation of Mary’s request for comparative analysis, it will be useful at this time to do some research. You know that you can obtain the financials of companies within the same sector or Standard Industry Code as Apix Printing (e.g., commercial printing), and that the North American Industry Classification System (NAICS) Standard Industry 2012 code for Apix Printing is presently 323111.  

Search for two other companies in the same industry as Apix Printing.

When you get to work the next day, you see the following e-mail from Mary:

Here is the list of financial ratios you asked for. I need you to explain the computation of each and compute these for Apix’s results for the financial statements you are using for the PowerPoint presentation. Also, compare Apix’s 2-year trend results to that of two other firms in the sector. Indicate how each of Apix’s ratios differ, and indicate whether the two other companies’ ratios or Apix’s ratios are indicative of better performance.

Explain the computation for each of the following, and compute each for Apix and two other companies in the same industry as Apix Printing:

• Current ratio
• (Long-term) debt to equity ratio
• Gross margin percentage
• Net profit margin percentage
• Return on equity percentage

Present your findings of the above data in a table. Add a paragraph that summarizes your results, indicating whether investors would find the financial analysis results of Apix competitive as compared to rivals in the sector. Be sure to include both positive and negative trends in your analysis.

Lillian has been on her medication for pneumonia for 24 hours. The physician says the pneumonia is improving, but she also is having an acute exacerbation of her COPD and a chronic irregular heart rate. Her vital signs are T 37C, B/P 140/87, P 82 and irregular, R 12, and pulse oximetry 92% on 2L O2 per nasal cannula. The physician is concerned about her blood pressure and wants to continue to watch it. She feels that Lillian will benefit from regular medication for her COPD while in the hospital and when she goes home. Lillian also is complaining of cigarette cravings and constipation. The physician is urging her to quit smoking.

The physician leaves the following orders.

• Albuterol MDI two puffs every 6 hours
• Ipratropium MDI two puffs every 6 hours
• Nicoderm 7 mg/24 hr transdermal patch daily
• Bisacodyl 10 mg suppository now x1 then 10 mg po daily
• Bathroom privileges
• Respiratory therapist to determine the need for O2 at home
• Cardiologist, Dr. B, to consult for irregular heart rate

For your first post, answer all of the following questions about the unfolding case study. Remember that you must also respond to at least one peer in this thread.
1. How does albuterol MDI work? Make sure to include the drug category, mechanism of action, onset and duration of action, and safety considerations.
2. How does ipratropium MDI work? Make sure to include the drug category, mechanism of action, onset and duration of action, and safety considerations.
3. How would the nurse properly administer the two MDIs when both have been scheduled at the same time of day?
4. Lillian asks the nurse why she is on two inhalers for her COPD when she used to use just one. What points would the nurse want to cover to answer her question, considering her history of noncompliance?

 

For your second post, answer all of the following questions about the unfolding case study. Remember that you must also respond to at least one peer in this thread.
The following morning, the cardiologist came to consult on Lillian’s case and left orders for anticoagulation because of Lillian’s chronic irregular heartbeat from atrial fibrillation. Dr. B left the following orders for anticoagulation.

• Heparin 5,000 units SQ every 12 hours
• Warfarin 2.5 mg po daily for a target INR of 2.5
• aPTT, PT, and INR now and then every morning
• Digoxin 0.25 mg po daily

1. What is the rationale for the cardiologist ordering heparin and warfarin at the same time?
2. What are some nursing implications when administering digoxin?

 

Ethical dilemmas are situations that involve conflicting moral or ethical choices. To truly meet the criteria for an ethical dilemma, there must first be a choice. If applicable laws say that client records must be kept in a password-protected location on your computer, there is no choice or moral decision involved. The action needed is very clear cut. Secondly, in order to be an ethical dilemma, the two available options must be in direct conflict or contradiction to one another, such that choosing one would result in the violation of the other. Human and social service professionals confront ethical dilemmas regularly. In these situations, professionals must think critically and consult with colleagues and ethical codes in order to minimize ethical impact.

In the media entitled Is It an Ethical Dilemma? in this week’s Learning Resources, there are two human and social services professionals discussing professional issues they are each having. Listen to each and consider which one represents an ethical dilemma. After you are finished, return to this page to begin your Discussion.

For this Discussion, you analyze an ethical dilemma that you have experienced in your own professional workplace or community work (not your personal or family life). You also use information from this week’s Learning Resources and from your own research to determine whether the ethical dilemma should have been handled differently.

To Prepare:

• Using the Walden Library or professional resources on the Internet, research and select a journal article, professional newsletter, or other professional publication that outlines an ethical dilemma in a human or social services agency environment. Consider how the dilemma was solved. Did the parties involved apply codes of ethics or ethical decision-making models?
• Select an ethical dilemma from your own professional experience (or community work) and reflect on how you managed the situation. Then consider how you might apply any information or techniques from the article you analyzed to your own past ethical dilemma.

By Day 3

Post a description of an ethical dilemma that you experienced in your professional workplace or in your community work (not your personal or family life). Explain how you managed the situation and why. Next, using information from the article you found in your research, explain whether you would now manage the situation you experienced differently and why.

I am a case manager so please relate the dilemma to something dealing with that of a social worker or mental heath professional.

The purpose of this assignment is to create an educational program that supports the implementation of risk management strategies in a health care organization.

In this assignment, you will develop an outline for an “in‐service”‐style educational risk management program for employees of a particular health care organization that will then form the basis for a PowerPoint presentation in Topic 5. Select your topic for this educational session from one of the proposed recommendations or changes you suggested in the Risk Management Program Analysis – Part One assignment to enhance, improve, or secure compliance standards in your chosen risk management plan example.

Create a 500‐750-word comprehensive outline that communicates the following about your chosen topic:

1. Introduction: Identify the risk management topic you have chosen to address and why it is important within your health care sector.
2. Rationale: Illustrate how this risk management strategy is lacking within your selected organization’s current risk management plan and explain how its implementation will better meet local, state, and federal compliance standards.
3. Support: Provide data that indicate the need for this proposed risk management initiative and demonstrate how it falls under the organization’s legal responsibility to provide a safe health care facility and work environment.
4. Implementation: Describe the steps to implement the proposed strategy in your selected health care organization.
5. Challenges: Predict obstacles the health care organization may face in executing this risk management strategy and propose solutions to navigate or preempt these potentially difficult outcomes.
6. Evaluation: Outline your plan to evaluate the success of the proposed risk management program and how well it meets the organization’s short-term, long-term, and end goals.
7. Opportunities: Recommend additional risk management improvements in adjacent areas of influence that the organization could or should address moving forward.

Physical, emotional, and sexual abuse can have a devastating impact on a child and his or her family members. Social workers need to understand how to recognize and respond to cases of abuse expertly and efficiently. With an empathetic and helpful social worker, victims/survivors of abuse can take their first step onto the long road toward healing. For this Assignment, read the case study Working With Survivors of Sexual Abuse and Trauma: The Case of Brandon and then consider what you would do if you were a social worker and had to report a parent of suspected child abuse.

By Day 7

Submit a 2- to 4-page paper in which you review the approach taken by the social worker in Brandon’s case. Identify how the social worker might have used the ecological model to understand Brandon’s situation based on a person-in-environment perspective. Explain the use of the ecological model in this case on micro, mezzo, and macro levels. Describe strengths the social worker may have missed in assessing Brandon and his mother. Review the challenges that the social worker identifies and explain the impact the abuse could have had on Brandon had his strengths not been identified and addressed. Please use the Learning Resources to support your answer.

Working With Survivors of Sexual Abuse and Trauma: The Case of Brandon

Brandon is a 12-year-old, Caucasian male who currently resides with his mother and her boyfriend. Six years ago, Brandon disclosed that his father had repeatedly sexually abused him between the ages of 4 and 6. Brandon’s mother called law enforcement immediately after the disclosure, and his father has been incarcerated since. Brandon has previously participated in therapy to address challenging behaviors, including physical aggression, difficulty following rules at home and school, and using inappropriate language with sexual overtones toward female peers. Brandon and his mother report that they ceased participating in therapy in the past after there was no change in Brandon’s behavior. Brandon’s teachers have suggested that his behaviors are similar to those of peers with attention deficit hyperactivity disorder, but his mother has declined educational or psychological testing because she does not want her son to be labeled and is unsure if she agrees with the use of psychotropic medication with children.

Brandon began attending trauma-focused treatment after demonstrating an increase in argumentative behavior and minor property destruction at home. His mother reported that the majority of undesired behaviors were initiated during interactions with her boyfriend. Brandon’s use of physical aggression has not increased in school; however, a female peer recently reported him for using sexually explicit language toward her. Brandon admitted to using inappropriate language toward the female peer but appeared to have a limited understanding of what the phrases used meant. Brandon’s mother noted during intake that she is concerned that her son will become a violent sexual offender or a pedophile and noted that his use of sexual language was likely the start of sexual behavior problems.

At the beginning of treatment, Brandon reported that he frequently feared for his physical safety but often could not pinpoint what made him feel unsafe. He had searched the Internet to find registered sexual offenders in his neighborhood, and he had begun sleeping with a loaded BB gun under his pillow in case someone entered the home to assault him again. Brandon had flashbacks when trying to fall asleep and described feeling like he was floating outside of his body when he thought of his abuse. He had seen a television show where victims spoke at the parole hearings of their perpetrators, and he spent many hours thinking about what he would say if he went to his father’s parole hearing in 3 years. Brandon felt like he loved his father very much and that his father was a great father except for when he hurt him. Brandon identified wanting to feel less worried, sleep better, and fight less with his mother as primary treatment goals.

I worked with Brandon in both individual and family sessions to address his symptoms of depression and post-traumatic stress disorder (PTSD). Utilizing the trauma-focused cognitive behavioral therapy approach, early sessions focused on coping skills and emotional regulation. As Brandon became more comfortable with expressing feelings and utilizing coping skills, he began discussing his sexual abuse history and the ongoing effect this experience had on his life. I met with Brandon’s mother for collateral sessions in order to help her identify and process her own feelings about his abuse and to develop skills to support Brandon through his treatment. Brandon’s mother was provided with psychoeducation regarding childhood sexual abuse, and her belief that her son would become a violent sexual offender as a result of his experience was challenged through cognitive behavioral therapy. She agreed to meet the agency psychiatrist, and after the initial consultation she agreed to have Brandon meet with the doctor. After a psychiatric evaluation, Brandon was prescribed a low dose of antidepressant medication.

Brandon completed a trauma narrative that addressed the details of his sexual abuse experience, his disclosure of the abuse, and the trial and subsequent imprisonment of his father. Brandon included a description of his feelings at each point in his narrative, as well as what he learned in treatment about childhood sexual abuse and coping skills to deal with uncomfortable feelings and impulsivity. Brandon shared his trauma narrative with his mother, who provided a safe and supportive space during this experience through the use of skills learned and practiced during collateral parent sessions. Brandon’s symptoms of depression and post-traumatic stress decreased steadily during the course of treatment. After 8 months of sessions and the successful completion of his trauma narrative, the family and I agreed that Brandon was ready to terminate trauma-focused treatment. Brandon continued receiving medication management with a psychiatrist and transitioned into home- and community-based treatment that focused on his ongoing impulsive behaviors.

Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

• Working With the Homeless Population: The Case of Diane
• Working With Survivors of Sexual Abuse and Trauma: The Case of Brandon