W6

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***ANSWER THE QUESTION 250 WORDS MIN***

 Discussion Questions: Discuss the complexities the U.S. faces when securing differing modes of transportation. How important is critical infrastructure protection maintenance in overall transportation security? 

***REPLY TO EACH POST 100 WORDS MIN EACH***

1. For this week’s question we were asked to discuss the complexities the U.S. faces when securing differing modes of transportation.  As we know, our Transportation sector is critical to our National Security, and without this sector we would not be able to be as effective.  Tied within the transportation sector includes all the Emergency Services (i.e. police, medical, firefighters, etc.) transportation.  Without a proper and well-maintained means of transportation, it would be difficult for any kind of Emergency Services to respond accordingly to threats.  Identified within the DHS 2020 Biennial National Strategy are challenge’s the Transportation Sector faces which include: Uncertainty about Risks; Resources and Budget Constraints; Performance Assessments; Resiliency and System Recovery.  Additionally, physical security, weapon detection programs, cybersecurity, preventing terrorist travel, insider threats, and our preparedness are all complexities which we face which hinder our ability to securing different modes of transportation (U.S. Department of Homeland Security, 2020).  Besides the Emergency Services sector suffering, it was interesting to find out how long we have been trying to secure our air transportation (flying).  In 1931, Byron Rickards had his aircraft hijacked (Klenka, 2019).  Yes, this did not happen in the U.S., but this just goes to show us that this problem of trying to secure air transportation is worldwide.  Today, we still face these issues unfortunately.  Drones and Unmanned Aerial Vehicles still pose threats which hinder the daily lives of many.  We will we ever be able to live without these complexities.  I really don’t believe so. Lastly, our critical infrastructure protection maintenance is very important to our transportation security.  We must be able to grow and advance as well as our adversaries are.  I feel the key to staying on top is to be resilient.  We will face many challenges but have to know that together, we here in the United States can overcome anything because we are the worlds greatest nation!

2. “U.S. critical infrastructure protection (CIP) requires both the stipulation of security from internal and external perils and the rehabilitation of physically damaged critical infrastructure which may interrupt services” (Hemme, 2015, pg.3). The United States relies heavily on transportation to compete globally and to support and relieve a slow domestic economy. Individuals depend on transportation, not just to get to work to get to other essential factors in their lives, such as socializing, accessing hospitals, and other things. This extensive transportation system may be sufficient to accommodate today’s population and economy, even though extremely overcrowded locations make that contestable. However, preservation and development are essential to support an expected 20% increase in the population. The rancorous debate regarding shortfalls and taxes has prevented the federal government from addressing the investment required to enhance transportation system performance.  Transportation systems functions at capacity for definite periods of the day. Unanticipated effects, such as crashes or inclement and extreme weather, can significantly interrupt traffic and exacerbate congestion and procrastination. Drivers and motor carriers on metropolitan area highways, and travelers on intercity planes, trains, and buses encounter obstacles more routinely because the expansion of the system has stalled notwithstanding the ongoing increase in the population and the economy. A significant performance problem across all modes is the lack of training for natural and human-made disasters, as well as for severe weather events, which may become more prevalent with climate change. “Heavy storm “Sandy” flooded subways, airport runways, roads, marine terminals, and railroad tracks in New York and New Jersey, causing tens of billions of dollars losses economically and added environmental damages” (Transportation Research Board, 2013, pg. 6).  Tense additions in the U.S. domestic production of crude oil and gas have dangerous entanglements for national security, climate influences, and transportation. Transportation estimates for two-thirds of U.S. natural gas consumption and have pushed the market for petroleum imports, frequently from volatile parts of the world. A decline in imports will be beneficial for the economy, but the availability of fossil fuels for transportation systems will have meaningful climate repercussions as transportation demand continues to expand. Based on the American Society of Civil Engineers (2013) their 2013 Infrastructure Report Card gives the transportation sector a C+ (“mediocre”) for bridges, a D (“poor”) for roads, and a D (“poor”) for transit systems. “Nationwide, from the 1950s to 1970s, largest bridges were built through the Interstate Highway System and were built with inexpensive and easy-to-build material” (Lowy & Baker, 2013). Interstate Highway System bridges were expected to be built instantly and were intended to survive for about fifty to sixty years; nonetheless, most bridges are crossing their fifty-year expiration date, resulting in the potential for breakdown. 

Essay- 2 page

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Select a public figure in the United States you are able to research.. The person should work for a public institution at the local, state, or federal level or at a nonprofit organization. 

Reference Article 48: “From Red Tape to Results: Creating a Government that Works Better and Costs Less” on page 514 of the textbook. In a two- to three-page paper, elaborate on how your selected public administrator uses any one (or more) of the four key principles to successfully analyze and solve a public problem. Include a short narrative describing your representative’s management style and why this is important when developing problem-solving strategies. ****See Attache****

The four key principles, which are listed on page 518 of the textbook, include the components shown below. ****See Attached****

  1. Cutting the red tape. 
  2. Putting customers first. 
  3. Empowering employees to get results.
  4. Cutting back-to-back to basics: Producing better government for less.  

Ensure your essay is at least two pages in length but is no longer than four pages in length, is double-spaced, and uses 12-point Times New Roman font with one-inch margins. Section headings are also encouraged to help organize your paper. 

Your essay must be written using APA format. Be sure to include a title page and a reference page, but please note that these will not count toward meeting the minimum page requirement. All sources used, including the textbook, must be cited. Title and reference pages do not count toward meeting the minimum page requirements. 

The purpose of this assignment is to gauge your understanding of the content, so focus on writing original content rather than simply regurgitating the textbook or other sources, whether by paraphrasing or using direct quotes. Paraphrasing is acceptable, but try to keep paraphrasing to a minimum. A good rule of thumb is to use 80% of your own work and to paraphrase 20% or less of the work of others.

week 8 discussion bilateral knee pain

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Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

Patient Initials: __TC_____ Age: ___15____ Gender: ___Male____

SUBJECTIVE DATA:

Chief Complaint (CC): Bilateral Knee Pain

History of Present Illness (HPI): TC is a 15-year-old African-American male high school student who is in 9th grade. He presents to the clinic today with complaints of dull bilateral knee pain. Pateint states that he’s experencing “a catching sensation under my kneecaps.” The patient states that this has been going on for weeks now. He said that his knees really bother him the most when playing basketball, but they still bother him even when he’s walking. He says the pain comes and goes and he rates the pain level as a 5 on a pain scale of 1-10 after taking 200mg of Ibuprofen. His last dose he stated was taken orally 45 minutes ago. He then stated that the pain without pain medicine is was 10/10 before. The patient states that resting and icing his knees helps to alleviate the pain also.

Medications:

Ibuprofen 200mg PO Q6-8hrs PRN pain

Multi-vitamin PO Daily

Allergies:

Sulfa drugs – Facial Swelling

Past Medical History (PMH):

No Past Medical Hx

Past Surgical History (PSH):

No Past Surgical Hx

Personal/Social History:

Patient is in high school. He enjoys playing basketball, football, and baseball. He lives at home with his parents and younger brother and sister.

Immunization History:

His immunizations are up to date.

Significant Family History:

P Grandmother- Diabetes

P Grandfather- HTN

M Grandmother- Diabetes, Heart Disease

© 2019 Walden University Page 1 of 4

M Grandfather- HTN, Hyperlipidemia

Review of Systems:

General: Denies weakness, no recent weight loss/gain, fever, and fatigue.

HEENT: The patient has no headache and no history of head injury. He denies blurred vision, double vision, and visual loss. no hearing loss. No sneezing, runny nose, and congestion. Patient denies a sore throat.

Respiratory: denies a cough and shortness of breath.

CV: Patient denies chest pain, and chest discomfort. Patient exhibits no palpitations or edema.

GI: Denies change in dietary patterns or bowel habits. He denies abdominal pain, nausea, and vomiting or diarrhea., stomach distress or blood in the stool

GU: Patient denies painful urination, frequency, and urgency

MS: Patient has bilateral knee pain for , Patient denies any other joint, muscle, or back pain. Denies any recent injury.

Psych: Patient denies depression or anxiety

Neuro: Patient denies headaches, syncope, dizziness, and has no numbness, or tingling in any extremities. Patient has no change in bowel or bladder control.

Integument/Heme/Lymph: Patient denies rash or itching. Skin warm and moist

Endocrine: Patient denies cold or heat intolerance. No polyuria or polydipsia.

Allergic/Immunologic: Sulfa Drug

OBJECTIVE DATA

Physical Exam:

Vital Signs: Blood Pressure 112/70; Pulse 85; Temp. 98.7; Resp. 18; Weight 170lbs: Ht. 5’10

© 2019 Walden University Page 2 of 4

General: Healthy looking young male, who appears slightly uncomfortable.

HEENT: PERRLA, EOMI, oronasopharynx is clear

Neck: Carotids no bruit, jvd or tmegally

Chest/Lungs: CTA AP&L

Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound

Musculoskeletal: Reduced range of motion with a facial grimace. Knees free from swelling and crepitus, and tibiofemoral joint space smooth and firm. No acute fractures noted. Clicking in the knee noted on exam.

Neuro: CN II – XII grossly intact, DTR’s intact

Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

ASSESSMENT:

Diagnostics:

Computerized tomography (CT) scan, Bilateral Knee X-ray, CBC, and Magnetic resonance imaging (MRI). 

Differential Diagnosis (DDx):

1. Osgood-Schlatter Disease: A common cause of knee pain in growing adolescents. It is an inflammation of the area just underneath the knee where the ligament from the patellar tendon attaches to the tibia. It is most often happening during growth spurts, when bones, muscles, tendons, and other structures are rapidly changing. Because physical activity puts additional stress on bones and muscles, for example, children who partake in athletics — especially running and jumping are at an increased risk for this condition. However, less active adolescents might as well experience this issue. (American Academy of Orthopedic Surgeons, 2018).

2. Patellar tendonitis: Patients with overuse of the legs has a probable comorbidity (Rebella, 2015).

3. Patellar instability: Knee catching or “clicking” with movement, pain, excessive patellar movement (Mahmoud, 2016).

4. Left Osteochondritis Dissecans: Pain, left knee (Jones & Williams, 2016).

5. Left Medial Meniscus Tear: Clicking in the knee noted on exam, pain (Dains, Baumann, & Scheibel, 2016).

© 2019 Walden University Page 3 of 4

References

American Academy of Orthopedic Surgeons. (2018). Osgood-Schlatter Disease (Knee Pain). Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatterdisease-knee-pain.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Jones, M. H., & Williams, A. M. (2016). Osteochondritis dissecans of the knee. The Bone and Joint Journal. doi:10.1302/0301-620X.98B6.36816

Mahmoud, T. (2016). Evaluation of combined arthroscopic lateral release and medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar instability. The Egyptian Orthopaedic Journal, 51(2), 117. doi:10.4103/1110- 1148.203144

Rebella, G. (2015). A prospective study of injury patterns in collegiate pole vaulters. The American Journal of Sports Medicine, 43(4), 808-815. doi:10.1177/0363546514564542

Landmark case law review : Honig v. Doe

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Landmark Case Law Review: Honig v. Doe

Throughout this course the founding principles of the main federal statute, the Individuals With Disabilities Education Act (IDEA), have been explored. Specific attention has been given to the core tenets of this comprehensive law:

  • Free Appropriate Public Education (FAPE),
  • Least Restrictive Environment (LRE),
  • Individualized Education Program (IEP), and the
  • Procedural Safeguards which are designed to protect the rights of parents and their children with disabilities within the public school system.

IDEA’s primary purpose is to assure that students with disabilities receive sufficient services throughout their educational career to enable them to lead productive adult lives.

The IDEA contains several components that are designed to provide specific rights and protections to afford parents an equal partnership in the design and implementation of their child’s IEP. These procedures also give families and school systems exclusive mechanisms by which to resolve their disputes. This means that, for example, a school system cannot take certain actions with respect to their child such as formal assessment or the alteration of their academic placement, without the express consent of the parent. Additionally, in providing a free appropriate public education, students cannot be suspended from school for more than five consecutive days for a conduct violation that was a manifestation of their disability (Honig v. Doe, 2012). 

While parents are required to be an integral part of the decision-making and educational planning process, they also have their right to disagree with the recommendations made by the school system. When a disagreement occurs, certain procedural safeguards are triggered which are intended to assist the parties in the successful resolution of the issue.

The 1988 Supreme Court case Honig v. Doe (Links to an external site.)involved two boys with disabilities, both of whom were harshly disciplined by their respective schools for aggressive behavior displayed at school. Due to the extreme behaviors exhibited, the two boys were recommended for expulsion. They were suspended indefinitely, until which time the school district completed the expulsion proceedings. The parents of both boys disagreed with the unilateral decision of the district regarding their exclusion from school and as a result, filed suit against the district.

According to the IDEA, children with disabilities are legally required to stay in their current “…educational placements pending the completion of any review proceedings unless parents and state or local educational officials agree otherwise” (Honig v. Doe, 2012, Facts of the Case, para. 2). The Supreme Court determined that each boy’s behavior was directly related to their disabilities; therefore, the school board’s decision violated the intent of the IDEA.

Instructions
Your written submission should follow the below criteria.

Content Expectations

  • Summarize the issue surrounding the court case, the parties involved and the case outcome.
  • Evaluate the impact of the case ruling on compliant implementation of special education programming.
  • Explain how the legislation, determined by the final ruling, promotes a collaborative decision-making process regarding special education placement and services.
  • Analyze the ethical and legal conflict regarding instruction and student placement that was brought to the forefront as a direct result of this court case.
  • Describe how your personal beliefs may have influenced your judgment and the fairness of the final court ruling if you were one of the teachers of John Doe or Jack Smith. 

Written Expectations

  • Syntax and Mechanics: Exhibit meticulous use of grammar, spelling, organization, and usage throughout your submission.
  • Source Requirement: Reference at least four scholarly sources including the course textbook in order to provide compelling evidence to support your ideas.
  • Page Requirement: Must be eight double-spaced pages in length (not including title and reference pages) 

@farhatullah – China and its Great Wall

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Please respond to the following, using sources under the Explore heading as the basis of your response:

  • Describe two (2) specific aspects about the Great Wall of China, such as facts about its size, length, purposes, varied materials, labor force, and its phases of construction. Consider the various purposes of such a wall and its impact for good or bad, and compare the Chinese wall in this respect to some specific wall of more modern times.

_____________________________________________________________________________________

What was the purpose of the Wall and how successful was it?

·         This part requires a bit of thought.  Walls are much more than just physical barriers, they also mark clearly defining boundaries for cultures and they are also symbolic and psychological barriers as well.  Think about how the ancient Chinese felt when they saw this Wall as well as how outsiders (particularly the Mongols) felt about seeing this.  Did it signify the superiority of China?  Did it mark a clear line between civilized society and barbarians? 

Examples of other more modern examples of walls and their uses

·         Lots to choose from here, so feel free to explore.  Some easy ones to discuss might include Hadrian’s Wall, the Berlin Wall, or even the proposed wall that President Trump wants to put up on the border with Mexico.  Do more than  just list one, talk about your example in some detail and assess how it compares (in purpose, design, and scope) to the Great Wall 

week5 discussion

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The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned. Provide a detailed response to the topic questions in the Discussion Area. For this assignment, post your responses directly to the Discussion Area; do not attach any documents.

To support your work, make sure you use your course and text readings. When asked, also use outside sources. As in all assignments, cite the sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Complete your participation for this assignment by the end of the week.

Sentencing Guidelines for DUI Offenses

https://www.youtube.com/watch?v=EeoIFWLbofk

https://www.youtube.com/watch?v=i6Oks_lzKZs

https://www.nbcnews.com/news/other/driver-who-confessed-dui-killing-youtube-video-gets-6-years-f8C11448085

In June 2013, Matthew Cordle killed Vincent Canzani while driving under the influence of alcohol. Matthew Cordle, twenty-two years old, prepared a video confession, which was viewed by thousands. In his confession, entitled “I Killed A Man,” Matthew told the world he would take responsibility for killing the sixty-one-year-old navy veteran. He made the video prior to being charged; however, the police were already investigating him concerning the accident and prior to the release of the video. He initially confessed in a YouTube video and later pleaded not guilty in court. He was ultimately arrested and charged with aggravated vehicular homicide where he could face two to eight years in prison. Matthew pleaded not guilty. In October 2013, Matthew Cordle received a sentence of 61⁄2 years in prison. Review the video links below and complete the assignment that follows:

  • Click here to view the video regarding Drunk Driving Confession goes Viral.
  • Click here to view the video regarding Matt Cordle Pleaded Not Guilty After He Confessed Online to Drunken Driving.
  • Click here to view the article regarding Driver who confessed to DUI killing in YouTube video gets 6 years, 6 months in jail.

In many states, a first-time DUI offender can be sentenced to 180 days in jail and a possible license revocation. Second, third, and fourth offenses usually land an offender in prison for at least a year.

In your response, answer the following:

  • Is the sentence of 180 days in jail for a first-time DUI offender too light? Share your responses with a rationale.
  • Would you be opposed to a sentence of two to five years for first-time offenders? Explain your reasoning.
  • Do you believe harsher sentences serve as a deterrent for DUI offenses? Share your responses with a rationale.
  • Should the remorse he expressed in the video influence the sentence he is given? Explain your reasoning.
  • Should a YouTube confession video be allowed as evidence in court? Share your responses with rationale.

Review your state’s law on DUI or DWI.

  • Discuss the charges and sentencing guidelines in your state for drunk driving that leads to fatalities.

Review the posts of at least two of your classmates and respond to what they have written. Be sure to respond to any feedback to your original post.

Nursing philosophy APA Style

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 You have now been exposed to various world-views of well known theorists and their nursing philosophies/theories, including other disciplines’ philosophies.In this project, you will write your own philosophy of nursing unique to your own current practice of nursing.Writing a philosophy is time-consuming, and requires much self-introspection. It involves writing down your beliefs and values about nursing. Often you ask the questions: ” What is nursing?” and “Why do I practice nursing the way I do it now?”Remember, there is no right or wrong philosophy! The goal here is to expound on your philosophy based on the knowledge you obtained or have understood or learned through the study of other theorists/philosophers.Steps to follow:

  1. Before beginning this project, review  MDC School of Nursing BSN Philosophy MDC School of Nursing BSN Philosophy – Alternative Formats . (This is an example of how concepts and philosophy guides and directs curriculum.)
  2. Your Personal Philosophy must address the five (5) topics as shown in the  Personal Nursing Philosophy Rubric (MP1) Personal Nursing Philosophy Rubric (MP1) – Alternative Formats
  3. It must be your original work.
  4. It should be no more than four pages long, double spaced, and typed in a MS WORD file.
  5. It should adhere to APA style (includes introduction, body, conclusion) with correct grammar and spelling are expected.

  

Personal Nursing Philosophy

Your Personal Philosophy must address and have the following Topics Headings:

  

Topic

Description

 

Key Concepts (20 pts.)

Explain   the key concepts of your philosophy/theory.

 

Metaparadigms

(20 pts.)

Describe   the four (4) Metaparadigms of nursing as you view them and how they apply in   your own practice area. 

 

Nursing Process – Philosophy

(15 pts.)

Express   how your philosophy could be applied to your present nursing practice,   research, administration and/or education. 

 

Nursing Process – Strengths & Limitations 

(15 pts.)

Elaborate   on your philosophy’s strength and limitations. 

 

Original Work

(10 pts.)

Paper   must be your original work. 

 

Paper Format

(10 pts.)

Paper   should be no more than four (4) pages long, double space and typed in   Microsoft WORD file. 

 

APA Style

(10 pts.)

Paper   should adhere to APA style (includes introduction, body, conclusion) with   correct grammar spelling are expected. 

Database Discussion

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(Chapter 10) Attached: List the three main approaches to database programming. What are the advantages and disadvantages of each approach?

Instructions:  Your response to the initial question should be 250-300 words.  Next respond to two postings provided by your classmates. The first post should be made by Wednesday 11:59 p.m., EST. I am looking for active engagement in the discussion.  Please engage early and often. You are require to create your initial thread in order to view and respond to the threads posted by other students.  There must be at least one APA formatted reference (and APA in-text citation) to support the thoughts in the post as needed.  Do not use direct quotes, rather rephrase the author’s words and continue to use in-text citations. 

Replies – 

1.  

List the three main approaches to database programming

There are several approaches to database programming, three points out of that are:

  1. Designing or building a brand-new language.
  2. Properly utilizing the database function library.
  3. Embedding the commands associated with database into a basic-purpose programming language.

What are the advantages and disadvantages of each approach?

The advantages and disadvantages of each approach is:

Disadvantage:

Inquiry linguistic structure can’t be checked at assemble time, conceivably mediocre execution.

It is difficult to reuse existing code written in more famous dialects; DB programming dialects regularly do not “feel” like a “genuine” programming language; absence of IDEs.

No powerful questions; requires language explicit pre-compiler; needs explicit IDE support.

Advantage:

Simple to use (for static questions); inquiry punctuation can be checked at order time.

No impedance befuddle; potentially execution benefits because of DB reconciliation; sentence structure check at incorporate time.

For the most part autonomous of the programming language utilized; permits dynamic questioning, in any event, utilizing different information base associations; great instrument support (utilization of libraries is now covered by standard functionalities of IDEs)

2.  

List the three main approaches to database programming. What are the advantages and disadvantages of each approach?

            The three main approaches of database programming include the technique which is a precompiled bunch of SQL statement(s) that is put away on the data set worker. The SQL proclamations are constantly executed on the information base worker. Put away strategies have for quite some time been a decent method of allowing the worker to handle your information. They can altogether lessen the responsibility on the customer, and once you become more acquainted with them you’ll think about how you at any point oversaw without them. There is absolutely more to a put away strategy than just referenced, however I do think this is the main part of a put away methodology (Reese, 2000).

            Consider everything: it’s a way of collection a cluster of SQL articulations, putting away it on the data set server, and executing it’s anything but a solitary call. The way that the put away methodology is pre-accumulated will save you time also when executed. Moreover, the put away method can be executed by quite a few clients, which means you may save a ton of transmission capacity just by calling the put away methodology as opposed to sending the entire SQL explanation each time. A put away strategy can contain any SQL articulation that your information base worker can comprehend. This implies you can utilize put away techniques for different tasks, such as executing inquiries both purported activity questions, for example, DELETE inquiries, and column returning questions, for example, SELECT statements (Leontiev et al, 2002).

            Another task you can utilize a put away methodology for is data set support. Use it to run clean up SQL explanations when the worker is least occupied and consequently save the time and exertion of doing this physically. I will not cover support errands in this part, yet they are significant, and you ought to know about the different undertakings you can perform with put away systems. In case you’re similar to me, you have been or are working for a little organization that doesn’t have an information base head, in which case you’re accountable for keeping the data set worker running. In all actuality, it’s anything but an optimal circumstance, however you surely become more acquainted with your DBMS in unexpected manners in comparison to you would simply being a software engineer, and that is not terrible by any means (Ohori & Ueno, 2011).

References

Leontiev, Y., Özsu, M. T., & Szafron, D. (2002). On type systems for object-oriented database programming languages. ACM Computing Surveys (CSUR), 34(4), 409-449.

Ohori, A., & Ueno, K. (2011, September). Making Standard ML a practical database programming language. In Proceedings of the 16th ACM SIGPLAN international conference on Functional programming (pp. 307-319).

Reese, G. (2000). Database Programming with JDBC and JAVA. ” O’Reilly Media, Inc.”.

Bible 104 Discussion Board Forum 1

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  You are meeting a friend for coffee at your local Barnes and Noble. This friend is skeptical about Christianity and the Bible. During the course of the conversation your friend says, “The Bible is really just a bunch of stories that are designed to help people cope with life in the real world. They give you something to do so that you feel better about your place in this crazy world.” Based on the material from Chapters 1–5 in Everyday Bible Study (both text and videos), how would you respond to your friend? Remember to you support your answer using material from Everyday Bible Study and the Scriptures. You may find the material in Chapters 1 and 5 most helpful for creating your response. 

Your thread must demonstrate an excellent understanding of the Everyday Bible Study text and clearly answer the prompt you selected. Your thread must be well supported with material from both the Everyday Bible Study text and the Scriptures. This material must be properly cited.  

  

· Respond to the questions/ideas that are presented in the instructor’s prompts.

· Summarize any related ideas that are presented in our Everyday Bible Study textbook related to the prompts. 

· Submit your thread of 400 words or more.

case study reply pain management

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Reply to each post Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post.

Respectfully agree and disagree with your peers’ responses and explain your reasoning by Including your rationales in your explanation.

Post 1

What pieces of the holistic assessment are missing from this scenario?

    According to the Holistic Nurses Association, holistic nursing is “all nursing practice that has healing the whole person as its goal” (HNA, n.d). The holistic nursing assessment allows nurses to formulate their care plan and diagnosis. The first piece that is missing from this scenario is what the pain feels like, I would have the patient describe the pain including the intensity and quality of the pain (Woo et al., 2020). Next, I would ask TC about the motivation and cognitive experiences related to the pain with questions like when this injury happened, how long the pain has been going on, what TC has used for medications to help the pain and does anything make the pain better or worse (Woo et al., 2020). Having the patient talk more about the injury while doing a complete assessment can add to the overall assessment.  

As a healthcare provider, what else do you need to understand about this patient related to pain management?

    As a health care provider, it would be important to understand if the patient has any allergies to medications specifically pain medications. If the patient does then we would avoid these medications and treat in other ways. I would also ask TC what other medications he is currently taking to ensure that there are no medication interactions. Next, I would run a complete blood count and a comprehensive metabolic panel on TC to ensure that his hemoglobin, hematocrit, platelets, kidney function, and liver function are all normal. NSAIDS can affect the kidneys and are metabolized in the liver (Woo et al., 2020). Similarly, acetaminophen is also metabolized in the liver (Woo et al., 2020). Next, I would need to screen the patient for substance abuse using the CAGE-AID questionnaire and the DAST-20 (Woo et al., 2020). A urine toxicology can also be run for substance abuse purpose. Last, I would also look up the patient on the MassPAT tool before prescribing narcotics to ensure that TC was not being prescribed opiates somewhere else (Mass.gov, 2021). This tool allows practitioners to view patient’s prescription history before prescribing narcotics to prevent abuse, misuse, diversion, duplicate therapy, and promotion of coordination of care between providers (Mass.gov, 2021).  

Describe the process of rational drug choice for this case study. In your process, discuss your thought processing of anti-inflammatory agents, topical agents, and narcotics.

    My rational drug choice with the limited information I have on TC and without imaging of his shoulder would lead me to believe that TC is suffering from acute pain. Acute pain is best treated with anti-inflammatory drugs (Woo et al., 2020). Due to TC rating the pain an 8/10 I would prescribe a non-steroidal anti-inflammatory and a topical agent. I would also recommend that TC try non-pharmacological measures including both heat and ice (Woo et al., 2020). I then would send TC to an orthopedic specialist where they can further evaluate his shoulder. I would tell TC he can take 200 mg to 800 mg of ibuprofen every 6 to 8 hours (Woo et al., 2020). It is recommended that TC start with a lower dose of NSAIDs as they are adequate to relieve pain in most people (Solomon, 2021). I would also recommend TC try a topical non-steroidal anti-inflammatory which is called voltaren gel. Voltaren gel 1% is typically used in arthritis but can be used to treat acute pain as it has anti-inflammatory properties (Woo et al., 2020). I did consider oxycodone for TC but because this is a schedule II drug with high chance for abuse, I would prefer to start TC on something with that does not have abusive properties. If pain is controlled on something that is not a narcotic, then I would always choose this first as an FNP. If the pain did not get better, then we could consider other options, or I am sure the orthopedic practitioner could as well.  

Include in your response the teaching you would provide to TC.

    My teaching for TC would include starting with a 200 mg dose of ibuprofen and seeing if that helps decrease his pain and then increasing as needed to 800mg maximum. It is important to tell TC that he can only take 3200 mg of ibuprofen in 24 hours. I would also counsel TC that he needs to avoid alcohol while using the NSAID for pain (Woo et al., 2020). Last, I would reiterate that TC needs to see orthopedics to evaluate the shoulder injury further.  

What is meant by the DEA Drug Classification Schedule? Explain each category/classification.

    The DEA Drug Classification Schedule are drugs, substances, and chemicals that are placed into five different categories based on what they are used for medically and the potential the drug has for abuse (DEA, n.d.). Schedule I drugs are drugs with no medical use and have the highest chance for abuse (DEA, n.d.). An example of a schedule I drug is heroin. Schedule II drugs have a high chance of abuse and can lead to both physical and psychological dependence (DEA, n.d.). An example of a schedule II drug is cocaine or oxycodone. Schedule III drugs have a moderate to low chance of physical or psychological dependence (DEA, n.d.). An example of a schedule III drug is codeine. Schedule IV drugs have a low chance of developing dependence (DEA, n.d). An example of a schedule IV drug is Ativan. Schedule V drugs are drugs that contain minimal amounts of certain narcotics, these drugs are typically used for antitussive, antidiarrheal, analgesic (DEA, n.d.). An example of a schedule V drug is lomotil. As a future APRN who can prescribe medication it is important to have an understanding of the drug classification schedule and knowing which medications have a high potential for abuse or misuse.  

Post 2

As an Advanced Nurse Practitioner (ANP), you are working in an urgent care setting. TC comes to the clinic with a work-related injury to the right shoulder. The patient rates the pain 8 on a scale of 0–10. The patient is unable to perform any ROM to the shoulder. There is no neck pain.

What pieces of the holistic assessment are missing from this scenario?

As a healthcare provider, what else do you need to understand about this patient related to pain management?

It is important to understand the type of pain and the type of injury that TC is suffering from. There are many different structures within the shoulder that could be affected by this type of injury. Due to TC being unable to perform any range of motion and complaining of an 8/10 pain level, there must be a significant internal injury to the shoulder. Treatment of pain has been a focus within healthcare for many years. With the development of pain medications, narcotics and highly addictive medications were founded. Prescribing addictive medications is dangerous for providers as well as patients. During the past 25 years, a more educated and aging population has increasingly expected pain relief when seeking treatment. Pain management was declared a human right and ethicists stated that a pain management standard of care is neither an absolute science nor is it free of risk (Woo & Robinson, 2020). For a patient such as TC, learning more about his work environment would be essential before prescribing medication. If work-related injuries are something that may occur frequently, prescribing narcotics which are addictive would not be a good plan for TC. 

Describe the process of rational drug choice for this case study. In your process, discuss your thought processing of anti-inflammatory agents, topical agents, and narcotics.

Like mentioned above, if job-related injuries are something that are frequent for TC, prescribing narcotics would not be a good therapy due to the highly addictive nature associated with them. Many areas could have been injured in TC’s shoulder such as the rotator cuff, muscles and tendons, or the subacromial bursa. Asking this patients questions including what he was doing at the time of the injury, could have a provider determine what part of the shoulder has been damaged. Determining if TC’s pain is acute or chronic will also have an impact on the treatment that will be given. Acute pain is in short duration and results from tissue injury. Chronic pain lasts for a period of time longer than 3 months. Anti-inflammatory medications such as ibuprofen, Advil or Aleve can be useful for a short time and work to target pain control without having systemic effects on the body. Topical applications of anesthetics such as lidocaine cream and voltaren gel or over the counter options can be used for minimal pain relief and therefore will only have short lasting effects on overall pain control. 

Include in your response the teaching you would provide to TC.

Teaching for TC would need to emphasize the differences between acute and chronic pain as well as how to avoid reinjuring this shoulder. Depending on the medication therapy prescribed to TC, teaching would need to be specific to that therapy. Due to TC not being able to perform any range of motion on assessment, as his provider I would recommend physical therapy, as well as anti-inflammatory medications and topical anesthetics to ease his pain during physical activity. 

What is meant by the DEA Drug Classification Schedule? Explain each category/classification.

The DEA classifies medications into five different schedules. The schedules are used to determine how medically acceptable a medication is as well as the dependency of the drug. Schedule I drugs are those that do not have any medical use and have a potential for abuse such as heroin and marijuana. Schedule II drugs are those that have an extremely high potential for abuse as well as the potential for psychological and physical dependence such as Vicodin, dilaudid, oxycodone, fentanyl, Adderall and Ritalin. Schedule III drugs have a low to moderate potential for abuse and physical dependence. Schedule III medications include Tylenol with codeine and testosterone. Schedule IV medications have a low potential for abuse and dependence such as Xanax, Valium, Ativan and Tramadol. Lastly, Schedule V medications have a lower potential for abuse that schedule IV drugs and contain a limited quantity of narcotics in them. Schedule V medications are often used for antidiarrheals and analgesics purposes such as Robitussin, Lomotil and Lyrica. 

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