**Read the Case Study (ATTACHED) & Question 1 Below. Decide whether you agree with the answer or not and find 2 academic sources to support your answer.(IN TEXT CITATIONS & PROPER REFERNCING) **

Question 1: Based on ethical principles and precedents Ashley absolutely has a duty to warn as Kendrick’s nurse. Although Ashley has to respect patient confidentiality, when a patient makes a direct threat against someone else the practitioner is legally obligated to warn the victim or notify the correct authorities. According to the Journal of the American Academy of Psychiatry and the Law:

“The legal duty of a psychiatrist or psychotherapist to warn an identifiable victim of a patient’s serious threat of harm has been well recognized in U.S. jurisprudence and clinical practice since the Tarasoff decision of the Supreme Court of California in 1976.” (Felthous, 2006)

Based on this, Ashley should immediately notify Kendrick’s psychiatrist of his threats and potential intentions upon discharge. The medical team can then decide what the best, and safest, course of action is for Kendrick’s treatment. If Kendrick is still feeling such intense animosity toward his ew-mother-in-law, it is possible he is still suffering from paranoid delusions. He may need an increased dosage of medication or prolonged in-patient therapy before living on his own. It is in the best interest of both the patient, his family, and the general public to take Kendrick’s threats seriously. (WEISS)

Felthous, A.R. (2006). Warning a Potential Vitctim of a Person’s Dangerousness: Clinician’s Duty or Victim’s Right? Journal of the American Academy of Psychiatry and the Law, 34(3), 338-348.

Question 2: It is evident as we proceed through this course there are several overarching guidelines that nurses must follow to protect the patient and provide the best care. In psychiatric nursing especially, it is important for the nurse to keep the privacy of the patient and details and information about them confidential. “Confidentiality, or nondisclosure of information, involves limits on the communications on “any information a nurse obtains about a patient in the context of the nurse-patient relationship” (Butts & Rich, 2016, p. 335).

In the case of Kendrick the nurse is required to keep information confidential to anyone that does not have permission to receive information. But, there are exceptions to confidentiality when “patients are a threat to themselves (suicide, for example) or to identifiable others” (Butts & Rich, 2016, p. 335). In this case, I think that the nurse does have a duty to warn because she would be protecting an identifiable individual, his ex-mother-in-law. In this case, Kendrick does not specifically threat her but his words do provide some evidence that she might be in danger. Provision 3.1 “Protection of the Rights of Privacy and Confidentiality” focuses on keeping the privacy and trust between a nurse and patient. A large part of confidentiality is trust and nurses do not want to lose that trust with a patient, especially with a patient with psychiatric conditions. But in this case, I think it turns to duty to warn and protecting the identified individual. 

Butts, J. B., & Rich, K. L. (2016). Nursing Ethics: Across the Curriculum and Into Practice (Fourth ed.). Burlington, MA: Jones & Bartlett Learning.   

** **Read Question 2 Below. Decide if the answer is accurate, why or why not? & find 2 academic sources to support your answer.(IN TEXT CITATIONS & PROPER REFERENCING) **

  My doctor also explained that birth control pills “trick the body into thinking it is pregnant.”  She explained that women do not normally ovulate when they are pregnant.  Can you explain to me why a pregnant woman does not ovulate?  How is this related to how the birth control pill works? 

Question 2: Ovulation occurs when an egg is released from the ovaries down the fallopian tube to be possibly fertilized. If the egg (or eggs) are fertilized, it will continue on its journey to the uterus to plant in the uterine lining and continue to grow. The body will no longer ovulate because all functions will focus on caring for the egg that already implanted. All further periods will then cease in order to keep its uterine lining to be able to provide a favorable environment for the embryo. When a women takes a birth control pill, it alters the levels of hormones in the body. The birth control pill stops the body from releasing follicle stimulating hormones (FSH) and luteinizing hormones (LH). FSH would normally cause an egg to grow by stimulating the ovarian follicle and LH is what would normally cause ovulation.

**Read Question 3 Questions Below. Respond to each answer & find 2 academic sources to support your answer. (IN TEXT CITATIONS & PROPER REFERENCING)  **

Question 1: One of the topics we learned that helped me through a personal situation this semester was related to bone structure, fractures and repair. When my 5-year old stepson broke both arms a few weeks ago, this was understandably terrifying for all of us parents. While getting x-rays, the doctor told us that he had broken both bones in one arm and one bone in the other, which I knew to be the radius and ulna (Amerman 211). As such, he received a hard cast up over his elbow on one arm and up to his elbow on the second. The doctor also stated that the growth plate was not affected by either break. I knew that he was referring to the epiphyseal plate, which is found between the diaphysis (shaft) and epiphysis (head) of the long bones in a developing skeleton (Amerman 260). The hyaline cartilage of an epiphyseal plate is replaced with bone when bone growth is complete. As we learned in our textbook, damage to the growth plate is particularly concerning in children as even minor injury can cause lifelong consequences, such as differences in limb length, limb deformities and early onset arthritis (Amerman 260). It was a great relief to all of us to know that Brady’s injuries should not cause any long-term damage. 

When we returned 2 weeks later to take follow up x-rays, the doctor noticed that there was actually a second fracture in the arm that we initially thought to only have one. As his cast was not placed up above his elbow initially and the area was not stabilized, the bone had already begun to heal crooked and appeared bowed out in the x-ray. Obviously, we were at first quite concerned about this as well. What we were told and what I already knew from A&P was that his bone would continue to grow and remodel and actually straighten itself back out over time. His bone initially not healing properly was not anything we should worry too much about as the body is resilient, particularly in young children and the issue would take care of itself. This knowledge was a great comfort to all of us. (HIGGINS)

Question 2: This course has helped me to learn a lot about myself, my health, and my experience. One specific example that has stuck out for me so far is around bone development. In my previous life as a teacher, one of my favorite students was born without ulnas. Until this class, I didn’t know what that meant exactly, besides that it was a bone of the arm. This led to my student’s arms coming down to almost a point on both, with the absence of wrists, hands, and most fingers. I know that the styloid process were the endpoint of my student’s arms (Amerman 243). I imagine this may have also impacted how the radius articulates with the humerus. I don’t know what caused him to have an issue in bone development specific to the ulnas. However, I do know that the ulna is a long bone, with ossification beginning in utero through endochondral ossification and grows distally from the radius (Radiopaedia). The lack of ulnas could be related to anything from the osteoblasts, which build bones, osteoclasts, which aid in bone resorption, or an issue with the epiphyseal plates of any existing part of the ulna he may have had. Although I haven’t been able to find images or stories that very closely depict a similar scenario, Ulnar hypoplasia does seem to resemble

 what I remember (Malik S. & Afzal M.)

Even with missing ulnas, my student rode his bike to school, played soccer, climbed ropes courses, and typed 5 paragraph essays with his elbows. Literally, the only thing I ever did for him was open a glue stick. It was amazing and inspiring. (CLARK)

Question 3: Have you ever had a dream that startled you so much that you reached out to hit something? My patient sure did and because we are stuck in twin beds and he was close to the wall he ended up fracturing his left middle phalanx.

He came into the clinic the morning after complaining of swelling to his left little finger and described what lead to the incident. I did not suspect a fracture to the finger but because the swelling was so severe and the extreme tenderness I completed an x-ray to be safe. As chapter 7 discussed the fingers on each hand are comprised of 14 bones including the proximal, middle, and distal phalanx except the thumb which is missing the distal phalanx. I am suprised that he was able to hit the wall in a way that only caused a fracture to the one bone. I was able to treat the injury in clinic with just a finger brace to protect the bone and prevent flexion and extenstion of the joint. (MARTINEZ)

**Read Question 4 Questions Below. Respond to each answer & find 2 academic sources to support your answer. (IN TEXT CITATIONS & PROPER REFERNCING) **

Question 4: A processed food product that I regularly eat is peanut butter. Right now, the brand I have in my pantry is Crunchy No Stir Peanut Butter Spread, which I purchased at Trader Joe’s. The ingredients include roasted peanuts, powdered sugar (cane sugar, cornstarch), palm oil, and sea salt. The goal of most food additives is to maintain or improve a foods safety, freshness, taste, texture, or appearance, but sometimes food additives can be harmful to our health, especially when eaten in large quantities.

Sugar: This additive is used to create flavor in the product.

Salt: This is used to enhance flavor and preserve the product.

Palm oil: a more healthful alternative to hydrogenated oils, this additive is a semisolid at room temperature. The saturated fats help to give no-stir peanut butter its relatively solid texture.

Although this product does contain additives, it does not have a huge list and most of the ingredients are familiar which is always a good sign. The major additive is palm oil, which is still better than the hydrogenated oils that are added to other types of nut butters. Hydrogenated oils increase shelf life, but are also known to raise the risk of cancer, diabetes, and heart disease. I will definitely continue to eat peanut butter; however, I will now consider purchasing a different version of the product. Stir peanut butter, where oil separates and rises to the top of the tube, is a more natural alternative.(SORGESTIN)

Question 4-1: Although I know they’re not a natural food and heavily processed, I absolutely love Kraft singles American cheese slices. No cheese is better for making grilled cheese sandwiches in my opinion. The ingredient list for Kraft singles is as follows:, Cheddar cheese (milk, cheese culture, salt, enzymes), Whey, Water, Protein concentrate, Milk, Sodium citrate, Calcium phosphate, Milkfat, Gelatin, Salt, Sodium phosphate, Lactic acid as a preservative, Annatto and paprika extract (color), Enzymes, Vitamin A palmitate, Cheese culture, Vitamin D3. 

Sodium citrates are generally used as acidity regulators in food and drinks. They also as emulsifiers for oils, which enables cheeses to melt without becoming greasy (Modernist Pantry, 2018). Calcium phosphate helps thicken, stabilize and firm processed foods. It’s also used to help blend oil-and-water based ingredients, prevent caking, retain moisture, regulate acidity and treat flour (Bruso, 2017). Sodium phosphate has many properties as a food additive. It’s used as a texturizer, which changes the appearance or feel of the food while increasing shelf life. It can also be used as an emulsifier (Robinson, 2017). Despite these food additives, I will definitely continue to eat Kraft singles. I try to eat healthy and focus on whole, natural foods… but nothing beats Kraft singles in a grilled cheese!(WEISS)

  **Read Question 4 Questions Below. Respond to each answer & find 2 academic sources to support your answer. (IN TEXT CITATIONS & PROPER REFERENCING) **

Question 4: A processed food product that I regularly eat is peanut butter. Right now, the brand I have in my pantry is Crunchy No Stir Peanut Butter Spread, which I purchased at Trader Joe’s. The ingredients include roasted peanuts, powdered sugar (cane sugar, cornstarch), palm oil, and sea salt. The goal of most food additives is to maintain or improve a foods safety, freshness, taste, texture, or appearance, but sometimes food additives can be harmful to our health, especially when eaten in large quantities.

Sugar: This additive is used to create flavor in the product.

Salt: This is used to enhance flavor and preserve the product.

Palm oil: a more healthful alternative to hydrogenated oils, this additive is a semisolid at room temperature. The saturated fats help to give no-stir peanut butter its relatively solid texture.

Although this product does contain additives, it does not have a huge list and most of the ingredients are familiar which is always a good sign. The major additive is palm oil, which is still better than the hydrogenated oils that are added to other types of nut butters. Hydrogenated oils increase shelf life, but are also known to raise the risk of cancer, diabetes, and heart disease. I will definitely continue to eat peanut butter; however, I will now consider purchasing a different version of the product. Stir peanut butter, where oil separates and rises to the top of the tube, is a more natural alternative.(SORGESTIN)

Question 4-1: Although I know they’re not a natural food and heavily processed, I absolutely love Kraft singles American cheese slices. No cheese is better for making grilled cheese sandwiches in my opinion. The ingredient list for Kraft singles is as follows:, Cheddar cheese (milk, cheese culture, salt, enzymes), Whey, Water, Protein concentrate, Milk, Sodium citrate, Calcium phosphate, Milkfat, Gelatin, Salt, Sodium phosphate, Lactic acid as a preservative, Annatto and paprika extract (color), Enzymes, Vitamin A palmitate, Cheese culture, Vitamin D3. 

Sodium citrates are generally used as acidity regulators in food and drinks. They also as emulsifiers for oils, which enables cheeses to melt without becoming greasy (Modernist Pantry, 2018). Calcium phosphate helps thicken, stabilize and firm processed foods. It’s also used to help blend oil-and-water based ingredients, prevent caking, retain moisture, regulate acidity and treat flour (Bruso, 2017). Sodium phosphate has many properties as a food additive. It’s used as a texturizer, which changes the appearance or feel of the food while increasing shelf life. It can also be used as an emulsifier (Robinson, 2017). Despite these food additives, I will definitely continue to eat Kraft singles. I try to eat healthy and focus on whole, natural foods… but nothing beats Kraft singles in a grilled cheese!(WEISS)

DUE 3/25/18

7AM NEW YORK TIME ZONE

175 WORD MINIMUM FOR EACH QUESTION

USE IN TEXT CITATIONS

MLA FORMAT