DQ acute lymphoblastic leukemia

Cindy is a 9-year-old female with acute lymphoblastic leukemia (ALL) who presents to the emergency department with a temperature of 38.4 degrees C. (101.2 F.) and a complaint of a sore throat. She has been receiving chemotherapy since her diagnosis 4 months ago. Cindy’s mom reports that her fever has been unresponsive to acetaminophen. No reports of nausea, vomiting, or diarrhea noted. She weighs 57 lbs. (25.9 kg), is 51.5 inches (128.8 cm.) and has NKDA. Cindy lives at home with her mom and dad, and her 3-year-old brother. Her mom stays at home with the children because of her diagnosis and resulting hospitalizations and treatment. Cindy has missed quite a few days of school and does not return telephone calls from her friends.

  1. What patient history has clinical significance to the nurse and why?

Her most recent vital signs were:

T: 100.8 F/38.2 C (oral)

P: 112 (reg)

R: 24 (reg)

BP: 102/66

O2 sat: 96% on room air

  1. What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

  • GENERAL APPEARANCE: Resting in bed with eyes closed, pale in appearance.
  • RESP: Breath sounds clear with equal aeration bilaterally, non-labored respiratory effort
  • CARDIAC: Skin is pale, cool to touch. Cap. refill 3-4 seconds in both hands. No edema noted, heart sounds regular with no abnormal beats, radial and pedal pulses present and strong.
  • NEURO: Patient appears lethargic, drowsy, oriented x4
  • GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Last BM yesterday evening
  • GU: Voiding without difficulty.
  • SKIN: Skin integrity intact. Central venous access device (CVAD) in place, dressing intact
  1. What patient assessment findings has clinical significance to the nurse and why?
  2. What is the nursing priority at this time?
  3. What nursing interventions will the nurse initiate based on the priority at this time?

DQ cystic fibrosis (CF)

Kyle is a nine-year-old boy with a history of cystic fibrosis (CF) who for the past two days has had a fever of 101.9 F and has felt more tired. His cough has become more frequent, and he is bringing up thick yellow mucus. His mother brought Kyle to his CF clinic where he is diagnosed with a left lower lobe pneumonia. Kyle is admitted to the pediatric unit for IV antibiotics. Kyle has a Broviac line for vascular access since he frequently needs IV antibiotics for respiratory infections. Kyle is below the 5th percentile for his weight at 41 pounds (18.6 kg) and is at the 5th percentile for height at 44.5 inches (113 cm). He has a G-tube in place for night feedings. Kyle is in 4th grade and lives at home with both parents. His mother is a stay-at-home mom, and his father works as an IT tech. The family has health insurance through the father’s employer. He receives Medicaid because of his chronic illness. He has missed many days attending school due to CF. The kids at school tease because he is so small.

  1. What patient history has clinical significance to the nurse and why?

The most recent vital signs were:

T: 102.6 F/39.2 C (oral)

P: 122 (reg)

R: 28 (reg)

BP: 108/58

O2 sat: 86% on room air

  1. What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

  • GENERAL APPEARANCE: Slightly anxious appearing and very quiet. Skin is pale with dark circles under both eyes. Appears much younger than age due to slow growth. Does not speak except for nodding head “yes” “no.” Sitting between his parents.
  • RESP: Respiratory efforts moderately labored with increased rate. Breath sounds coarse crackles and wheezing throughout lung fields bilaterally with fine crackles heard on inspiration at right base. Moderate subcostal retractions noted, nail beds have a bluish hue in color and have pronounced clubbing.
  • CARDIAC: Pale, warm & moist forehead. No edema, heart sounds regular with elevated rate, no abnormal beats, and pulses strong, equal with palpation at radial/pedal/post-tibial landmarks, brisk cap refill noted at forehead Justin has an implanted Broviac line at the left upper chest. The site is clean and dry with a small scar at the insertion site.
  • NEURO/MENTAL: Alert & oriented to person, place, time, and situation (x4). Appears to be moderately anxious, listening intently to provider and nurse but not speaking, holding on to Dad’s hand.
  • GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Liver non-palpable, PEG tube in place with expected healing around tube/site
  • GU: Voiding without difficulty, urine clear/yellow
  • SKIN: Skin integrity intact, skin turgor elastic, no tenting present
  1. What patient assessment findings have clinical significance to the nurse and why?
  2. What is the nursing priority at this time?
  3. What nursing interventions will the nurse initiate based on the priority at this time?

Reducing Ambiguity in Business Requirements

Write a 4-6 page paper in APA format (not including the cover page and reference page).  Read the case, see attached.  Prepare your composition to cover the following topics or questions within the body section of the paper described for this assignment:

  • Why are ambiguous business requirements the leading cause of system development failures?
  • Why do the words and and or tend to lead to ambiguous requirements?
  • Research the web and determine other reasons for bad business requirements.
  • What is wrong with the following business requirement: The system must support employee birthdays because every employee always has a birthday every year.

Discussion Question (6-month-old female)

Susie is a 6-month-old female who was brought into the emergency department for diarrhea and vomiting over the past two days. She had two large loose stools the first day and now her mother reports that she has been less active, is not interested in playing, and has been sleepier today. She is unable to keep any feedings down today. She has had 5 loose, watery stools and emesis x4 this morning. She has not had a wet diaper since yesterday evening. Susie has not had any immunizations since birth. She is 26 inches in length and weighs 16 pounds, 4 ounces. She weighed 17 pounds, 2 ounces at her last office visit two weeks ago. Susie’s mother is 21 years old, a single mother, and this is her first child. Susie’s mom is not currently working and lives with her parents and she feels overwhelmed as a new mother.

  1. What patient history has clinical significance to the nurse and why?

The most recent vital signs were:

T: 102.2 F/39.0 C (oral)

P: 158 (reg)

R: 36 (reg)

BP: 62/42

O2 sat: 95% on room air

 

2.What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

  • GENERAL APPEARANCE: Irritable when awake, alternates with lethargy once quiet. When awake and crying, tears are not present
  • RESP: Breath sounds clear with equal aeration bilaterally, non-labored
  • CARDIAC: Skin is pale, cool to touch, cap refill 3–4 seconds in both hands, brachial pulses palpable bilaterally
  • NEURO: Lethargic, does not maintain eye contact with mom or caregiver
  • GI: Abdomen soft with hyperactive BS x4 quadrants, no apparent tenderness to palpation
  • GU: 5 mL dark amber, cloudy urine noted in urine collection bag-sent to lab
  • SKIN: Anterior fontanel depressed, eyes slightly sunken, lips and tongue are dry with no shiny saliva present, when skin over abdomen is pinched, remains tented for 2–3 seconds
  • 3.What patient assessment findings have clinical significance to the nurse and why?
  • 4.What is the nursing priority at this time?
  • 5.What nursing interventions will the nurse initiate based on the priority at this time?

ERP

Write a 4- page paper in APA format (not including the cover page and reference page).  Read the case, Closing Case Two (attached files).  Prepare your composition to cover the following topics or questions within the body section of the paper described for this assignment:

 

  • Why do you think it is so difficult to find successful ERP implementation?
  • How do you think cloud computing will help ERP implementations find success?
  • What advice would you give a company deciding to implement an ERP system?
  • How can integrating SCM, CRM, and ERP help improve business operations at your school?

Windshield Survey of Your Neighborhood Tempe, Arizona

Assignment:

Windshield Survey of Your Neighborhood

One way to understand your community is through a tool called “windshield surveys”. A Windshield Survey is simply a method for observing a neighborhood/community. It allows the observer to gain insight and understanding of a community and its people. Utilize the Windshield/Walking Survey to complete this assignment. The following elements are included in a typical windshield survey:

  • Boundaries
  • Housing and zoning
  • Open space
  • Commons
  • Transportation
  • Social service centers
  • Stores
  • Street people and animals
  • Condition of the area
  • Race and ethnicity
  • Religion
  • Health indicators
  • Politics
  • Media
  • Business & industry

Write a 1200-1700-word essay exploring your own neighborhood (look within your zip code). Consider the list above when writing your assessment.

  • What did you learn about your neighborhood?
  • Did any of your findings surprise you?
  • Based on the components of the windshield survey elements, how would you describe your neighborhood?
  • Think about improvements to your community. Discuss how housing and zoning could be improved.
  •  What would the impact of more open spaces mean for the community?
  • How could transportation in your area be improved?
  • Describe the services available and how to improve for all populations?

Assignment Expectations-

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again before submission to ensure you have addressed its criteria at the highest level.

Length: 1200 – 1700-word essay: title and reference page do not count towards the minimum word count.

Structure: While APA format is not required for the body of this assignment, academic writing is expected. Include a title page and reference page in APA style.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

DQ Danny 4 month old Male Case Study

Danny is a 4-month-old male in the emergency department accompanied by his mother, Sarah, a 19-year-old single mother. Sarah appears visibly tired and reports that Danny has been getting up more frequently in the night, crying but refusing to eat his formula feedings and reports episodes of gagging, arching his back, and frequent crying during and immediately following formula feedings. Sarah reports that she has interpreted this behavior as a sign that she is overfeeding Danny and has started watering down his Similac. The following growth measurements are provided: 12 lbs 4 oz (5.6 kg), 22 inches (55.9 cm). Using the CDC chart, he is below the 5th percentile for his weight and length. Danny lives with his 19-year-old mom and maternal grandmother in a small two-bedroom mobile home. Danny’s grandmother is 56 years old, is obese, and suffers from poorly controlled type 2 diabetes, hypertension, and smokes 2 packs per day. Grandmother watches Danny during the day while mom works part-time at a local fast food restaurant. Three or four nights per week, grandmother watches Danny while Sarah spends her nights drinking and socializing with men and other adults at the local bar. Sarah became pregnant with Danny following a brief relationship with a 48-year-old man. Father is not involved in Danny’s life and is currently in prison.

  1. What patient history has clinical significance to the nurse and why?

The most recent vital signs were:

T: 96.8 F/36.0 C (axillary)

P: 150 (reg)

R: 34 (reg)

BP: 75/50

O2 sat: 97% on room air

2.What patient vital signs have clinical significance to the nurse and why?

Current Assessment:

  • Danny is thin and pale in appearance. Skin folds noted around his buttocks. No respiratory or neurological concerns noted. Reflexes and muscle tone within normal limits. Danny is alert, minimally interactive, and does not make eye contact with his mother. Danny’s anterior fontanel is flat and open. Sarah leaves the room during the assessment to make a telephone call and smoke a cigarette.
  • GENERAL APPEARANCE: Danny is lying in his crib, eyes closed. Becomes irritable during assessment, difficult to console. Mom is not at bedside.
  • RESP: No respiratory distress noted. Lungs sound clear throughout.
  • CARDIAC: Apical pulse regular
  • NEURO: Pupils round, reactive. More alert as assessment continues, remains very difficult to console.
  • GI: Bowel sounds audible x4. Last BM unknown.
  • GU: Diaper changed during assessment, no bruising or skin issues noted around peri area.
  • SKIN: Pale, no open wounds or additional skin concerns noted.
  • GI: Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Liver non-palpable, PEG tube in place with expected healing around tube/site
  • GU: Voiding without difficulty, urine clear/yellow
  • SKIN: Skin integrity intact, skin turgor elastic, no tenting present
  • 3.What patient assessment findings have clinical significance to the nurse and why?
  • 4.What is the nursing priority at this time?
  • 5.What nursing interventions will the nurse initiate based on the priority at this time?

Health Promotion template complete a table for each childhood stage

Assignment:

Utilizing the Child Development and Health Promotion template, complete a table for each childhood stage (infant, toddler/ preschooler, school-age and adolescent) with the following information:

  • Normal vital signs for this age
  • Normal measurements for this age
  • Cognitive abilities (Fine motor, gross motor, language, problem-solving)
  • Psychosocial development theories
  • Immunizations due
  • Nutrition guidelines
  • Health promotion activities
  • Injury prevention education

APA formatting is not required. However, a title page and references should be included.

Assignment Expectations

Length: Complete four charts, one for each of the different stages:

Infant, Toddler/Preschooler, School Age, Adolescent.

Structure: Provide Sherpath and Text References with completed tables. Utilize the Child Development and Health Promotion Worksheet

to complete this project. APA formatting is not required for this assignment except for the references should be included in APA format.

References: Use the appropriate APA style in-text citations and references for all resources utilized.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

Spotify

Write a 4-6 page paper in APA format (not including the cover page and reference page).  Read the case, Closing Case Two (attached).  Prepare your composition to cover the following topics or questions within the body section of the paper described for this assignment:

  • How is Spotify taking advantage of mobile devices?
  • How is Spotify a Music as a Service business?
  • Why should Spotify care about mobile application management?
  • Why should Spotify care about mobile device management?
  • Without wireless technologies and mobile devices, would Spotify be successful? Why or why not?

DQ Psychosocial Integrity

Read pages 21- 25 in the NCLEX test plan and discuss one category under Psychosocial Integrity. Pick one area, such as family dynamics or mental health concepts and reflect on where in your program of study these areas have been covered. What, in your estimation has not been covered to date.