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Case Study: Nurse practitioner

Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week
history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling”
cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every
spring and fall.
Physical Examination
Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with
frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one
medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal
polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with
neutrophils, eosinophils, and plasma cells.)
Lungs: Clear to auscultation and percussion
Initial Post: Answer the following questions about Anna Sanchez and her condition.
What evidence suggests that Anna does not have an acute severe infection?
If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a
cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
What class of antibodies bind to the mast cells?
What physiological mechanisms caused the redness of Anna’s nasal mucosa?
What mechanisms caused Anna’s clear postnasal drainage?

Sample Solution

Recruitment took place at the beginning of a class period after permission had been granted by the instructor. The researcher then explained the goals of the study and distributed individual sign-up sheet to preserve the anonymity of the participants. Any student who wished to participate was welcome. The researcher hoped to recruit at least 15 participants in each section of the French phonetics course to meet the requirement for representativeness, but due to lack of enrollment, there were only 7 participants per group. The qualitative data from the participants provided rich enough data to obtain a credible picture and ensure saturation. Thus the requirements for the representativeness/saturation trade-off was met. Both groups received the same instruction in French phonetics and pronunciation. The phonetics course was held every Monday, Wednesday, and Friday for fifty minutes. Fridays were dedicated to lab work, while Mondays and Wednesdays were lectures. At the University of Illinois, French pronunciation is taught following an explicit methodology. Each phonological feature is explained in detail according to the manner of pronunciation: tongue position, jaw position, lips, etc. Data Collection Before the first phonological feature was taught, the participants completed the pre-test (Time 1). The post-test (Time 2) was completed after the instruction of the features. Both pre-test and post-test included two types of reading/recording exercises: a short text and short sentences (created by the researcher), targeting specific phonological features of French: /y/ vs. /u/, or the “silent e” (or schwa). While reading the texts and sentences, each participant was required to record themselves at Time 1 and at Time 2. The recordings took place in the phonetics laboratory at the University of Illinois, where participants can be monitored. The researcher asked the students to record themselves only once to control for repeated recordings, which may allow the students to modify their pronunciation.
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