The nurse is concerned that the infant may have tracheoesophageal fistula (TEF) with esophageal atresia. TEF is a condition where there is an abnormal connection between the esophagus and the trachea, leading to the passage of excessive amniotic fluid into the respiratory system.
This can cause copious frothy bubbles of mucus in the mouth and nose, as well as drooling. It is a potentially life-threatening condition that requires immediate medical attention and surgical intervention to repair the abnormal connection.
In more detail, polyhydramnios refers to an excess accumulation of amniotic fluid during pregnancy, which can occur when there is impaired fetal swallowing. When the infant is born, the abnormal connection between the esophagus and trachea allows amniotic fluid to enter the respiratory system, leading to the observed symptoms of frothy bubbles of mucus in the mouth and nose, as well as drooling. This is indicative of tracheoesophageal fistula (TEF) with esophageal atresia, a congenital condition where the esophagus ends in a blind pouch and does not connect to the stomach. Immediate medical intervention is necessary to ensure the infant's well-being.
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An occupational health nurse in the clinic of an industrial plant is developing a guidebook for clinic workers. Which of the following actions should the nurse include as a secondary prevention strategy? A. Teach plant workers about proper lifting techniques. B. Set up an influenza immunization campaign. C. Help plant workers identify signs of carpal tunnel syndrome. D. Collaborate with physical therapists to develop programs for injured employees to return to work.
Help plant workers identify signs of carpal tunnel syndrome as a secondary prevention strategy.
Option (C) is correct.
Secondary prevention strategies focus on early detection and intervention to minimize the impact of a health condition. By helping plant workers identify signs of carpal tunnel syndrome, the nurse is implementing a secondary prevention strategy.
Early identification of symptoms allows for timely intervention and management, potentially preventing the condition from progressing and causing further harm or disability. This proactive approach helps promote the health and well-being of the workers and contributes to maintaining a safe and productive work environment.
Therefore, the correct option is (C).
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State the signs and symptoms seen in graves disease which are not usually associated with other causes of thyrotoxicosis
Answer:
Eye trouble is one of them.
Explanation:
you must reassess your patient within two minutes after administering nitroglycerin, as one of the side effects is:
You must reassess your patient within two minutes after administering nitroglycerin, as one of the side effects is a drop in blood pressure.
Nitroglycerin, a common vasodilator medication, is used to treat angina pectoris (chest pain). It works by increasing the size of blood vessels in the body, allowing blood to flow more freely. However, one of the side effects of nitroglycerin is a drop in blood pressure, which can cause dizziness, lightheadedness, and fainting.
Therefore, it is important to reassess your patient within two minutes of administering nitroglycerin to ensure that their blood pressure has not dropped too much and that they are not experiencing any adverse effects.
If necessary, you may need to administer additional medication or take other steps to stabilize the patient's blood pressure and prevent complications.
Overall, close monitoring is essential when administering nitroglycerin to ensure the safety and well-being of the patient.
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Which of the four tissue types have intercellular junctions?
9. Important to problem solving are all but one of these. Which is the least likely to be effective?
Emotionally remaining distant and in computer mode, interacting as little as possible, is the least likely to be effective when problem-solving with a client.
Importance to problem solving:Effective problem-solving needs the client's active involvement and empathy, which entails treating them as a person with legitimate sentiments and carefully evaluating their current level of functioning.
Building rapport and trust with the client also benefits from being aware of your thoughts and feelings and choosing to be serene, forgiving, and pleasant.
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Missing parts;
Important to problem solving are all but one of these. Which is the least likely to be effective?
Become conscious of how you are thinking and feeling and choose to be calm, patient and plea
Carefully assess the client's current stage of functioning.
Respond to the client as a person with valid feelings.
Emotionally remain distant and in computer mode. Interact as little as possible.
efforts to treat lactic acid buildup in muscles were attempted using dissected muscle specimens in the laboratory. one of these experiments involved ammonium formation from dissolved ammonia. under conditions of excessive lactic acid:
In efforts to treat lactic acid buildup in muscles, one experiment attempted using dissected muscle specimens in the laboratory involved ammonium formation from dissolved ammonia. Under conditions of excessive lactic acid, the following steps occur:
1. Lactic acid buildup causes a decrease in the pH level of the muscle tissue, creating a more acidic environment.
2. To counteract this acidity, dissolved ammonia in the muscle tissue reacts with hydrogen ions (\(H^{+}\)) present due to the excess lactic acid.
3. This reaction between ammonia (\(NH_{3}\)) and hydrogen ions (\(H^{+}\)) forms ammonium ions (\(NH_{4} ^{+}\)), which help neutralize the acidic environment.
4. The neutralization of acidity helps to alleviate some of the negative effects associated with lactic acid buildups in muscles, such as muscle fatigue and soreness.
In summary, under conditions of excessive lactic acid buildup, the formation of ammonium from dissolved ammonia can help neutralize the acidic environment in muscle tissue, potentially reducing the negative effects of lactic acid buildup.
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When the clinic of Dr. Lewi and King agreed to accept individual covered by a large managed care organization, the deciion of the provider-owner wa baed on a computer financial analyi and projection of expected effect the new patient load would have on the practice. A a reult, the practice added a econd office manager and a new clinical medical aitant. A the practice aborb the new patient, what can the provider-owner do to determine whether their financial analye and projection were correct?
When determining the credibility of different types of sources, including academic articles and websites, it is necessary to focus on certain criteria. These criteria include authority, currency, accuracy, relevance, and objectivity. Thus, it is important to ensure that the source is written by a specialist in the area; the source is published within the past five years.
Information presented in the article should be accurate, and the peer-review process is important for scholarly works. Content needs to be relevant and include only factual and credible data on the topic. Objectivity is important to be noted because a paper needs to be free of bias. These criteria work for website and academic articles, but in the field of scholarly writing, much attention is also paid to peer-reviewing
Timeliness
Your resources need to be recent enough for your topic. If your paper is on a topic like cancer research, you would want the most recent information, but a topic such as World War II could use information written in a broader time range.
Authority
Does the information come from an author or organization that has authority to speak on your topic? Be sure there is sufficient documentation to help you determine whether the publication is reliable including footnotes, bibliographies, credits, or quotations.
Audience
Who are the intended readers and what is the publication's purpose? There is a difference between a magazine written for the general public and a journal written for professors and experts in the field.
Relevance
Does this article relate to your topic? What connection can be made between the information that is presented and your thesis? An easy way to check for relevance is by reviewing the Abstract or Summary of the article before downloading the entire article.
Perspective
Biassed sources can be helpful in creating and developing an argument, but make sure you find sources to help you understand the other side as well. Extremely biased sources will often misrepresent information and that can be ineffective to use in your paper.
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After checking the urinary drainage system for kinks in the tubing, the nurse determines that a client who has returned from the post-anesthesia care has a dark, concentrated urinary output of 54 ml for the last 2 hours. What priority nursing action should be implemented
The priority nursing action that should be implemented after checking the urinary drainage system for kinks in the tubing with a dark, concentrated urinary output of 54 ml for the last 2 hours is to report the findings to the surgeon.
When a patient is critically unwell, fluid resuscitation is sometimes guided by the amount of urine produced as a measure of acute renal impairment. In critically ill patients, neurohormonal variables and functional alterations may affect diuresis and natriuresis even though a decrease in urine production may be linked to a drop in glomerular filtration rate due to a reduction in renal blood flow or renal perfusion pressure. After examining the urinary drainage system for tube kinks with 54 ml of black, concentrated urine produced over the previous two hours, the main nursing step is to inform the surgeon of the results.
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Darla Huntley, RMA, works in a pulmonology practice. She has been instructed to schedule Betty Robinson for a spirometry within one week. Ms. Robinson has never had one before. After the procedure is scheduled, what information should Darla provide Ms. Robinson to ensure that she is prepared on the day of her test? Under what health-related circumstances would Darla need to reschedule the test for Ms. Robinson? How many maneuvers must be completed for Ms. Robinson's PFT to be considered successful on the day of her testing?
Answer:
Darla should tell Ms. Robinson that spirometry is a simple test for figuring out how well the lungs work. During the test, the patient will be asked to take a deep breath and then blow as hard as they can into a mouthpiece connected to a spirometer. The spirometer will measure how much air the patient can blow out of their lungs and how fast they can do it.
Advice on medication: Darla should tell Ms. Robinson that she shouldn't use any bronchodilator inhalers, like albuterol, for four to six hours before the test.
Darla should tell Ms. Robinson when to expect her at the test and how long the test is likely to last.
Wear clothes that are comfortable. Darla should tell Ms. Robinson to wear clothes that are comfortable and won't make it hard for her to breathe.
Darla might have to reschedule Ms. Robinson's test if something goes wrong with her health. For example, if Ms. Robinson has recently had chest surgery, a heart attack, or a stroke, Darla may need to reschedule the test to avoid any possible health risks.
For Ms. Robinson's spirometry test to be successful, she must do at least three things that give acceptable and repeatable results. If Ms. Robinson can't do three maneuvers, Darla may have to reschedule the test to make sure the results are correct.
Major source:
American Thoracic Society/European Respiratory Society. (2005). ATS/ERS statement on respiratory muscle testing. American Journal of Respiratory and Critical Care Medicine, 171(8), 866-878. doi: 10.1164/rccm.200401-044STWhen should you find out what to do in case of an emergency while working?
Answer:
You should find out when it happens. You should call 911 and if you are on fire ...STOP DROP AND ROLL
Explanation:
Consider the following order for penicillin g potassium that has been reconstituted to
a dosage strength of 250,000 units/mL:
Administer 2.5 mL penicillin g potassium IM tid.
Is this dosage safe?
Why or why not?
To determine the safe dosage, there are different parameters to be checked, such as the patient's weight, age, health status, etc, penicillin G potassium is an antibiotic, and the IM (intramuscular) route of administration is associated with a higher risk.
What are the recommended penicillin dosages?The appropriate dosage is determined by the individual's health status, the severity of their diseases, and other factors and the recommended dosages of penicillin G potassium can vary depending on the specific indication, the severity of the infection, and the patient's individual response to the medication.
Hence, to determine the safe dosage, there are different parameters to be checked, such as the patient's weight, age, health status, etc, penicillin G potassium is an antibiotic, and the IM (intramuscular) route of administration is associated with a higher risk.
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Lucera rushed through a training video about the new patient monitoring system at her hospital. As a result, she
does not know how to use the system competently. What type of general standard has Lucera most violated?
O communication standards
O team-related standards
O values-related standard
O performance standard
Answer:
performance standard
Explanation:
In this scenario Lucera mostly violated the performance standard. That is because by not paying close attention to the training video she does not know how to properly operate the needed equipment and therefore cannot meet the performance standard that has been established by the health department in the hospital. Failure to meet these standards is a serious issue as errors can lead to injuries or even death of a client in such scenarios.
Answer:
Performance Standard
Explanation:
It is D because if she rushed through it then she would be performing poorly.
Make me brainiest please. :)
3. Which of these is a vaccine most similar to? **
a
O a
a bacteria
O a vinus
O an innoculation
a disease
Answer:
an innoculation a disease
a 74-year-old woman complains of heaviness in her chest, nausea, and sweating that suddenly began about an hour ago. she is conscious and alert, but anxious. her blood pressure is 144/84 mm hg and her heart rate is 110 beats/min. she took two of her prescribed nitroglycerin (0.4-mg tablets) before your arrival but still feels heaviness in her chest. you should: a. recall that geriatric patients often take multiple medications and that interactions can occur with potentially negative effects. b. give her high-flow oxygen, avoid giving her any more nitroglycerin because it may cause a drop in her blood pressure, and transport. c. transport her at once and wait at least 20 minutes before you consider assisting her with a third dose of her prescribed nitroglycerin. d. assist her in taking one more of her nitroglycerin tablets, reassess her blood pressure, and contact medical control for further instructions.
You should keep in mind that older people frequently have slower absorption and excretion rates, which may call for adjusting a drug's dosage. Therefore, choice A is the right response.
Because they may be dealing with many illnesses or other health issues concurrently, adults 65 and older typically take more medications than adults in any other age group. For people who are confined to their homes or reside in remote places, managing various prescriptions can be costly, time-consuming, and challenging.
The existence of a concomitant condition, which is typical in the elderly, can also impact renal function. Older patients may need lower or less frequent dosages due to reduced medication clearance caused by decreased renal function.
We can therefore draw the conclusion that You should be aware of the fact that older individuals typically have slower rates of absorption and excretion, which may necessitate changing a drug's dosage.
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What is one of the first things that your brain needs to determine in order to accurately perceive an
incoming image?
O-depth
O what is the figure and what is the background (figure-ground)
O the color of the item
O the movement path of the item
Answer:
the movement path of the item
Explanation:
The first thing that the brain needs to determine in order to accurately perceive an incoming image is the movement path of the item. So the correct option is D.
What is the process of image perception by the brain?
Recent research on visual perception has started to show how brain activity and consciousness visual experience are related. Transcranial magnetic stimulation of the human occipital lobe alters how people typically see objects, which may indicate that key components of visual perception are reliant on activity in early visual cortical regions.
Microelectrode recordings in animals reveal that numerous brain regions work together to produce the experience of the depth and brightness of visual surfaces. While neurons in future areas react in a way that is more akin to visual perception, activity in early areas is more closely connected with the physical characteristics of things.
There are about 30 discrete visual centers in the monkey brain, and each of these areas has separate modules and parallel processing streams, according to 40 years of neuroscience study.
Therefore, the correct option is D.
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Which of the following shows the correct relationship among the epidemiology terms listed?
- mortality > incidence > prevalence
- incidence > prevalence > mortality
- prevalence > incidence > mortality
- mortality > morbidity > prevalence
The correct relationship among the epidemiology terms listed is: incidence > prevalence > mortality. Incidence represents new cases of a disease, prevalence represents the total number of cases, and mortality represents the deaths caused by the disease. Incidence contributes to the prevalence, and mortality is a subset of prevalence.
The correct relationship among the epidemiology terms listed is: incidence > prevalence > mortality.
Incidence refers to the number of new cases of a disease or health condition within a specific population over a given period. It represents the rate at which new cases occur and provides information about the risk of developing the condition.
Prevalence, on the other hand, refers to the total number of cases of a disease or health condition present in a population at a given point in time. It includes both new and existing cases and provides a measure of the burden of the condition in the population.
Mortality refers to the number of deaths caused by a particular disease or health condition within a specific population and time period.
It represents the outcome of the condition and provides information about the severity and impact on survival.
The relationship among these terms is such that incidence precedes prevalence because new cases contribute to the overall prevalence. Prevalence, in turn, includes both incident cases and existing cases.
Finally, mortality is a subset of prevalence as it represents the ultimate outcome of the disease, specifically the deaths that occur among the prevalent cases.
Therefore, the correct relationship is incidence > prevalence > mortality.
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PLZ can you pls pray because there was an accident close to my house two cars crash and in one of the cars was a little kid there where giving the kid and mom cpr pls pray
Answer:
I hate hearing this. I'm praying. Jehovah will resurrect them together in the new world to come Revelation 21:3&4
why is the heart located close to the lungs
Answer:
The heart is a strong and muscular, cone-shaped organ that is about the size of a fist. It pumps blood throughout the body and is located behind the breastbone between the lungs. Deoxygenated blood flows from the heart to the lungs where it gives up wastes and is freshly oxygenated.
Explanation:
Hope it can help you lovelots
Answer:
The heart is slightly tilted towards the left side because the right lung is larger than the left lung. This condition provides the heart with enough space to function properly and pump blood efficiently to different parts of the body.
Explanation:
This is because the heart's bottom-left chamber (the 'left ventricle') is responsible for pumping oxygenated blood around the whole body, so it needs to be stronger and larger than the right ventricle, which only pumps blood to the lungs.
the primary treatment for ulcer caused by the presence of h. pylori is ____.
The primary treatment for an ulcer caused by the presence of Helicobacter pylori (H. pylori) is a combination of antibiotics and acid-reducing medications.
The standard treatment regimen for H. pylori-associated ulcer typically involves a course of antibiotics such as amoxicillin, clarithromycin, or metronidazole, in combination with a proton pump inhibitor (PPI) such as omeprazole or lansoprazole, and sometimes bismuth subsalicylate. This treatment regimen is usually given for 10 to 14 days and has been shown to be highly effective in eliminating H. pylori and promoting ulcer healing.
It is important to note that if the ulcer is severe or has caused complications, such as bleeding or perforation, additional treatments may be necessary, such as endoscopy, surgery, or other interventions. Additionally, some ulcers may not be caused by H. pylori and may require different treatment approaches. It is important to consult a healthcare provider for an accurate diagnosis and appropriate treatment plan.
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__ is a side effect that can occur rapidly after spinal anesthesia is administered? a. Cardiac ayrrthmias b. Paralysis c. Hypotensive episode d. Esophageal reflux
C. Hypotensive episode is a side effect that can occur rapidly after spinal anesthesia is administered.
What is spinal anesthesia?Spinal anesthesia is a type of regional anesthesia that is used to numb the lower part of the body. It is commonly used for childbirth, but it can also be used for other procedures, such as knee surgery.
Hypotension is a side effect that can occur rapidly after spinal anesthesia is administered. This is because the local anesthetic used in spinal anesthesia can block the nerves that control the blood vessels. This can lead to a decrease in blood pressure, which can be dangerous.
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The principal purpose of the National Institutes of Health is to:
the adult client is experiencing a midlife crisis. which factor would attribute to this condition? hesi eaq
The adult client is experiencing a midlife crisis and the factor which would attribute to this condition is that the client is examining life goals and relationships.
A midlife crisis is a transition of identity and authority that may occur in old people, generally forty to sixty years recent. Example- Feeling stuck during a rut or hopeless concerning your choices for the longer term. Displaying dramatic changes in mood, like irritability or anger. participating in erratic or impulsive decision-making, like getting high-ticket things sort of a new automotive.
You can take four steps to beat your midlife crisis: talking somebody you trust, reframing your scenario, effecting a life audit, and setting new goals. If you are managing somebody who's showing these signs, try and strike the proper balance between being sympathetic and addressing any negative behavior directly.
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5. the nurse is caring for a client who develops compartment syndrome from a severely fractured arm. the client asks the nurse how this can happen. the nurse's response is based on the understanding that: a. a bone fragment has injured the nerve supply in the area b. an injured artery causes impaired arterial perfusion through the compartment c. bleeding and swelling cause increased pressure in an area that cannot expand d. the fascia expands with injury, causing pressure on underlying nerves and muscles
The correct answer is C. Compartment syndrome occurs when bleeding and swelling increase pressure within a compartment that cannot expand,
Leading to decreased blood flow to tissues within the compartment. This can result in tissue damage and even necrosis if not promptly addressed. In the case of a severely fractured arm, the pressure may increase within the compartment due to bleeding and swelling, leading to compartment syndrome.
The priority nursing interventions for a client with compartment syndrome include close monitoring of neurovascular status, frequent assessments of the affected limb for signs of further swelling or changes in sensation, and ensuring that the affected limb is elevated to reduce swelling. Urgent medical intervention may be required to relieve the pressure and restore blood flow if compartment syndrome is suspected.
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Discuss normality and abnormality of sex orientation among children and adolescents in a school context.
Sexual orientation is a complex aspect of human development that involves the individual's romantic, emotional, and sexual attraction to others. In children and adolescents, sexual orientation is still in the process of development and can be influenced by a variety of factors, including genetics, environment, and personal experiences.
Normality and abnormality of sexual orientation in children and adolescents should not be judged based on societal norms or stereotypes. It is essential to recognize that sexual orientation is a natural aspect of human diversity, and there is no one "normal" or "abnormal" sexual orientation. All sexual orientations, including heterosexuality, homosexuality, and bisexuality, are normal and valid.
In a school context, it is crucial to provide a safe and inclusive environment that respects the diversity of sexual orientations. Schools should provide comprehensive sexuality education that includes information about sexual orientation and gender identity to help students understand and respect each other's differences.
It is also essential to address discrimination and harassment based on sexual orientation or gender identity in schools. Teachers and staff should be trained on how to create a safe and inclusive environment for all students, regardless of their sexual orientation or gender identity.
Parents and caregivers can also play a crucial role in supporting their children's sexual orientation. They can provide a safe and supportive environment for their children to explore and express their sexual orientation without fear of rejection or discrimination.
In conclusion, sexual orientation in children and adolescents is a normal aspect of human diversity and should be respected and valued. Creating a safe and inclusive environment in schools and at home can help support the healthy development of children and adolescents, regardless of their sexual orientation.
Ronaldo was born without the ability to experience pain, though he can
Ronaldo was born unable to feel pain, yet being able to sense pressure changes and temperature changes. Ronaldo has a condition known as congenital analgesia, which means he cannot feel pain but is sensitive to pressure and temperature.
Ronaldo's illness is also known as pain insensitivity. It is an uncommon situation where a person has never felt any kind of pain in their body. The condition is brought on by changes in a person's genes. The condition has no known cure. The cones are the photoreceptor cells that are responsible for vision. Cones are specialized types of photoreceptors that perform effectively under bright light. Cones are particularly sensitive to little details and have a high spatial resolution.
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Critically analyse the impact of Covid-19 in developing
countries and How covid-19 affacted their economy.Give 5 points and
analyse each points.
The impact of Covid-19 in developing countries has been significant, affecting their economies in multiple ways.
What are the key ways in which Covid-19 has impacted the economies of developing countries?The Covid-19 pandemic has had profound economic consequences for developing countries. Here are five key points highlighting the impact:
1. Economic contraction: Many developing countries experienced a sharp economic downturn due to lockdowns, reduced economic activity, and disrupted global supply chains. This led to a decline in GDP growth rates and negative impacts on various sectors such as tourism, manufacturing, and trade.
2. Increased poverty and inequality: The pandemic exacerbated existing social and economic disparities, pushing more people into poverty and widening income inequalities. Vulnerable populations, including informal workers and those in the informal sector, faced job losses, reduced incomes, and limited access to social safety nets.
3. Disruptions in trade and remittances: Developing countries heavily reliant on exports and remittances faced challenges as global trade contracted and remittances from abroad declined. Restrictions on travel and disruptions in logistics disrupted supply chains, impacting export-oriented industries and reducing foreign exchange earnings.
4. Fiscal challenges: Governments in developing countries faced fiscal strain as they grappled with increased healthcare expenditures, implementing social protection measures, and addressing economic challenges. Reduced tax revenues and increased public spending led to budget deficits and a higher debt burden.
5. Reduced investment and financing gaps: The pandemic led to a decline in foreign direct investment (FDI) and limited access to financing for development projects. Investors became more risk-averse, diverting funds away from developing countries, leading to reduced investment in critical sectors like infrastructure and healthcare.
These points demonstrate the wide-ranging economic repercussions of the Covid-19 pandemic on developing countries, highlighting the need for targeted support and interventions to mitigate the impact and foster recovery.
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What are the 7 types of shock?
The 7 types of shock are: Hypovolemic shock , Cardiogenic shock ,Septic shock , Anaphylactic shock , Neurogenic shock, Obstructive shock, Metabolic shock
Hypovolemic shock: This occurs when there is a loss of blood or fluid in the body, leading to decreased blood flow to vital organs.
Cardiogenic shock: This occurs when the heart is unable to pump enough blood to meet the body's needs, often as a result of a heart attack.
Septic shock: This occurs when an infection spreads throughout the body, leading to a drop in blood pressure and decreased blood flow to vital organs.
Anaphylactic shock: This is a severe allergic reaction that can lead to decreased blood pressure and difficulty breathing.
Neurogenic shock: This occurs when there is damage to the spinal cord, leading to decreased blood pressure and decreased blood flow to the vital organs.
Obstructive shock: This occurs when there is a blockage in the blood vessels, leading to decreased blood flow to vital organs.
Metabolic shock: This occurs when there is a severe imbalance in the body's metabolism, leading to decreased blood flow to vital organs.
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Insurance companies establish their own _____ and don’t have to pay what physicians ______.
Answer:
1. fee structure
2. charge
Explanation:
Just a guess here
Felicia is working with a patient who just had gastric bypass. while felicia helps take care of the patient after surgery, what other member of the medical team will mostl likely come visit her?
Answer:
Dietition
Explanation:
After a gastric bypass, most of the time a patient will receieve couseling and lifestyle advice from a dietition.
10. Which of the following are keys to thinking critically? (Check all that apply)
✓ Define your terms
✓ Tolerate uncertainty
✓ Consider other interpretations
Statistical analysis
Experimenter effects
Don't oversimplify
Ask questions
Avoid emotional reasoning
Answer:
Avoid emotional reasoning
Statistical analysis
Define your terms
Ask questions
Consider other interpretations
Explanation:
Emotional reasoning causes one to act solely on their feelings, making the conclusion inaccurate
Statistical Analysis is reasonable and valid. It can help you think reasonably
Defining your terms makes you decide what you are okay and not okay with.
Asking questions makes it easier to find answers. Nothing wrong with that.
Considering other point of views besides your own can give you a new outlook, and close discernment.