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What type of medication is furosemide and how does it work? What are the advantages of this classification of diuretics? Explain your answer. (USLO 6.2, 6.3, 6.4, 6.6)
Abnormal electrolytes and other laboratory test results may occur when taking loop diuretics. Explain the imbalances. Would the following serum electrolyte and laboratory values be expected to increase, decrease or remain unchanged? (USLO 6.3, 6.6, 6.8)
3. What is the teaching for patients taking loop diuretics?
PICOT is an acronym used to help develop clinical research questions and guide you in your search for evidence:
P = Patient population
I = Intervention or issue of interest
C = Comparison of interventions or comparison of interests
O = Outcome
T = Time frame
For example, you may wish to research the effects of interrupted sleep on cognition of ICU patients 65 or older.
Using this PICOT model,
In _________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?
In ICU patients who are 65 or older, how does interrupted sleep (awakened one time or more in four hours) as compared to uninterrupted sleep influence the patients cognitive ability over 5 days?
Assignment Directions
Begin by selecting a topic in nursing Download topic in nursingthat is of interest to you. Next, use PICOT to format possible research questions about that topic. Provide 3 possible PICOT research questions.
Include the following:
Title page
Provide a brief description of the topic and background information.
Explain the significance of the topic to nursing practice.
Provide 3 clearly stated PICOT questions.
This week, we’ll be reading the first and second chapters of Being Mortal. For this assignment, you’ll be answering reading questions on those chapters. There will also be a separate discussion assignment to allow you a chance to talk with other students about what you read.
Submit your answers to the following questions. These questions are designed to highlight the main points of the chapters and to allow me to assess students’ understanding of them.
Reading Questions for Being Mortal:
1. Contrast Alice Hobson’s and Sitaram Gawande’s experiences of growing old, the former in the modern United States, and the latter in what Dr. Atul Gawande calls a “premodern” part of India. How are these two different experiences affected by the different world views of these two places?
2. In modern society, according to Dr. Gawande, old age and infirmity have gone from being a shared, multigenerational responsibility to a more or less private state something experienced largely alone or with the aid of doctors and institutions” (17). He analyzes the causes that he sees as being responsible for these shifts. Summarize his causal analysis.
3. At the beginning of chapter 2, Dr. Gawande states that “[m]edicine and public health have transformed the trajectory of our lives” (25), and three graphs follow to illustrate visually what he means. Explain how changes in medicine and public health have led to many of us to have old age declines that now mirror the second or third graphs instead of the first.
4. Starting on page 31, Dr. Gawande looks at both the classical and new views of aging. Summarize both of these and explain why he ultimately concludes that “the classical wear-and-tear model may explain more than we knew” (33). How does this process ultimately lead to a condition which he calls “frailty,” and what are some of the physical and mental ways in which frailty manifests itself (34)?
5. What are some of the ways in which individuals and society are harmed by our not frankly addressing this reality of frailty?
6. Dr. Gawande shadows his colleague Dr. Juergen Bludau, the chief geriatrician at the Center for Older Adult Health at his hospital, to observe how he interacts with and treats his elderly patients. When Dr. Bludau assesses patient Jean Gavrilles, what does he conclude is the “single most serious threat” she faces, and what are some of the suggestions he makes to help her make her condition “more manageable and to avert at least some of the worst effects” (41)?
7. Dr. Gawande asked Chad Boult, a geriatrics professor, what can be done “to ensure that there are enough geriatricians for the surging elderly population.” Dr. Boult explains that it is “too late” because the number of these specialists is declining and there will be a net loss with coming retirements. What alternative solution does Dr. Boult propose?
Now that you’ve completed the homework reading questions on some of the main points in chapters 1 & 2 of Being Mortal, I’d like to invite you to participate in a discussion on what you read. Please make a substantive post of at least SIX complete sentences by Wednesday, November 10th. Then respond to at least one other student’s post by Friday, November 12th. Please Note: You must complete both of these posts to receive any credit at all for the assignment.
You may discuss any point in the two chapters which struck you, but I will also give you a few ideas in case you need a starting point. (You may choose one of these or else formulate a different focus of your own.)
1. Toward the end of the chapter, Dr. Gawande tells the story of Dr. Felix Silverstone, a geriatrician whom he had quoted earlier in the book. As you’ll remember, Dr. Silverstone was still practicing medicine until he was 82, when he decided to retire because of his wife’s declining health. Recounting his transition to retirement, Dr. Silverstone said poignantly, “I didn’t think I would survive the change. I was taking apart my life as well as the house. It was terrible” (47-48). “What buoyed him, despite his limitations, was having a purpose,” notes Dr. Gawande. Some of this significant work took a professional form–he mentored a young geriatrician, he formed a professional reading group, he headed a committee to improve health care services at his retirement facility–but his primary focus became taking care of his wife, Bella. “She is my purpose now,” he shared, and he devoted a combination of his professional knowledge as a geriatrician and his personal interest as a loving spouse to this new endeavor (49-50).
Dr. Silverstone’s need for some sort of stimulation and social engagement reminded me of what Dr. Bludau said about the need for “retention of enough function for active engagement in the world” (41). It also reminded me of Dr. Gawande’s father’s wish to remain active in his community even as he faced a terminal illness. Last week’s discussion on combating loneliness also comes to mind.
This can be hard for some older people who are still healthy as well. We look forward to retirement, but it can actually be a wrenching adjustment, as it was for Dr. Silverstone. Life quickly becomes boring without meaningful activities to fill it, and some people can become quite isolated and miss the interaction that they used to have at work or with their children or other parents when they were younger adults. I have read that it’s important to retire to something as opposed to from something. Similarly, I once read in a novel the opinion that to be happy, you need to have something to love, something to look forward to, and some significant work to do.
Have you given any thought to how you will fill your own retirement with “active engagement in the world” or with significant work? (I write this aware that many of you are still pondering what career you’ll choose, let alone what your retirement will be like.) Do you have any examples around you of elderly people who are currently living fulfilling lives along these lines? Do you have any ideas of how we might reach out to elderly people to help them be less isolated and more involved with society? And this doesn’t even have to be limited to elderly people. We are currently facing an epidemic of loneliness in our society that affects other ages as well.
2. Dr. Gawande looks at how we’ve changed our views of old age from a venerated, honored position (so much so that people lied about being older than they were) to its lowered status as it became more rare and people had more opportunities to thrive outside of the multi-generational home. As I read this section, I also thought about advertising in America which is focused on younger people as companies vie for their brand identity. I see this on American tv which has long used commercials as a source of revenue. Because companies are most interested in the 18-49 demographic, they want this reflected in the casts of the shows that they sponsor. Whenever I see someone older than 40 on American tv, I tell my husband, “Oh, he’s a goner,” and sure enough, the character is often killed off in an early episode. This is very different from British tv which features characters of all ages. Older people–including older women–often hold rich, meaningful, leading roles. It’s not surprising to me that in England, old age is seen as starting at 68, when the cut-off is 62 for many other countries. Our American focus on youth was also promoted by the Baby Boomers when they were young; there was a saying, “Never trust anyone over 30.” I have seen this redefinition of old age edge further downward since; for example, I was walking down the hall one day, and I heard a student saying, “Oh he’s really old; he’s twenty-five.” Twenty-five is old? Another student wrote in his journal that at 19, he was already fearing old age.
What can we do as a nation to shift our perceptions of age? In surveys, people of every age report good things about their decade, and, indeed, there are many rewards of being older. I’ve been recently reassessing my life in middle age, and I’m happy to report that I feel less angst now, I have accumulated more resources (such as long-term friendships or an education) etc… When it comes down to it, I’d love to get rid of some of the aches I now have or to regain some of the energy I’ve lost, but I wouldn’t do it if it meant I also had to give up some of my life experience or relationships. How can we help people to fear life less and to let go of some of their ageist ideas (even as, as question 3 below notes, frailty is a part of the aging condition)?
3. Dr. Gawande talks about how we can sometimes feel as if we’ve failed if we age: “We need help, often for long periods of time, and regard that as a weakness rather than as the new normal and expected state of affairs. We’re always trotting out some story of a ninety-seven-year-old who runs marathons, as if such cases were not miracles of biological luck but reasonable expectations for all. Then when our bodies fail to live up to this fantasy, we feel as if we have something to apologize for” (28). He stresses that aging is normal: “(a)lthough the processes can be slowed–diet and physical activity can make a difference–they cannot be stopped” (31). With our society’s emphasis on youthfulness and our fear of aging and loss of independence, this can be unsettling to hear. In the later part of the book, he shares some exciting new alternative models for caring for elderly, dependent people, so we can look forward to reading about those, but do you have thoughts on Dr. Gawande’s normalization of aging and eventual frailty?
4. When Dr. Gawande was talking about the historical past and how, even when children started leaving home, there was usually one child who stayed behind to care for aging parents, “often the youngest daughter,” I thought about how many people today are still caring for their dependent elders. According to the Pew Research Center, 40.4 million caregivers provide unpaid care for Americans sixty-five-years and older. And if you look just at care for one debilitating form of illness, dementia, according to the Alzheimer’s Association: “16 million Americans provide unpaid care for people with Alzheimer’s or other dementias. These caregivers provided an estimated 18.6 billion hours of care valued at nearly $244 billion.” This responsibility can be especially taxing for “sandwich generation” caregivers, people who are both caring for dependent children and their aging parents at the same time. An article also recently appeared in the Times about elderly children who are trying to care for even older parents and who were finding the physical demands of being a caregiver in later life especially taxing.
Whether to care for older parents or not is a complicated question. Some people, like Dr. Silverstone, embrace the idea of taking care of dependent elders, and some would find it culturally unthinkable not to do so. Some find fulfillment and joy in caregiving. However, it’s also true that care needs can become almost impossible, as with the last stages of Alzheimer’s when patients can’t move independently and require round-the-clock care. Hiring outside caregivers can also be prohibitively expensive, and there isn’t currently a sufficient social safety net to provide adequate financial help. The physical, psychological, and financial demands of care-giving can be draining, especially since people can live so much longer with a debilitating condition than they used to. I heard an interview last semester on Terry Gross’s NPR program, Fresh Air, with Tia Powell, a doctor and bioethicist, about her new book, Reimagining Dementia. At the end of the interview, Gross asked Dr. Powell about her own fears of developing dementia, given her genetic history. Dr. Powell talked about her bright children and their interesting lives and said that she didn’t want them to have to make a sacrifice, like giving up a career path, to take care of her. She said we should re-think reflexively shaming people who find it to difficult to care for someone with overwhelming needs.
What are your thoughts about long-term care-giving for elders in America? Do you have any ideas for re-imagining caregiving? Should care-giving fall predominantly on the shoulders of women as it historically has? Is there a point at which it can become too much or should it be shouldered no matter what? Do caregivers need to be provided with more services than they currently have?
The theory of pluralism states that there are limits to how much interest group influence politics because of the competition among a vast number of groups. We all have different and varied interests that will affect how we perceive issues and for every interest group there is another that opposes it. We as Americans have a variety of different racial and ethnic backgrounds, speak different languages, and practice different religions.
In contrast to pluralism, hyper-pluralism is an American political theory asserting that when a group becomes too diverse in its make up (i.e. race and ethnicity, beliefs and practices, etc.) and some groups possess greater power and influence than others, it’s no longer governable as a collective.
We were taught that the collective culture of the United States has often been explained using the metaphor of the ‘melting pot.’ This metaphor is used to describe the ways in which different cultures come together in one nation to form a single culture.
Is the United States of America still a melting pot? or is there another term that you would use for the United States. Do you think that we still come together to form an “American Culture” and what is that?
After carefully reviewing the Learn items, respond to the following prompts:
Describe and evaluate the development of the agenda of American foreign policy from the end of World War II to the present. Your discussion should explain how American foreign policy was impacted by changes within the global system during the same period of time.
In the course of your discussion (above) address the following proposition: The United States has been, on balance, a force for good in the world since the end of the Second World War. Do you agree or disagree?
Highlight the relevance of the Christian faith and worldview to foreign policy.
Interview Analysis
You will conduct two interviews with practicing professionals in the field of law enforcement. These individuals may occupy positions in federal, state, county, or municipal police agencies, probation, parole, public defenders, judges, or prosecutors’ offices.
It is preferable that you conduct the interviews in person, but telephone interviews will be acceptable if in-person interviews cannot be arranged.
Focus on the following questions in your interviews:
Why are ethics and character so important in the field of law enforcement?
Do the interviewees feel that police are more ethical today or were more ethical 10 years ago?
Why do police officers become involved in misconduct?
Do the interviewees feel that there is enough training offered in ethics at the police academy level? If not, why is that?
Do the interviewees believe that law enforcement agencies are doing enough to promote diversity, equity, and inclusion in their recruitment, hiring, and procedural practices?
Should ethics training be offered as an ongoing process for law enforcement officers?
Do the interviewees feel that education and/or training in ethics would reduce incidents of police corruption?
Report the results of these interviews in a paper that answers the proposed questions. Apply to your paper information that has been read and discussed in class on various ethical issues to form a synthesis of practical law enforcement ideologies. Be sure to discuss with the interviewees at least four contemporary ethical issues that they are dealing with as criminal justice practitioners. Finally, offer your own insights on the perspectives of the individuals you interviewed and materials covered in the text readings and Seminar discussions.
In this discussion, you will focus on the current benchmarks used in clinical practice. Each student will examine the use of a benchmark or core measure applicable to their individual practice and discuss the process used to reach goals and how each goal is measured. Compare and contrast the benchmark or core measure discussed with the National Strategy for Quality Improvement in Health Care, led by the Agency for Healthcare Research and Quality (2011), which established a set of three overarching aims. (Imply in to a nurse practitioner )
Where the concepts can be applied: This discussion will help you articulate your goals for your individual practice.
Short essay:
Choose one TV show as your example for discussion. Use one person or one theme from the show.
Explain fully if you think that TV portrayals reflect or determine the way society regards people according to selective perception explained in our textbook. (I would use the textbook to help you with this) s
What social values and social attitudes are portrayed?
Search the online RU Ham Library Catalog search bar with phrases such as:
television criticism
television aesthetics
television and women
religion on television
minorities on television
men on television
NOTES:Here is an example of research notes for an essay.
A TV portrayal of “family” in Modern Family
Does the mother work? (This could be an example of a social attitude about women’s place in the home but could be a social value about the importance of motherhood so you could argue both!)
Does the dad stay at home?
Do the portrayals reflect the current roles of moms and dads in the family? (and what does that even mean? Is there a “one size fits all” role for moms and dads? (You are beginning to have to discuss gender roles and society’s assumption that “family” means having heterosexual parents, etc.)
Where would a show like Modern Family fit into this analysis?
Is the show set for today or in the past? That will determine your answer to some extent. For example, if you chose the portrayal of “family” in the original That 70s Show, you would have to research the role of the family in society and the attitudes about the family during the 1970s – NOT today.
Write a research paper describing the design and purpose of the experiment along with the contributions in modern psychology attributed to the experiment.
Address the Following: Purpose of Experiment? Who performed the experiment? Where was the experiment conducted? Describe the participants in the experiment. Describe the Experimental Design: What were the different variables in the experiment? What observations were made during the experiment? What conclusions/assumptions were made after the experiment? Were there any unethical elements to this experiment? How has this experiment impacted modern psychology?
In light of the way devolution to the UK nations has developed since 1998, the UK can no longer sustain being a unitary state and should become a federal state. Critically evaluate this statement in light of the legal development of national devolution within the UK.