Lauren is the owner of a busy salon in her town. She has three other hairdressers who work in the salon with her so she also feels a fair degree of responsibility for making sure the business stays busy for everyone. She is a master of her craft and has been at it for over years. Recently she has started to have some aching pain in her shoulder which seems to get aggravated with her long days at work. She is starting to feel concerned that this complaint might interfere with her ability to continue working at a high level with her customers.

Her primary discomfort seems to come on late in the day after a lot of work. Her work involves moving around a fair amount, but she also has to stand in one position behind the chair with her arms elevated for long periods.

 

She has been considering going to see the doctor since this seems to be getting worse. However, she's also very interested in looking at anything that she can do that might address or alleviate the problem so she wouldn't have to see the doctor. She thought massage therapy might be helpful for this problem and is also interested to hear about stretching or exercise options that could be helpful.

• What are some of the major muscles that are engaged in bringing her arms up into the common position she uses when cutting hair?
• There is not much space between the underside of the acromion process and the head of the humerus. What are several tissues located in the space that might get pinched when she holds her arms elevated?

Jennifer Williams is a 43-year-old recently divorced female who has two teenage daughters aged 18 and
16 years. Her 16-year old daughter is 7 months pregnant. Jennifer's ex-husband is an alcoholic and is
involved with her daughters but cannot be relied on for financial assistance. She lives in an older home
in a low-income neighborhood. Her aging and widowed mother, who lives a few blocks away, is in the
early stages of Alzheimer's disease and needs regular assistance. Ms. Williams is the main caregiver for
her mother. She is employed full-time as an office assistant and regularly has difficulty making ends
meet financially.

A number of recent events have been challenging for Jennifer. Her pregnant daughter recently broke up
with her boyfriend and Jennifer knows she will be largely supporting and raising her grandchild. She also
recently had an intense argument with her oldest daughter about attending college—something she
supports but can't afford. In addition to all of these issues, Jennifer's mother fell and broke her arm. She
is now trying to meet the increasing care her mother needs.

All these events have been weighing heavily on Jennifer's mind. She is feeling highly anxious and is
experiencing difficulty sleeping. She has had intermittent diarrhea and has become highly irritable,
leading to arguments at work with her coworkers. Jennifer also began experiencing headaches. Fearing
she had something seriously wrong with her, she went to an urgent care clinic. After a brief visit focusing
on her headache, she was told not to worry because she was “only experiencing a tension headache”
and was a little hypertensive, and she was advised to see her primary care physician. Jennifer was
relieved to learn she did not have a brain tumor, but she has no intention of seeing another physician for
the headaches. She does not want to spend any more money on herself.

        ZOOM         Case Analysis Template:
Select your case and use this format to analyze the important Concepts you identify.
Remember, there are likely more than 3, but use 3 as your maximum.
1.) Identify relevant data from the present problem/ situation:
- Summarize the current situation and factors
2.) Personal/ Social history:
- Summarize: familial, occupational, and recreational aspects of the patient's personal life
that have the potential to be clinically significant.
3.) What are the interrelated Concepts for this case that you have identified and choose to
focus your paper? Discuss the principles within the Concept/s selected, apply those
principles to the case.
Ex/ Adherence Case and Class Activity Example
1) Adherence
2) Health Promotion
3) Patient Education
4.) Bring in a research article to further support your case, how can the research support further
investigation of the concepts you are looking at, how as a nurse can the research help you
support (ie. Education, collaboration, communication) a patient/ family.
5.) Conclusion: What outcomes would be important to include for this patient/ case?
What is your conclusion (wrap -up) and key elements of the case?              

1. The nurse working in a long-term care facility incorporates a focused assessment of
the immune system for all newly admitted patients over the age of 65. Older adults

are more likely to develop problems related to immune function than are middle-
aged people. The focused immune assessment includes a systemic approach based

on age-related changes in immunologic function. (Learning Objective 4)
a. What changes in the immune system in the older adult increase the incidence of
infection and cancer in this population?
b. Explain why older adults may have decreased inflammatory responses.
c. Why are older adults at increased risk of gastroenteritis and diarrhea secondary
to proliferation of intestinal organisms?

2. The nurse educator for an oncology unit is preparing an in-service presentation for
new nurses about the care of patients with immunodeficiencies. Patients with cancer
who are receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection.
The nurse educator focuses on special care needs of this patient population.
a. What is the rationale for assessing the pulse and respiratory rates for 1 full
minute in a patient with immunodeficiency?
b. What special precautions about dietary restrictions and food preparation should
be included in the teaching for a patient with immunodeficiency?
c. What nursing actions should be implemented to decrease the risk of infection in
the patient with immunodeficiency?
3. Molly Baker, a 22-year-old patient, presents to the clinic with the diagnosis of
allergic rhinitis. She states that she develops paroxysmal sneezing, clear nasal
drainage and congestion, watery, red eyes, and nasal itching from the late spring
until the first frost in the fall. She states that she has a dry cough and voice
hoarseness. She complains of feeling extremely tired, unable to sleep at night, and
having difficulty concentrating on her collegiate course work.
a. What further assessment should the nurse provide?

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of
   fibromyalgia syndrome. The nurse at the clinic obtains a history and physical
   assessment of the patient. (Learning Objective 2)
   a. On what areas should the nurse concentrate when interviewing the patient
   during the history process?
   b. On what areas should the nurse concentrate when assessing the patient?
   c. What diagnostic tests are used with fibromyalgia syndrome?

How many calories in that fast-food meal? Ontario menu labelling legislation takes effect
Jan. 1
CBC News · Posted: Dec 29, 2016
Restaurant-goers in Ontario are going to notice a little extra something on some menus as of Jan.
1: calorie counts.
Legislation that comes into effect Sunday under the Healthy Menu Choices Act, 2015 requires
that all restaurants with 20 or more locations must clearly display the caloric information for any
food and drink items.
Not only will the information have to be on menus, but it will also need to be clearly displayed
on menu boards and even on restaurant apps. Hospitals, schools, daycares and correctional
institutions are exempt.
The Heart and Stroke Foundation supports the initiative, believing that providing people with
more information helps them make better choices.
"Menu labelling is one small thing that empowers parents and empowers Ontarians to take
control of the choices that they make when they're having lunch or dinner at a restaurant," said
Joe Belfontaine, executive director of the Ontario branch of the Heart and Stroke Foundation.
"Certainly it's not the end-all or be-all, but it's an important tool in the toolbox."
Although Ontario is the first province in the country to require nutritional labelling at restaurants,
Belfontaine said that he hopes other provinces will follow suit.
Will it make a difference?
Whether including caloric counts will have any lasting health benefits, however, is questionable.
New York City has had food labelling requirements at restaurants since 2008. Since then,
researchers have attempted to ascertain whether it's made a difference to the city's population.
Calories of each food item appear on a McDonald's drive-thru menu in New York City. The city
made it mandatory for restaurants to display nutritional information since 2008. (Associated
Press)
A 2012 study in the American Journal of Public Health concluded posting calories on foods had
no direct impact on what foods people chose to buy. Over time, it appeared that people simply
ignored the labelling altogether.
A more recent study from Tulane University suggested that the New York City mandate
"plausibly reduced the obesity rate by 2.5 percentage points."
Dr. Sean Wharton, an internal medicine specialist who also runs a weight management and
diabetes clinic in Toronto, believes that the move is a positive one by the government, 
particularly for those who are paying close attention to their nutrition. However, it's likely a
different story for the general population.
"From an overall population level, I'm not so sure it'll have the big impact that we're actually
looking for," Wharton said.
"I don't think it's going to decrease weight from a population basis, but I think an informed
consumer is better at making choices and making judgements."
Wharton also noted that data supporting the idea of health benefits from such labelling is weak.
As well, he said, no studies have found that nutrition intake is any better in a general population
when such measures are undertaken.
While the evidence may be slim for a smaller waistline associated with menu labelling, experts
believe that it's important that people make informed decisions.
"I think it's important for consumers to have choice," Belfontaine said. "I think it's important for
consumers to have the right information."

Requiring restaurants to put calorie counts on menus is an example of which mechanism of policy

•  A. Exhortation
•  B. Expenditure
•  C. Taxation
•  D. Regulation
•  E. Public Ownership

Dr Wharton suggests that “an informed consumer is better at making choices and making judgements.” What ethical principle does this represent?

•  A. Autonomy
•  B. Non-maleficence
•  C. Beneficence
•  D. Justice