What is the interaction between macrophages and T lymphocytes during the presentation of antigen? 2.Melissa’s illness is caused by a virus

Case Study 2 Innate and Adaptive Immunity Melissa is a 15-year-old high school student. Over the last week, she had been feeling tired and found it difficult to stay awake in class. By the time the weekend had arrived, she developed a sore throat that made it difficult to eat and even drink. Melissa was too tired to get out of bed, and she said her head ached. On Monday morning, her mother took her to her doctor. Upon completing the physical exam, he told Melissa the lymph nodes were enlarged in her neck and she had a fever. He ordered blood tests and told Melissa he thought she had mononucleosis, a viral infection requiring much bed rest. 1.Innate and adaptive immune defenses work collectively in destroying invasive microorganisms. What is the interaction between macrophages and T lymphocytes during the presentation of antigen? 2.Melissa’s illness is caused by a virus. Where are type I interferons produced, and why are they important in combating viral infections? 3.Humoral immunity involves the activation of B lymphocytes and production of antibodies. What are the general mechanisms of action that make antibodies a key component of an immune response?

Assignment Requirements: Before finalizing your work, you should: •Ensure you have written at least four double-spaced pages. •be sure to read the Assignment description carefully (as displayed above); •consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and •utilize spelling and grammar check to minimize errors. •follow the conventions of Standard American English (correct grammar, punctuation, etc.); •be well ordered, logical, and unified, as well as original and insightful; •display superior content, organization, style, and mechanics; and •use APA 6th Edition format.

What were the consequences of this for the patient, others, myself?


The student is to choose an incident that occurred during one of the clinical days this week. The issue can be from the patient’s pathophysiology, education needs, psychosocial needs, socioeconomic conditions, cultural/religious concerns, or a combination of these factors. It can be an incident like a cardiopulmonary arrest, a procedure like a dressing change or bladder catheterization, or an interaction (positive or negative) with a family member, staff person, or physician.

Paragraph 1: Briefly describe the scenario.

I went to the Operating Room (OR) on Monday afternoon (4 pm -8:30 pm the surgery lasted) and was able to witness and observe a surgery by a Gynecologic Oncologist who removed a mass from the pelvic area on a female patient in her 50’s. prior to meeting the surgeon the surgical team get the room prepped for sterile field, do the counts of all instruments, gauzes, pads, drapes and sutures and they write on a dry erase board. He was assisted by (2) residents. However during the course of the surgery the mass was found and removed and the attendees assumed they were done and could close the patient up. However, the surgeon new the mass he removed was not the place of origin of the cancer. He went up to her abdomen and begin inspecting the large intestine (while showing me and stating what I was looking at in hands was the transverse colon) and he went all the wat to the small intestine and there he found what was the source of her cancer that obviously metastasized to her pelvic region. Due to regulations of the hospital he asked the OR nurse to contact a trauma surgeon or the surgeon in the ER. Because of the time there were no surgeons available and the one that was on call contacted back in OR room and stated it would take him about 20 min to back to the hospital (that doesn’t include the time it would take him to scrub in). The surgeon over the phone gave my surgeon permission to go ahead and cut out the tumor in the small intestine and that we he came back tomorrow he would make an addendum to the patients chart stating he gave the surgeon I was watching permission to resection her small intestine. The residents as well as I and everyone else in the room was impressed how he knew that the cancer did not originate in her pelvic region. He let us know he’s been doing this so long that it comes with time and that the residents would get there to eventually after they have did hundreds upon hundreds of surgery’s. Since the patient was under for quite some time the anesthesiologist had to order a pint of blood to infuse into her since the surgery became much more complicated than expected. So I was able to witness them place the order in from their computer screen warm it in a warmer machine than piggy back it on her IV. Finally when the residents were told to close her up (I witnessed the internal suturing (dissolvable sutures) which would dissolve without her coming back to have them removed) and then they begin to staple her stomach on top and they were almost done until the surgical nurse and the OR nurse noticed the discrepancy on the sponge count. There was supposed to be 24 total that’s what was write on the board but the surgical nurse only counted 23 as well as the OR nurse did too! The surgeon told the residents to open the patient back up and low and behold a sponge was left inside the patient! They removed and redid all the suturing and stapling again. Finally the patient was closed up all the way now and the count for the surgical needle holders was off. So now the OR nurse had to call X-ray and I was able witness the portable x-ray team take an x-ray of the patients abdomen and pelvic area where the surgeon and resident were working to see if the needle holders were in her stomach. We than had to wait from confirmation from the cardiologist (who was on staff) to approve the x-ray that there was no instrument left in the patients abdomen. It was cleared and the needle holders somehow I think were found in the trash. Finally she was ready to come off sedation and a post op team came in to transfer to recovery. I t was a very eye opening experience for me. But it did prove to me that I absolutely love being in the operating room. I can’t wait to go back.

Paragraph 2: Explain the issue.

The issues was the surgery was more complex than expected to be; gauze (sponge) was left inside the patient’s body and possible needle holders.

Paragraph 3: Use the Critical Incident Analysis Model below, and reflect on what occurred. Address only the relevant questions.

Critical Incident Analysis Model

1 What was I trying to achieve?

2 Why did I respond like I did?

3 What strengths and /or limitations did I demonstrate in this situation?

4 What were the consequences of this for the patient, others, myself? The consequences are for the patient and staff. If they would have left the gauze pad inside the patients abdomen that would have eventually if not immediately caused the patient to get an infection (due to a foreign body left inside her) and may cause her to go septic. The consequences that would have affected the staff and surgeon. If they had not did the count and left the gauze inside her they could have been sued as well as the hospital when she began to show signs of illness.

5 How was this person (or persons) feeling? I know patient was going through divorce

6 How did I know that? When the patient was getting closed up the surgeon scrubbed out and let us know he was going out to talk with the family to inform them of how the surgery went. That’s when one of the OR nurses stated she was going through divorce and that when she came out of surgery they were to contact her sister and she would come up.

7 How did I feel in this situation? I felt very bad for the patient. I did not get to speak to her prior to the surgery nor after. However, when the nurse stated that to the surgeon I could only imagine the stress she must be going through. She just recently got diagnosed with cancer and at the same time she is going through divorce. I can only pray she has a great support system to get through everything. Even the surgeon felt bad when he was told.

8 What internal factors were influencing me including attitudes about working with patients of diverse backgrounds?

9 How did my actions match my beliefs?

10 What factors made me act in incongruent ways?

11 What knowledge did or should have informed me?

12 How does this connect with previous experiences?

13 Could I handle this better in similar situations?

14 What would be the consequence of alternative actions for the patient, others, and myself? The consequences the patient would either have gotten very ill or died. The staff and surgeon along with hospital could have been sued by either the patient or her family (if she passed away because of simple medical error.)

15 How do I feel now about the experience? As stated above I absolutely loved my experience. In a crazy way it felt like a television show.

16 Can I support myself and others better as a consequence?

17 Has this changed my way of knowing?

Caring for a baby that is preterm or of low birth weight affects the whole family and requires support inside and outside the home.

1-Having a place that families can go to for information and assistance takes a lot of stress off the parents because they can see that there is support out there for them and they can ask all the questions they want and someone will do their best to find an answer for them. When a family member is sick, I know I ask all the questions and feel uneasy when no one answers them or takes the time to answer them so having a place to find some answers helps relieve anxiety and stresss during a rough time.

2-For many families with preterm infants, even if there are no long-term complications, it takes time to get that infant or child back to where they need to be. Stress can be a big factor for the parents and support is needed. There are often times frequent doctor’s visits to various specialists and physical, occupational and speech therapy may also be involved. I have a family member that was preterm and is doing well but every day life for them is busy in trying to get that child back to where they should be developmentally, physically and nutritionally. They are only able to have one parent work because of the demands of therapy, appointments, and nutritional needs etc. Caring for a baby that is preterm or of low birth weight affects the whole family and requires support inside and outside the home.

3- It is at least encouraging the United States has advanced technologies and robust medical devices to save many lives of premature newborns. However, the burden that is left with the new parent like you said – like complications, stress, developmental delays etc can result into overwhelmed distress and cost to the family and community overall. Efforts should be made and population should be educated to minimize premature. The government and health care facilities should make efforts to ensure that people who are pregnant, or planned to be pregnant are provided everything possible to increase their chances of having full-term pregnancy. There are many things pregnant mothers can do to boost chances of having full term pregnancy, such as prenatal care (prenatal vitamins), quit smoking, get flu shot, etc.

impact of WIC on breastfeeding initiation and gestational weight gain:

Education is key here regardless of whether the mother wants to breastfeed or formula feed. I think helping the mother see the benefits of breastfeeding is important but also helping her know that she will be supported regardless is also important. Also, providing the mother with education on signs and symptoms of malnutrition such as the amount of wet diapers is important so that she knows what to look for and when to notify a provider should these symptoms start to occur. Situations like this can also cause a lot of stress on the mother and feelings of inadequacy can occur so assessing the mother carefully for any signs of post-partum depression or discouragement is also important as you mentioned. Helping the mother to know that there any many resources available to her is also important.

2-Because of the mother’s reluctance to breastfeed, the first assessment I would do immediately is to determine the status of the infant. Checking to ensure adequate hydration by asking about the number of wet diapers and checking the infant for lethargy or dry mucous membranes would be the first priority.

After determining the safety of the infant, I would utilize the rest of the information gained from the functional health assessment to determine the needs and decisions the mother would like to made.

In either case, I would be interested to know if she has adequate support systems in place, including child care and the nature of her employment because breastfeeding can be impacted by these situations both for timing of feeding, milk supply, and opportunities for pumping. If the mother has decided to breast feed, a lactation consultant might be a good resource for support and education. A website such as womenshealth.gov/breastfeeding could also be given as a resource if there is available access to the internet.

The newborn’s health will be a priority regardless of her decision. Education concerning development will be important, and it would be important to determine the level of understanding the mother has about feeding an infant and what her body requires to provide an adequate and healthy milk supply. Adequate nutrition and hydration through breastfeeding is determined by output and weight gain. Nutritional status of the mother is an important consideration. Referral to public assistance programs specifically geared towards the nutritional health of breastfeeding and pregnant women and children such as the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) would be an important consideration if there is financial concern in the family. In a longitudinal study Sonchak determined that this program did not decrease breastfeeding initiation, and in fact increased breastfeeding (2017). The health benefits of breastfeeding for the infant should be discussed as being the best option for feeding the baby, but without pressure, blame, or shame if that is not a viable option for this mother or family.

For formula feeding, the developmental milestones and health status would be the same. The method of preparing the feeding would need evaluation to see if education is needed. In feeding formula, the type of formula and the method of preparation are two areas that frequently need education. Cow’s milk should not be an option until after the child is 1 year of age, and the proper concentration of formula must be emphasized in order to ensure the child is receiving the appropriate number of calories and nutrition. WIC will also help provide formula if the mother has a financial need, and dilution of the formula to save money would be less likely.

Finally, the emotional component should be assessed and addressed. Mothers frequently feel guilt, regardless of their choice of method to feed their baby. By providing education on what the baby’s needs are and what the signs and symptoms are for adequate nutrition as well as what to look for if there is a problem, the mother can alleviate guilt by providing the best nutritional plan for whichever method she chooses. By focusing on the health of the infant she will be able to clearly decide how to best meet the nutritional needs in a way that works for her, her budget, and her lifestyle.


Sonchak, L. (2017). The impact of WIC on breastfeeding initiation and gestational weight gain: Case study of South Carolina Medicaid mothers. Children And Youth Services Review, 79115-125.

U.S. Health and Human Services, (2018). Breastfeeding. [HTML] Retrieved from https://www.womenshealth.gov/breastfeeding

3-If I found out that the mother of the newborn infant was reluctant to breastfeed her baby, I would get more information from the mother. I would ask the mother if she’s fearful, is it any religious beliefs, does she think it’s painful, or is it because she doesn’t have much information about breastfeeding. It’s important to assess her knowledge of breastfeeding prior to beginning any education to see what areas need further education. Assessing her ability and willingness to learn is also important. After understanding why, she is reluctant to breastfeed, I would educate her on the benefits of breastfeeding. It is easier for babies to digest breast milk than it is to digest formula. Breast milk contains antibodies that help the baby fight of viruses and bacteria later in life. It helps builds the infants immune system and infants tend to get sick less often. “Breast milk has all the nutrients an infant needs to grow. Breastfeeding lowers the infants risk for developing asthma and allergies” (WebMD, n.d.). Breastfeeding is a way that the mother and infant can bond.

It is during infancy that their nutrient requirements per pound of body weight are proportionally higher than any other time during their life cycle (United States Department of Agriculture, 2009). It is important to know if the baby is getting the proper amount of nutrients if the mother breastfeeds or bottle feeds. It is common for a mother who breastfeeds to worry about her infant getting enough because there is no way to measure the breast milk if the infant is drinking from the breast. Unfortunately, this will discourage mothers from breastfeeding. As nurses we can reassure the mother that there are ways to confirm that the baby is receiving enough nutrients needed. If the infant is gaining weight each visit or if the infant is soaking 6 diapers or more in a 24-hour period. If the infant stops eating, isn’t fussy, and seems satisfied than he/she is getting enough to eat. When infants are bottled fed, you can look for these signs to tell you if the infant is getting enough.

As a nurse, our main priority is to always show support with whatever decision our patients. Making sure the new mothers have all the resources available to them is important. As nurses, we can encourage our new mothers to breastfeed and it is important that we are readily available to them when and if they have any questions or concerns.

Department of Agriculture. (2009). Infant nutrition and feeding.

Retrieved 3/26/2018, from https://wicworks.fns.usda.gov/wicworks//Topics


To prepare for this assignment view the following brief video from the American Medical Association titled, “Health Literacy and Patient Safety:

To prepare for this assignment view the following brief video from the American Medical Association titled, “Health Literacy and Patient Safety: Help Patients Understand.” The video can be accessed through the following link:

Part I: Pamphlet
Develop a pamphlet to inform parents and caregivers about environmental factors that can affect the health of infants.
Use the “Pamphlet Template” document to help you create your pamphlet. Include the following:
Select an environmental factor that poses a threat to the health or safety of infants.
Explain how the environmental factor you selected can potentially affect the health or safety of infants.
Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
Offer examples, interventions, and suggestions from evidence-based research. A minimum of three scholarly resources are required.
Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.
In developing your pamphlet, take into consideration the healthcare literacy level of your target audience.
Part II: Pamphlet Sharing Experience

Share the pamphlet you have developed with a parent of an infant child. The parent may be a person from your neighborhood, a parent of an infant from a child-care center in your community, or a parent from another organization, such as a church group with which you have an affiliation.
Provide a written summary of the teaching / learning interaction. Include in your summary:
Demographical information of the parent and child (age, gender, ethnicity, educational level).
Description of parent response to teaching.
Assessment of parent understanding.
Your impressions of the experience; what went well, what can be improved.
Submit Part I and Part II of the Accident Prevention and Safety Promotion for Parents and Caregivers of Infants assignment by the end of Topic 1.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.


Describe one potential health-related consequence to low health literacy and a population at risk for this potential consequence, explaining why they are at risk.

DUE 3/30/18 7 P.M EST


Health Literacy

The government has defined health literacy as “The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2020, 2011). Scholars have demonstrated that health literacy skills are stronger predictors of health status than age, income, employment status, education level, and race or ethnicity. Individuals with inadequate health literacy often struggle with basic tasks when managing a chronic condition such as reading and comprehending prescription bottles, appointment slips, self-management instructions, and educational brochures. The problems are compounded when the individual has several conditions requiring different medications. Inadequate health literacy can be a barrier to controlling disease that can lead to medication errors, increased hospitalization, poor health outcomes, and greater health care costs.


*Provide an example that illustrates the difference between literacy and health literacy.
*Describe one potential health-related consequence to low health literacy and a population at risk for this potential consequence, explaining why they are at risk.