Overview

In this journal, you will make a submission to your portfolio. Remember that you will submit portfolio artifacts in different courses throughout the Computer Science program. This portfolio is an opportunity for you to catalog your learning and showcase your best work to future employers. You will also reflect on the work that you have done in these projects. Reflecting will help add context to refresh your memory when you review your portfolio in the future.

Prompt

For this course, you will be submitting one portion of each project into the GitHub repository for your portfolio. From Project One, submit the business requirements document. From Project Two, submit the system design document. Together, these documents showcase your work in system analysis and design. These documents demonstrate your ability to collect requirements from the customer and design a system that meets those needs.

You will also reflect on the work that you have done in these projects. Reflecting is a valuable skill to cement your learning. It also will help add context to refresh your memory when you use your portfolio in the future. Update the README file in your repository and include your answers to each of the questions below. You could include the questions and write a few sentences in response to each one, or you could write a paragraph or two weaving together all of your answers.

• Briefly summarize the DriverPass project. Who was the client? What type of system did they want you to design?
• What did you do particularly well?
• If you could choose one part of your work on these documents to revise, what would you pick? How would you improve it?
• How did you interpret the user’s needs and implement them into your system design? Why is it so important to consider the user’s needs when designing?
• How do you approach designing software? What techniques or strategies would you use in the future to analyze and design a system?

1. You will design a project to study some aspect of air and briefly describe it.
2. In 3 sentences you will describe:
   1. Sentence 1: Your project. Briefly, state the type of project and the data you would collect. If you cannot think of anything, look back at the lecture for ideas.
   2. Sentence 2: Where would you set this project? More than one location? One? Describe the location.
   3. Sentence 3: What is/are the long term benefits to conducting this project?
3. You may embed a photo if you think that will help describe your project.
4. You do not need to label your sentences as “Sentence 1” etc.
5. You may not copy someone else’s idea.
6. Remember all of your good sentence rules! Do not write long, run-on sentences. Be short and concise. Make sure your spelling and grammar are good.

Syndrome of inappropriate antidiuretic
hormone secretion (SIADH) occurs when
there’s a continuous, inappropriate action
or excessive secretion of antidiuretic hor–
mone (ADH), specifically the hormone
arginine vasopressin (AVP), which is pro–
duced in the hypothalamus and secreted
by the posterior pituitary gland. AVP
controls the conservation and release of
water in the body. SIADH occurs even in
the presence of an increased or normal
plasma volume and results in hypo–
osmolality and hyponatremia (blood se–
rum sodium levels less than 135 mEq/L).
In SIADH, hyponatremia isn’t the result
of a sodium deficiency; rather, it’s caused
by an excess of water.
Causes
SIADH is often thought of as a manifes–
tation of another disease or condition, as
a symptom rather than a cause. SIADH is
associated with diseases/conditions that
affect the osmoreceptors of the hypothal–
amus, which detect changes in osmotic
pressure. These osmoreceptors cause an
afferent neurologic signal to be sent to
the hypothalamus, which then triggers re–
lease of ADH from the posterior pituitary
gland to regulate blood concentration
(see Understanding SIADH).
According to the Mayo Clinic, causes
of SIADH include medications, such as
hydrochlorothiazide, methotrexate, cip–
rofloxacin, cisplatin, haloperidol, and
amphetamines; central nervous system
disturbances; cancers/tumors; lung dis–
eases; surgical procedures, such as for
traumatic brain injury and exploratory
laparotomy; HIV/AIDS; and congestive
heart failure (CHF).
SIADH in children occurs due to water
imbalance caused by medication admin–
istration, such as chemotherapy; brain
tumors; or fluid imbalances.
Complications
SIADH is the leading cause of hypona–
tremia in hospitals, with approximately
one-third of all hyponatremia cases being
directly attributed to it.
Complications of SIADH are related
to the magnitude and rate of hyponatre–
mia development. Onset can be acute,
develop in less than 48 hours, and lead
to potentially life-threatening complica–
tions. However, if hyponatremia is chron–
ic and has developed slowly over many
days or weeks, complications are often
subtle and can be easily overlooked.
Whether acute or chronic, hyponatremia
is a serious electrolyte imbalance that
studies show leads to increased morbid–
ity and mortality both inside the hospital
and out.
© SERGEY KHAKIMULLIN | DREAMSTIME.COM
www.NursingMadeIncrediblyEasy.com July/August 2018 Nursing made Incredibly Easy! 21

patho puzzlerCopyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Mild complications generally associ–
ated with chronic SIADH and a serum
sodium level of greater than 125 mEq/L
include:
• headaches
• depression
• memory problems
• muscle cramps
• tremors
• anorexia
• weight gain
• decreased urine output.
Severe complications of SIADH are
more often associated with an acute onset
of hyponatremia and a serum sodium level
of less than 120 mEq/L. These complica–
tions are more advanced and related to
systemic water intoxication. Neurologic
complications develop because of osmoti–
cally induced cerebral edema. Monitoring
for cardiac and pulmonary complications
is essential because vascular congestion
Understanding SIADH
Source: Nurse’s 5-Minute Clinical Consult: Diseases. Philadelphia: PA: Lippincott
Williams & Wilkins; 2006.
CEREBRAL EDEMA
Intracellular
fluid shift
Increased renal tubule permeability
Excessive ADH secretion
Elevated
glomerular
filtration rate
Dilutional
hyponatremia
Increased
sodium
excretion
HYPONATREMIA
Reduced
plasma
osmolality
Increased water retention and expanded extracellular fluid volume
Diminished
aldosterone
secretion
Decreased sodium
reabsorption in
proximal tubule
stresses both the heart and lungs. In severe
SIADH, complications can include:
• hallucinations
• seizures
• cerebral edema, leading to brain
herniation
• noncardiogenic pulmonary edema
• CHF
• coma
• death.
Diagnosis
The diagnosis of SIADH can be challeng–
ing because there’s no single definitive
test for it. Often, SIADH will be first
suspected due to abnormally low serum
sodium levels discovered during routine
blood chemistry for another condition.
Note that patients with serum sodium
levels below 120 mEq/L are at a high
risk for seizures. Although hyponatre–
mia can be found in nearly all patients
with SIADH, a low serum sodium level
isn’t sufficient to act as a positive test for
SIADH. The primary reason for this is be–
cause other common conditions can lead
to hyponatremia, such as gastrointestinal
illness (with corresponding vomiting and
diarrhea) and adrenal insufficiency.
Uric acid levels can be used as a gen–
eral indicator. SIADH will often cause
uric acid levels to be low. This presents
in around 70% of SIADH cases, whereas
patients with salt depletion present in
around 40% of cases.
A reliable way to test whether a patient
meets the basic criteria to be considered for
SIADH is to perform these three checks:
1. Is the patient hyponatremic (serum
sodium level less than 135 mEq/L)?
2. Does the patient present with hypo–
osmolality (less than 280 mOsm/kg)?
3. Is urine osmolality high?
If these three conditions are met, then
the distal nephrons are being acted on by
AVP. Although this is helpful, it doesn’t
indicate if AVP is being secreted inappro–
priately, as may be the case with patients
with cirrhosis or CHF.
22 Nursing made Incredibly Easy! July/August 2018 www.NursingMadeIncrediblyEasy.com

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.Some of the tests for SIADH fall into
the category of positive test by negative
finding. An example of this is when the
patient’s clinical assessment offers find–
ings that don’t support decreased effec–
tive intravascular volume, yet the patient
presents with hyponatremia. One simple
way to begin to isolate what’s happening
and why is to put the patient on a sodium
restriction. Patients who have SIADH will
continue to excrete sodium in their urine
that’s less than maximally dilute, regard–
less of dietary restrictions.
Unfortunately, imaging still doesn’t
have a lot to offer in the way of diagnostic
tools. It’s more typically used to confirm
the existence of underlying conditions
that may cause the release of AVP, such
as CHF, or identify conditions caused by
hyponatremia secondary to SIADH, such
as hydrocephalus.
Treatments
Supportive care for SIADH is determined
by a multitude of factors. Treatment is
based on:
• patient health and tolerance to therapy
or medications
• determination as chronic (unknown du–
ration) or acute (less than 48 hours)
• degree of hyponatremia (mild, moder–
ate, or severe)
• presentation as symptomatic or
asymptomatic
• lab values for urine osmolality and cre–
atinine clearance.
Because SIADH may be the result of an
underlying cause, initial treatment may
include either addressing the primary
medical condition or adjusting or discon–
tinuing current medications in the event
of a drug-induced condition. Otherwise,
hyponatremia is corrected by reduc–
ing fluid retention and avoiding further
buildup by limiting fluid intake.
Fluid intake may be restricted to 500
to 1,500 mL/day. Calculations must con–
sider all intake, including oral, I.V., and
metabolic production in comparison to
Signs and symptoms
• Weight gain
• Anorexia
• Tachycardia
• Dyspnea
• Headache
sheet
cheat
• Fatigue
• Weakness
• Change in LOC
• Lethargy
• Vomiting
• Muscle weakness and cramping
• Muscle twitching
• Seizures
• Decreased urination
water loss through urine, stool, skin,
and respiration. A rise in serum sodium
concentration is expected. However, this
nonpharmacologic approach can be dif–
ficult for patients to adhere to. Taking a
daily weight measurement is important,
as is rigorous measurements of intake and
output.
Pharmacologic approaches include 3%
sodium chloride solution, loop diuretics,
urea, demeclocycline, lithium, conivaptan,
and tolvaptan. Sodium chloride solution
administration must be closely moni–
tored due to the possibility of pulmonary
edema. The loop diuretic furosemide may
be administered with 3% sodium chloride
solution to avoid edema or as a stand-alone
treatment. Note that the effectiveness of
lithium can be unreliable and may result
in renal toxicity. Adverse reactions of
conivaptan include hypotension, elevated
blood urea nitrogen, increased thirst, and
infusion-site reactions. Adverse reactions
of tolvaptan may include increased thirst,
dry mouth, and urinary frequency, along
with reports of constipation, nausea, diz–
ziness, weakness, hyperglycemia, and
urinary tract infection.
Continuous venovenous hemofiltra–
tion and sustained low-efficiency daily
dialysis are invasive procedures used in
the case of exceptional, cardiac-related
emergencies.
www.NursingMadeIncrediblyEasy.com July/August 2018 Nursing made Incredibly Easy! 23

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.patho puzzler
Management of SIADH is focused
on treating symptoms related to hypo–
natremia, whether mild, moderate, or
advanced. Correction rates are monitored
closely regardless of treatment due to
the risk of central pontine myelinolysis
(CPM)—the dysfunction of brain cells
caused by the destruction of the myelin
sheath of nerve cells in the central por–
tion of the brainstem. This adverse reac–
tion can occur in relation to a rapid rise
in serum sodium levels and can lead to
decreased level of consciousness (LOC),
dysphagia, mutism, quadriparesis, and
death.
The key to avoiding CPM is careful
and appropriate correction of the patient’s
hyponatremia based on the degree of
sodium deficiency, whether the patient is
symptomatic, and whether the hypona–
tremia is acute or chronic in nature, with
frequent lab testing of serum sodium
levels. In addition to lab testing, frequent
monitoring of the patient’s neurologic sta–
tus must be performed to identify changes
as early as possible. Total sodium correc–
tion must not exceed 10 mEq in a 24-hour
period, with some authors recommending
an even more conservative rate of 8 mEq in
a 24-hour period.
Accuracy and vigilance
SIADH needs to be accurately diag–
nosed and then controlled and moni–
tored appropriately. As always, safety is
paramount. Your vigilance is crucial for
patients with this
diagnosis. ■
key points
Nursing considerations REFERENCES
• Maintain strict input and output, with daily Children’s Hospital of
weights; fluid restriction of 500 to 1,500 mL/day Philadelphia. Syndrome
• Monitor for urine retention and assess for of inappropriate antidi–
uretic hormone secretion
signs and symptoms of dehydration (SIADH). www.chop.
• Perform hourly neurologic checks; assess edu/conditions-diseases/
for changes in LOC syndrome-inappropriate–
antidiuretic-hormone–
• Monitor vital signs and lab values for urine secretion-siadh.
osmolality, creatinine clearance, and blood Corona G, Giuliani C,
urea nitrogen Verbalis JG, Forti G, Maggi
M, Peri A. Hyponatremia
improvement is associated with a reduced risk of
mortality: evidence from a meta-analysis. PLoS One.
2016;11(3):e0152846.
Cuesta M, Thompson CJ. The syndrome of inappropriate
antidiuresis (SIAD). Best Pract Res Clin Endocrinol Metab.
2016;30(2):175-187.
Decaux D, Musch W. Clinical laboratory evaluation of
the syndrome of inappropriate secretion of antidiuretic
hormone. http://cjasn.asnjournals.org/content/3/4/1175.
full.
Gross P. Clinical management of SIADH. Ther Adv
Endocrinol Metab. 2012;3(2):61-73.
Mayo Clinic. Hyponatremia. www.mayoclinic.org/
diseases-conditions/hyponatremia/basics/causes/
con-20031445.
Medline Plus. Central pontine myelinolysis.
https://medlineplus.gov/ency/article/000775.htm.
Mosby’s Dictionary of Medicine, Nursing, and Health
Professions. 10th ed. St. Louis, MO: Elsevier; 2016.
Mujtaba B, Sarmast AH, Shah NF, Showkat HI, Gupta RP.
Hyponatremia in postoperative patients. www.omics
online.org/open-access/hyponatremia-in-postoperative–
patients-2327-5146-1000224.pdf.
Nardone R, Brigo F, Trinka E. Acute symptomatic sei–
zures caused by electrolyte disturbances. J Clin Neurol.
2016;12(1):21-33.
Pfennig CL, Slovis CM. Electrolyte disorders. In: Marx JA,
Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency
Medicine: Concepts and Clinical Practice. 8th ed. St. Louis,
MO: Elsevier; 2014.
Pillai BP, Unnikrishnan AG, Pavithran PV. Syndrome of
inappropriate antidiuretic hormone secretion: revisiting
a classical endocrine disorder. Indian J Endocrinol Metab.
2011;15(suppl 3):S208-S215.
Sahay M, Sahay R. Hyponatremia: a practical approach.
Indian J Endocrinol Metab. 2014;18(6):760-771.
Thomas CP. Syndrome of inappropriate antidiuretic
hormone secretion workup. http://emedicine.medscape.
com/article/246650-workup.
University of Rochester Medical Center. Antidiuretic
hormone. www.urmc.rochester.edu/encyclopedia/
content.aspx?contenttypeid=167&contentid=antidiure
tic_hormone.
University of Rochester Medical Center. Syndrome of
inappropriate antidiuretic hormone secretion in children.
www.urmc.rochester.edu/encyclopedia/content.aspx?con
tenttypeid=90&contentid=p01974.
Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis,
evaluation, and treatment of hyponatremia: expert
panel recommendations. Am J Med. 2013;126(10 suppl 1):
S1-S42.
At Northern Arizona VA Medical Center in Prescott, Ariz., Jean
Brennan is a Geriatrics and Extended Care Clinical Nurse Educator,
Sabra Carpenter is an LPN, Jessica Florence is an RN, Jennifer
Hemphill is a Nurse Manager, Ramona Hicks is a Charge RN, Kim
Rooper is a Nursing Officer of the Day, Jason Sewell is an RN, and
Kimber Wagner-Hines is a Charge RN.
The authors have disclosed no financial relationships related to this
article.
DOI-10.1097/01.NME.0000534117.45270.21
24 Nursing made Incredibly Easy! July/August 2018 www.NursingMadeIncrediblyEasy.com

Introduction

As we have learned in this unit, education is an important factor in determining occupation and income, as well as health. The COVID-19 pandemic has created major set backs in education, leading to questions regarding the K-12 system. One idea that has gained traction as a result is “funding students, not systems”.

Your Tasks

Task 1- Read/Research

Please take a few moments to review the SCHOOL Act

User generated content is uploaded by use

Cognitive development between the ages of 7 and 11 is impressive, beginning with improvements in control processes, and increase in processing speed and capacity, and a growing foundation of knowledge. This chapter in our book discusses the views of Piaget and Vygotsky regarding the child’s cognitive development, which involves a growing ability to use logic and reasoning (as emphasized by Piaget) and to benefit from social interactions with skilled mentors (as emphasized by Vygotsky). According to Piaget, school-age children are much better able than preschoolers to understand logical principles, provided the principles are applied to concrete examples. Because the school years are also a time of expanding moral reasoning, this chapter also looked at Kohlberg’s stage theory of moral development as well as current evaluations of his theory.

Additionally this chapter explores the information-processing perspective on cognitive development, beginning with the Gibson’s concept of affordances. It then discusses changes in the child’s processing speed and capacity, control processes, knowledge base, and metacognition. Linguistic development during the school years is also extensive, with children showing improvement in vocabulary and pragmatics. This is clearly indicated by their newfound delight in words and their growing sophistication at telling jokes. If you have ever spent time in a second grade classroom you can immediately tell what stage the children are in by who is telling and who is getting the jokes. Jokes become very funny to children at this age because of their newfound ability to hold 2 or more concepts in their head at the same time allowing them to fully understand the humor in the jokes they are telling and hearing.

1. Which main theory of cognitive development (Piaget, Vygotsky, Information Processing, etc) stands out the most to you? Why?
2. Which theory of language development (social learning, assimilation and accomidation, or operant conditioning) stands out the most to you? Why?
3. Share a personal experience (first hand or someone you know, respecting confidentiality) with learning disabilities and/or special education/inclusion.

Read a passage concerning US Army Sergeant Timothy Hennis. Under the US Constitution, the Fifth

Amendment prohibits the same sovereign entity from trying a defendant for the same crime twice.

However, it does not prohibit another sovereign entity for charging the defendant. What do you think?

Should a State be allowed to charge and convict a defendant for the same crime they were found not

guilty of in another State or Federal Court? Why or why not?

In qualitative research, choosing an applicable research topic and problem should incorporate a desire to understand how and why something is happening. Sometimes researchers might also explore what is happening and if it aligns with individuals’ perspectives or understanding of an issue or event.

• Write a succinct research problem statement that you are considering for your mock study in this class.
• respond to at least 1 in a minimum of 150 words. Then, share an example from your professional experience to support your assertions.

Discussion 2
Think about the different types of qualitative research topics that are available. Depending on your particular scholarly and professional interests, these topics can be vast and encompass so many areas of our social world, including leadership, business, education, and healthcare, among others.

• How does a researcher find people and places to study?
• respond to at least one in a minimum of 150 words. Explain why you agree or disagree. Then, share an example from your professional experience to support your assertions.

Assignment
This week, you will begin formulating a mock qualitative study by focusing on key areas of qualitative study alignment, including developing a research problem, purpose, and research question(s).

Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

• Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

case study

Insomnia
31-year-old Male

BACKGROUND

This week, we examine a 31-year-old male who presents to the office with a chief complaint of insomnia.

SUBJECTIVE

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM

The patient is alert and oriented to person, place, time, event. He makes good eye contact and is dressed appropriately for time of year. He denies auditory/visual hallucinations. Judgement, insight, and reality contact are all intact. Patient denies suicidal/homicidal ideation, and is future oriented.

Decision Point One

Select what you should do:

Zolpidem: 10 mg daily at bedtime

Trazodone 50 mg po at bedtime

Hydroxyzine: 50 mg daily at bedtime