Management of Patients With Oral and Esophageal Disorders 
1. George Smith, a 55-year-old patient is admitted to the intensive care unit after a thoracotomy approach was used for an esophagectomy to remove an early stage adenocarcinoma of the distal esophagus and gastroesophageal junction. The patient has a history of GERD and Barrett’s esophagus. The patient sought medical treatment for dysphagia with solid foods, feeling that there was a lump in his throat and substernal pain with swallowing and subsequent regurgitation of undigested food and the development of hiccups. The patient has no other medical problems. (Learning Objectives 6 and 7)

1. Describe the esophageal cancer that the patient has and how it relates to his history of GERD and Barrett’s esophagus.
2. Explain the rationale for the early symptoms and late symptoms of esophageal cancer.
3. What course of cancer treatment should the nurse anticipate that the patient in this case study would have?
4. What nursing care should be provided for the patient in the intensive care unit in the early postoperative period?
5. Explain the care the nurse should provide when the patient begins to eat.

2. Mr. Owens is a 62-year-old man who underwent a neck dissection yesterday due to cancer of the mouth. You are the nurse assigned to care for Mr. Owens during his first postoperative day. Initial assessment finds Mr. Owens sitting up in bed; he is drowsy, but oriented ×3 when aroused. He has significant edema in his neck and mouth area, but does not appear to be in respiratory distress. His respiratory rate is 16 to 18, and his oxygen saturation is 96% on 40% oxygen via face tent. He has two peripheral IV lines both infusing Lactated Ringer’s solution at 75 mL/hr. Two Jackson Pratt drainage tubes are partially filled with serosanguinous drainage. (Learning Objective 5)

1. What is the rationale for the patient being placed in Fowler’s position after surgery?
2. The nurse notes that there has been 240 mL output in the drainage tubes during the first 24 hours after the surgical procedure. What should the nurse do?
3. Postoperatively, the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements related to anorexia and dysphagia. The nurse instructs Mr. Owens to eat soft food and suggests that he tilt his head to the unaffected side to facilitate swallowing. What is the rationale for these instructions?
4. In reviewing Mr. Owens’ medical record, what findings in his health history are associated with development of oral cancer?

Purpose of Assignment

This assignment will help to identify the normal growth and development by topic for each age group. In the final column of the assignment you need to observe a child and apply the information you gathered and document your findings in comparison by the particular age of that child.

Competency

Apply the foundations of pediatric nursing when caring for clients with health alterations.

Scenario

You are working in a large urban pediatric clinic after-hours.
A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

• The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
• Born at 36 weeks gestation.
• Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
• T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
• A swab for respiratory syncytial virus (RSV) is positive.

Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.
After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.
Client is discharged with these orders:

• methylprednisolone 0.4 mg/kg oral BID for 3
• Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
• Call if needed prior to the Q4 dose.
• Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
• Return for re-evaluation in 3 days

APA Format
 1) Minimum  6  full pages (No word count per page)- Follow the 3 x 3 rule: minimum three paragraphs per page
           Part 1: minimum 1 page
           Part 2: minimum 1 page
           Part 3: minimum 1 page
           Part 4: minimum 1 page
           Part 5: minimum 1 page
           Part 6: minimum 1 page
   Submit 1 document per part
2)¨******APA norms
All paragraphs must be narrative and cited in the text- each paragraph
         Bulleted responses are not accepted
         Don’t write in the first person 
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed.
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
6) You must name the files according to the part you are answering: 
Example:
Part 1.doc 
Part 2.doc
__________________________________________________________________________________
Part 1: Nursing Research
1. Discuss the characteristics and requirements that research tools should have on quantitative research to give validity to the study.
2. Give 2 examples
Part 2: Nursing Research
Sample:
The population of interest in this project is school-going adolescent habitual smokers. School-going adolescents are the focus because it is between the age of 12 and 18 that most of them start to engage in smoking and substance abuse.
Method:
Convenience sampling is a non-probability and non-random sampling
1. Describe why you were to choose a specific method to select a sample over other methods.
a. Defend the method you preferred.
Part 3: Pathophysiology
 
You are caring for a patient who has been admitted to the coronary care unit for chest pain unrelieved by nitroglycerin and to rule out myocardial infarction. He is placed on a continuous electrocardiogram (ECG) monitor, and there are orders for him to have 12-lead ECGs every 12 hours for the next 48 hours.
1. Discuss the type of information that can be yielded from continuous monitoring ECG versus a 12-lead ECG.
2. What factors should you consider in selecting the electrode placement and lead (electrical view of the heart) for continuous ECG monitoring?
3. What is the purpose of ordering 12-lead ECGs every 12 hours in this patient?
Part 4: Pathophysiology
 
A 56-year-old patient with newly diagnosed stage 1 hypertension has been referred to you for counseling regarding lifestyle modifications. He is married, with four children—two in high school, two in college. His job as a senior vice-president for a major retail chain requires that he work long hours and frequently eat at restaurants. He smokes two packs of cigarettes a day, has a body mass index (BMI) of 29 kg/m2, and a waist–hip ratio of 1.6. He usually drinks one to two dry martinis to relax after he gets home from work.
1. How would you develop a realistic plan to help this patient reduce his blood pressure and prevent complications?
2. Which risk factors would be among your top two or three priorities for this patient and why
3. What interventions or recommendations would you provide for modifying these?
Part 5: Health Care Policy
 
1. Describe the key concepts underlying community activism:
a. Social justice
b. Community
c. Consciousness-raising
d. Critical reflection
e. Praxis
f. Empowerment
a.give examples of how each of these concepts applies to a specific context.
2. Examine how Advanced Practice Nurses can engage in community activism to limit further negative health impacts from Big Tobacco in their respective health communities.
Attached below is an additional resource, an article, that details various ways by which nursing professionals can engage in community activism.
Patient Advocacy in the Community and Legislative Arena:
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html?css=print
Part 6: Nursing Research
 
1. What type of analysis you are conducting in your research studies? (Inferential data analysis)
2. What are the advantages and disadvantages of both inferential analysis and qualitative analysis?

Topic 4 DQ 2
What part does negotiation play in patient education?
Unlike in the ancient days, patients in modern society have a role and control over their health because they can address their views and opinions. Thus, in the contemporary world, physicians do not act like small ‘gods’ who know and have the final say about a patient’s health; instead, they involve the patients in effective communication and negotiation to discuss patients’ health and possible medication (Orchard, n.d). Patient education involves establishing medication decisions that will work effectively for the patient, physician, and family of the patients. Negotiation helps in patient education because it allows physicians to learn about their culture, beliefs, and values before prescribing any medication. Negotiation identifies areas of agreement and disagreement and provides a forum for discussing solutions. While some health care professionals do not agree with negotiation, patient education can only be as effective as a patient’s willingness and ability to carry out the prescribed recommendations.
For instance, while making and teaching patients about important health decisions, such as quitting smoking, negotiation and face-to-face communication prove more effective (Eisemann, Wagner, & Reece, 2018). Unlike public awareness through platforms, such as awareness campaigns and mass media, negotiation and effective communication prevent and encourage the victims to quit smoking. Nurses’ main role and aim in the health sector is to provide quality and patient-centered healthcare. This is possible upon understanding the patient; therefore, negotiation and effective communication help patient education and provide quality healthcare minimize hospital readmissions (Contributor, 2019). Moreover, during the negotiation processes, the patient’s family also learns some of the essential activities to undertake, especially in the case of genetic diseases, to reduce the probability of contracting such diseases.
 
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.