What are managerial actions that a rural community hospital CEO can take to alleviate the revenue shortfalls of the maldistribution of primary care physicians and inefficient patient throughput caused by nurse staffing shortages?

COMMENTARY AND QUESTIONS:  The United States is suffering a shortage of licensed physicians and registered nurses to provide primary health care.  While the physician shortage is profession-wide, there is a greater shortage of primary care physicians than specialty physicians.  Further, the United States is suffering from physician maldistribution, with more physicians (primary and specialty) choosing to practice in affluent urban areas as opposed to more economically depressed rural areas.  Rural community hospitals that depend upon physician referrals for inpatient admission, outpatient surgery, and diagnostic testing revenues are suffering because there aren’t enough physicians to generate sufficient revenues for the hospital to be financially viable.  Rural patients who have the economic means and ability are responding to the primary care shortage by seeking primary care in the urban areas, which means that they are referred to urban hospitals for inpatient admission, outpatient surgery and diagnostic testing.
Hospitals across the U.S. have critical shortages of nursing staff and are suffering the consequences of inadequate patient throughput.  Patient throughput is the process of moving patients through the hospital at the appropriate time in the patient’s treatment so that the patient’s bed can be opened for a new revenue-generating patient.  For example, an ICU patient should be moved to a lower-care medical-surgical floor as soon as possible so that the ICU bed is available for a new patient.  Similarly, this same patient should be moved to a rehabilitation hospital as soon as they no longer need acute care so that the patient’s medical-surgical bed is available for a new revenue-generating patient.  In some instances, patient throughput is being slowed down because there isn’t enough nursing staff on the medical-surgical floor to receive patients from the ICU or other higher care areas.  The inability to move patients through the hospital to lower levels of care (and ultimately to discharge) negatively impacts the hospital’s revenues.
The combination of primary care physician shortages, physician maldistribution negatively impacting the rural areas, and critical nurse staffing shortages have a cumulative negative effect on rural community hospitals.  Please discuss the following:
1.  What are managerial actions that a rural community hospital CEO can take to alleviate the revenue shortfalls of the maldistribution of primary care physicians and inefficient patient throughput caused by nurse staffing shortages?
2.  Should the CEO seek to recruit primary care physicians and/or nurses from foreign countries to move into the rural community and establish a professional practice in the community?  If yes, there would be additional primary care physicians to make patient referrals to the hospital (e.g., revenue-generating) and additional nurses to staff the hospital clinical service locations so that patients could be moved through quicker.
3.  However, what is the effect of recruiting international medical and nurse graduates to the United States on the global health care economy in less developed countries?  Does the CEO have a socio-ethical duty to not recruit qualified medical practitioners away from their home country when they are sorely needed to take care of patients in that home country; or is the CEO’s duty to their own rural community in the United States?

Explore the website :    www.nasdaq.com and write 3-5 pages typed double space 12 times new roman font. Please explore the website and write what info you found on the website. Explore different tabs i.e. Our Businesses, Quotes, Markets, News, Investing, Personal Finance, Portfolio.

Case Study 2.1
Explore the website :    www.nasdaq.com and write 3-5 pages typed double space 12 times new roman font. Please explore the website and write what info you found on the website. Explore different tabs i.e. Our Businesses, Quotes, Markets, News, Investing, Personal Finance, Portfolio.

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient has been diagnosed with protein malnutrition. The role genetics plays in the disease. Why the patient is presenting with the specific symptoms described.

Scenario:
An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient has been diagnosed with protein malnutrition.
The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response.

What might be a characteristic influencing your response?
The scenario reflects this to be an unidentified race, so if this patient was African American would this create characteristics influenced by race? It may or may not just support your point with a citation.
In this elderly female, there are several contributing factors for her presenting with these symptoms.
If you do not find any genetic factors contributing, provide a citation supporting this. As a student, be sure to support your points until you become the expert.

Considering the ethical dilemma shared above, how might someone object to using utilitarianism as a viable means of solving that ethical dilemma? Do you find the objection helpful or unhelpful?

Prior to beginning work on this discussion forum, read Chapter 3 of the How Should One Live? An Introduction to Ethics and Moral Reasoning, and Chapter 2 of John Stuart Mill’s Utilitarianism also in your textbook’s Primary Sources section.
The first discussion this week will focus on explaining and evaluating the utilitarian ethical theory as discussed in Chapter 3 of the textbook. Your instructor will be choosing the discussion question and posting it as the first post in the main discussion forum. The requirements for the discussion this week include the following:
Discussion Topic: Strengths and Weaknesses of Utilitarianism
After reading Chapter 3 of the textbook, consider utilitarianism’s advantages and disadvantages as an ethical theory.
Please address the following questions (not necessarily in this order):
1. Reflect on yourself:

Consider a time when you (or someone you know) faced an ethical dilemma. Describe the circumstance and include relevant facts about the ethical issue.
Discuss whether utilitarian principles were used to address the dilemma. If not used, do you believe that if utilitarian theory had been employed, the ethical dilemma would have had a different outcome?

2. Engage with the text:

Using at least one quote from one of the required readings, explain what you believe are the strengths of utilitarianism.
Using at least one quote from one of the required readings, explain what you believe are utilitarianism’s weaknesses (objections).

Several objections to utilitarianism are discussed in Chapter 3, Section 3.5 of the textbook, and John Stuart Mill (2017/1863) discusses eight objections to Utilitarianism (in Chapter 3 of the textbook, the text can be found under “Primary Sources” and the objections under the section, “Objections and Replies”).
3. Reflect on the theory:

Considering the ethical dilemma shared above, how might someone object to using utilitarianism as a viable means of solving that ethical dilemma? Do you find the objection helpful or unhelpful?

The total word count for all your posts should be at least 600 words, excluding references.

Describe your understanding of the homeostasis process by summarizing how the food you have (or have not) eaten today affects your blood glucose level.

1. Describe your understanding of the homeostasis process by summarizing how the food you have (or have not) eaten today affects your blood glucose level.
Provide answer here
2. Summarize the function of four organelles found in a basic human cell.
Provide answer here
3. Describe how substances move in and out of a cell.
Provide answer here
4. Choose two organs that are found in different body cavities. Describe their location in relation to each other, using at least three positional medical terms.
Provide answer here

RAND > The RAND Blog > When Is a Terrorist Really a Terrorist?

RAND > The RAND Blog >

When Is a Terrorist Really a Terrorist?
COMMENTARY (The Hill)

Privacy – Terms

OBJECTIVE ANALYSIS.
EFFECTIVE SOLUTIONS.

Travelers are evacuated out of the terminal and onto the tarmac after a shooting at Fort Lauderdale-Hollywood International Airport in Florida, January 6,
2017
Photo by Andrew Innerarity/Reuters

by Brian Michael Jenkins

January 27, 2017

S
ecurity footage shows what looks like an all-too-typical episode of lone-wolf terrorism: A single young man

pulls a handgun from his waistband and begins firing at helpless victims in an airport baggage claim area.

The results were certainly terrifying — five dead, six wounded, countless others traumatized as witnesses to

the carnage.

But while this month’s attack at the Fort Lauderdale-Hollywood Airport in Florida outwardly bore the hallmarks of a

terrorist event, it should not be automatically lumped in with the many deadly acts of ideologically inspired violence

that plague the globe — at least not based on what is now known about the attacker, 26-year-old Iraq War veteran

Esteban Santiago.

More than 15 years after fear of international terrorism seized the world’s consciousness on 9/11, Americans seem

almost eager to explain away senseless acts of mass violence as being driven by ideology, preferably jihadi ideology.

This is a mistake that only stokes the fear of terrorism and exaggerates the influence and reach of America’s Islamist

extremist foes.

As word of the Fort Lauderdale attack spread across the media landscape, journalists, online commentators and

many Americans immediately sought to identify the terror nexus that would conveniently attribute the killings to

jihadi motivations.

And there it was: Santiago had complained to the FBI that U.S. authorities were forcing him to watch Islamic State in

Iraq and Syria (ISIS) videos in his home state of Alaska and heard voices urging him to join the terrorist group. He

later told investigators that he had participated in jihadi online chat rooms, though this has not yet been

corroborated.

But does this make Santiago a terrorist? Not necessarily. It could point to a delusional mental state with only a thin

connection to terrorism. Such mental conditions are commonly at play in these kinds of attacks, even when the

connection to terrorism is less tenuous.

Who’s to say if mental
health interventions
could have helped
prevent some of the
attacks that are
commonly attributed to
terrorist motives?

To be sure, those who commit mass murder are seldom society’s happy campers, but that should not necessarily

expand America’s terrorist list to include individuals with histories of aggression, substance abuse or mental illness

who put on an ISIS or al Qaeda jersey on their way to the attack.

Who’s to say if mental health interventions could have helped prevent some of

the attacks that are commonly attributed to terrorist motives, but were

committed by individuals with deep personal or emotional problems, some with

twisted needs to self-explain their rage, even when their deadly missions are

planned to end in their own deaths?

Was Muhammad Youssef Abdulazeez, the shooter who killed five people in

Chattanooga, Tennessee in 2015, a lone-wolf terrorist dedicated to jihad or a

disturbed individual with alcohol, drug and money problems whose family had

sought and failed to get him therapy?

Was the 2016 killing of 49 people at a gay nightclub in Orlando, Florida an act of

terror committed on behalf of ISIS as the killer, Omar Mateen, told police before he was killed, or was it an act of rage

by an angry homophobe on steroids?

It is probably not lost on America’s jihadist enemies that their ideology has become a conveyor for individual

discontents. Whether planned or not, the jihadists have attracted a self-selecting audience of troubled souls through

social media outreach, publicizing their atrocities and urging extreme violence.

All of this is reinforced by intense global media coverage of attacks with terrorist links.

Countering mass violence demands a distinction between those truly radicalized and inspired by jihadist ideology

and those with lesser links, including those whose mental states and violent tendencies preexist their exposure to

jihadist ideology.

But this is not a simple task in the face of a public that prefers easy answers.

To some audiences, ascribing murderous rampages to political motives may make more sense than a more nuanced

explanation that includes mental illness. Terrorism gives Americans a clear culprit and a distant enemy to fear and

loathe, whereas mental illness could arouse sympathy, inappropriately mitigating the violence.

And in a curious way, death at the hands of terrorists ennobles the dead and wounded. They are not merely random

victims of mindless murder, but casualties of war.

Terrorism is also something that can seem easier to address: Security can be increased, jihadist organizations can be

destroyed, violent extremism can be countered. A terrorist can be shot or shut up in prison.

Sorting out how to deal with mental disorders that sometimes don’t show themselves until they erupt in bloodshed

is a much more difficult task.

Brian Michael Jenkins is a senior adviser to the president of the nonprofit, nonpartisan RAND Corporation and an

author of numerous books, reports and articles on terrorism-related topics.

This commentary originally appeared on The Hill on January 26, 2017. Commentary gives RAND researchers a

platform to convey insights based on their professional expertise and often on their peer-reviewed research and

analysis.

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Define psychiatric interview and its importance to the psychiatric nurse practitioner’s role. Compare the phases and critical tasks involved in performing the initial interview. Explain the on going process of the psychiatric assessment.

After studying Module 2: Lecture Materials & Resources, discuss the following:

Define psychiatric interview and its importance to the psychiatric nurse practitioner’s role.
Compare the phases and critical tasks involved in performing the initial interview.
Explain the on going process of the psychiatric assessment.

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Architecture and design utilizing online research tools

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How many receptors have been found for opioids? What are their names?

Topic: Opioid Receptors – Signaling against pain always with pleasure?
This week you learned about the concept of receptors, GTP-binding  proteins and different signal transduction pathways operating in cells.  As you work on this week’s discussion board assignment, consider the  following.  Chronic pain is one of the most common reasons adults  seek medical care. The condition has been linked to restrictions in  mobility and daily activities, anxiety and depression and often to  dependence on opioids. According to a 2016 CDC analysis of National  Health Interview Survey (NHIS) data, an estimated 20.4% (50.0 million)  of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million)  had high-impact chronic pain. Opioid-based medications have been used by  man as an analgesic and euphoric for over 5000 years of which morphine  is the most widely known and used. Morphine and the other opioids  codeine, papaverine and thebaine are extracted from the poppy plant Papaver somniferum.  All four natural opioids bind to different opioid receptors which are  distributed throughout the central nervous system and also within  peripheral tissue of neural and non-neural origin. All opioids (natural  or synthetic) used in clinical practice today to reduce pain exert their  action at the MOP receptor. However, some have additional activities  most namely reduction in conscious level and euphoria, making them drugs  of abuse.
This week I want you to read the following scientific review article  (Pathan H. & Williams J. Basic opioid pharmacology: an update. Br.  J. Pain 6(1): 11-16 (2012) and do some research on NCBI PubMed (https://pubmed.ncbi.nlm.nih.gov/) on this week’s topic and discuss the following aspects with your class mates:

How many receptors have been found for opioids? What are their names?
How do those opioid receptors differ? Which components do they share?
What is known about the intracellular signaling pathways of those opioid receptors?
In which way might increased knowledge about the intracellular  signaling components of the opioid receptor help to develop new  generations of analgesics without addictive properties?

Case study : Susan is a 16-year-old with sudden onset of severe sore throat for the past day. She feels like she had a fever but did not check her temperature (i.e., subjective fever). What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision.

Case 1 
Review the pharyngitis scenarios and determine the most likely cause, including pathogen and mode of transmission. Discuss data that support your decision and treatment strategies. 
Scenario 1:  Susan is a 16-year-old with sudden onset of severe sore throat for the past day. She feels like she had a fever but did not check her temperature (i.e., subjective fever). She states it is very painful to swallow, and she thinks she sees white spots on her throat. She denies cough, rhinorrhea, nausea, otalgia, shortness of breath, or headache. She reports no exposure to sick individuals. 

Medications: none.
Allergies: none.
Social history: nonsmoker and drinks alcohol (two to three beers) one to two times a month.
Physical examination: vital signs – temperature 101.0°F; pulse 100 beats per minute; respirations 18 per minute; blood pressure 110/66 mmHg.
General: ill and tired appearance.
Head, Eyes, Ears, Nose, and Throat: unremarkable except for erythematous oropharynx with small petechiae and white tonsillar exudates.
Neck: anterior cervical lymphadenopathy; two on right, three on left; all small (< 0.5 cm) and tender.
Cardiovascular, Lungs, and Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
Discuss data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

Scenario 2: Mr. Jones is a 54-year-old man with complaints of a scratchy, raw sore throat and painful swallowing, mild productive cough, and runny nose for the past 2 days. He says his sputum is whitish-yellow. His ears feel full, and he feels like he is getting achy. He reports taking throat lozenges and denies nausea, fever, shortness of breath, chest pain, or headache. He states he teaches in a high school and a lot of his students have had colds. 

Medications: none.
Allergies: none.
Social history: nonsmoker and does not drink alcohol.
Physical examination: vital signs – temperature 99.0°F; pulse 84 beats per minute; respirations 18 per minute; blood pressure 120/70 mmHg.
General: cough during exam.
HEENT: unremarkable except for mild erythematous oropharynx with no exudates; nares with mild erythema and scant yellowish discharge.
Neck, CV, Lungs, Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
Discuss data that support your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.
Compare the causes, clinical manifestations, diagnosis, and treatment of pharyngitis in these two cases.

Case 2
Review the pulmonary infection scenarios and discuss whether the diagnosis is infectious rhinitis, influenza, acute bronchitis, acute bronchiolitis, or pneumonia. Discuss the most common pathogen and mode of transmission Discuss data that support your decision and treatment strategies. 
Scenarios 1: Jack is a 21-year-old complaining of a sudden onset of myalgia with his body aching all over and headache for the past day. He feels tired and has the chills, and his temperature was 100°F. He has a mild nonproductive cough. He denies rhinorrhea, sinus pain, nausea, otalgia, or shortness of breath. He reports exposure to sick contacts in his dorm, stating, “Everyone seems to be coughing and catching a cold or the flu.” 

Medications: none.
Allergies: penicillin.
Past medical history: healthy.
Social history: college student, lives in a dormitory. Nonsmoker and drinks alcohol once a week, about two or three beers.
Physical examination: vital signs – temperature 100°F; pulse 98 beats per minute; respiratorations18 per minute; blood pressure 110/70 mmHg; pulse oximeter 98%.
General: ill and tired appearance.
Head, Eyes, Ears, Neck, Throat: unremarkable.
Neck: no lymphadenopathy; negative Kernig sign, negative Brudzinski sign.
Cardiovascular lungs, abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder?
Discuss the mode of transmission and discuss the data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

 Scenarios 2: Mr. Menendez is a 65-year-old man presenting with 2–3 days of coughing up thick yellow sputum, shortness of , and fever (he did not check the actual temperature), and chills. He states his chest hurts when he breathes. He denies headache, rhinorrhea, sinus pain, and nausea. He reports no exposure to sick individuals. 

Medications: lisinopril 10 mg a day by mouth.
Allergies: no known drug allergy.
Social history: smokes 1 pack of cigarettes per day (has done so for 30 years); denies alcohol use; works as a landscaper.
Physical examination: vital signs – temperature 101°F; pulse 98 beats per minute; respirations 22 per minute; blood pressure 140/86 mmHg; pulse oximeter 93%.
General: ill and tired appearance, coughing during visit with thick yellow sputum noted.
HEENT: unremarkable.
Neck: small anterior and posterior cervical nodes.
CV: unremarkable.
Lungs: right basilar crackles with dullness to percussion in right lower lobe.
Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder?
Discuss the mode of transmission. Discuss the data that support your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

 Case 3
Jamie is a 1-year-old girl who is coughing and has had rhinorrhea with yellowish discharge for the past day. Her father says today he felt like she had a fever and has not been eating or playing; she has been mostly sleeping. Her 5-year-old sibling has had a cold for a week. 

Medications: none.
Allergies: no known drug allergies.
Vaccinations: up to date for age.
Social history: in day care; lives with mother, father, and 5-year-old sibling.
Physical examination: vital signs – temperature 101.5°F; pulse 120 beats per minute; respirations 34 per minute; blood pressure 100/60 mmHg; pulse oximeter 92%.
General: sitting in father’s lap; ill, lethargic appearance, and coughing.
HEENT: nasal flaring, nasal mucus yellowish bilaterally; oropharynx with mild erythema.
Neck: small anterior and posterior cervical nodes.
CV: unremarkable.
Lungs: intercostal retractions, expiratory wheezing.
Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.
Professional Reflection on the 3 cases. Citations and references.

You are a medical professor in charge of creating college assignments and answers for medical college students. You design and conduct lectures, evaluate student performance and provide feedback through examinations and assignments. Answer each question separately. Include and Introduction. Provide an answer to this content

Case 1 
Review the pharyngitis scenarios and determine the most likely cause, including pathogen and mode of transmission. Discuss data that support your decision and treatment strategies. 
Scenario 1:  Susan is a 16-year-old with sudden onset of severe sore throat for the past day. She feels like she had a fever but did not check her temperature (i.e., subjective fever). She states it is very painful to swallow, and she thinks she sees white spots on her throat. She denies cough, rhinorrhea, nausea, otalgia, shortness of breath, or headache. She reports no exposure to sick individuals. 

Medications: none.
Allergies: none.
Social history: nonsmoker and drinks alcohol (two to three beers) one to two times a month.
Physical examination: vital signs – temperature 101.0°F; pulse 100 beats per minute; respirations 18 per minute; blood pressure 110/66 mmHg.
General: ill and tired appearance.
Head, Eyes, Ears, Nose, and Throat: unremarkable except for erythematous oropharynx with small petechiae and white tonsillar exudates.
Neck: anterior cervical lymphadenopathy; two on right, three on left; all small (< 0.5 cm) and tender.
Cardiovascular, Lungs, and Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
Discuss data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

Scenario 2: Mr. Jones is a 54-year-old man with complaints of a scratchy, raw sore throat and painful swallowing, mild productive cough, and runny nose for the past 2 days. He says his sputum is whitish-yellow. His ears feel full, and he feels like he is getting achy. He reports taking throat lozenges and denies nausea, fever, shortness of breath, chest pain, or headache. He states he teaches in a high school and a lot of his students have had colds. 

Medications: none.
Allergies: none.
Social history: nonsmoker and does not drink alcohol.
Physical examination: vital signs – temperature 99.0°F; pulse 84 beats per minute; respirations 18 per minute; blood pressure 120/70 mmHg.
General: cough during exam.
HEENT: unremarkable except for mild erythematous oropharynx with no exudates; nares with mild erythema and scant yellowish discharge.
Neck, CV, Lungs, Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder and mode of transmission?
Discuss data that support your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.
Compare the causes, clinical manifestations, diagnosis, and treatment of pharyngitis in these two cases.

Case 2
Review the pulmonary infection scenarios and discuss whether the diagnosis is infectious rhinitis, influenza, acute bronchitis, acute bronchiolitis, or pneumonia. Discuss the most common pathogen and mode of transmission Discuss data that support your decision and treatment strategies. 
Scenarios 1: Jack is a 21-year-old complaining of a sudden onset of myalgia with his body aching all over and headache for the past day. He feels tired and has the chills, and his temperature was 100°F. He has a mild nonproductive cough. He denies rhinorrhea, sinus pain, nausea, otalgia, or shortness of breath. He reports exposure to sick contacts in his dorm, stating, “Everyone seems to be coughing and catching a cold or the flu.” 

Medications: none.
Allergies: penicillin.
Past medical history: healthy.
Social history: college student, lives in a dormitory. Nonsmoker and drinks alcohol once a week, about two or three beers.
Physical examination: vital signs – temperature 100°F; pulse 98 beats per minute; respiratorations18 per minute; blood pressure 110/70 mmHg; pulse oximeter 98%.
General: ill and tired appearance.
Head, Eyes, Ears, Neck, Throat: unremarkable.
Neck: no lymphadenopathy; negative Kernig sign, negative Brudzinski sign.
Cardiovascular lungs, abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder?
Discuss the mode of transmission and discuss the data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

 Scenarios 2: Mr. Menendez is a 65-year-old man presenting with 2–3 days of coughing up thick yellow sputum, shortness of , and fever (he did not check the actual temperature), and chills. He states his chest hurts when he breathes. He denies headache, rhinorrhea, sinus pain, and nausea. He reports no exposure to sick individuals. 

Medications: lisinopril 10 mg a day by mouth.
Allergies: no known drug allergy.
Social history: smokes 1 pack of cigarettes per day (has done so for 30 years); denies alcohol use; works as a landscaper.
Physical examination: vital signs – temperature 101°F; pulse 98 beats per minute; respirations 22 per minute; blood pressure 140/86 mmHg; pulse oximeter 93%.
General: ill and tired appearance, coughing during visit with thick yellow sputum noted.
HEENT: unremarkable.
Neck: small anterior and posterior cervical nodes.
CV: unremarkable.
Lungs: right basilar crackles with dullness to percussion in right lower lobe.
Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder?
Discuss the mode of transmission. Discuss the data that support your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.

 Case 3
Jamie is a 1-year-old girl who is coughing and has had rhinorrhea with yellowish discharge for the past day. Her father says today he felt like she had a fever and has not been eating or playing; she has been mostly sleeping. Her 5-year-old sibling has had a cold for a week. 

Medications: none.
Allergies: no known drug allergies.
Vaccinations: up to date for age.
Social history: in day care; lives with mother, father, and 5-year-old sibling.
Physical examination: vital signs – temperature 101.5°F; pulse 120 beats per minute; respirations 34 per minute; blood pressure 100/60 mmHg; pulse oximeter 92%.
General: sitting in father’s lap; ill, lethargic appearance, and coughing.
HEENT: nasal flaring, nasal mucus yellowish bilaterally; oropharynx with mild erythema.
Neck: small anterior and posterior cervical nodes.
CV: unremarkable.
Lungs: intercostal retractions, expiratory wheezing.
Abdomen: unremarkable.

Answer the following questions or provide responses based on this scenario. 

What is the most likely diagnosis and pathogen causing this disorder? Discuss the mode of transmission and discuss data that supports your decision.
What diagnostic test, if any, should be done?
Develop a treatment plan for this patient.
Professional Reflection on the 3 cases. Citations and references.

. Do not write who you are in the answer.