Outline the epidemiology of cardiac arrest survival and mortality rates in Australia

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Task 2. Post Cardiac Arrest Syndrome (PCAS) is a pathological process involving multiple organs. The four key components of PCAS are: anoxic brain injury, myocardial dysfunction, ischaemia/reperfusion injury and persistent precipitating pathology. 1 Due to the development of PCAS the number of patients surviving to hospital discharge remains low despite an increase in the number of patients developing Return of Spontaneous Circulation (ROSC) post cardiac arrest. You have been asked by the manager for clinical practice, at the ambulance service you work for, to develop a report on the paramedic management of Post Cardiac Arrest Syndrome (PCAS) for the next in-service. The report must be an evidence-based analysis of published data from peerreviewed sources and include the following: Outline the epidemiology of cardiac arrest survival and mortality rates in Australia;• Describe the pathophysiology and clinical manifestations of PCAS;• Describe the evidence for the recommended paramedic management of patients• post ROSC and explain how particular interventions reduce the detrimental effects of PCAS;

Project Technical Paper

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Refer back to all of the assignments you have completed related to Reliable Pharmaceutical Supply. Read the following specifications and answer the questions in an eight to ten (8–10) page paper.
To process a prescription order, RPS needs to know about the patients, the nursing home, and the nursing home unit where each patient resides. Each nursing home has at least one, but possibly many, units. A patient is assigned to a specific unit. An order consists of one or more prescriptions, each for one specific drug and one specific patient. An order, therefore, consists of prescriptions for more than one patient. Careful tracking and record keeping is crucial. In addition, each patient has multiple prescriptions, and one pharmacist fills each order.

  1. Based on the above information, create an entity-relationship diagram that shows the data storage requirements for the system. Add six (6) attributes to each data entity and show minimum and maximum cardinality.
  2. Then, create a domain model class for the same information. Include six (6) attributes for each class and show minimum and maximum multiplicity.

 
There are several points in the order-fulfillment process at which information must be recorded in the system. Case manifests must be printed at the start of each shift. Because a prescription may take a long time to be used completely, information must be entered into the system each time a medication is sent, noting the quantity sent and which pharmacist filled the prescription for that shift.
Prescriptions contain basic information such as ID number, original date of order, drug, unit of dosage (pill, teaspoon, suppository), size of dosage, frequency of dosage, and special instructions (take with food, take before meals). There are several types of prescriptions, each with unique characteristics. Some orders are for a single, one-time-use prescription. Some orders are for a number of dosages. Some orders are for a certain time period. Information about the prescription order must be maintained. An order occurs when the nursing home phones in the needed prescriptions. Because prescriptions may last for an extended period of time, a prescription is a separate entity from the order itself. The system records which employee accepted and entered the original order.
The system has basic data about all drugs. Each drug has generic information such as name, chemical, and manufacturer. More detailed information for each type of dosage, such as the size of the pill, is also kept. A single drug may have many different sizes and types.
Information about the fulfillment of orders must also be maintained. For example, on a prescription for a number of pills, the system must keep a record of each time a pill or number of pills is dispensed. A record is maintained of which pharmacist fulfilled the order. Assume all prescriptions are dispensed only as needed for a 12-hour shift.

  1. Develop an activity diagram for each use case related to entering new orders, creating case manifests, and fulfilling orders (at least three (3) total diagrams).
  2. Develop a system sequence diagram for each use case.
  3. Develop a state machine diagram for an order.
  4. Design a three-layer architecture for this new system.

 
The RPS system has users who process orders in the Reliable offices and users who place orders and monitor order information in the nursing homes.

  1. Design two (2) separate menu hierarchies, one (1) for Reliable employees and one (1) for nursing home employees.

 
 

  1. Write out the steps of the dialog between the user and the system for the use case Place new order for nursing home employees.
  2. Review the input form you created for collecting orders from the nursing homes. Identify all of the input controls necessary to ensure the prescriptions are correct. Recommend other procedures or controls to ensure that there are no mistakes with prescriptions.

 
Create a work breakdown structure of your proposed plan. Write a memo to the senior executive team at RPS that includes a summary of the created system and three (3) recommendations for future changes/improvements to the system.
The format of the paper is to be as follows:
Typed, double-spaced, Times New Roman font (size 12), one-inch margins on all sides, APA format.
Use headers for each of the subjects being covered, followed by your response.
In addition to the eight to ten (8–10) pages required, a title page is to be included. The title page is to contain the title of the assignment, your name, the instructor’s name, the course title, and the date.
 
 
Note: You will be graded on the quality of your answers, the logic/organization of the report, your language skills, and your writing skills.

Critically evaluate, with evidence, the need to develop a pictorial depiction of a healthy diet.

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This is the QUESTION
a) Describe, including an illustration, the Eatwell plate, or the recently updated
Eatwell guide.
(20 marks)
b) Critically evaluate, with evidence, the need to develop a pictorial depiction of
a healthy diet.
(40 marks)
c) An article in a populist UK daily newspaper Daily Mail Online, Published April
2014 stated Almost two decades after the eatwell plate was created, health
experts, including Dr Mike Rayner, who first came up with the idea, say it is
time to start again. The recommendations are based on outdated nutritional
data, and worse, are encouraging poor habits, they say
Critically discuss this statement.
(40 marks)

science

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QUESTION 1

  1. What lab value will best reflect renal function in a client taking multiple medicines?
creatinine clearance
potassium levels
sodium levels
urinalysis

0.5 points   
QUESTION 2

  1. Which teaching point is correct with respect to the concept of “tolerance”?
Tolerance is a state where people become used to pain, and therefore need less pain medicine.
In tolerance, larger doses are needed to achieve prior effects because a body learns to push back.
Tolerance occurs in slow metabolizers. Slow metabolism leads to prolonged sedation.
Tolerance occurs in fast metabolizers. Faster metabolism leads to faster sedation.

0.5 points   
QUESTION 3

  1. Which statement regarding the blood-brain barrier demonstrates a need for further teaching?
“It can protect the brain from potentially toxic substance injuries.”
“It can be a significant obstacle to entry of therapeutic agents.”
“It is not fully developed at birth.”
“It lets in therapeutic agents in but filters out everything else.”

0.5 points   
QUESTION 4

  1. A client who has been taking an antiepileptic medication with a narrow therapeutic window for 2 weeks seems confused and forgetful. What should be the priority action of the nurse?
Call the prescriber and have them change the seizure medication.
Give an antihistamine under house protocol to stop the allergic response.
Seek a plasma drug level order from the client’s prescriber.
Set up oxygen and obtain an order for activated charcoal.

0.5 points   
QUESTION 5

  1. The nurse is assessing a client who has requested an adrenergic drug for dyspnea. Which sign would make the nurse hesitate to give the medication?
Pulse oximetry saturation of 88%
Blood pressure of 130/86
Respiratory rate of 28
Irregular heart rate of 122

0.5 points   
QUESTION 6

  1. A nurse is caring for a client being treated with Minipress (prazosin), an alpha blocker. What counseling should the client receive?
Rise slowly from lying to standing to avoid dizziness and a possible fall.
Void before taking the medication to avoid urine retention
Take a daily laxative to avoid constipation
Avoid drinking more than 600 mls of fluid per day while taking this medication

0.5 points   
QUESTION 7

  1. For which client would a beta adrenergic blocker like Atenolol be prescribed?
A client with urinary retention
A client who suffers from diarrhea
A hypertensive client with a heart rate of 104
A client who suffers from asthma

0.5 points   
QUESTION 8

  1. How would a nurse explain the way pilocarpine (Salagen), a cholinergic, would resolve dry mouth symptoms?
It stimulates salivation by blocking nicotinic receptors
It stimulates salivation by stimulating muscarinic receptors
It stimulates salivation by stimulating alpha receptors in the brain
It stimulates salivation by redirecting fluid from the optic nerve

0.5 points   
QUESTION 9

  1. A client with Alzheimer’s disease has been taking Exelon (rivastigmine), a cholinesterase inhibitor for a week. What anticipated side effects of this cholinergic medication would the nurse anticipate?
Numbness and tingling in the extremities
Hypertension, tachycardia, and palpations
Diarrhea, urgency and possible bradycardia
Tinnitus and hearing loss

0.5 points   
QUESTION 10

  1. A nurse in the emergency department is caring for a client whose family reports that she had taken an overdose of diazepam. Which of the following medications should the nurse have available to reverse the CNS depression caused by this drug?
Ondasteron (Zofran)
Magnesium sulfate
Flumazanil (Romazicon)
Protamine sulfate

0.5 points   
QUESTION 11

  1. The client diagnosed with a general anxiety disorder is prescribed alprazolam (Xanax), a benzodiazepine. Which information should the clinic nurse discuss with the client?
Explain to the client that this medication is intended for short-term use only.
Tell the client to expect rigidity as a side effect
Tell the client to avoid foods that are high in vitamin K
Instruct the client to take the medication before driving to avoid transit anxiety

0.5 points   
QUESTION 12

  1. A nurse is caring for a patient who has been taking phenytoin (Dilantin) for 6 weeks. Upon review of the laboratory results, the nurse notes that the patient’s phenytoin level is 18 mcg/mL. What is the nurse’s best action?
The nurse should contact the prescriber to suggest a dose increase.
This drug level is in the therapeutic range, so the nurse can give the medicine as ordered.
Suspect that another drug is preventing Phenytoin metabolism, and hold the causative medication.
This drug level is too high; the nurse should contact the prescriber about reducing the dose.

0.5 points   
QUESTION 13

  1. The provider is considering starting a diabetic client on valproic acid (Depakote) for nerve pain this week. During the health history, the patient tells the nurse, “I drink a six pack of beer daily and two to three six packs on weekends.” What would be the priority nursing action?
Obtain a lab order to assess his current level of valproic acid.
Tell the client his alcoholism is causing his nerve pain, so medicine won’t help.
Seek an order for liver function labs to see if Depakote would be safe for him
Reassure the client that beer and Depakote are compatible

0.5 points   
QUESTION 14

  1. A nurse is reviewing a client’s list of medications and notices that he is taking two anticholinergics. Which of his recent symptoms could be caused by his anticholinergic medications? (Select all that apply)
Epigastric distress
Tachycardia
Dry mouth
Frequent loose stools
Blurred vision

0.5 points   
QUESTION 15

  1. A client is using a prn scopolamine patch for motion sickness. Knowing that the medication has anticholinergic side effects, the client should be taught to anticipate which side effects? (Select all that apply!) |
Urine retention
Blurred vision
Dry mouth
Diarrhea
Wheezes

0.5 points   
QUESTION 16

  1. A nurse is taking a history on a client admitted for medication related syncope. Which of these comments from the client needs to be reported to the physician? (Select all that apply)
“I just gave you my medication list the last time I was here. Nothing’s changed! Look it up!”
“I’m taking an herbal supplements to help me sleep, but nothing else is changed.”
“I’m taking over-the-counter substitutes for the medicines I can’t afford.”
“I get my medicines over the internet, so I never run out of medicine. It’s cheaper”
“I wish I didn’t have to bother the doctor every time I need a medication refill.
“My cardiologist never orders anything. He just tells my regular doctor what to order.”

0.5 points   
QUESTION 17

  1. The most common adverse effect associated with antiepileptic medications is CNS depression. Knowing this, which signs and symptoms would the nurse watch for during assessments? (Select all that apply!)
Drooling
Insomnia
Confusion
Hyperventilation
Unsteady gate

0.5 points   
QUESTION 18

  1. A nurse recognizes that the actions of benzodiazepines include which of the following benefits? (Select all that apply.)
Sleep facilitation
Relief of general anxiety
Suppression of seizures and/or seizure activity
Reversal of Parkinsonism
Improvement of muscle coordination

0.5 points   
QUESTION 19

  1. What advice should parents of a child taking Ritalin (methylphenidate) receive? (Select all that apply)
Insomnia is a risk. Give the medication in the morning
It should always be given before the meal
It is cheaper (wisest), to order the medication via the internet.
It is a C2 substance. Automatic refills are not allowed.
It is a gateway drug to other stimulants. Teens seek it to lose weight. Keep control of it.
There is no need to worry about addiction in these medications in well-adjusted children.

0.5 points   
QUESTION 20

  1. A 68 year old male has a history of seizures and has been taking phenytoin (Dilantin) for years. His last seizure occurred 2 years ago, so he has decided that he no longer needs the medication. What would be the best action of the nurse? (Select all that apply.)
Recommend that he start cutting his pills in half, and see how it goes
Affirm his plan to stop taking it, but tell him to restart it if tremors occur
Recommend that he develop a withdrawal plan with his prescriber
Educate the client that suddenly stopping the drug could precipitate seizures.
Tell the client that once a medication for seizures is started it can never be stopped.