The Case Of The Man With The Weak Arm

This week’s topic  is :  The Case of the Man with the Weak Arm

Albert, a seventy-two year old African-American man, is brought into the emergency room by his daughter. Approximately 45 minutes before arriving, Albert dropped his book when his right arm and hand “fell asleep”. When he tried to rise, he noticed his right leg was weak and he needed to hold onto the couch to stand up. He had a difficult time talking because the right side of his face and mouth were “numb” and his tongue felt “thick”.

In obtaining a medical and family history it was noted that Albert has smoked at least 1 pack of cigarettes per day for the last 40 years and both of his parents died of strokes when they were in their mid sixties. He has previously been diagnosed with both essential hypertension and hypercholesterolemia. He admits to “skipping” his anti-hypertensive medication because of the unpleasant side effects it causes. Albert notes that he has been experiencing short (5 – 10 minutes) incidences of weakness on his right side, but he attributed this to the position he was in, causing his arm or leg to “fall asleep”. He has also noticed that he is having mild headaches, but recently, these have been less frequent.

Physical examination indicated that Albert was alert and anxious, but his speech was slurred. He was afebrile, had a respiratory rate of 16 breaths per minute, a regular heart rate of 86 beats per minute and a blood pressure of 190/120 mm Hg. Albert had no irregular heart sounds and presented with slight bilateral edema of the ankles. Examination of the nervous system indicated intact tactile sensory function, decreased strength of the right extremities, a diminished gag reflex, diminished right deep tendon reflexes, and right facial droop. Based on these symptoms the emergency room physician suspected a thrombolytic stroke and immediately ordered a head CT scan and various blood tests. The physician also discussed the relative benefits and risks of various treatments and courses of action with Albert and his daughter. Albert was given aspirin for possible thrombosis and a b-blocking anti-hypertensive and his condition was monitored closely while awaiting the test results.

Results of the laboratory tests indicated hyperglycemia, hypercholesterolemia, normal blood clotting times and platelet numbers. In addition, the head CT was normal. Despite the treatments initiated, Albert’s condition continued to deteriorate. While his blood pressure decreased to 170/84 mm Hg, his heart rate was elevated to 100 beats per minute and became irregular. He continued to demonstrate decreased sensation on his right side, slight dysarthria, and further decreases in strength in both right extremities. Based on these results, treatment with plasminogen activator was initiated and an electrocardiogram (ECG) was conducted. The results of the ECG indicated atrial flutter.

After 5 hours, Albert’s condition improved to the point that the hemiparesis and dysarthria were at baseline levels and his blood pressure was stabilized at 156/70 mm Hg. Further treatments were then initiated to stabilize Albert’s atrial flutter and hypertension. He was given digoxin, which stabilized the atrial flutter and heart rate at 80 beats per minute and an angiotensin converting enzyme (ACE) inhibitor was prescribed for the hypertension. An echo-cardiogram indicated bilateral stenosis of the carotid arteries. Anti-thrombolytic therapy (325 mg aspirin/day) was also prescribed. Albert was encouraged to stop smoking and to modify his diet and was discharged.

What symptoms suggested that Albert was having a stroke? What risk factors did Albert present which would support the symptoms observed? Why does Albert’s treatment include aspirin?

discussion 1 Clinical case scenario

discussion 1 Clinical case scenario

A 39-year-old homeless man presents to the emergency department for cough and fever. He says that his illness has been worsening over the past 2 weeks. He originally had dyspnea on exertion and now is short of breath at rest. On questioning, he tells you that he lives in a homeless shelter when he can, but he frequently sleeps on the streets. He has used IV drugs (primarily heroin) “on and off” for many years. He denies medical history but the only time he gets medical attention is when he comes to the emergency department for an illness or injury. On review of systems, he complains of fatigue, weight loss, and diarrhea. On examination, he is a thin, disheveled man appearing much older than his stated age. His temperature is 100.5°F (38.0°C), his blood pressure is 100/50 mm Hg, his pulse is 105 beats/min, and his respiratory rate is 24 breaths/min. His initial oxygen saturation is 89% on room air, which comes up to 94% on 4 L of oxygen by nasal cannula. Significant findings on examination include dry mucous membranes, a tachycardic but regular cardiac rhythm, a benign abdomen, and generally wastedappearing extremities. His pulmonary examination is significant for tachypnea and fine crackles bilaterally, but no visible signs of cyanosis. His chest x-ray is read by the radiologist as having diffuse, bilateral,

interstitial infiltrates that look like “ground glass.”

Answer the following questions

1-What is the most likely cause of this patient’s current pulmonary

complaints?

2-What underlying illness does this patient most likely have?

3-What testing and treatment should be started now?

Formulate an initial interpretation of the meaning or implication of your calculations.

Assignment 4: Correlations

This week, you explore key statistical concepts related to data and problem solving through the completion of the following exercises using SPSS and the information found in your Statistics and Data Analysis for Nursing Research textbook. The focus of this assignment will be on correlation coefficients, tools that can help to determine the strength of the relationship between variables. Because multiple factors influence health care variables, it is important for you to understand how to calculate and interpret correlation coefficients.

To prepare:

· Review the Statistics and Data Analysis for Nursing Research chapters that you read as a part of the Week 6 Learning Resources. As you do so, pay close attention to the examples presented—they provide information that will be useful for you to recall when completing the software exercises.

You may also wish to review the Research Methods for Evidence-Based Practice video resources.

· Refer to the Week 6 Correlations Exercises and follow the directions to calculate correlational statistics using Polit2SetB.sav data set (see attached file)

· Compare your data output against the tables presented in the Week 6 Correlations Exercises SPSS Output document (see attached file)

· Formulate an initial interpretation of the meaning or implication of your calculations.

To complete:

· Complete the Part I and Part II steps and Assignments as outlined in the Week 6 Correlations Exercises page (see attached file). Due Thursday 10/05/17 by 6pm

This assignment requires the use of SPSS Software

Required Media

Walden University. (n.d.). Correlations. Retrieved August 1, 2011, from http://streaming.waldenu.edu/hdp/researchtutorials/educ8106_player/educ8106_correlations.html

Required Readings

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

  • Chapter      23, “Using Statistics to Examine Relationships”

Chapter 23 explains how to use statistics to examine relationships between groups using correlational analyses, scatter diagrams, Spearman rank-order correlation coefficient, and Kendall’s tau.

Statistics and Data Analysis for Nursing Research

  • Chapter      4, “Bivariate Description: Crosstabulation, Risk Indexes, and Correlation”      (pp. 59–61 and 68–78)

This chapter describes components of bivariate descriptive statistics, including crosstabulation, risk indexes, and correlation. The chapter also discusses the concepts of absolute risk, relative risk, odds ratio, and correlation matrices.

  • Chapter      9, “Correlation and Simple Regression” (pp. 197–209)

This portion of Chapter 9 continues the discussion of inferential statistics and explores correlation and simple linear regression.

Journal Review On Depression And Anxiety Psychological Research Topic

Description: Extra Credit Opportunity – 20 points

What: You are going to write a Journal Review on any psychological research topic (of your choice) from a

professional journal. You will turn in your review AND a hard copy of the journal article.

What’s a Journal Review? It is a summary and commentary on published research in a professional journal.

What is a profession journal article? A professional journal is a scientific journal in which researchers publish their

results. Sometimes they are also called “Peer Review” journals because a researcher will publish his/her research

and the larger scientific community will read the research and write a critique of it. To get your work published in a

professional journal is a mark of achievement and a sign that your research meets high scientific and academic

standards. The first sign is whether or not the research article has what is called an ABSTRACT – a short paragraph

summary at the beginning of the article which briefly explains the research and results. If your article doesn’t have

an ABSTRACT then chances are you are not looking at a professional journal.

Where can I find a professional journal? They are easy to find. Try any of the below:

1. Go to the APA website below (American Psychological Society) and you can browse the journals by title or

subject. Their website is http://www.apa.org/pubs/journals/index.aspx

2. Use any search engine for professional journals – psychology

3. Use your VCU online library search tools; and if you need some help simply stop by the library and ask any of

the research assistants.

4. If you look in the back of your textbook, you’ll see a reference section for all the research used in the text, it

will give you the name of the author, title of research, date of publication, the journal name and even the

page number for their research. Enter that information in your search engine and it’ll take you right to the

article……and you may be able to obtain a free PDF of the article, especially if you use the VCU search tools.

Signs that a journal is NOT a professional journal. If your journal has any of the following, you should not use it:

Here’s a good website clarifying the difference: http://www.lib.ncsu.edu/guides/spmaterials/

Advertisements are a clear sign it is not a professional journal.

  •  Easy to read, non‐specific; professional journals are not intended for the general public.
  •  Lack of statistical data; look for charts, graphs, and statistical data.
  • Popular magazines such as Time, Newsweek, Sports Illustrated
  •  Blogs and online chat rooms are NOT professional journals
  •  Psychology Today is NOT a professional journal

Describe the design of the relevant research or study in the article

I need to complete 3 research articles, which means I have to do 3 complete rows, 3 citations, 3 abstract/purpose, ect… , the sections are listed below, provide references

This is a Collaborative Learning Community (CLC) assignment.

Locate no more than 10 research articles related to your EBP project.

Use the assigned Topic Materials “CLC: EBP Research Table” and “CLC Assignment: Evidence-Based Practice (EBP) Project Student Guide.” You will use the “CLC: EBP Research Table” to consolidate and present the findings. Pay attention to the prompts for each column

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CLC: EBP Research Table

 

Citation

Include the APA reference   note.

Abstract/Purpose 

Craft a 100-150 word   summary of the research.

Research/Study 

Describe the design of   the relevant research or study in the article.

Methods

Describe the methods   used, including tools, systems, etc.

Setting/Subject

Identify the population   and
the setting in which the study was conducted.

Findings/Results

Identify the relevant   findings, including any specific data points that may be of interest to your   EBP project.

Variables

Describe the independent   and dependent variables in the research/study.

Implication for Practice

Articulate the value of   the research to the EBP project your group has chosen.

 

Independent   Variable

Dependent   Variable