E. is a 29-year-old woman with a 7-month history of heavy, irregular menses, a 5-lb weight gain, constipation, and decreased energy. her past history is unremarkable. she takes no prescription medications but uses iron and calcium supplements. she has a family history of thyroid disease. on examination, her weight is 152 lbs, her heart rate is 64 bpm, and her blood pressure is 138/86. her thyroid gland is mildly enlarged, without nodularity. she has trace edema in her lower extremities, and her reflexes are slow. laboratory studies are as follows: tsh is 15.3 miu/ml (elevated), free t4 is 0.3 miu/ml, and total cholesterol is 276 mg/ml.

diagnosis: primary hypothyroidism answer the following questions. include two references, cited in apa style.

list specific goals of treatment for m. e. what drug therapy would you prescribe? why?
what are the parameters for monitoring the success of the therapy?
discuss specific patient education based on the prescribed therapy.
list one or two adverse reactions for the selected agent that would cause you to change therapy.
what would be the choice for second-line therapy?
what over-the-counter and/or alternative medications would be appropriate for m. e.?
what lifestyle changes would you recommend to m. e.?
describe one or two drug–drug or drug–food interactions for the selected agent.

The nurse working at the senior center notices mrs jones, a 78-year old crying. the nurse approach mrs jones and asks if she needs . mrs jones stars “ i am so embarrassed. i had another accident and my pants are all wet. it’s like i’m a baby. i never should have come to the senior center." whar factors may be contributing to urinary incontinence? how should the nurse respond to mrs jones?

Harold, a fifty-eight year old grocery store manager, had recently been waking up in the middle of the night with abdominal pain. this was happening several nights a week. he was also experiencing occasional discomfort in the middle of the afternoon. harold decided to schedule an appointment with his physician. the doctor listened as harold described his symptoms and then asked harold some questions. he noted that harold's appetite had suffered as a result of the pain he was experiencing and as a result of the fear that what he was eating may be responsible for the pain. otherwise, harold seemed fine. the doctor referred harold to a physician that specialized in internal medicine and had harold make an appointment for a procedure called an endoscopy. the endoscopy was performed at a hospital later that week. during the procedure, a long, thin tube was inserted into harold's mouth and directed into his digestive tract. the end of the tube was equipped with a light source and a small camera which allowed the doctor to observe the interior of harold's stomach. the endoscope was also equipped with a small claw-like structure that the doctor could use in order to obtain a small tissue sample from the lining of harold's stomach, if required. the endoscopy revealed that harold had a peptic ulcer. analysis of a tissue sample taken from the site showed that harold also had an infection that was caused by helicobacterpylori bacteria. the doctor who performed the endoscopy gave harold prescriptions for two different antibiotics and a medication that would decrease the secretion of stomach acid. the doctor also instructed harold to schedule an appointment for another endoscopy procedure in 6 months. 1. list the subjective findings in this case study. 2. what is an endoscopy? (2 points) what is a biopsy? 3. how was a biopsy performed on harold? 4. differentiate between gastric and duodenal ulcers by location. 5. what role does h. pylori play in the formation of peptic ulcers? 6. define occult and frank blood. (4 points) what is a guaiac test? 7. how can peptic ulcers cause bleeding? 8. why were antibiotics prescribed? 9. why would a medication that would decrease the secretion of stomach acid be beneficial?

An order exist within the system and it is generally up to you to find out the order, the four segments that make health care financial system work are: a. the original records b. the information system c. the account system d. the reporting system discuss these four segments; in your responses, provide an example of each.