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Current Events Journal Topic 7 (Presidentialism & Parliamentarism) 1page

Current Events Journal Topic 7 (Presidentialism & Parliamentarism) 1page.

Topic 7 (Presidentialism & Parliamentarism): Unless some country is going through a constitutional change, it’s unlikely you’ll find something direct about presidentialism or parliamentarism. Therefore, you should find some news story about the relationship somewhere between an executive (i.e., a president or a prime minister) and his or her legislature..The news link is https://www.bbc.com/news/world-us-canada-47656236What Needs to Go In an Entry? Each entry needs to have four things: 1) A link to the story you are using, if it is available on the web. If you find a story in a print publication, you should be able to find and provide the link to it online. Many radio and television stories also likely have web links to listen or watch. 2) A short description of the event being covered. You do not need to get in great detail here. Just tell enough to cover the main points of the story. This need not be more than 2-3 sentences. **Important: Do not cut and paste text from the story itself and use that as your summary. This constitutes plagiarism. The summary must be in your own words!** 3) Somewhere, in either the summary or the questions, you need to make it clear why you see a connection between this particular event or news story and the topic we have just covered. For example, one could write an entry on a story about the poor condition of roads in Kenya and how that has contributed to a recent traffic accident there. However, you should also make clear that you understand that this story is related to the topic of The State (if you’re writing for that particular topic), in that even minimalists think that states should maintain roads, and the fact that Kenya does not do that very well is some indication of a weaker state. 4) At least 2 questions that came to mind as you read the story. I anticipate that these will mostly be “how” or “why” questions. For example, if you’ve read a story about ethnic violence in Myanmar (Burma), a question might be, “Why did Group A attack Group B?” If civilians, or even children, were targeted in the attack, a good question would be “Why did the attackers target children?” A really good question integrates significant amounts of context from the story. For example, if you were reading a story from August 2013 about the elections in Zimbabwe, and the story mentioned how then-President Mugabe’s ZANU-PF party won quite a few seats in opposition strongholds (such as Masvingo Province), and how the last election in 2008 had involved significant violence against members of the opposition there, you could ask, “Why did people in Masvingo Province, who had voted for the opposition in the past, vote for Mugabe’s party in this election? Wouldn’t the violence people in the region suffered at the hands of ZANU-PF supporters in 2008 have made them unlikely to ever vote for ZANU-PF?” These questions should be something that intrigues, puzzles, or even confuses you about the story. After a few weeks of this, you will hopefully be asking the types of questions that political scientists try to answer in their work. Bad questions (for the purpose of this assignment) would be ones that are more strictly factual in nature. For example, if you read an article on the 2013 election in Zimbabwe, and it mentioned that ZANU-PF won in Masvingo Province, a good question would *not* be, “How many people voted in Masvingo Province?” Other inappropriate questions would be, “When did Zimbabwe get its independence?” “How old is Robert Mugabe?” “What are the main crops grown in Masvingo Province?” etc. Also, avoid questions that simply ponder what will happen in the future. For example, “How much longer will authoritarianism last in Zimbabwe?” is not a good question for this assignment. Political scientists mainly focus on analyzing things that have happened in the past.
Current Events Journal Topic 7 (Presidentialism & Parliamentarism) 1page

What Is the Expected Current in This Circuit Based on Ohms Law Physics Lab Report

What Is the Expected Current in This Circuit Based on Ohms Law Physics Lab Report.

I’m working on a physics question and need guidance to help me learn.

Watch this video (Links to an external site.). It gives an overview of the lab kit (VERY helpful). Take out the components and play along if you like! ⭐️ What is the voltage of your battery?⭐️ To make sure you don’t break the multimeter we’re going to calculate the minimum resistance that we can connect to the battery. If you want a maximum possible current of 150 mA, what is the smallest resistance you can attach to your battery?⭐️ Create Circuit 1(shown below) using a 20 ohm resistor, your battery, the switch (leave the switch open), and the Ammeter (which is the multimeter set up to measure current). Take a picture of your physical circuit setup and include it here.NOTE: Always check the values of resistors before putting them in the circuit using the Multimeter in Ohmmeter mode. ⟸⟸ Circuit 1⭐️ What is the expected current in this circuit based on Ohm’s Law?⭐️ What is the actual current when you close the switch? (don’t forget to open the switch after you measure)⭐️ Move the Ammeter in the circuit so that is between the switch and the resistor. What is the current now (when the switch is closed)?⭐️ How do the answers of #6 and #7 compare? Are the answers consistent with your understanding of current?Remove the Ammeter and rebuild the circuit as shown below ⟸⟸ Circuit 1 (without the Ammeter)Watch this brief video on measuring voltage in a circuit (Links to an external site.).⭐️ Change the multimeter to Voltmeter mode (using the 2000 mV range). Close the switch. What is the voltage across (i) the battery, (ii) the switch), and (iii) the resistor?NOTE: Remember the battery voltage is positive and the other ones are negative or zero .⭐️ What does the sum of the voltages add up to? Is it as expected? Explain.Open the switchPART II: 2 Resistor Series CircuitSet up Circuit 2 shown below using a 100 ohm resistor and a 20 ohm resistor. This is 2 resistors in series. ⟸⟸ Circuit 2 ⭐️ Calculate the expected equivalent resistance of this circuit.⭐️ Measure the actual equivalent resistance of this circuit. (make sure the switch is off for this part)⭐️ What do you expect the current to be (i) through the battery, (ii) between the resistors?⭐️ Measure the current at those two points. Is it as expected?⭐️ What do you expect the voltage drop across each resistor to be? Explain.⭐️ Measure the voltage across each resistor. Is it as expected?Open the switchPART III: 2 Resistor Parallel CircuitSet up Circuit 2 shown below using a 100 ohm resistor and a 20 ohm resistor. This is 2 resistors in parallel. ⟸⟸ Circuit 3 ⭐️ Calculate the expected equivalent resistance of this circuit.⭐️ Measure the actual equivalent resistance of this circuit. (make sure the switch is off for this part)⭐️ What do you expect the current to be through (i) the battery, (ii) the 100 ohm resistor (iii) the 20 ohm resistor?⭐️ Measure the current at those three points. Is it as expected?⭐️ What do you expect the voltage drop across each resistor to be? Explain.⭐️ Measure the voltage across each resistor. Is it as expected? Open the switchPART IV: Equivalent resistance of a 4 Resistor CircuitWe’re just using resistors and wires for this one: Make up your own circuit using 4 resistors (make sure to choose 4 resistors that aren’t too different from each other and don’t just put them all in series! )⭐️ Draw a circuit diagram. Include a picture of your circuit diagram here. ⭐️ Calculate the expected equivalent resistance of this circuit. (using resistor addition formulas)⭐️ Measure the actual equivalent resistance of this circuit.
What Is the Expected Current in This Circuit Based on Ohms Law Physics Lab Report

NA4 JNTU Virtual Private Network and Security Discussion

research paper help NA4 JNTU Virtual Private Network and Security Discussion.

Hello, Answer below 3 questions in a separate WORD DocCyber security PlanningA.DiscussionIn 500 words, What are the main reasons why a VPN is the right solution for protecting the network perimeter? Do they also provide protection for mobile devices? If you do use a VPN, which one and why did you select that particular one? Use APA format and add 2 clickable reference at end=======================Network Security:A. Discussion: In no less than 250 words, explain the difference between an access control list (ACL) that is used in routers to block traffic and firewalls. What similarities do they share? Use APA format and add 2 clickable reference at end———————————————-B. Assignment:12.1 List three design goals for a firewall.12.2 List four techniques used by firewalls to control access and enforce a security policy.12.3 What information is used by a typical packet filtering firewall?12.4 What are some weaknesses of a packet filtering firewall?12.5 What is the difference between a packet filtering firewall and a stateful inspection firewall?12.6 What is an application-level gateway?12.7 What is a circuit-level gateway?12.9 What are the common characteristics of a bastion host?12.10 Why is it useful to have host-based firewalls?12.11 What is a DMZ network and what types of systems would you expect to find on such networks?12.12 What is the difference between an internal and an external firewall?
NA4 JNTU Virtual Private Network and Security Discussion

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(pages 187-192#3#6#14#19#20#23#30#37#40#45……………………………………………………………………………………….Chapter 43. Consider the delay of pure ALOHA versus slotted ALOHA at low load. Which one isless? Explain your answer.78. In the binary countdown protocol, explain how a lower-numbered station may bestarved from sending a packet.11. Six stations, A through F, communicate using the MACA protocol. Is it possible fortwo transmissions to take place simultaneously? Explain your answer.21. Name two networks that allow frames to be packed back-to-back. Why is this featureworth having?27. Give two reasons why networks might use an error-correcting code instead of errordetection and retransmission.30. What is the maximum size of the data field for a 3-slot Bluetooth frame at basic rate?Explain your answer.35. List some of the security concerns of an RFID system.39. Store-and-forward switches have an advantage over cut-through switches with respectto damaged frames. Explain what it is.9. Compare the deference between MAC (Medium Access Control)sublayer and LLC (Logical Link Control) sublayer,10 In network there are 4 devices that from the outside look very similar. Describe the difference between hubs, switches, bridges, and routers.12. A seven-story office building has 15 adjacent offices per floor. Each office contains awall socket for a terminal in the front wall, so the sockets form a rectangular grid in the vertical plane, with a separation of 4 m between sockets, both horizontally and vertically. Assuming that it is feasible to run a straight cable between any pair of sockets, horizontally, vertically, or diagonally, how many meters of cable are needed to connect all sockets using(a) A star configuration with a single router in the middle?(b) A classic 802.3 LAN?
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NUR 6501 University of Maryland Eastern Shore Pathophysiology Questions Discussion

NUR 6501 University of Maryland Eastern Shore Pathophysiology Questions Discussion.

Question 1 A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 12 years of age. She began to develop dark, coarse facial hair when she was 14 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. Question 1 of 2: What is the pathogenesis of PCOS? QUESTION 2 A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 12 years of age. She began to develop dark, coarse facial hair when she was 14 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted. Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. Question 2 of 2: How does PCOS affect a woman’s fertility or infertility? QUESTION 3 A 20-year-old female college student presents to the Student Health Clinic with a chief complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 4 days. She denies nausea, vomiting, or difficulties with defecation. Last bowel movement this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular. Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having pelvic inflammatory disease (PID). Question: What is the pathophysiology of PID? QUESTION 4 A 27-year-old male comes to the clinic with a chief complaint of a “sore on my penis” that has been there for 3 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. Social history: works as a bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms. Physical exam within normal limits except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis. Question: Describe the 4 stages of syphilis. QUESTION 5 A 19-year-old female presents to the clinic with a chief complaint of “fluid filled bumps” and intense pruritis of her vulva. She states these symptoms have been present for about 10 days, but she thought she had a yeast infection. She self-medicated with over the counter (OTC) metronidazole (Flagyl™) intravaginally but the symptoms got worse. No other complaints except for fatigue out of proportion to her activity level. Past medical history noncontributory. Social history: sexually active with several men and did forget to use a condom during one sexual encounter. Physical exam negative except for pelvic exam which revealed multiple fluid filled (vesicular) lesions on the vulva and introitus. Positive lymph nodes in inguinal areas. The APRN diagnoses the patient with herpes simplex virus-type 2 known as genital herpes. Question: What is the pathophysiology of HSV-2? QUESTION 6 A 27-year-old male presents to the clinic with a chief complaint of a gradual onset of scrotal pain and swelling of the left testicle that started 2 days ago. The pain has gotten progressively worse over the last 12 hours and he now complains of left flank pain. He complains of dysuria, frequency, and urgency with urination. He states his urine smells funny. He denies nausea, vomiting, but admits to urethral discharge just prior to the start of his severe symptoms. He denies any recent heavy lifting or straining for bowel movements. He says the only thing that makes the pain better is if he sits in his recliner and elevates his scrotum on a small pillow. Past medical history negative. Social history + for sexual activity only with his wife of 3 years. Physical exam reveals red, swollen left testicle that is very tender to touch. There is positive left inguinal adenopathy. Clean catch urinalysis in the clinic + for 3+ bacteria. The APRN diagnoses the patient with epididymitis. Question: Discuss how bacteria in the urine causes epididymitis. QUESTION 7 A 42-year-old male presents to the clinic with a chief complaint of fever, chills, malaise, arthralgias, dysuria, urinary frequency, low back pain, perineal, and suprapubic pain. He says he feels like he can’t fully empty his bladder when he voids. He states these symptoms came on suddenly about 12 hours ago and have gotten worse. He noticed some blood in his urine the last time he voided. He tried to have a bowel movement several hours ago but could not empty his bowel due to pain. Past medical and social history noncontributory. Physical exam reveals an ill appearing male. Temperature 101.8 F, pulse 122, respirations 20, BP 108/68. Exam unremarkable apart from left costovertebral angle (CVA) tenderness. Rectal exam difficult due to enlarged and extremely painful prostate. Complete blood count revealed an elevated white blood cell count, elevated C-reactive protein and elevated sedimentation rate. Urine dip in the clinic + for 2+ bacteria. Question: Explain the differences between acute bacterial prostatitis and nonbacterial prostatitis. Discuss how bacteria in the urine causes epididymitis. QUESTION 8 A 32-year-old woman presents to the clinic with a chief complaint of pelvic pain, excessive menstrual bleeding, dyspareunia, and inability to become pregnant after 18 months of unprotected sex with her husband. She states she was told she had endometrioses after a high school physical exam, but no doctor or nurse practitioner ever mentioned it again, so she thought it had gone away. She has no other complaints and says she wants to have a family. Past medical history noncontributory except for possible endometriosis as a teenager. Social history negative for tobacco, drugs or alcohol. The physical exam is negative except for the pelvic exam which demonstrated pain on light and deep palpation of the uterus. The APRN believes that the patient does have endometriosis and orders appropriate laboratory and radiological tests. The diagnostics come back highly suggestive of endometriosis. Question: Explain how endometriosis may affect female fertility. QUESTION 9 An APRN working in an anticoagulation clinic has been asked by the local college to present a lecture on platelets and their role in blood clotting to the graduate pathophysiology nursing students. Question: What key concepts should the APRN include in the presentation? QUESTION 10 A 36-year-old woman presents to the clinic with complaints of dyspnea on exertion, fatigue, leg cramps on climbing stairs, craving ice to suck or chew and cold intolerance. The symptoms have come on gradually over the past 4 months. The only thing that make the symptoms better is for her to sit or lie down and stop the activity. She denies bruising or bleeding and states this is the first time this has happened. Past medical history noncontributory except for a new diagnosis of benign uterine fibroids 6 months ago after experiencing heavy menstrual bleeding every month. Social history noncontributory and she denies alcohol, tobacco, or drug use. Physical exam: pale, thin, Caucasian female who appears older than stated age. Physical exam remarkable for a soft I/IV systolic murmur, pallor of the mucous membranes, spoon-shaped nails (koilonychia), glossy tongue, with atrophy of the lingual papillae, and fissures at the corners of the mouth. The APRN suspects the patient has iron deficient anemia (IDA) secondary to excessive blood loss from uterine fibroids. The appropriate laboratory tests confirmed the diagnosis. Question: Discuss iron deficiency anemia and how the patient’s menstrual bleeding contributed to the diagnosis. QUESTION 11 A 67-year-old woman presents to the clinic with complaints of weakness, fatigue, paresthesias of the feet and fingers, difficulty walking, loss of appetite, and a sore tongue. These symptoms have been present for several months but the patient thought they were due to her recent retirement and geographic move from the Midwest to New England. The symptoms have gotten worse over the past few weeks and she has noticed that she is much more forgetful. This is of great concern as she worries she might have the beginning stages of Alzheimer’s Disease. Past medical history significant for Hashimoto thyroiditis that she developed in her early 20s. The rest of PMH and social history non- contributory. Physical exam reveals an average sized female whose skin has a sallow appearance. BP 128/74, Pulse 120, respirations 18 and temperature 99.0F orally. Examination of the head and neck reveals a smooth and beefy red tongue. Abdominal exam negative for hepatomegaly or splenomegaly. The APRN recognizes these symptoms and physical exam indicate the patient has pernicious anemia. After appropriate laboratory data received, the definitive diagnosis of pernicious anemia was made. Question 1 of 2: How does pernicious anemia develop? QUESTION 12 A 67-year-old woman presents to the clinic with complaints of weakness, fatigue, paresthesias of the feet and fingers, difficulty walking, loss of appetite, and a sore tongue. These symptoms have been present for several months but the patient thought they were due to her recent retirement and geographic move from the Midwest to New England. The symptoms have gotten worse over the past few weeks and she has noticed that she is much more forgetful. This is of great concern as she worries she might have the beginning stages of Alzheimer’s Disease. Past medical history significant for Hashimoto thyroiditis that she developed in her early 20s. The rest of PMH and social history non- contributory. Physical exam reveals an average sized female whose skin has a sallow appearance. BP 128/74, Pulse 120, respirations 18 and temperature 99.0F orally. Examination of the head and neck reveals a smooth and beefy red tongue. Abdominal exam negative for hepatomegaly or splenomegaly. The APRN recognizes these symptoms and physical exam indicate the patient has pernicious anemia. After appropriate laboratory data received, the definitive diagnosis of pernicious anemia was made. Question 2 of 2: How does pernicious anemia cause the neurological manifestations that are often seen in patients with PA? QUESTION 13 A 49-year-old man with a 22-year history of severe rheumatoid arthritis (RA) presents to clinic for his preadmission testing (PAT) and medical clearance for a planned right total hip arthroplasty. The patient had been severely limited in ambulation due to the RA. Current medications include prednisone 20 mg po qd and methotrexate 7.5 mg Thursdays, 5mg Fridays, and 7.5 mg Saturdays. The patient had a complete blood count (CBC) with manual differentiation and red blood cell indices, complete metabolic panel (CMP) and coagulation studies (prothrombin time [PT], international normalized ratio [INR] and activated partial thromboplastin time [aPTT]). All the laboratory studies come back within normal limits except for the red blood cell indices. The hemoglobin and hematocrit were low along with mean corpuscle volume, plasma iron and total iron binding capacity, and transferrin also being low. There was a normal reticulocyte count, normal ferritin, serum B12, folate and bilirubin. The APRN in the PAT clinic recognizes that the patient has anemia of chronic disease (ACD). Question 1 of 2: What is ACD and how does it develop? QUESTION 14 A 49-year-old man with a 22-year history of severe rheumatoid arthritis (RA) presents to clinic for his preadmission testing (PAT) and medical clearance for a planned right total hip arthroplasty. The patient had been severely limited in ambulation due to the RA. Current medications include prednisone 20 mg po qd and methotrexate 7.5 mg Thursdays, 5mg Fridays, and 7.5 mg Saturdays. The patient had a complete blood count (CBC) with manual differentiation and red blood cell indices, complete metabolic panel (CMP) and coagulation studies (prothrombin time [PT], international normalized ratio [INR] and activated partial thromboplastin time [aPTT]). All the laboratory studies come back within normal limits except for the red blood cell indices. The hemoglobin and hematocrit were low along with mean corpuscle volume, plasma iron and total iron binding capacity, and transferrin also being low. There was a normal reticulocyte count, normal ferritin, serum B12, folate and bilirubin. The APRN in the PAT clinic recognizes that the patient has anemia of chronic disease (ACD). Question 2 of 2: Why do patients with chronic kidney disease (CKD) develop ACD? QUESTION 15 A 14-year-old female is brought to the Urgent Care by her mother who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. Past medical history not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning. Labs at Urgent Care demonstrated normal hemoglobin and hematocrit with normal white blood cell (WBC) differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at Urgent Care referred the patient and her mother to the ED for a complete work up of the low platelet count including a peripheral blood smear for suspected immune thrombocytopenia purpura (ITP). Question: What is ITP and why do you think this patient has acute, rather than chronic, ITP? QUESTION 16 A 22-year-old male is in the Surgical Intensive Care Unit (SICU) following a motor vehicle crash (MVC) where he sustained multiple life-threatening injuries including a torn aorta, ruptured spleen, and bilateral femur fractures. He has had difficulty maintaining his mean arterial pressure (MAP) and has required various vasopressors. He has a triple lumen central venous catheter (CVC) for monitoring his central venous pressure, administration of medications and blood products, as well as total parenteral nutrition. Per hospital protocol, he is receiving an unfractionated heparin 1:1000 flush after administration of each of the triple antibiotics that have been ordered to maintain patency of the lumens. Seven days post injury, the APRN in the SICU is reviewing the patient’s morning labs and notes that his platelet count has dropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. The APRN suspects the patient is developing heparin induced thrombocytopenia (HIT). Question 1 of 2: What is underlying pathophysiology of heparin induced thrombocytopenia? QUESTION 17 A 22-year-old male is in the Surgical Intensive Care Unit (SICU) following a motor vehicle crash (MVC) where he sustained multiple life-threatening injuries including a torn aorta, ruptured spleen, and bilateral femur fractures. He has had difficulty maintaining his mean arterial pressure (MAP) and has required various vasopressors. He has a triple lumen central venous catheter (CVC) for monitoring his central venous pressure, administration of medications and blood products, as well as total parenteral nutrition. Per hospital protocol, he is receiving an unfractionated heparin 1:1000 flush after administration of each of the triple antibiotics that have been ordered to maintain patency of the lumens. Seven days post injury, the APRN in the SICU is reviewing the patient’s morning labs and notes that his platelet count has dropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. The APRN suspects the patient is developing heparin induced thrombocytopenia (HIT). Question 2 of 2: The APRN assesses the patient and notes there is a decreased right posterior tibial pulse with cyanosis of the entire foot. The APRN recognizes this probably represents arterial thrombus formation. How does someone who is receiving heparin develop arterial and venous thrombosis? QUESTION 18 A 33-year-old female is brought to Urgent Care by her husband who states his wife has gotten suddenly confused and complains of a severe headache. He also noticed large bruises on her legs which were not there yesterday. Only significant past medical history is that the patient developed herpes zoster 2 weeks ago and was given acyclovir for treatment. Physical exam revealed well developed female who is only oriented to person. Large areas of ecchymosis noted on both arms and legs. Stat CBC revealed a platelet count of 18,000/mm3, hemoglobin of 8 g/dl and hematocrit of 24%. The patient was immediately transported to the Emergency Room by Emergency Medical Services (EMS) where further work up demonstrated idiopathic thrombotic thrombocytopenic purpura (TTP). Question: What is the pathophysiology of TTP? QUESTION 19 A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection that was found on the preoperative urine culture and sensitivity (C & S). The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately transferred to the surgical intensive care unit (SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were: CBC with markedly decreased platelet count, peripheral blood smear showed decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin time. The d-dimer was markedly elevated, and fibrinogen level was low. The diagnosis of disseminated intravascular coagulation (DIC) was made based on clinical picture and laboratory data. Question 1 of 2: What is DIC and how does it develop? QUESTION 20 A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection that was found on the preoperative urine culture and sensitivity (C & S). The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately transferred to the surgical intensive care unit (SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were: CBC with markedly decreased platelet count, peripheral blood smear showed decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin time. The d-dimer was markedly elevated, and fibrinogen level was low. The diagnosis of disseminated intravascular coagulation (DIC) was made based on clinical picture and laboratory data. Question 2 of 2: What factors contribute to the development of DIC?
NUR 6501 University of Maryland Eastern Shore Pathophysiology Questions Discussion

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