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Module 03 Content

1.

Top of Form

Imagine you have been asked to speak to a group of parents about promoting self-esteem in school-age children. You need to research the topic and prepare a visually appealing PowerPoint slideshow to accompany your presentation. Your PowerPoint slideshow will need to:

0. Have a title slide.

1. Contain 5-10 content slides that include Speaker Notes which provide supporting details to use when elaborating on the slide contents.

2. Address the following questions:

3. How does level of self-esteem typically change during middle childhood? What factors contribute to this change?

4. What are some influences on school-age children’s self-esteem?

5. Does very high self-esteem always have positive effects on children’s adjustment? Why or why not?

6. What are the typical consequences of low self-esteem?

7. What are some other strategies that parents and teachers can use to promote children’s self-esteem? What behaviors should adults avoid, and why?

8. Be written using proper spelling/grammar.

9. Cite at least 3 academic references and present the sources in APA format on a References slide.

For information about creating PowerPoint presentations or how to add Speaker Notes, consult the resources below.

Bottom of Form

nursing

You receive a change-of-shift report about a recently admitted client. The outgoing nurse reports that the client is immobile and has required two nurses for repositioning. Consider the following questions, and respond to each in your initial discussion post:

What complications are associated with immobility?

What nursing interventions can help prevent these complications?

How will you ensure your own safety when assisting this client?

How will you ensure the client’s safety

must contain at least two professional references, published within the past 5 years.

nursing

Assessment 3 Instructions: Disaster Recovery Plan
Develop a disaster recovery plan to lessen health disparities and improve access
to community services after a disaster. Then, develop and record a 10-12 slide
presentation of the plan with audio and speaker notes for the Vila Health system,
city officials, and the disaster relief team.

Vila Health Disaster Recovery Scenario

Intro: For a healthcare facility to be able to fill its role in the community, it must actively plan not
only for normal operation, but also for worst-case scenarios which could occur. In such disaster, the
hospital’s services will be particularly crucial, even if the specifics of the disaster make it more difficult
for the facility to stay open.
In this scenario, you will resume your role as the senior nurse at Valley City Regional Hospital. Like
many facilities within the Vila Health network, Valley City Regional serves as the primary source of
health care for a wide area of North Dakota. As such, it is even more imperative than usual that it stay
open and operational in all situations. Doing this means planning and preparation.
The administrator of the hospital, Jennifer Paulson, wants to talk to you about disaster preparedness
and recovery at Valley City Regional. But first, you should read some background information about
events in Valley City in the past few years, including the involvement of the hospital.

Background Information:

News Article: HOPE FOR THE BEST, PLAN FOR THE WORST

Op-ed by Anne Levy, Valley City Herald

Valley City has had a great year, growing on a number of fronts. But all of our growth and success
exists in the shadow of the recent past, a case of recent wounds slowly healing and fading to scars.

No one who was in Valley City two years ago will ever forget the catastrophic derailment of an oil-
tanker train and the subsequent explosion and fire. While fatalities were fewer than they could have
been, six residents of our city lost their lives. Nearly two hundred were hospitalized, and much of the
city was temporarily evacuated. Several homes near the railroad tracks were leveled, and our water
supply was contaminated by oil leakage for several months.

Life has resumed, and we have begun to thrive again, in our fashion. But the nagging feeling recurs:
When the disaster struck, were our institutions properly prepared? No one wakes up in the morning
expecting a train derailment, of course. But responsible institutions think about things that could go
wrong within the realm of possibility, and make a plan. Many individuals performed brave, inspired,
selfless service in the chaos of the derailment, but it is clear in retrospect that much of the work was
improvised, disorganized, and often circular or at cross-purposes.

For the first two hours of the crisis, the Valley City Fire Department was caught unprepared by the
damage to the city water supply caused by the explosion, which was more extensive than had been
considered possible. The Fire and Police departments had trouble coordinating radio
communications, and a clear chain of command at the scene between departments was painfully
slow to emerge. The hospital was woefully understaffed for the first six hours of the crisis, taking far

too long to find a way to bring additional staff and resources onto the scene. The city health
department was unacceptably dilatory in testing the municipal water supply for contaminants.

A call from the Herald’s offices to City Hall confirmed that the city’s disaster plan is over a decade old,
and is unfortunately myopic both in the events it considers as possible disasters and in the agencies it
plans for. It is of utmost importance to the future of our city that this plan be revised, revisited, and
expanded. All city agencies should review their own disaster plans and coordinate with the city for a
master plan. The same goes for crucial non-government agencies, most especially the Valley City
Regional Hospital. Of course, this all exists in the shadow of budget cuts both at city hall and the
hospital.

The sun is shining today, without a cloud in the sky. This is the time to make sure we are ready for the
next storm, so to speak, to hit our city. No one knows what the next crisis will be or when it will come.
But we can count on the fact that no one will get up that morning expecting it.

Valley City, ND, Demographics:
Population: 8,295 (up from 6,585 in 2010 census)

Median Age: 43.6 years. 17.1% under age 18; 14.8% between 18 and 24; 21.1% between 25 and
44; 24.9% 46 – 64; 22% 65 or older.

Officially, residents are 93% white, 3% Latino, 2% African-American, 1% Native American, 1% other.

—additionally, unknown number of undocumented migrant workers with limited English proficiency

Special needs: 204 residents are elderly with complex health conditions; 147 physically disabled
and/or use lip-reading or American Sign Language to communicate.

Note that the Valley City Homeless shelter runs at capacity and is generally unable to accommodate
all of the city’s homeless population. Also, the city is in the midst of a financial crisis, with bankruptcy
looming, and has instituted layoffs at the police and fire departments.

Valley City Region Hospital Fact Sheet
105-bed hospital (currently 97 patients; 5 on ventilators, 2 in hospice care.)

NOTEWORTHY: Both of VCRH’s ambulances are aging and in need of overhaul. Also, much of the
hospital’s basic infrastructure and equipment is old and showing wear. The hospital has run at
persistent deficits and has been unable to upgrade; may be looking at downsizing nursing staff.

Staff Interviews:

Jennifer Paulson, Administrator, Valley City Hospital
Hello, thanks for stopping by. I hope you’re settling in well.

I’d been planning on talking to you about disaster planning in the near future anyway, but now it looks
like it’s a lot more urgent. I’m not sure if you’ve heard, but the National Weather Service says we’re
going to be at an elevated risk for severe tornadoes in Valley City this season. I’m taking that as a
clear sign that it’s time we get serious about disaster planning. And it’s not just me… The mayor just
called me and asked the hospital to check our preparedness for a mass-casualty event, given recent

qualms about the way the derailment was handled. For instance, did you see that op-ed in the paper
about disaster planning?

Anyway. My particular concern is patient triage in the near term and recovery efforts over the next six
months. As I work on a more formal response to the Mayor about where we’re at for this threat, I’d
appreciate it if you could do some research and planning on this matter. Even if we dodge the bullet
on these tornadoes, there’ll be something else in the future. We need to stop putting it off and get
serious about our disaster planning.

What I’d like for you to do first is take some time to talk to a good cross-section of people here at the
hospital about what happened last time, and about our disaster plan in general. Make sure you get
people from administration as well as frontline care staff; after all, problems can be visible in one area
but not another a lot of times. So spread it around! Since you weren’t here for the train crisis, I think
you’re in a unique position to have a fresh, unbiased outlook on it. Actually, first you might find it
useful to take a look at the hospital fact sheet, just to brush up on our basics here. After you’ve looked
at the fact sheet and done some talking to people, I’d like you to swing back by and we’ll talk about
next steps.Thanks!

Kate McVeigh, RN
Hey there! Yeah, I think I have a minute or two to talk about the derailment. Wow. It’s crazy. I guess
that’s been a while, but it still feels like it just happened. It’s all so vivid!

I was on shift when it happened, so I was here for the whole thing. The blast, the first few injuries, and
then the wave. I think I was working for 16 hours before Heather, the former head nurse, told me to
leave before I passed out.

I just remember a big jumble. We had waves of people coming in before we were really aware of what
we were up against. Someone actually brought out the disaster plan but it was kind of useless. Just a
bunch of words about using resources wisely and what have you, no concrete steps or plan. And then
people started pouring in and we started treating them and there just wasn’t time to figure out how to
make that stuff about using resources wisely into an actual, concrete plan. I mean, of course it’s good
advice to use your damned resources wisely in an emergency! But just saying that doesn’t help.
Without a plan, we were just working our way through a line, or really more like a crowd, without any
thought of triage or priorities or anything. You knew as you were doing it that it was bad, but what
could you do? There was always a next person to help.

You know what would have been useful in that damn disaster plan? Strict, functional checklists and
lists of steps and such. Concrete plans for a chain of command. Clear lists of what to do and what our
priorities should have been. And I’m just talking doctor and nurse time here, as far as waste goes. I
know we had critical problems with supplies and such, but I was too focused on patient care to really
know what was going on there.

OK. I have to go do rounds. Good luck. Yikes. I’m all anxious just thinking about that again.

Megan Campbell, RN
Oh, I remember the night of the derailment really well. I’ll never forget it. I was off that night, out for
dinner with my family. Heard the boom and the word spread through the Pizza Hut about what had
happened pretty quickly. I kept expecting a call telling me to come in to the hospital, but none ever
came. After maybe ten minutes of that, I figured I’d better just come in on my own. It was pretty clear
there were going to be a lot of people moving through the hospital.

I guess that was a little bit of a failure, but it’s nothing compared to what I saw when I showed up at
the hospital. I just hustled into the ER and started helping out. It wasn’t clear who was in charge, and

nobody was making any decisions. People just started piling in with burn wounds, smoke inhalation,
blunt trauma from the explosion, you name it. And we were just dealing with them first-come, first
serve, more or less. Just working our way through the room while people kept coming in and piling
up. I knew that this wasn’t the right way to be doing this – heck, we all knew – but the room was too
chaotic for anyone to take a second and say “stop” and impose some kind of systematic approach. I
don’t know for sure if any lives were lost because of the muddle, but I know people with some very
serious injuries suffered a lot longer than they needed to while we were treating people with minor
sprains and contusions who’d just happened to get to the ER a little earlier.

Hope this helps!

Courtney Donovan, M.D.
I can’t say that I feel great about the state of disaster planning here at the hospital. I know we keep
talking about doing something, but it never seems to get any further than talk. I mean, no offense, but
I think this is the third time since the derailment that someone has tried to talk to me about lessons
learned. There’s a point where just that repetition makes it clear that no lessons have been learned.

But just to be a good sport: The big lesson from the derailment is that our staff is intelligent,
resourceful, energetic, and flexible. That’s the good news. Stuck with a horrific situation and a
disaster plan that I’d describe as “aspirational,” we got through a very rough event. It was more
painful than it needed to be, since we had to improvise most of it and improvisation is never the most
efficient way to do things. But we provided real help to people and I think we kept the loss of life
admirably low.

But god. There was no structure, no thought to anything. I tried to get the nurses to perform some
triage, but they were too busy reacting to the latest mini-crisis to pop up in front of them. I don’t blame
them, of course! I tried to give some orders, but then like the nurses I was always pulled in to sit with
the next patient, and someone else would come out and countermand whatever I’d said, and it just
went on like that all night.

On a personal level, I know I pushed myself too hard that night. I mean, with good reason, but still. I
was exhausted and loopy after 14 hours or so, and it’s just luck that I didn’t make any serious medical
errors. I’m not the only one who put it all out there. I know most of the medical staff were in bad shape
towards the end, too. I guess that’s always going to be a risk, but I think we could have planned our
operations a little better. If we’d been more thoughtful about what we were doing, maybe we wouldn’t
have needed to grind ourselves down so far.

You know what else? I’ve never felt good about our long-term check-ins afterwards. People who had
recurring problems related to the derailment came in, but neither we at the hospital or anybody in
public health did enough to check in with people on an ongoing basis in the months after the disaster.
Even when we were having those water contamination issues! People forget about that–the
derailment disaster really continued for months afterwards as the cleanup went on.

I hope you’re serious about taking this information and turning it into something useful. For god’s
sake, please don’t just write it all down and keep it on your laptop this time.

Mike Horgan, Associate Director Hospital Operations
I have been screaming about the need to update our disaster plan for years. I was screaming about it
before the train incident, too, but nobody would listen then. I figured people might listen afterwards,
but that hasn’t been the case, at least so far. If I’m talking to you about this right now, maybe it’s a
good sign.

Look. I respect the heck out of Jen Paulson, she’s been a great hospital administrator. But she’s also
got a lot on her plate, and is never, ever able to properly take a step back and look at the big picture.
Not her fault, it’s a systemic thing.

And all of our disaster-planning problems are systemic. The disaster plan as it exists is basically a
binder full of memos, each memo just being something I or Jen or someone else went and wrote
down after we’d had a conversation about what to do if there was a catastrophic snowstorm or what
have you. At best, it works as a bunch of notes that you could use to build a real disaster plan out of.
As something you could act on in a crisis? No way. And we proved that in the train incident.

One thing that makes me crazy about all of this: in all of our conversations, we act like we here at the
hospital can cook up a plan on our own that’ll get us through anything. But that’s just crazy. We can
and should have a plan. But when the stuff hits the fan, we’re not on our own and we can’t work from
a plan that pretends we are. We interface directly with first responders: the fire department, the EMTs,
and the police and sheriff’s departments. Our plan needs to coordinate with them. We saw that in
spades on the night of the train explosion. We barely had functional communication with any of the
other agencies for the first few hours of the crisis! People were being brought over by the ambulance
load and just kind of dumped off so that they could go pick up the next wave! There was a serious
problem with understandably panicked people crowding the hospital, mostly trying to find out where
their loved ones were and if they were OK, and it was three in the morning before we had police here
doing crowd control.

So if you’re helping Jen work on an improved disaster plan: First, thank you. Second, please,
PLEASE reach out to people at other agencies around town and work out some joint-operation
protocols for next time.

Andrew Steller, Hospital CFO
Well, welcome to the house of gripes.

Sorry. It’s just that this is kind of a tough stretch, since the budget realities we’re facing make
everything extra difficult and fraught. Believe me, I understand the importance of planning for the next
disaster. It’s just that this is one more thing that our shortfalls are going to make really, really difficult.

It’s looking pretty likely that we’re going to need to cut our nursing staff pretty soon. Aside from the
day-to-day problems that’ll cause, it’ll have a huge impact in a disaster. But it’s worse than that.
Impact from a disaster doesn’t just happen in the midst of the crisis. It lingers, just like we saw with
the derailment. And we’re going to have a hell of a time in that aftermath phase if we’re dealing with a
reduced workforce and reduced resources.

I mean, think about who gets impacted when something major happens. The impact, especially long-
term, doesn’t affect everyone equally. Think about any kind of special-needs population: people who
don’t speak English, people with grave health problems who need ongoing care, people with serious
economic problems… Those people are going to be affected up-front at least as much, if not more
than, the baseline population, but then their recovery is going to be that much harder. That’s a reality
that’s been borne out over and over. You see it with health impact, economic impact, even physical
impact. If you were a little bit behind before, you’ll be a bit further behind after. We need, as both a
moral and legal imperative, to provide equal access and service for all of the different parts of a
diverse community. And again, we’ll be facing that situation with reduced capacity.

Another thing that’s going to be a factor in our post-disaster recovery is government. Does FEMA step
in? How long do they stay? Is there a disaster declaration, with some recovery funding? How about at
the state level? Who’s coordinating all of this? This sort of thing requires a ton of communication and
collaboration with governmental entities at all levels. We like to pretend we’re autonomous in these

situations but we aren’t at all. There’s always a minefield of government funding and health policy to
dig through as we try to put ourselves back together.

Sorry to be the voice of gloom and doom here. This stuff isn’t impossible, but god knows it’s difficult.

Anthony Martinez, Director, Facilities
Hey there. Disaster planning, huh? Yeah, it’d be good to have a disaster plan. It’s hard to do in real
life, when you’re trapped by the realities of a budget cycle. You know? Whatever we plan, whatever
we think is the right thing to do for the long term, there’s also this reality that Vila Health HQ expects
us to hit certain monetary targets and we have to not only factor that into any idea about disaster
planning, but also have to focus on hitting those targets rather than sitting down and, you know,
making a plan.

I try to do things in my own way as much as I can. For critical supplies in the building, I work to build
as much of a cushion as the budget process will allow. Same for critical facilities; if we can financially
make it work to make something redundant, I do it. It’d be great if this was more formally planned out
and not a case of me stashing away a cache of saline solution when I can, but you deal with the
reality you have and not the reality you wish you had.

This is all a response to that damn derailment, of course. God, that was a mess. I was new to this
position then, still trying to clean up the disaster I’d stepped into. My predecessor, well, Ed Murphy
was a great golfer but not much of a long-term thinker. Across the board, we had enough supplies for
the next week’s normal operations and nothing more. Ed had read some book about just-in-time
inventory and was all excited about how efficient that could make us. And that kind of efficiency’s
great if you’re running an assembly line, but it doesn’t work so well if you have a hospital and
something unexpected comes up, like an oil train jumping the tracks and blowing up.

I’d just started to build up some surplus supplies when that happened, nowhere near enough. We
burned through supplies at a terrifying rate that night. Especially bandages and blood plasma. It didn’t
help that the floor staff were just running around like crazy trying to treat people as they came in, not
putting any thought into prioritizing who got what. I’m not blaming them, they were doing the best they
could in a tough situation. But it meant that we were out of plasma for a while until Jackie Gifford from
Fargo Methodist drove in with a truckload of replacements for us. It was like that all night, making
frantic calls to hospitals and agencies all over the area, trying to get supplies. And keeping an eye on
the fuel situation for the hospital generator, since the fire took out power for half the town.

God, what a mess. Took us six months to clean all that up. So disaster planning? Yeah, I’m all for it.

Follow-up report with Jennifer:

Jennifer Paulson, Administrator, Valley City Hospital
Thanks for talking to everyone! I bet you heard a lot.

I’d like you to take some time to sit and think about what you’ve heard and seen, and try to knit it all
together into some overall conclusions that we can use to work up a plan to be ready for the next
disaster.

Ultimately, I’d like you to be able to present a compelling case to community stakeholders (mayor and
city disaster relief team) to obtain their approval and support for the proposed disaster recovery plan.
I’d like you to use MAP-IT, and work up an approach supported by Healthy People 2020, and put it all
into a PowerPoint. We’ll save the PowerPoint deck and the audio of its accompanying presentation at
the public library so that the public can access it and see that we’re serious. Ideally, I’d like this to be

used as a prototype for other local communities near Valley City, and possibly other facilities in the
Vila Health organization.

___________________________________________________________________________________

Professional Context

Nurses perform a variety of roles and their responsibilities as health care
providers extend to the community. The decisions we make daily and in times of
crisis often involve the balancing of human rights with medical necessities,
equitable access to services, legal and ethical mandates, and financial
constraints. In the event of a major accident or natural disaster, many issues can
complicate decisions concerning the needs of an individual or group, including
understanding and upholding rights and desires, mediating conflict, and applying
established ethical and legal standards of nursing care. As a nurse, you must be
knowledgeable about disaster preparedness and recovery to safeguard those in
your care. As an advocate, you are also accountable for promoting equitable
services and quality care for the diverse community.

Nurses work alongside first responders, other professionals, volunteers, and the
health department to safeguard the community. Some concerns during a disaster
and recovery period include the possibility of death and infectious disease due to
debris and/or contamination of the water, air, food supply, or environment.
Various degrees of injury may also occur during disasters, terrorism, and violent
conflicts.

To maximize survival, first responders must use a triage system to assign victims
according to the severity of their condition/prognosis in order to allocate equitable
resources and provide treatment. During infectious disease outbreaks, triage does
not take the place of routine clinical triage.

Trace-mapping becomes an important step to interrupting the spread of all
infectious diseases to prevent or curtail morbidity and mortality in the community.
A vital step in trace-mapping is the identification of the infectious individual or
group and isolating or quarantining them. During the trace-mapping process,
these individuals are interviewed to identify those who have had close contact
with them. Contacts are notified of their potential exposure, testing referrals
become paramount, and individuals are connected with appropriate services they
might need during the self-quarantine period (CDC, 2020).

An example of such disaster is the COVID-19 pandemic of 2020. People who had
contact with someone who were in contact with the COVID-19 virus were
encouraged to stay home and maintain social distance (at least 6 feet) from
others until 14 days after their last exposure to a person with COVID-19. Contacts
were required to monitor themselves by checking their temperature twice daily
and watching for symptoms of COVID-19 (CDC, 2020). Local, state, and health
department guidelines were essential in establishing the recovery phase. Triage
Standard Operating Procedure (SOP) in the case of COVID-19 focused on inpatient

and outpatient health care facilities that would be receiving, or preparing to
receive, suspected, or confirmed COVID- 19 victims. Controlling droplet
transmission through hand washing, social distancing, self-quarantine, PPE,
installing barriers, education, and standardized triage algorithm/questionnaires
became essential to the triage system (CDC, 2020; WHO, 2020).

This assessment provides an opportunity for you to apply the concepts of
emergency preparedness, public health assessment, triage, management, and
surveillance after a disaster. You will also focus on evacuation, extended
displacement periods, and contact tracing based on the disaster scenario
provided.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency
in the following course competencies and assessment criteria:

 Competency 1: Analyze health risks and health care needs among distinct
populations.

 Describe the determinants of health and the cultural, social, and
economic barriers that impact safety, health, and disaster recovery
efforts in a community.

o Competency 2: Propose health promotion strategies to improve the
health of populations.

 Present specific, evidence-based strategies to overcome
communication barriers and enhance interprofessional collaboration to
improve disaster recovery efforts.

o Competency 3: Evaluate health policies, based on their ability to
achieve desired outcomes.

 Explain how health and governmental policy affect disaster recovery
efforts.

o Competency 4: Integrate principles of social justice in community
health interventions.

 Explain how a proposed disaster recovery plan will lessen health
disparities and improve access to community services.

o Competency 5: Apply professional, scholarly communication strategies
to lead health promotion and improve population health.

 Organize content with clear purpose/goals and with relevant and
evidence-based sources (published within 5 years).

 Slides are easy to read and error free. Detailed audio and speaker
notes are provided. Audio is clear, organized, and professionally
presented.

Note: Complete the assessments in this course in the order in which they are
presented.

Preparation

When disaster strikes, community members must be protected. A comprehensive
recovery plan, guided by the MAP-IT (Mobilize, Assess, Plan, Implement, Track)
framework, is essential to help ensure everyone’s safety. The unique needs of
residents must be assessed to lessen health disparities and improve access to
equitable services after a disaster. Recovery efforts depend on the
appropriateness of the plan, the extent to which key stakeholders have been
prepared, the quality of the trace-mapping, and the allocation of available
resources. In a time of cost containment, when personnel and resources may be
limited, the needs of residents must be weighed carefully against available
resources.

In this assessment, you are a community task force member responsible
for developing a disaster recovery plan for the Vila Health community using MAP-
IT and trace-mapping, which you will present to city officials and the disaster relief
team.

To prepare for the assessment, complete the Vila Health: Disaster Recovery
Scenario simulation (see above).
Begin thinking about:

 Community needs.
 Resources, personnel, budget, and community makeup.
 People accountable for implementation of the disaster recovery plan.
 Healthy People 2020 goals.
 A timeline for the recovery effort.

You may also wish to:

 Review the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework,
which you will use to guide the development of your plan:

 Mobilize collaborative partners.
 Assess community needs.
 Plan to lessen health disparities and improve access to services.
 Implement a plan to reach Healthy People 2020 objectives.
 Track community progress.
o Review the assessment instructions and scoring guide to ensure that

you understand the work you will be asked to complete.

Instructions

Complete the following:

1. Develop a disaster recovery plan for the Vila Health community that will
lessen health disparities and improve access to services after a

disaster. Refer back to the Vila Health: Disaster Recovery Scenario to
understand the Vila Health community.

 Assess community needs.

 Consider resources, personnel, budget, and community makeup.

 Identify the people accountable for implementation of the plan and
describe their roles.

 Focus on specific Healthy People 2020 goals.

 Include a timeline for the recovery effort.

o Apply the MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework
to guide the development of your plan:

 Mobilize collaborative partners.
 Assess community needs.

 Use the demographic data and specifics related to the disaster to
identify the needs of the community and develop a recovery plan.
Consider physical, emotional, cultural, and financial needs of the
entire community.

 Include in your plan the equitable allocation of services for the
diverse community.

 Apply the triage classification to provide a rationale for those who
may have been injured during the train derailment. Provide
support for your position.

 Include in your plan contact tracing of the homeless, disabled,
displaced community members, migrant workers, and those who
have hearing impairment or English as a second language in the
event of severe tornadoes.

o Plan to lessen health disparities and improve access to services.
o Implement a plan to reach Healthy People 2020 objectives.
o Track and trace-map community progress.
 Use the CDC’s Contract Tracing Resources for Health

Departments as a template to create your contact tracing.
 Describe the plan for contact tracing during the disaster and

recovery phase.

o Develop a slide presentation of your disaster recovery plan with an
audio recording of you presenting your assessment of the Vila Health:
Disaster Recovery Scenario for city officials and the disaster relief
team. Be sure to also include speaker notes.

Presentation Format and Length
You may use Microsoft PowerPoint (preferred) or other suitable presentation
software to create your slides and add your voice-over along with speake

nursing

Disaster
preparedness
plan

Presented by

Good afternoon everyone, my name is ………….., and I am a registered nurse here at Umass. Thank you for coming today. I am collaborating with a group of healthcare professionals to create a disaster preparedness plan for Umass. Today I will present disaster preparedness and recovery in hopes to prepare Umass for any future disasters.

1

Definition of a disaster

Types

Wildfires

Earthquakes

Chemical

Explosions

… and many more

2

Any accidental or unanticipated event that impairs the normal functioning of a community and the destruction surpasses the community’s resources is referred to as a disaster. It could be a natural calamity, technological issue, or a man-made menace that brings catastrophe to the community; all are included in disaster. (International Federation of Red Cross and Red Crescent Societies, 2022). Types of disasters include wildfires, earthquakes, hurricanes, chemical disasters, explosions, etc.

2

What is map-it framework?

mobilize

Mobilize collaborative partners

assess

Assess community needs

plan

Plan to improve access to services and lessen health disparities

implement

Implement a plan to reach Healthy People 2020 objectives

3

track

Track the community progress

Applying MAP-IT is considered the best track to develop a recovery plan after any disaster. The words MAP-IT in the scheme symbolize “Mobilize”, “Assess”, “Plan”, “Implement,” and “track”. This framework is also being used to design and analyze treatment plans to achieve healthy people 2020 goals. The objectives include health services, behavior, social factors, policies, and biology. (Office of Disease Prevention and Health Promotion, 2020b).

3

Map-it framework

mobilize

Collaborative and Internal Partners such as..

Police

Fire department

Hospitals

American Red Cross

… and more

assess

Assessment of Community Need

Evacuation

Transportation

Water Supply

Triage

4

The first part of the MAP-IT framework is to mobilize. All the personnel in the medical center are put into action to set up a strategic plan. They are mobilized and assessed for any shortfall. The aim is to ensure that adequate staff is present in the area at the time of disaster and all the individuals are well aware of their duties to tackle the issue. As shown in the Villa Health scenario, there was a lack of staff with specific duties. Staff from the hospital, as well as community resources, are also taking part. All the departments, including emergency rooms, pharmacies, securities, and administration in the medical care center, are supposed to work as a team. We can also involve local law enforcement, fire department, shelter for permanently or temporarily displaced individuals, and other community resources. In order to use our medical resources adequately, we can also collaborate with other hospitals in the area.

The next step is to assess the problem. Doing this allows us to determine the resources we lack and how things are affected due to their shortage. We’ll focus on the most pressing issues because we won’t be able to address them all; therefore, prioritization is critical. Currently, we have enough supplies to function on a normal day till now. If the supplies are not replenished, the available ones will last shortly. Non-perishable items would be extremely helpful in bolstering our catastrophe preparedness. Looking beyond what we can do as a healthcare center, we must consider additional issues that may pose a huge community problem. Ensuring that transportation is ready, whether for evacuating or traveling to the disaster. Containment of an event such as a fire would require the collaboration of other emergency personnel.

4

Map-it framework

plan

To improve access to services and to lessen health disparities.

Ambulance transportation

American Red Cross

Secondary Hospitals

Hospital Staff

implement

To reach Health People 2020 objectives by utilizing a plan

Improve health outcomes

Access to care for everyone

5

We’ll need to devise a disaster preparedness strategy to implement in the event of a local crisis. The next step is to set up a plan to allocate the responsibilities and achieve our goal. A chain of command is built, and it is guaranteed that proper communication exists between all the stakeholders to plan an effective strategy to prepare for disaster. The departments that respond first are those of local law enforcement and firefighters. The instructions are passed on to each department in emergencies according to the chain of command established.

During a regular shift, the hospital will normally be having a limited number of staff members. In order to call for more staff immediately in case of emergency, a phone call or text message can be sent. A group of skilled team members sent to the disaster site will play their role in making decisions about the referral of patients to specific hospitals based on their condition and the treatment needed. A local ambulance can also play its part in patients’ quick and safe evacuation. Furthermore, we must make use of the community’s assets. National Guard, American Red Cross for disaster assistance, and homeless shelters can also be called for help. Time is of the essence in this stage.

It must be assured that all the team members are well aware of their duties and are determined to perform their assigned tasks with great responsibility before implementing the plan. Various training, in-services, drills, and online modules are conducted to fully prepare the front liners. The community meetings are held to ensure its complete involvement. The plan should be reviewed every few years to assess its applicability and look for any further improvements to timely achieve the required goals.

5

Map-it framework

6

TRACK

Regular follow-ups

Compare

Let’s talk about the final step, which is the track. We must undergo a re-evaluation of our plan and determine the shortcomings. We should analyze our past experiences, compare the outcomes, assess the points we are lacking, and always work for their improvement. After any disaster, everyone should be allowed to share the perspectives that help us work out our deficits and improve them next time.

6

Physical & cultural barriers
to safety

PHYSICAL

Physical and mental

CULTURAL

Awareness of difference and ones own cultural values. Managing and understanding the depth of difference. Building cultural knowledge etc.

7

Cultural Hurdles-The US Department of Health and Human Services. The “Cultural and Linguistic Competency well explains cultural barriers to safety in Disaster Preparedness and Response Fact Sheet.”

Difference- Responders and survivors may belong to distinct ethnic, cultural, or linguistic traits. Having the knowledge of various stereotypes and communicating with them allows health care professionals to provide culturally competent care. (U.S. Department of Health and Human Services, 2020b). This is exemplified through pain. Some cultures are stoic, and they may react differently when they witness or experience sorrow in others.

Individual self-assessment: health care professionals should assess their perceptions and stereotypes. He should analyze his reaction while talking to a person speaking a different language or wearing an outfit that feels awkward to him (U.S. Department of Health and Human Services, 2020b).

Understanding the diversity and managing its traits -Denotes the various ways in which different cultures express themselves. Taking a medical history gives a health care professional a brief apprehension of the patient’s cultural beliefs. It enables him to treat the patient accordingly to get better outcomes (U.S. Department of Health and Human Services, 2020b). Having a strong affinity with the people we serve, a better understanding of their cultures and beliefs can help us fulfill our goals.

Fostering a basic knowledge about other cultures, their specific stereotypes, and beliefs about specific diseases, therapies, and customs may provide emergency personnel with adequate information required for timely and effective treatment (U.S. Department of Health and Human Services, 2020b). Minorities in the United States are more vulnerable to damage in different crises stages owing to interconnections between susceptibility, racism, and economic power.

Physical Barriers- In the disaster recovery process, ignoring the disabled people among the disaster survivors has become a common practice. All the efforts are directed towards the non-disabled people, and disabled ones suffer in that case. Attempts made for risk reduction are also greatly influenced by gender inequalities and some beliefs that are part of that culture’s social norms (Lunga, 2019).

7

Economic barriers to disaster planning & post disaster recovery

Economic

Homes

8

Economics: The biggest crisis that a community faces following calamity is unemployment, which is the major barrier to the recovery process. People need jobs for their survival and living. Hence, unemployment, inadequate insurance coverage, insufficient local government aid, and delayed allocation of emergency funds are some of the many factors that halt the disaster recovery process (Rouhanizadeh, 2020).

As indicated in the article issued in the International Journal of Disaster Risk Reduction, communities are less prepared to deal with emergencies. Various factors in a community contribute to this drawback. These include cultural diversity in the affected area, language differences, a large number of elderly and disabled people, and less voluntary participation of the public in emergency crises (Rouhanizadeh, 2020).

Moreover, lack of exposure and knowledge makes the residents incapable of dealing with emergencies. Housing- System or channel used for water distribution, telecommunications system, electric power, and transportation all form the society’s infrastructure. Any restriction to housing or infrastructure will pose harm to the people’s houses, enterprises, commercial buildings, and hospitals (Rouhanizadeh, 2020).

8

Determinants of health 1

Social

Health

Behavior

Physical Factors

9

Healthy vs unhealthy

Social Factors-All, the physical and social aspects of an environment in which a person is born, lives and grows into an adult contribute to the social determinants of health (U.S. Department of Health and Human Services, 2020a). Examples include resources, crimes, and schools.

Health Services: Community health depends upon the availability and quality of health services. The aim of healthy people’s target 2020 is to make both the availability and quality health care possible in the community. Mostly the people with no health insurance do not follow a precautionary care plan and delay the medical treatment they need (U.S. Department of Health and Human Services, 2020a).

U.S. Department of Health and Human Services, 2020 demonstrates human behavior as one of the chief determinants of health. A person must make it his responsibility to take a healthy diet plan and avoid all the unhealthy activities that include smoking, alcohol consumption, and various processed meals. (U.S. Department of Health and Human Services, 2020a).

Physical factors-Considering the physical and psychological aspects of aging, elderly people are more susceptible to being affected by pertaining health issues (U.S. Department of Health and Human Services, 2020a).

9

Determinants of health 2

POLICY CREATING

10

Policy creating- Policies made at federal, municipal, and state levels affect the health of a population. Raising the cost of alcohol, for example, can improve public health by reducing the number of people who drink alcohol (U.S. Department of Health and Human Services, 2020a).

Following a declared catastrophe, states and local governments can seek assistance from the federal government as allowed by the Robert Stafford Disaster Relief and Emergency Assistance Act. The federal government supplies financial, technical, and logistical aid. The deployment of all these resources is the responsibility of The Federal Emergency Management Agency (FEMA). It also plays its part in providing jobs to the people and provides financial support. (FEMA, 2021)

10

conclude

11

Your presence is highly appreciated, and I’ll be looking forward to more suggestions from your side.

11

references

12

References

FEMA. (2021, November 18). Robert T. Stafford Disaster Relief and Emergency Assistance Act. https://www.fema.gov/disaster/stafford-act

Gartrell, A., Calgaro, E., Goddard, G., & Saorath, N. (2020). Disaster experiences of women with disabilities: Barriers and opportunities for disability inclusive disaster risk reduction in cambodia. Global Environmental Change, 64, 102134. https://doi.org/10.1016/j.gloenvcha.2020.102134

Lunga, W., Pathias Bongo, P., van Niekerk, D., & Musarurwa, C. (2019). Disability and disaster risk reduction as an incongruent matrix: Lessons from rural zimbabwe. Jàmbá Journal of Disaster Risk Studies, 11(1). https://doi.org/10.4102/jamba.v11i1.648

Office of Disease Prevention and Health Promotion. (2020a). Determinants of health. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Office of Disease Prevention and Health Promotion. (2020b). Program planning. https://www.healthypeople.gov/2020/tools- and-resources/Program-Planning

Rouhanizadeh, B., Kermanshachi, S., & Nipa, T. (2020). Exploratory analysis of barriers to effective post-disaster recovery. International Journal of Disaster Risk Reduction, 50, 101735. https://doi.org/10.1016/j.ijdrr.2020.101735

U.S. Department of Health and Human Services. (2020). Cultural and Linguistic Competency in Disaster Preparedness and Response Fact Sheet. https://www.phe.gov/Preparedness/planning/abc/Pages/linguistic-facts.aspx

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nursing

1

Remote Collaboration and Evidence-Based Care

Remote Collaboration and Evidence-Based Care

Hello, my name is Huvie Gately, and this video presentation is for NURS 4030: Making Evidence-Based Decisions, Assessment 4-Remote Collaboration and Evidence-Based Care. For this assignment, I will utilize and discuss the Vila Health case study presented by Capella University. I intend to propose an evidence-based care plan to help improve the safety and outcomes for the Vila Health patient, reflecting on relevant evidence that was used in the decision-making of this care plan and how this plan positively benefits the patient. I will identify benefits and delineate strategies to navigate the challenges of interdisciplinary collaboration to plan care within this very specific context of a remote team. I hope to explain how this interdisciplinary collaboration could be best leveraged to improve outcomes in any related future care situations. Lastly, I will portray how I incorporated an evidence-based practice model to help in the development of my care plan.

Introduction

Caitlynn is a two-year-old patient who has recently been admitted to Valley City Regional Hospital for pneumonia and malnutrition. Elaborate testing and evaluation of symptoms revealed the diagnosis of cystic fibrosis. Not only will the family have to come to terms with this progressive and life-long diagnosis and its implications on their daily routine, but there are other significant dynamics that must be considered. Caitlynn’s family lives in a very rural town about an hour or more away from the hospital. The town’s small population and limited resources can cause tremendous difficulty for the family in caring for their child, understanding and being educated about the disease, and treating her illness. Her parents are still married, but separated, both employed but work very long hours and money is still quite tight.

I will be helping the interdisciplinary team in the development of an effective care plan that will improve the safety and outcome of Caitlynn’s newly diagnosed illness. Using various evidence-based practices, I will be addressing all the relevant concerns and focusing on the proper and necessary interventions that will benefit Caitlynn and her family.

Care Plan

The hospital’s pediatrician, Dr. Anderson, recommended a variety of treatments that will immediately be incorporated into Caitlynn’s everyday routine. This plan includes a new dietary plan to aid in her malabsorption of nutrients, respiratory interventions like aerosol treatments and chest percussions, and additional monitoring of any and all symptoms at home. In an article by Somaraju & Solis-Moya, Dr. Anderson’s methodology of utilizing pancreatic enzymes and a high fat, high calorie diet is validated as well (2020). The authors discuss how the enzymes must be taken with every food consumed and the dosage adjusted depending on the type of food as well. In addition to a new dietary protocol, respiratory therapies and hygiene is necessary and Caitlynn’s family needs to be educated on the techniques that can be implemented at home. THese include inhalation therapy, effective coughing when she is a little older, mobilization of secretions by percussion and physiotherapy, and the use of her chest muscles. Additionally, a study conducted by Lechtzin et al. in 2017 discusses the benefits of home monitoring as an intervention in preventing respiratory exacerbations of CF. The article suggests the use of spirometry and a symptom diary which can help detect trouble before it becomes life-threatening.

Challenges of Interdisciplinary Collaboration

As aforementioned, Caitlynn and her family live in a very small rural town with limited resources. Telemedicine will allow them to access vital resources that can provide them with the help they need to manage this new and scary diagnosed chronic illness. The entire team of doctors, therapists, and social workers must band together to provide adequate education and information to this distance-challenged family. They have to address symptom management, treatment compliance and coping strategies. The team must have regularly scheduled telehealth appointments so that check-ins can occur to address any and all concerns or barriers to treatment.

Telemedicine is still relatively new in the medical world, with new innovations arising constantly. As new developments occur, many online applications have been devised to aid in CF treatment compliance. For example, in an article by Hillen et al., the authors discuss an innovative online web-based exercise plan that is personalized for each patient and allows the patient to participate from home (2021). The study concluded that having access to this exercise program from home, made it easier to comply with the plan and therefore encouraged adherence, which in turn improved lung function. Caitlynn’s parents can join this online exercise website and learn about how to help her exercise properly and effectively, right from the comfort of their remote home.

Another study discusses the concept of a mobile application that can help by providing education, enzyme dosage calculation, nutrition management, treatment organization, a health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with other patients with cystic fibrosis (Floch et al. 2018). Teaching Caitlynn’s parents about this web-based wealth of information regarding their young daughter’s diagnosis is extremely beneficial as it will alleviate some of the stress of navigating her illness and all of the recommended therapies that will add to the quality of her and their lives.

Another challenge the interdisciplinary team must address for Caitlynn’s family is finding coping mechanisms and support systems. Since they live in a rural town with limited resources, it may be difficult to locate any kind of local support. Caitlynn’s is the local pediatrician’s first case of diagnosed cystic fibrosis in his practice! It is vital that the family feels supported and learns how to effectively cope as they learn how to manage this illness. Telehealth allows for Caitlynn’s family to access online support groups and other cystic fibrosis communities. Actually, Lang et al. stated in their 2019 article that telehealth does in fact enable online group therapy and support groups, where multiple children can participate in the group from their own homes, thereby limiting the risk of infection. Introducing Caitlynn’s parents to support groups and these online therapy meetings can be extremely beneficial, especially as she grows up and needs social support from peers. By meeting other families dealing with this diagnosis, this family will not feel alone and will be strengthened.

Evidence-Based Model

Caitlynn’s care plan was based off the Knowledge-to-Action (KTA) evidence-based practice model. In this model, the entire healthcare team will set goals, assemble the team, develop a plan, evaluate the data, and implement and adjust the plan accordingly (Spooner et al. 2018). In this case study, the goal is to provide Caitlynn with a care plan specific to her cystic fibrosis and to provide guidance and resources to her parents as they incorporate telemedicine into their daily routine. This plan utilized all members of the interdisciplinary team including physicians, nurses, respiratory therapists, and social workers. By applying this KTA model, the team can measure the efficacy of their care plan and change it if necessary. In addition, by using this model, the healthcare team can apply these interventions to other families who may live remotely and require constant connection to a medical team and support system.

Conclusion

Cystic Fibrosis is a very complex and lifelong illness that requires constant interventions and support, both medically and socially. Since Caitlynn is too young to care for herself, her parents are given the task of providing her with the best quality care that can improve her outcome. Since they live far from appropriate healthcare service, the family is definitely challenged. Telemedicine can help to bridge the gap between this far-removed family and the doctors and nurses who can help guide them in caring for their child. It can reduce the cost of traveling over an hour to the hospital and it can provide the necessary education and tools to assist in understanding the illness. Telehealth can also serve as an online support system so the family can know they are not alone. Overall, as telemedicine continues to evolve in healthcare, more patients like Caitlynn, who are distance-challenged, can have the access to healthcare that may not be available in their remote areas, and managing their illnesses will be a little less daunting.

References

Hillen, B., Simon, P., Schlotter, S., Nitsche, O., Bähner, V., Poplawska, K., & Pfirrmann, D. (2021). Feasibility and implementation of a personalized, web-based exercise intervention for people with cystic fibrosis for 1 year. BMC Sports Science, Medicine & Rehabilitation, 13(1), 1-95. https://doi.org/10.1186/s13102-021-00323-y

Floch, J., Zettl, A., Fricke, L., Weisser, T., Grut, L., Vilarinho, T., Stav, E., Ascolese, A., & Schauber, C. (2018). User needs in the development of a health app ecosystem for self-management of cystic fibrosis: User-centered development approach. JMIR mHealth and uHealth, 6(5), e113-e113. https://doi.org/10.2196/mhealth.8236

Lang, R. L., Wilson, C., Stockton, K., Russell, T., & Johnston, L. M. (2019). CyFiT telehealth: Protocol for a randomised controlled trial of an online outpatient physiotherapy service for children with cystic fibrosis. BMC Pulmonary Medicine, 19(1), 21-21. https://doi.org/10.1186/s12890-019-0784-z

Lechtzin, N., Mayer-Hamblett, N., West, N. E., Allgood, S., Wilhelm, E., Khan, U., Aitken, M. L., Ramsey, B. W., Boyle, M. P., Mogayzel, J., Peter J, Gibson, R. L., Orenstein, D., Milla, C., Clancy, J. P., Antony, V., Goss, C. H., & eICE Study Team. (2017). Home monitoring of patients with cystic fibrosis to identify and treat acute pulmonary exacerbations. eICE study results. American Journal of Respiratory and Critical Care Medicine, 196(9), 1144-1151. https://doi.org/10.1164/rccm.201610-2172OC

Somaraju, U. R. R., & Solis-Moya, A. (2020). Pancreatic enzyme replacement therapy for people with cystic fibrosis. Cochrane Database of Systematic Reviews, 8, CD008227. http://doi.org/
10.1002/14651858.CD008227.pub4

Spooner, A. J., Aitken, L. M., & Chaboyer, W. (2018). Implementation of an Evidence‐Based practice nursing handover tool in intensive care using the Knowledge‐to‐Action framework. Worldviews on Evidence-Based Nursing, 15(2), 88-96. https://doi.org/10.1111/wvn.12276

nursing

1

PICO(T) Questions and an Evidence-Based Approach

PICO(T) Framework and an Evidence-Based Approach

In developing care practices, it is essential for health care providers to use evidence when creating treatment strategies. One technique to aid in making those care plans is to use the PICO(T) research framework. This acronym stands for population/problem, intervention, comparison, outcomes, and, when relevant, timeframe (Dhir & Gupta, 2021). This strategy helps formulate and frame an appropriate question that will guide the research along a more fine-tuned and specific path. Based on some secondary research, this assessment will define and expound upon a practice issue of patients with diabetic foot ulcers, apply the PICO(T) framework, look for supporting evidence, define the discovered information, and explain how everything all works together.

Using the PICO(T) Approach When Caring for Diabetic Foot Ulcers

The issue to be reviewed is the need to prevent and effectively treat patients with or who are at risk for diabetic foot ulcers. A patient with uncontrolled diabetes can experience both diabetic neuropathy and peripheral artery disease, which can both lead to the unfortunate diagnosis of a diabetic foot ulcer (Zhong et al. 2017). This information has sparked the research aimed at determining the most effective ways of treating patients with this malady. The chosen interventions that will be used are proper foot care, foot screenings, regular debridement, effective dressings, and antibiotic treatment. The condition being searched is diabetic foot ulcers, and the target demographic is the diabetic patient. This study will compare diabetic foot ulcer treatments and preventative techniques. This research aims to have a better understanding of successful therapies so that excellent evidence-based treatment can be provided. The PICO(T) question being asked is: When a diabetic is suffering from foot ulcers, does negative pressure wound therapy lead to better wound healing as opposed to standard moist therapy?

Identifying Sources of Evidence

Current guidelines indicate the necessity for wound dressings to be maintained in a humid environment, absorb exudate, prevent infections, and induce healing. Some examples of these dressings include hydrogels, alginate dressings, hydrocolloids, and foam adhesives (Firlar et al. 2022). Diabetic wound dressings are usually non-adhesive, regular bandages and some may have antibacterial properties within their makeup. To identify relevant evidence that specifically reflects the above PICO(T) question, it was important to narrow down the search for the most targeted research about wound therapies. The search for evidence started with the Summon database where the CRAAP model was used to locate credible evidence. This test allows for that final check as to whether or not the source is credible and trustworthy.

The first source of credible evidence that was uncovered is an article by Borys et al. (2019) and explores “negative pressure wound therapy use in diabetic foot syndrome.” This article directly answered the aforementioned PICO(T) question because it addresses the pros and cons of negative pressure wound therapy and its effect on wound healing. It even states that this treatment can effectively reduce the size of the ulcer in just 16 days. Another source of evidence was noted by Seidel et al. (2020), and explains “negative pressure wound therapy compared with standard moist therapy.” This scholarly article directly relates to the PICO(T) question because it discusses the difference between negative pressure and standard moist therapies in the treatment of diabetic foot ulcers.

Findings from the Articles

Over 400 million people worldwide suffer from diabetes, and about 15% of them will develop a diabetic foot ulcer during their lifetime (Seidel et al. 2020). As was mentioned earlier, diabetic foot ulcers are associated with peripheral neuropathy and/or peripheral artery disease in the lower extremities of diabetics and there is a high correlation between these ulcers and lower leg amputations (Borys, 2019). Since these ulcers are very common in diabetics, it is essential to efficiently and effectively provide proper wound healing techniques.

The article by Borys et al. (2019) provides information on negative pressure wound therapy as it relates to diabetic foot wounds. The researchers conducted their own study on 162 patients with partial foot amputation wounds treated with negative pressure wound therapy. The evidence showed that more patients healed more completely, and more cost effectively, with the use of negative pressure wound therapy compared to the control group. In Seidel’s article, the study compares negative pressure and standard moist wound therapy on diabetic foot ulcers. His study included 368 patients in various healthcare settings and all had a diabetic foot ulcer. They were observed for 16 weeks during the implementation of both types of wound therapy using pictures and documentation to aid in their observations. The data showed that negative pressure wound therapy helped achieve up to 95% of the granulation of the wound bed, but a secondary therapy was necessary to close the wound (Seidel, 2020). The idea of this negative pressure therapy being superior was not validated, but still is considered an excellent treatment for diabetic foot ulcers. This article had a lot of credibility because it had a very detailed study of the two main kinds of therapy and it informed the reader about each therapy’s effectiveness.

Relevance of the Findings from the Articles

The relevance of these articles was evaluated to ascertain that the information within them were applicable to the PICO(T) question and framework. Both pieces had statistical data on diabetic foot ulcers that concentrated on the closure rates of the diabetic foot ulcer wound beds. In Seidel’s article (2020), the main differences between negative pressure and standard moist wound therapies were delineated and he concluded that one was not superior to the other in wound closure, but that the negative pressure therapy did excel in wound granulation. Both articles had relevant and credible information pertaining to the PICO(T) question and explained the research studies conducted to arrive at the conclusion that both therapies work together for optimal success in treating and closing diabetic foot ulcer wounds.

Conclusion

The PICO(T) framework is a functional tool that helps to discover credible information sources related to the different therapies to treat diabetic foot ulcers. This assessment used this framework and question process to describe a practice issue related to negative pressure wound therapy versus standard moist therapy, identified several sources of evidence, and explained and validated those sources. The research concludes that although not a superior therapy, negative pressure wound therapy does provide excellent rates of granulation at the wound bed, and together with other therapies, patients with diabetic foot ulcers can heal more quickly and effectively.

References

Borys, S., Hohendorff, J., Frankfurter, C., Kiec‐Wilk, B., & Malecki, M. T. (2019). Negative pressure wound therapy use in diabetic foot syndrome—from mechanisms of action to clinical practice. European Journal of Clinical Investigation, 49(4), e13067-n/a. https://doi.org/10.1111/eci.13067

Dhir, S. K., & Gupta, P. (2021). Formulation of research question and composing study outcomes and objectives. Indian Pediatrics, 58(6), 584-588. https://doi.org/10.1007/s13312-021-2246-y

Firlar, I., Altunbek, M., McCarthy, C., Ramalingam, M., & Camci-Unal, G. (2022). Functional hydrogels for treatment of chronic wounds. Gels, 8(2), 127. https://doi.org/10.3390/gels8020127

Seidel, D., Storck, M., Lawall, H., Wozniak, G., Mauckner, P., Hochlenert, D., Wetzel-Roth, W., Sondern, K., Hahn, M., Rothenaicher, G., Krönert, T., Zink, K., & Neugebauer, E. (2020). Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: Results of the german DiaFu-RCT. BMJ Open, 10(3), e026345-e026345. https://doi.org/10.1136/bmjopen-2018-026345

Zhong, A., Li, G., Wang, D., Sun, Y., Zou, X., & Li, B. (2017). The risks and external effects of diabetic foot ulcer on diabetic patients: A hospital‐based survey in Wuhan area, China. Wound Repair and Regeneration, 25(5), 858-863. https://doi.org/10.1111/wrr.12589

nursing

Care Coordination Presentation

Care Coordination Presentation

Good afternoon, everyone! My name is ………., and I am a registered nurse here at UMass Memorial. Care Coordination is an essential practice of primary care that employs nurses to bridge the gap between the patients, their families, and the healthcare team for a safer patient care practice. Nurses design more effective care plans to improve the health outcomes of the patients and coordinate such plans among the health care team and other concerned people for the coordination and continuity of care. Nurses are obligated to implement a continuum of care that follows an ethical framework and consumes all the resources optimally for the welfare of patients. This presentation aims to raise nurses’ understanding of the fundamental principles of care coordination and ethical decision-making while implementing effective strategies for patient-centered care.

Effective Strategies for Collaborating with Patients

Patient care involves a team-based care plan that includes collaborating with medical care staff and the patient’s family members. The agenda is to raise awareness about the disease among all the concerned people. All the nursing staff members, health professionals, specialists, paramedic staff, the patient’s family, and the patient himself should be part of this team. The main aim of this team-based care plan is the availability of effective and safer care to the patients (Poitras et al, 2018). The agency presents two main strategies that might prove helpful for better outcomes. Both strategies involve collaboration with patients’ families.

The first strategy comprises wider approaches, including team-based care that involves all the concerned people in the health care department for patient-centered care, reconciling medication to ensure better patients outcomes, a coordinated care administration, use of Information technology that creates better communication among the health care facilitators and patients thus promoting the quality of care.

The second strategy following particular care coordination involves designing a coordinated care plan for the patients, allowing proper communication and education of the patients, determining the patient’s requirements and reaching health goals, assisting with care transition, implementing proper monitoring and follow up plans, promoting patients’ health goals and including community resources into the plan.

As indicated by the researchers at Johns Hopkins University, nurse-guided primary care has improved the health outcomes for community organizations. This model involves a specially educated nurse. The nurse takes a preliminary assessment of the patient, collaborates with other health care facilitators, determines the patients’ needs, involves the health specialist, and follows a highly coordinated care plan (Haas et al., 2019). Guided care can save up to 11% on total health care expenses and limit hospital re-admissions, thus providing safe, effective, and inexpensive care to the patients.

Change Management and Patient-Centered Care

The health care team needs to make changes in health management to ensure the patients’ involvement in their health care plan. They are supposed to guide the patients properly about the disease and advise them on specific adjustments to improve their health. The health care providers used to apply facts and logic, insisting the patients follow a health care plan which was usually ignored on the part of the patients (Bergerum et al., 2019). This was followed by a reprimand being repeated by the physician. This tactic never worked in improving the health of the patients. The need is to change the attitude of the whole care management and care plan. The research has shown that instead of arguing or forcing the patients to follow the health care plan, it is needed to go for more patient-centered approaches. Health professionals should question the patients to think of ways of improving their health and make a plan themselves, assess the barriers encompassing their ways, and suggest a more appropriate and suitable plan (Poitras et al, 2018). This tactic has paved the path to achieving health care goals.

Care coordination and guided care plan have brought positive changes to the health care system. Making the patients a part of their team and transmitting essential knowledge to the patients enhances the patient’s involvement. This increases the patients’ satisfaction and guarantees effective care provision to them (Chen et al., 2020). Coordinated care planning has been shown to improve the quality of care.

Ethical Decision Making and Coordinated Care Plans

Nurses are supposed to have complete knowledge of ethical principles to impact patient care from the ethical aspect. A nurse having a better understanding of ethical decision-making can influence the health care team accordingly. A nurse must keep a balance between autonomy and beneficence for the establishment of an effective care plan. The aim is to respect the patients’ rights and allow them to make decisions on their own regarding their treatment (Bergerum et al., 2019). The ethical care coordination plan demands the active involvement of the patients. Moreover, the American Nurses Association Code of Ethics directs the nurses to speak for the patients’ rights. Nurses stand for the patients in the execution of the care plan and advocate for their rights even if it goes against the opinions of other team members.

Cultural aspects are also considered in the ethical care coordination plan. Cultural sensitivity and acceptance are one of the evidence-based practices that help understand how different patients belonging to different cultures behave in particular situations. This involves complete acquaintance of other cultures and acceptance on the side of the health care provider (Bergerum et al., 2019). Such behavior provides a peaceful environment for effective care. Understanding about patient’s culture enables healthcare facilitators to adopt a better healthcare approach for the patient. They can console them well in case of any gloomy situation and guide them about the next plan of action. Respecting other cultures is important. It creates a sense of acceptance and rapport among the patients and health care providers. Nurses must have a basic understanding of how different cultures interact to avoid any dynamic misinterpretation.

Healthcare Policy Provisions on Outcomes and Patient Experiences

“Patient Protection and Affordable Care Act has played a significant role in improving the health care system” (Chen et al., 2020). Research shows that following Affordable care act policies facilitate patients. Patients would have greater access to a coordinated care plan, facilitate continuity of effective care and limit re-admissions if the health care policies are put in action effectively. It’s been researched that countries with coordinated care plans and proper health management systems have better patient outcomes and save the health budget for other welfare (Chen et al., 2020). Taking preventive measures before the health problems worsen and following after-care precautions can reduce the mortality rate and lower re-admissions of treated patients. This can reduce the burden on the health care departments, and they can focus on the smaller number of patients more attentively.

Conclusion

A vital part is played by the nurses in care coordination and continuum of care. Patient-centered care plan based on patients’ preferences and needs results in better patient outcomes. Along with the awareness of health care policies, nurses must be culturally competent. They must have a better acquaintance with other cultures. This allows them to provide effective treatment to patients belonging to diverse backgrounds having different cultures and social values. This impacts the nurse’s care coordination plan keeping ethical aspects into consideration. The nurses should allow patients to make decisions about treatments and choose the most suitable care plan. Nurses are supposed to educate the patients about the disease and possible adjustments they can bring in their routine plan to cope with the pertaining illness. They should avoid dictating them. Instead, they should involve them in making a carefully coordinated plan that suits their routine and is easy to follow.

References

Bergerum, C., Thor, J., Josefsson, K., & Wolmesjö, M. (2019). How might patient involvement in healthcare quality improvement efforts work—a realist literature review. Health Expectations, 22(5), 952–964. https://doi.org/10.1111/hex.12900

Chen, C.-C., & Cheng, S.-H. (2020). Care continuity and care coordination: A preliminary examination of their effects on hospitalization. Medical Care Research and Review, 78(5), 475–489. https://doi.org/10.1177/1077558720903882

Haas, S., Swan, B. A., & Jessie, A. T. (2019). Care coordination: Roles of registered nurses across the care continuum. Nursing Economics, 37(6), 317–322.

Poitras, M.-E., Maltais, M.-E., Bestard-Denommé, L., Stewart, M., & Fortin, M. (2018). What are the effective elements in patient-centered and multimorbidity care? a scoping review. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3213-8

nursing

Disaster Recovery Plan

Disaster Recovery Plan

Slide 1- Good afternoon everyone, ………., and I am a registered nurse here at Umass. Thank you for coming today. I am collaborating with a group of healthcare professionals to create a disaster preparedness plan for Umass. Today I will present disaster preparedness and recovery in hopes to prepare Umass for any future disasters.

Slide 2- Any accidental or unanticipated event that impairs the normal functioning of a community and the destruction surpasses the community’s resources is referred to as a disaster. It could be a natural calamity, technological issue, or a man-made menace that brings catastrophe to the community; all are included in disaster. (International Federation of Red Cross and Red Crescent Societies, 2022). Types of disasters include wildfires, earthquakes, hurricanes, chemical disasters, explosions, etc.

Slide 3-Applying MAP-IT is considered the best track to develop a recovery plan after any disaster. The words MAP-IT in the scheme symbolize “Mobilize”, “Assess”, “Plan”, “Implement,” and “track”. This framework is also being used to design and analyze treatment plans to achieve healthy people 2020 goals. The objectives include health services, behavior, social factors, policies, and biology. (Office of Disease Prevention and Health Promotion, 2020b).

Slide 4-The first part of the MAP-IT framework is to mobilize. All the personnel in the medical center are put into action to set up a strategic plan. They are mobilized and assessed for any shortfall. The aim is to ensure that adequate staff is present in the area at the time of disaster and all the individuals are well aware of their duties to tackle the issue. As shown in the Villa Health scenario, there was a lack of staff with specific duties. Staff from the hospital, as well as community resources, are also taking part. All the departments, including emergency rooms, pharmacies, securities, and administration in the medical care center, are supposed to work as a team. We can also involve local law enforcement, fire department, shelter for permanently or temporarily displaced individuals, and other community resources. In order to use our medical resources adequately, we can also collaborate with other hospitals in the area.

The next step is to assess the problem. Doing this allows us to determine the resources we lack and how things are affected due to their shortage. We’ll focus on the most pressing issues because we won’t be able to address them all; therefore, prioritization is critical. Currently, we have enough supplies to function on a normal day till now. If the supplies are not replenished, the available ones will last shortly. Non-perishable items would be extremely helpful in bolstering our catastrophe preparedness. Looking beyond what we can do as a healthcare center, we must consider additional issues that may pose a huge community problem. Ensuring that transportation is ready, whether for evacuating or traveling to the disaster. Containment of an event such as a fire would require the collaboration of other emergency personnel.

Slide 5-We’ll need to devise a disaster preparedness strategy to implement in the event of a local crisis. The next step is to set up a plan to allocate the responsibilities and achieve our goal. A chain of command is built, and it is guaranteed that proper communication exists between all the stakeholders to plan an effective strategy to prepare for disaster. The departments that respond first are those of local law enforcement and firefighters. The instructions are passed on to each department in emergencies according to the chain of command established.

During a regular shift, the hospital will normally be having a limited number of staff members. In order to call for more staff immediately in case of emergency, a phone call or text message can be sent. A group of skilled team members sent to the disaster site will play their role in making decisions about the referral of patients to specific hospitals based on their condition and the treatment needed. A local ambulance can also play its part in patients’ quick and safe evacuation. Furthermore, we must make use of the community’s assets. National Guard, American Red Cross for disaster assistance, and homeless shelters can also be called for help. Time is of the essence in this stage.

It must be assured that all the team members are well aware of their duties and are determined to perform their assigned tasks with great responsibility before implementing the plan. Various training, in-services, drills, and online modules are conducted to fully prepare the front liners. The community meetings are held to ensure its complete involvement. The plan should be reviewed every few years to assess its applicability and look for any further improvements to timely achieve the required goals.

Slide 6- Let’s talk about the final step, which is the track. We must undergo a re-evaluation of our plan and determine the shortcomings. We should analyze our past experiences, compare the outcomes, assess the points we are lacking, and always work for their improvement. After any disaster, everyone should be allowed to share the perspectives that help us work out our deficits and improve them next time.

Slide 7-Cultural Hurdles-The US Department of Health and Human Services. The “Cultural and Linguistic Competency well explains cultural barriers to safety in Disaster Preparedness and Response Fact Sheet.”

Difference- Responders and survivors may belong to distinct ethnic, cultural, or linguistic traits. Having the knowledge of various stereotypes and communicating with them allows health care professionals to provide culturally competent care. (U.S. Department of Health and Human Services, 2020b). This is exemplified through pain. Some cultures are stoic, and they may react differently when they witness or experience sorrow in others.

Individual self-assessment: health care professionals should assess their perceptions and stereotypes. He should analyze his reaction while talking to a person speaking a different language or wearing an outfit that feels awkward to him (U.S. Department of Health and Human Services, 2020b).

Understanding the diversity and managing its traits -Denotes the various ways in which different cultures express themselves. Taking a medical history gives a health care professional a brief apprehension of the patient’s cultural beliefs. It enables him to treat the patient accordingly to get better outcomes (U.S. Department of Health and Human Services, 2020b). Having a strong affinity with the people we serve, a better understanding of their cultures and beliefs can help us fulfill our goals.

Fostering a basic knowledge about other cultures, their specific stereotypes, and beliefs about specific diseases, therapies, and customs may provide emergency personnel with adequate information required for timely and effective treatment (U.S. Department of Health and Human Services, 2020b). Minorities in the United States are more vulnerable to damage in different crises stages owing to interconnections between susceptibility, racism, and economic power.

Physical Barriers- In the disaster recovery process, ignoring the disabled people among the disaster survivors has become a common practice. All the efforts are directed towards the non-disabled people, and disabled ones suffer in that case. Attempts made for risk reduction are also greatly influenced by gender inequalities and some beliefs that are part of that culture’s social norms (Lunga, 2019).

Slide 8-Economics: The biggest crisis that a community faces following calamity is unemployment, which is the major barrier to the recovery process. People need jobs for their survival and living. Hence, unemployment, inadequate insurance coverage, insufficient local government aid, and delayed allocation of emergency funds are some of the many factors that halt the disaster recovery process (Rouhanizadeh, 2020).

As indicated in the article issued in the International Journal of Disaster Risk Reduction, communities are less prepared to deal with emergencies. Various factors in a community contribute to this drawback. These include cultural diversity in the affected area, language differences, a large number of elderly and disabled people, and less voluntary participation of the public in emergency crises (Rouhanizadeh, 2020).

Moreover, lack of exposure and knowledge makes the residents incapable of dealing with emergencies. Housing- System or channel used for water distribution, telecommunications system, electric power, and transportation all form the society’s infrastructure. Any restriction to housing or infrastructure will pose harm to the people’s houses, enterprises, commercial buildings, and hospitals (Rouhanizadeh, 2020).

Slide 9-Social Factors-All, the physical and social aspects of an environment in which a person is born, lives and grows into an adult contribute to the social determinants of health (U.S. Department of Health and Human Services, 2020a). Examples include resources, crimes, and schools.

Health Services: Community health depends upon the availability and quality of health services. The aim of healthy people’s target 2020 is to make both the availability and quality health care possible in the community. Mostly the people with no health insurance do not follow a precautionary care plan and delay the medical treatment they need (U.S. Department of Health and Human Services, 2020a).

U.S. Department of Health and Human Services, 2020 demonstrates human behavior as one of the chief determinants of health. A person must make it his responsibility to take a healthy diet plan and avoid all the unhealthy activities that include smoking, alcohol consumption, and various processed meals. (U.S. Department of Health and Human Services, 2020a).

Physical factors-Considering the physical and psychological aspects of aging, elderly people are more susceptible to being affected by pertaining health issues (U.S. Department of Health and Human Services, 2020a).

Slide 10-Policy creating- Policies made at federal, municipal, and state levels affect the health of a population. Raising the cost of alcohol, for example, can improve public health by reducing the number of people who drink alcohol (U.S. Department of Health and Human Services, 2020a).

“Following a declared catastrophe, states and local governments can seek assistance from the federal government as allowed by the Robert Stafford Disaster Relief and Emergency Assistance Act” (FEMA, 2021). The federal government supplies financial, technical, and logistical aid. “The deployment of all these resources is the responsibility of The Federal Emergency Management Agency” (FEMA). It also plays its part in providing jobs to the people and provides financial support. (FEMA, 2021)

Slide 11-Your presence is highly appreciated, and I’ll be looking forward to more suggestions from your side.

References

FEMA. (2021, November 18). Robert T. Stafford Disaster Relief and Emergency Assistance Act. https://www.fema.gov/disaster/stafford-act

Gartrell, A., Calgaro, E., Goddard, G., & Saorath, N. (2020). Disaster experiences of women with disabilities: Barriers and opportunities for disability inclusive disaster risk reduction in cambodia. Global Environmental Change, 64, 102134. https://doi.org/10.1016/j.gloenvcha.2020.102134

Lunga, W., Pathias Bongo, P., van Niekerk, D., & Musarurwa, C. (2019). Disability and disaster risk reduction as an incongruent matrix: Lessons from rural zimbabwe. Jàmbá Journal of Disaster Risk Studies, 11(1). https://doi.org/10.4102/jamba.v11i1.648

Office of Disease Prevention and Health Promotion. (2020a). Determinants of health. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Office of Disease Prevention and Health Promotion. (2020b). Program planning. https://www.healthypeople.gov/2020/tools-and-resources/Program-Planning

Rouhanizadeh, B., Kermanshachi, S., & Nipa, T. (2020). Exploratory analysis of barriers to effective post-disaster recovery. International Journal of Disaster Risk Reduction, 50, 101735. https://doi.org/10.1016/j.ijdrr.2020.101735

U.S. Department of Health and Human Services. (2020). Cultural and Linguistic Competency in Disaster Preparedness and Response Fact Sheet.

nursing

Module 4 project

Prepare a poster from the required template in your group that includes the following:


Content must include:

· You mission statement (thoughts to inspire below)

· What inspired you to become a nurse?

· Where do you feel the most called? Is there a certain population of people or a certain disease process that you feel you want to work with?

· What is your primary motivation and goals in your career? Is there anything specific that you wish to accomplish as a nurse?

· What values do you want to bring to the profession?

· Mission statement example: “To be knowledgeable and compassionate professional nurses that truly make a difference in patients’ lives through providing holistic nursing care.”

· 3-5 most important qualities in a nurse

· Describe the roles of the nurse for the program you & your group members are currently enrolled (5-6)

· What is the Nurse Practice Act?

· Compare and contrast the scope of practice for the LPN and RN (5-6 bullets)

· Use at least 3 scholarly sources to support your findings. One of these should be the one of the associations for the license you will obtain.

· Add in-text citations.

Format:

· Poster presentation

· Minimum 3 references in APA format

· Add photos to enhance visual understanding of the presentation

· Standard American English (correct grammar, punctuation, etc.)

· Simple to understand, looks neat!

· Be creative

· Professional organization, style, and mechanics in APA format

· Run your postor through Grammarly and make corrections to identified errors before submission. Plagiarism score must be less than 15%.

· Note: You must use the following link to create your Grammarly account. You must use your Rasmussen student email address: 
https://www.grammarly.com/signin?page=edu


Grading Rubric:

Levels of Achievement

Criteria

Emerging

Competence

Proficiency

Mastery

Group Mission Statement

(10 Pts)

Initial introduction does not include explanations of the sections of the paper. Failure to submit introduction will result in zero points for this criteria.

Introduction includes a brief explanation for the sections of the paper.

Introduction includes a clear explanation of the sections of the paper and supporting evidence.

Introduction includes a comprehensive explanation for the sections of the paper with detailed examples and supporting evidence.

Points: 6

Points: 8

Points: 9

Points: 10

Roles of the Nurse

(20 Pts)

Role of the nurse section lacks suggestions and/or supporting evidence. Failure to submit this section will result in zero points for this criteria.

Role of the nurse section includes minimal discussion with limited supporting evidence.

Role of the nurse section includes discussion with examples and supporting evidence.

Role of the nurse section offers substantial contributions and detailed examples with supporting evidence.

Points: 12

Points: 16

Points: 18

Points: 20

Scope of Practice

(20 Pts)

Scope of practice lacks presentation and/or supporting evidence.

Failure to submit this section will result in zero points for this criteria.

Scope of practice includes minimal presentation with limited supporting evidence.

Scope of practice includes presentation and examples with supporting evidence.

Scope of practice includes substantial presentation and detailed examples with supporting evidence.

Points: 12

Points: 16

Points: 18

Points: 20

Nurse Practice Acts

(30 Pts)

Nurse practice act section lacks comparing and contrasting and/or supporting evidence.

Failure to submit this section will result in zero points for this criteria.

Nurse practice act section includes minimal comparing and contrasting with limited supporting evidence.

Nurse practice act includes compare and contrast with examples with supporting evidence.

Nurse practice act includes substantial compare and contrast and detailed examples with supporting evidence.

Points: 18

Points: 24

Points: 27

Points: 30

Creativity, Organization, Style, & Photos

(10 Pts)

Lacks photos, creativity and style

Failure to submit this section will result in zero points for this criteria.

Includes minimal creativity, style, organization & photos

Includes creativity, style, organization & photos

Includes substantial creativity, style, organization & photos

Points: 6

Points: 8

Points: 9

Points: 10

Spelling and Grammar

(5 Pts)

Spelling and grammar contain substantial errors that make sentences and/or paragraphs incoherent.

Spelling and grammar errors occur but are inconsistent. Paragraphs and sentences are coherent but may exhibit spelling errors, run-on’s or fragments, and/or improper verb tense usage.

Displays proper grammar application, and writing contains minimal to no spelling errors. May contain rare improper uses of words (ex., their vs. there), a misplaced modifier, or a run-on sentence, but does not detract from the overall understanding of the sentence and/or paragraph.

Demonstrates an exemplary application of spelling and grammar.

Points: 2

Points: 3

Points: 4

Points: 5

APA Citation

(5 Pts)

Citations do not follow APA Style. Quotations, paraphrases, and summaries are not cited, or there is no attempt to cite them using APA style.

Errors in APA citations are noticeable and may detract from the ability to locate the original source (for example, no title provided, year of publication is missing, no punctuation).

Errors in APA citations are less noticeable and do not detract from the ability to locate the original source (for example, a missing or misused comma or period, missing parentheses, author name not properly abbreviated, indentation is misaligned).

APA citations are free of style and formatting errors.

Points: 2

Points: 3

Points: 4

Points: 5

nursing

Develop a 20-minute presentation for nursing colleagues highlighting the fundamental principles of care coordination. Create a detailed narrative script for your presentation, approximately 4-5 pages in length, and record a video of your presentation.

Nursing

Week 8: Discussion: Business Plan

Purpose

The purpose of this discussion is to explore the business plan. A business plan is a written document that describes in detail a proposed program, project, or service. The depth and complexity of the business plan will vary by the project. For projects with large capital investments, a thorough business plan is crucial. DNP-prepared nurses are often required to submit a business plan to gain approval for any proposed change in staffing, to obtain new equipment, or develop a new program. Our discussion this week allows us to look at a business plan.

Instructions

Reflect upon your readings and personal or professional experience and address the following.

· Examine why it is essential for the you to be able to present a solid business plan when meeting with stakeholders regarding your DNP project.

Please review the following link for complete discussion requirements:

Nursing

 

MAKE UP SOAP NOTE 1

Opened: Saturday, February 19, 2022, 12:00 AMDue: Saturday, March 5, 2022, 11:59 PM

You must used the template provided in this class under Course Document – If any part of the Soap Note is missing the Soap Note will be taken as invalid and the previous grade will prevail ( No Exception) – do not change or modify in any matter the format of the Template provided (attached)

This soap note Main Diagnoses is: Scleroderm

All vaccinations up to date including 2 COVID19 vaccines and booster. 

65 years old female patient, who lives alone in a one bedroom efficiency in Miami, with the minimum pension. Pt reports that a cousin supports her monetary at times. No Smoker, No Drinker.

The patient brought her last laboratories results that show: Severe dehydration, malnutrition and anemia. (include in your SOAP note the names of the labs that show these results.

Pt has a PMH of Asthma since childhood, hypothyroidism and arthritis since 2010. Current Medications; Levothyroxine 25mcg every morning, with empty stomach. Albuterol PRN Today she presented with swollen hands bilaterally complaining of pain and impossible to do the activities of daily living. In the last 3 months she has been having problems swallowing and passing food, but it was getting worse to swallow. During the last weeks, she was not able to tolerate any solid food and barely drink water.. Pt states feeling very week and almost impossible to come to the consultation today.. He has lost 15 kilos in the last three months. She is 1.5 mt height and weights : 51 kilos.

Note: You must use the information above to create your SOAP NOTE however you cannot copy and paste this information. You have to use your own words to create your case.

Due date: March 05, 2022 at 23:59

Rubric as follows:

Subjective: 10%

Objective: 20&

Assessment: 25%

Planning: 25%

Correct APA format and References: 10%

Maximum score: 90%

  • 2 months ago
  • 20

Nursing

A 5-year-old Gabriel is a multiracial male weighing 48 lbs with an allergy to penicillin arrives in the emergency room, no cultural considerations identified. You are handed the following notes on the patient that read:

He arrived in ER with his mother after falling out of bed after jerking movement activity as witnessed by his older brother while sleeping. Right-upper extremity appears with deformity. Mother and child speak English. Child has no significant medical history. Mother reports incontinent of urine during episode.

Your Assessment

Vital Signs: T 102.9, P 135, R 24, BP 118/60, O2 sat 100% RA

General Appearance: appears drowsy; face flushed, quiet

Neuro: oriented X3

Cardiovascular: unremarkable

Respiratory: lungs clear

Integumentary: very warm, dry

GI/GU: abdomen normal

Physician Orders

· Complete Blood Count (CBC)

· Complete Metabolic Panel (CMP)

· Urinalysis with culture and sensitivity (U/A C&S)

· Blood Cultures x 2

· X-rays kidneys,

· Influenza screening

· Acetaminophen 15 mg/kg PO now

· Ibuprofen 10 mg/kg PO now

· Pad side rails

· Suction at bedside with seizure precautions

· Radiographs of right arm

· Cast to right arm

· Start PO fluids and increase as tolerated

The physician discharges Gabriel from ER to home with a diagnosis of; Right ear infection, Acute Febrile Seizure and fracture of the right ulna.

Discharge orders include:

· Follow up with pediatrician in 7 days

· Follow up with pediatric orthopedics in 7-10 days

· Cefuroxime 30mg/kg PO BID for 10 days not to exceed 1,000mg daily. What is the recommended dosage if cefuroxime is supplied as an oral suspension 125mg/5ml or 250mg/5ml?

· Acetaminophen 15 mg/kg PO Q4 hours PRN fever or pain and ibuprofen 10 mg/kg PO Q6 hours PRN fever and pain for up to 3 days

· Acetaminophen is available as 160 mg/5 mL. Ibuprofen is available as 100 mg/ 5 mL.

· What is the amount of acetaminophen in mg and ml per dose? What is the amount of ibuprofen in mg and ml per dose?

Instructions

Develop a discharge plan with three goals listed in order of priority, prior to discharge from current orders. Provide rationale for why you listed the goals in a particular order. Also, list three nursing interventions to meet each of the goals (you should have nine interventions in total). Last, give the mother the exact dosage she will need to give the child for acetaminophen, ibuprofen, and the cefuroxime when she gets home and explain why the exact dosage is important.

Format

· Standard American English (correct grammar, punctuation, etc.)

· Logical, original and insightful

· Professional organization, style, and mechanics in APA format

· Submit document through Grammarly to correct errors before submission

NURSING

 

  • Why is it important to articulate your Personal Philosophy of Nursing?
  • What is the relationship between your Personal Philosophy of Nursing and your professional practice?
  • What theories of nursing have you studied?
  • Does your nursing practice follow any particular theorist(s)? Explain.
  • Initial response due Wednesday at 2359pm CST.
  • Two peer responses due Saturday at 2359 pm CST.
    • 30

    nursing

    Create a PowerPoint on PAIN SCALE WITH PQRST

    show Evidence-based material, share the rationale of why and how we do this assessment

    Create a scenario in which you would use this as an RN in the long-term setting

    If there’s a chart or document, show us how to document our findings

    Include education for the client, family, and interdisciplinary team

    Nursing

    Description : in no less than 1000 Words … APA format:

    Interview an older member of  your family , and ask him or her to list any health problems , and to rate his or her health on a scale of 1 to 10.(with 10 being the highest). Ask him or her to describe a typical day’s activities. Keep a 24 hour dietary recall . 

    1.What does this tell you about this person’s risks  or strengths to aging?

    2. From the information you obtained : a) Devise screening recommendations for your relative. Explain why you chose these recommendations

    b)Derive at least one nursing diagnosis . Why did you chose this one ?

    c)What theory of aging best fits your relative .ription: 

      • 5

      Nursing

      • Explain what most excited and/or concerned you throughout your pediatric clinical experience.
      • Discuss how your personal definition of family and family roles has changed or stayed the same.
      • How has your understanding of family and family roles influenced your assessment of children and their families?
      • Explain how your understanding of culture (both the culture of the provider and that of the child and his or her family) has changed and how it may have influenced the assessments you conducted during your practicum.
      • Assess how you did with accomplishing the goals and objectives you developed in Week 1 for the practicum experience.
      • Based on your practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice.
      • Use title page and references according to APA.

      Nursing

      MAKE UP SOAP NOTE 1

      Opened: Saturday, February 19, 2022, 12:00 AM

      Due: Saturday, March 5, 2022, 11:59 PM

      Instructions: Only for those students who scored 70% or less in SOAP note 1 – Not for those with zero grade in previous submission.

      You must used the template provided in this class under Course Document – If any part of the Soap Note is missing the Soap Note will be taken as invalid and the previous grade will prevail ( No Exception) – do not change or modify in any matter the format of the Template provided.

      This soap note Main Diagnoses is: Scleroderm

      All vaccinations up to date including 2 COVID19 vaccines and booster. 

      65 years old female patient, who lives alone in a one bedroom efficiency in Miami, with the minimum pension. Pt reports that a cousin supports her monetary at times. No Smoker, No Drinker.

      The patient brought her last laboratories results that show: Severe dehydration, malnutrition and anemia. (include in your SOAP note the names of the labs that show these results.

      Pt has a PMH of Asthma since childhood, hypothyroidism and arthritis since 2010. Current Medications; Levothyroxine 25mcg every morning, with empty stomach. Albuterol PRN Today she presented with swollen hands bilaterally complaining of pain and impossible to do the activities of daily living. In the last 3 months she has been having problems swallowing and passing food, but it was getting worse to swallow. During the last weeks, she was not able to tolerate any solid food and barely drink water.. Pt states feeling very week and almost impossible to come to the consultation today.. He has lost 15 kilos in the last three months. She is 1.5 mt height and weights : 51 kilos.

      Note: You must use the information above to create your SOAP NOTE however you cannot copy and paste this information. You have to use your own words to create your case.

      Due date: March 05, 2022 at 23:59

      Rubric as follows:

      Subjective: 10%

      Objective: 20&

      Assessment: 25%

      Planning: 25%

      Correct APA format and References: 10%

      Maximum score: 90%

      nursing

      4/22/22, 3:44 PM Assessment 3 Instructions: PICO(T) Questions and an …

      https://courserooma.capella.edu/webapps/blackboard/content/listContent.jsp?course_id=_361012_1&content_id=_11134612_1 1/3

      Assessment 3 Instructions: PICO(T) Questions and an Evidence-
      Based Approach

      Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the
      evidence you locate, which could help to answer the question.

      Introduction

      PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

      It stands for:

      P – Patient/population/problem.
      I – Intervention.
      C – Comparison (of potential interventions, typically).
      O – Outcome(s).
      T – Time frame (if time frame is relevant).

      The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell &
      Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are
      starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the
      nurse will be looking for evidence, searches become more efficient and effective. Essentially, by precisely defining
      the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence
      during their search. When applying the PICO(T) approach, the nurse can isolate the interventions of interest and
      compare to other existing interventions for the evidenced impact on the outcome of the concern.

      You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This
      activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue
      at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own
      practice and self-assessment and demonstrates your engagement in the course.

      Reference

      Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

      Professional Context

      As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly
      resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement
      skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing
      practice outcomes are positively impacted.

      PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are
      going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because
      different word choices for similar concepts will lead you toward different existing evidence and research studies that

      Course Navigation 

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      would help inform the development of your initial question. When writing a PICO(T)-formatted research question,
      you want to focus on the impact of the intervention and the comparison on the outcome you desire.

      Scenario

      For this assessment, please use a health care issue of interest from your current or past nursing practice.

      If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies
      presented in the resources and select one of those as the basis for your assessment.

      Instructions

      For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research
      question and research it.

      Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is
      relevant and you should include that as well, when writing a question you can research related to your issue of
      interest. After you define your question, research it, and organize your initial findings, select the two sources of
      evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each
      source’s specific findings and best practices related to your issues, as well explain how the evidence would help you
      plan and make decisions related to your question.

      If you need some structure to organize your initial thoughts and research, the PICOT Question and Research
      Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based
      Practice guide) might be helpful.

      In your submission, make sure you address the following grading criteria:

      Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
      Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases,
      journals, websites, etc.).
      Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.
      Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T)
      question.
      Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the
      current APA style.

      Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the
      scoring guide would look like:

      Assessment 3 Example [PDF].

      Additional Requirements

      Your assessment should meet the following requirements:

      Length of submission: Create a 3-5-page submission focused on defining a research question and
      interpreting evidence relevant to answering it.
      Number of references: Cite a minimum of four sources of scholarly or professional evidence that support
      your findings and considerations. Resources should be no more than 5 years old.
      APA formatting: Format references and citations according to the current APA style.

      Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you
      complete the final capstone course.

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      Competencies Measured

      By successfully completing this assessment, you will demonstrate your proficiency in the course competencies
      through the following assessment scoring guide criteria:

      Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and
      studies.

      Explain the findings from articles or other sources of evidence that are relevant to the health care issue.
      Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

      Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
      Explain the relevance of the findings from chosen sources of evidence to making decision related to a
      PICO(T) question.

      Competency 3: Apply an evidence-based practice model to address a practice issue.
      Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted
      research question.

      Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
      evidence.

      Organize content so ideas flow logically with smooth transitions; contains few errors in
      grammar/punctuation, word choice, and spelling.
      Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA
      format.

      SCORING GUIDE

      Use the scoring guide to understand how your assessment will be evaluated.

      VIEW SCORING GUIDE 

      Nursing


      (Student Name)

      Miami Regional University

      Date of Encounter:

      Preceptor/Clinical Site:

      Clinical Instructor: Patricio Bidart MSN, APRN, FNP-C

      Soap Note # ____ Main Diagnosis ______________

      PATIENT INFORMATION

      Name:

      Age:

      Gender at Birth:

      Gender Identity:

      Source:

      Allergies:

      Current Medications:

      ·

      PMH:

      Immunizations:

      Preventive Care:

      Surgical History:

      Family History:

      Social History:

      Sexual Orientation:

      Nutrition History:


      Subjective Data:

      Chief Complaint:

      Symptom analysis/HPI:

      The patient is …


      Review of Systems (ROS) (This section is what the patient says, therefore should state Pt denies, or Pt states….. )

      CONSTITUTIONAL:

      NEUROLOGIC:

      HEENT:

      RESPIRATORY:

      CARDIOVASCULAR:

      GASTROINTESTINAL:

      GENITOURINARY:

      MUSCULOSKELETAL:

      SKIN:


      Objective Data:

      VITAL SIGNS:

      GENERAL APPREARANCE:

      NEUROLOGIC:

      HEENT:

      CARDIOVASCULAR:

      RESPIRATORY:

      GASTROINTESTINAL:

      MUSKULOSKELETAL:

      INTEGUMENTARY:


      ASSESSMENT:


      (In a paragraph please state “your encounter with your patient and your findings ( including subjective and objective data)


      Example : “Pt came in to our clinic c/o of ear pain. Pt states that the pain started 3 days ago after swimming. Pt denies discharge etc… on examination I noted this and that etc.)

      Main Diagnosis

      (Include the name of your Main Diagnosis along with its ICD10 I10. (Look at PDF example provided) Include the in-text reference/s as per APA style 6th or 7th Edition.

      Differential diagnosis (minimum 3)


      PLAN:

      Labs and Diagnostic Test to be ordered (if applicable)

      · –

      · –

      Pharmacological treatment:

      Non-Pharmacologic treatment:

      Education (provide the most relevant ones tailored to your patient)

      Follow-ups/Referrals

      References (in APA Style)

      Examples

      Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.).

      ISBN 978-0-8261-3424-0

      Domino, F., Baldor, R., Golding, J., Stephens, M. (2010). The 5-Minute Clinical Consult 2010

      (25th ed.). Print (The 5-Minute Consult Series).

      NURSING

      For this project assignment, submit a 1-page status of your Project. It may be helpful to use the outline you submitted earlier as your guide. Identify the parts of your project you have completed and those that still need work. Identify areas in which you are experiencing any difficulty and the ways you will plan to overcome the difficulty.

      • 5

      Nursing

      1. In no more than 250 words. As a nurse, write your short-term and long-term goals, a leadership experience you have had in any area of your life, or any information that you feel would be helpful for the committee to consider. 

           

      2. please describe any obstacles you have overcome or continue to face. For example, you can discuss how you balance your professional and academic obligations, or how you balance financial needs with the cost of education. 

        • 10

        nursing

        4/22/22, 3:44 PM Assessment 4 Instructions: Remote Collaboration and …

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        Assessment 4 Instructions: Remote Collaboration and Evidence-
        Based Care

        Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve
        the outcomes for the Vila Health patient and examine how remote collaboration provided benefits or challenges to
        designing and delivering the care.

        Introduction

        As technologies and the health care industry continue to evolve, remote care, diagnosis, and collaboration are
        becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which
        evidence-based models and care can help remote work produce better outcomes will become critical for success.
        Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of
        institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those
        engaging in remote collaboration.

        Professional Context

        Remote care and diagnosis is a continuing and increasingly important method for nurses to help deliver care to
        patients to promote safety and enhance health outcomes. Understanding best EBPs and building competence in
        delivering nursing care to remote patients is a key competency for all nurses. Additionally, in some scenarios, while
        you may be delivering care in person you may be collaborating with a physician or other team members who are
        remote. Understanding the benefits and challenges of interdisciplinary collaboration is vital to developing effective
        communication strategies when coordinating care. So, being proficient at communicating and working with remote
        health care team members is also critical to delivering quality, evidence-base care.

        Scenario

        The Vila Health: Remote Collaboration on Evidence-Based Care simulation provide the context for this assessment.

        Instructions

        Before beginning this assessment, make sure you have worked through the following media:

        Vila Health: Remote Collaboration on Evidence-Based Care.

        You may wish to review Selecting a model for evidence-based practice changes. [PDF] and Evidence-Based Practice
        Models, which help explain the various evidence-based nursing models.

        For this assessment, you are a presenter! You will create a 5-10-minute video using Kaltura or similar software. In the
        video:

        Course Navigation 
        Jamie Kraus
        FACULTY 6 NEW


        Destin Jennings
        COACH

        Tutorials Support Log Out Jacqueline Barnett

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        Propose your evidence-based care plan that you believe will improve the safety and outcomes of the patient
        in the Vila Health Remote Collaboration on Evidence-Based Care media scenario. Add your thoughts on what
        more could be done for the client and what more information may have been needed.
        Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decisions
        about the plan you proposed
        Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss
        strategies you found in the literature or best practices that could help mitigate or overcome one or more of
        the collaboration challenges you observed in the scenario.

        Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your video.
        Discuss why these sources of evidence are credible and relevant. Important: You are required to submit an APA-
        formatted reference list of the sources you cited specifically in your video or used to inform your presentation. You
        are required to submit a narrative of all your video content to this assessment and to SafeAssign.

        The following media is an example learner submission in which the speaker successfully addresses all competencies
        in the assessment.

        Exemplar Kaltura Reflection.
        Please note that the scenario that the speaker discusses in the exemplar is different from the Vila
        Health scenario you should be addressing in your video. So, the type of communication expected is
        being model, but the details related to the scenario in your submission will be different.

        Make sure that your video addresses the following grading criteria:

        Propose your own evidence-based care plan to improve the safety and outcomes for a patient based on the
        Vila Health Remote Collaboration on Evidence-Care media scenario.
        Explain the ways in which you used an EBP model to help develop your plan of care for the client.
        Reflect on which evidence you found in your search that was most relevant and useful when making decisions
        regarding your care plan.
        Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within
        the context of a remote team.
        Communicate in a professional manner that is easily audible and uses proper grammar, including a reference
        list formatted in current APA style.

        Refer to Using Kaltura as needed to record and upload your video.

        Note: If you require the use of assistive technology or alternative communication methods to participate in this
        activity, please contact DisabilityServices@Capella.edu to request accommodations. If, for some reason, you are
        unable to record a video, please contact your faculty member as soon as possible to explore options for completing
        the assessment.

        Additional Requirements

        Your assessment should meet the following requirements:

        Length of video: 5-10 minutes.
        References: Cite at least three professional or scholarly sources of evidence to support the assertions you
        make in your video. Include additional properly cited references as necessary to support your statements.
        APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used
        to create and deliver your video. Be sure to format the reference page according to current APA style. Submit
        a narrative of all of your video content.

        Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you
        complete the final capstone course.

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        Competencies Measured

        By successfully completing this assessment, you will demonstrate your proficiency in the following course
        competencies and scoring guide criteria:

        Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
        Reflect on which evidence you collected that was most relevant and useful when making decisions
        regarding the care plan.

        Competency 3: Apply an evidence-based practice model to address a practice issue.
        Explain the ways in which you used the specific evidence-based practice model to help develop the
        care plan identifying what interventions would be necessary. This requires a particular evidence-based
        model, such as the Johns Hopkins, Iowa, Stetler, or other.

        Competency 4: Plan care based on the best available evidence.
        Propose your evidence-based care plan to improve the safety and outcomes for the Vila Health patient
        with a discussion of new content for the care plan.

        Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on
        evidence.

        Identify benefits and propose strategies to mitigate the challenges of interdisciplinary collaboration to
        plan care within the context of a remote team.
        Communicate via video with clear sound and light, and include a narrative of video content.
        Provide a full reference list that is relevant and evidence-based (published within five years), exhibiting
        nearly flawless adherence to APA format.

        SCORING GUIDE

        Use the scoring guide to understand how your assessment will be evaluated.

        VIEW SCORING GUIDE 

        Nursing

        Cardiac disease a one of the leading causes of death in the United States. Since it is so prevalent, you want to ensure your co-workers are fully prepared to care for patients. You are hosting a lunch to provide a refresher on heart disease and how to care for patients. During the lunch, you will present a PowerPoint Presentation to your co-workers.

        Instructions

        Provide a detailed overview of Heart failure disease process

        Diagnosis

        Treatment

        Multidimensional care including risk reduction, health promotion, and nursing interventions specific to the disease process

        Nursing

          

        Bench mark Assignment

        Note : For this assignment I choose Diabetes Mellitus Type 2

        Assignment Instructions

        The purpose of this assignment is to identify a clinical practice guideline in your specialty area. You will be challenged to evaluate this guideline and discuss its use in clinical practice. This assignment is due at the end of Week 8 but can be completed anytime during this course. This assignment requires a considerable amount of time for completion. Do not wait until week 8 to begin this assignment.

        Choose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommended medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.

        Clinical Practice Guideline Prompts:

        HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

        PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence

        · Does the clinical practice guideline adequately address the health problem? Describe.

        · Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?

        · Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?

        · How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.

        ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

        · Does this clinical practice guideline need revision(s)? Please explain your answer in detail.

        · If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?

        · How might changes in US demographics and healthcare reform affect this clinical practice guideline?

        · What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

        EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

        LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

        REFERENCES (APA formatting, current within past 5 years.)

        • 2 months ago
        • 25

        Nursing

        Discuss why it is important for a person working in health care to understand statistical concepts. Provide an example of how statistical data is used in your organization or specialty area today and what you are expected to do with this information as a practitioner.   

        Nursing

         

        This week you have learned about common Dermatology disorders in the Adult and Geriatric patient. For the purpose of this discussion please answer the following questions on herpes zoster. 

        • Common Signs and symptoms seen
        • Screening assessment tools
        • Recommended diagnostic tests (if any)
        • Treatment plans both pharmacologic and non-pharmacologic based on current clinical practice guidelines

        Please use spa style reference and use articles no later then five years ago

          • 10

          NURSING ;

          Project outline 1

          Project outline 2

          Project outline for Hypertension

          Rasmussen University

          Chukwuemeka Mbionwu F.

          01/30/2022

          ASSIGNMENT

          The requirements for your Project include the following:

          · Must be 6-8 pages.

          · Must include an introductory paragraph that describes the entire project.

          · The project must have all of the following: identification of the alteration in health (disease), the role nutrition plays in the prevention of this disease, its etiology, progression, treatment, recommended diet, type of nursing assessment and nursing interventions needed with regard to nutrition, outline of what should be included in client education and two strategies to help ensure adherence (overcome barriers) to the recommended diet.

          · Must have a title page and an APA Editorial formatted Reference page with at least three scholarly peer reviewed references. There must also be appropriate APA Editorial formatted in-text citations.

          Below is the outline and the first page you did before, so just follow it and finish it up AND PLS DON’T INCLUDE THE LAST PARAGRAPH REGARDING THE CHALLENGES THS PAPER IS FACING, JUST FOLLOW THE OUTLINE, THANKS

          In the project of identifying the dietary requirements for hypertension, I outlined various parts/sections that I needed to complete. So far, there are a few parts that I have been able to complete with less difficulty. The first section has been completed where I was able to find data and information on the relationship between diet, nutrition and hypertension. This was easy because there is a lot of information available online that is related to the issue. I was also able to complete etiology of hypertension where I researched how a number of factors such as obesity and high cholesterol resulting into hypertension among individuals. This was easy to understand because I already had knowledge of the etiology of hypertension and I was just gathering additional information to support the points I have.

          On the progression of the disease, the information was also easy to come by over different articles that provide information on the topic. Addressing the treatment options available was hard because when I researched, I found a wide range of treatment options and it was hard to decide which of the treatment options is best for hypertension. According to research, there are both pharmacological and non-pharmacological treatment options with most of the researchers recommending diet change and the use of physical exercise to help manage hypertension.

          I thought it would be easy finding the recommended foods for patients with hypertension but when doing research, I realized there are various types of diet that are recommended for hypertensive with some of them confliction with regard to the foods to avoid and what to consume more. When it comes to the project, I am yet to complete the remaining sections of the project I am working hard to have the project complete as soon as possible. The remaining section are nursing assessment, interventions, client education and adherence.

          Topic: Investigating dietary management in controlling Hypertension

          1. Role of nutrition in prevention of Hypertension

          This section provides an overview of nutrition and the relationship between nutrition and hypertension. A detailed connection between health and growth and how hypertension is related to the concepts will be provided.

          2. Etiology

          This section explains the process in which hypertension occurs. This includes the manner of causation based on scientific evidence available.

          3. Progression

          This section provides the process in which the symptoms of hypertension develops over time. In this section, a comparative analysis will be provided on how the hypertension progresses in different people particularly between male and females. Also, a detailed description will be provided in relation to when acceleration of the condition is expected based on different age ranges of different genders.

          4. Treatment

          In this section, the treatment process of hypertension is provided. This includes a brief outline of the recommended medications in treating the condition. Also, nursing interventions necessary in assisting the patient with hypertension treating and management is provided in this section.

          5. Recommended diets

          This section outlines the different meals that should be offered to the patient. Also, an explanation of the benefit realized from the use of every meal and components is provided.

          6. Nursing assessment

          This section outlines the evaluations done on patients with hypertension. Each assessment will be described in terms of the inputs or tests needed and the respective diagnosis such as risk of Heart attack or stroke among other factors.

          7. Nursing interventions

          This section will focus at strategies that can be used in assisting the patient with hypertension management. However, elements such as diets are briefly discussed as they have been discussed in length in the previous sections.

          8. Client education

          This section consists of information to be given to the patients particularly in relation to following the prescriptions and diet recommendations. Also, the section will focus at guiding the family members and relatives of the patient on areas to observe in relation to giving care to the patient.

          9. Adherence

          This section describes the patient compliance necessary to attain the treatment goals for the condition. This will include compliance to both medications and assistive devices.


          nursing

          EVALUATION OF DEPRESSION CLINICAL PRACTIE GUIDELINES 1

          Evaluation of Depression Clinical Practice Guidelines

          United State University

          Common Illness Across the Lifespan: MSN 591

          Abstract

          Depression is a mental disorder characterized by chronically depressed mood and by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home. It is highly prevalent in the US. Despite its increased prevalence, its management has been controversial in the US, with the recommendation that its treatment, both pharmacologic and non-pharmacologic, is effective for about 60 percent of the affected individuals. This underscores the possibility of concluding whether the available guideline is trustworthy. Therefore, it needs further revision to direct the delivery of care to depression patients effectively.

          Healthcare Problem

          1. Description of Depression

          Depression (major depressive disorder) is a common and significant clinical condition characterized by impaired mood, thinking, and behavior. Fortunately, it can be treated. Depression leads to feeling of sadness accompanied by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home (Goldman, 2019). Depression is a kind of mood illness characterized by chronic sorrow and lack of interest. It is distinct from the mood swings that individual encounter on a daily basis. Significant life experiences, such as grief or job loss, may trigger depression. However, psychiatrists consider grieving to be a component of depression only when it persists. Depression signs vary in severity from moderate to severe and the manifestations are as follows

          · Depressed mood

          · Loss pleasure in previously appreciated activities

          · increase or reduced appetite

          · increased or reduced sleep

          · Energy loss or excessive weariness

          · feeling of extreme guilt

          · impaired though process, decision making and concentration

          · Suicidal or self-harm ideations

          Depression is a chronic condition, not a transitory one. It is composed of series lasting at least two weeks. Depression may endure weeks, months, or even years (Goldman, 2019).

          2. Epidemiology of Depression

          Between 2013 and 2016, 8.1percent of American adults aged 20 and older experienced depression over a two-week period. Women (10.4 percent) were nearly twice as likely to suffer depression as males (5.5 percent). Depression was much less prevalent among non-Hispanic Asian people than it was among Hispanic, non-Hispanic black, or non-Hispanic white individuals (CDC, 2019). Depression prevalence reduced as family wealth grew. Around 80% of persons with depression reported experiencing at least some difficulties at work, at home, or in social situations as a result of their depression. Between 2007–2008 and 2015–2016, the proportion of American adults diagnosed with depression remained stable. Additionally, depression has been to affect the Hispanic and African American communities more than the rest of the United States population. Women have been found to suffer from depression more than their male counterparts. according to the Center for Disease Control (2019), depression has high prevalence in individuals whose income is below the poverty line, and that the prevalence for depression decreases as the amount of income increase (NIMH, 2020).

          3. Pathophysiology of depression

          I. Stress

          Psychological stress and traumatic life experiences early in life are both significant intermediate indicators of depression’s development. While stress response suggests consistency or preservation of homeostasis, chronic stimulation of the stress response system may have detrimental or even deadly implications by increased risk of overweight, cardiovascular disorders, depression, as well as other illnesses (Ormel, et al., 2019). The hypothalamic–pituitary–adrenal axis (HPA) and its three major components —hypothalamic neurosecretory cells, pituitary gland, and adrenal cortex—function together to ensure successful adaptation to altered environmental circumstances and activation of the organism’s reserves in response to various types of stress. To begin, traumatic situations in one’s life are the most powerful triggers of depression. Second, depressive individuals usually have higher cortisol (the human endogenous glucocorticoid) and corticotropin (ACTH) levels in their plasma, urine, and cerebrospinal fluid (Ormel, et al., 2019). Additionally, depressed people have an enlarged hypophysis and suprarenal glands, as well as impaired corticosteroid receptors activity. Increased HPA axis stimulation is reported in 50percent of depressed individuals, and continued antidepressant treatment tends to reduce this stimulation.

          II. Genetics

          Depression is a highly varied condition. Some genetic variability is intrinsic to polygenicity; afflicted people may have diverse configurations of susceptible alleles and healthy persons may also have some of these variations (Ormel, et al., 2019). Depression is a polygenic condition originating from the combined action of multiple genetic variations with separately tiny effect sizes. Defects at particular loci affect strictly defined systems such as conduction of dopamine in the prefrontal brain (Shadrina, et al., 2018). Owing to these mutations, succeeding offspring’s have significant likelihood of experiencing depression.

          III. Neurotransmitter Imbalances

          a) Norepinephrine

          In individuals with Depression, Norepinephrine deficiency is related with a loss of positive emotional resources, including decreased enjoyment, motivation, pleasure, attention, vigor, and passion, as well as a loss of self-belief. Depression patients showed impaired Norepinephrine function in the lobar NE, which resulted in anhedonia, a lack of vigor and desire, and other associated depressive manifestations (Liu, et al., 2018).

          b) serotonin

          5-HT deficit in the brain may exacerbate unpleasant feelings associated with Depressive disorders, such as depression, self-criticism, anger, worry, anxiety, aggressiveness, irritation, and isolation. Previous investigations discovered that blood 5-HT levels were considerably lower in individuals with MDD than in control subjects, implying a 5-HT deficit in people with MDD (Phillips, 2017). Similarly, postmortem investigations revealed decreased 5-HT and 5-HIAA levels in the central nervous system of depressive and suicidal individuals (Liu, et al., 2018). Reduced serotonin production over time may add to the increased vulnerability to MDD. Increasing scientific and clinical data establishes a relationship between antidepressant treatments and brain 5-HT systems, indicating that perturbation of central 5-HT systems plays a critical role in the pathogenesis of MDD. The serotonergic malfunction that contributes to the etiology of MDD is mostly due to decreased neuronal 5-HT production and aberrant 5-HT receptor activity.

          c) dopamine

          Dopamine (DA) is a neurotransmitter found in the hypothalamus and pituitary gland that serves as a critical neurobiological substrate for pleasure, focus, desire, psychomotor speed, and the capacity to perceive pleasure, all of which may contribute to human emotion regulation. Depression is characterized by impairments in all of these processes (Liu, et al., 2018). Furthermore, instantaneous bidirectional modulation (suppression or stimulation) of specific midbrain DA neurons modifies several distinct depressed symptoms generated by chronic stress, indicating that mechanisms impacting symptoms of depression modify the limbic DA neuronal programming of action. Additionally, impaired DA neuron activity may result in depressed symptoms such as despair and lack of interest. In individuals with MDD, the amount of DA compounds in the CSF was significantly lower than in control subjects. Inadequate DA receptor activity may culminate to a breakdown of regulation from the prefrontal cortex to the amygdala, leading in amygdala hyperexcitability and the development of stress and abnormal anxiety.

          4. Clinical Practice Guideline

          Depression management requires a thorough examination and accurate diagnosis. The evaluation should be depended on a thorough history, physical exam, and investigation of the patient’s mental status. History should be gathered from all possible sources, most notably family. The diagnosis should be made using the most up-to-date diagnostic criteria (Gautam, et al., 2017). The process of developing a therapeutic plan includes agreeing on the therapy environment, drugs, and psychological therapies that will be employed. Patients and carers may be contacted actively throughout the therapy plan’s development. A reasonable, practical, and adaptable therapy plan may be developed to meet the demands of clients and caregivers. Additionally, the treatment plan may be analyzed and updated on a continual basis. A thorough evaluation of the client’s suicide risk must be conducted. During the history taking process, suicidal thoughts and other adverse outcomes for suicide such as manic episodes, extreme anxiety, panic disorder, and alcohol or drug misuse must be assessed (Gautam, et al., 2017). In older individuals, it has been shown that the degree of depressive symptoms is a major predictor of suicide thoughts over time. Additionally, the evaluation covers a history of prior suicide tries, as well as the type of previous attempts. Additionally, patients’ family histories of suicide should be elicited. Apart from inquiring about suicidal ideations, it is critical to inquire about the extent to which the patient wants to act on the suicidal thoughts as well as the extent to which the individual has formed plans or started to commit suicide during mental status tests.

          Many patients who suffer from depression recur. As a result, patients and, if necessary, their relatives may be taught about the danger of recurrence. They may be taught to recognize the warning indications and manifestations of recurrent episodes. Additionally, individuals might be urged to seek appropriate therapy as soon as feasible during a new episode to reduce the probability of a complete recurrence or consequence. Electroconvulsive therapy (ECT), psychosocial therapies and antidepressants, and are the primary treatment choices for depression. Other therapies that are less often used or are utilized in individuals with depression that is resistant to treatment include light therapy, repeated transcranial magnetic stimulation (rTMS), ,transcranial direct stimulation, deep brain activation, vagal nerve activation, and sleep deprivation treatment (Gautam, et al., 2017). Benzodiazepines are often used in conjunction with other medications, particularly during the early period of therapy. Additionally, thyroid supplements and lithium may be utilized as adjunctive therapy in rare circumstances when a patient does not react to antidepressants.

          The fact that this guideline begins with assessment of the patient and monitoring, I believe it adequately addresses depression, given the diverse methods of treatment and assessment of the client. Involvement of caregivers and family and education to all of them regarding the management of depression is key of key importance. Management of depressive patients based on this guideline has been effective in controlling the disease. However, this management is rarely found in primary care. This means that individuals are not able to access the care until it is too late and the symptoms too adverse. Using this guideline laid by the American Psychological Association, clinicians and other care providers can follow a stepwise methodology for caring and treatment of depression patients, from assessment, through diagnosis and education to treatment and follow ups. This enables complete recovery of the patient as well as preventing relapse.

          Management of depression patients is based on trial methods. this means that different antidepressants are prescribed to manage the disease in trial for which works best for the patient. I feel that this is not effective to try patients on several drugs before they are finally given the drug they could tolerate. This is because the drugs could have adverse effects that can be prevented by secure and selective prescription. Additionally, the effectiveness of nonpharmacological intervention of managing depression is highly depended on the psychotherapist, owing much to their character and personality, as well as skills and expertise acquired during practice. Due to this, it can be difficult to ascertain its effectiveness in managing depression. However, it has been found that medications do not work for all depressive patients, and that only 60 percent of the depressive patients can be treated with drugs (Schimelpfening, 2021)

          5. Analysis of the guideline

          As mentioned previously that depression medication only account for about 60 percent recovery, it is important to revise the clinical guideline in quest to get a solution that can adequately cure depression. Additionally, non-pharmacologic interventions are not reliable since their effectiveness are dependent on the psychotherapist. There is a need to establish a dependable drug for treatment of depression. This will help to eliminate the try and error practice that is currently being used to manage depression patients. Also, there is need to in cooperate mental health screening in primary care as method of health promotion, in order to identify and treat depression early enough. This calls for a collaborative approach to manage the patient to ensure that the depression is done away with, and that relapses are eliminated. Furthermore, there are several antidepressants used despite the weak evidence for us. it would be important that these drugs are cleared so that only drugs with strong recommendations for use are utilized to manage depressive patients. The new guideline will ensure that there is a standard treatment of depression, and that following this treatment, clinicians are able to manage their patients well, to prevent recurrence of the condition and enhance patient satisfaction

          6. Evaluation

          It is critical to examine the efficacy of a new or amended clinical practice guideline to ascertain how it influences patient care, practitioner behavior and knowledge, and the variables that lead to non-compliance, if any. The evaluation findings indicate whether the updated clinical practice guideline achieved the anticipated care outcomes and is helpful in treating and managing depression. The following methodologies are used to assess the updated depression clinical practice guideline’s efficiency:

          · The first stage in determining the amended guideline’s efficacy is to examine potential modifications in care service and practice as a result of the new guideline criteria. This is accomplished by analyzing the conversion of clinical practice and health outcomes in regions with very high levels of guideline promotion to the change in places with low levels of guideline implementation.

          · The next stage is to compare the change of healthcare outcomes in regions with a high rate of guideline adoption to those with a low rate of guideline adoption. This may be accomplished by conducting a focus group to highlight the primary factors that affected the guideline’s adoption.

          7. Learning points

          · Depression is a significant psychological disorder facing a large population in the United States, especially the Hispanic population, African American communities, and those whose income is low.

          · The current guidelines are not sufficiently addressing the problem of depression since it has been discovered that the current therapeutic measures are only helpful to about 60% of the affected individuals.

          · It is important to integrate mental health screening for susceptible individuals in to primary care to facilitate early detection and treatment of depression.

          Conclusion

          To conclude, depression (major depressive disorder) is a common and significant clinical condition characterized by impaired mood, thinking, behavior and feeling of sadness accompanied by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home. Its pathophysiology ca be explained in terms of neurotransmitter imbalances, genetics and stress. the current guidelines do not adequately address the issue since it is only effective in some people and therefore, they should be revised to ensure that the treatment is effective to all individuals.

          References

          CDC. (2019, June 7). Products – Data briefs – Number 303 – February 2018. Centers for Disease Control and Prevention.
          https://www.cdc.gov/nchs/products/databriefs/db303.htm

          Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian journal of psychiatry59(Suppl 1), S34.

          Goldman, L. (2019). Depression: What it is, symptoms, causes, treatment, and more. Medical and health information.
          https://www.medicalnewstoday.com/articles/8933

          Liu, Y., Zhao, J., & Guo, W. (2018). Emotional roles of mono-aminergic neurotransmitters in major depressive disorder and anxiety disorders. Frontiers in psychology9, 2201.

          NIMH » major depression. (2020). NIMH » Home.
          https://www.nimh.nih.gov/health/statistics/major-depression

          Ormel, J., Hartman, C. A., & Snieder, H. (2019). The genetics of depression: successful genome-wide association studies introduce new challenges. Translational psychiatry9(1), 1-10.

          Phillips, C. (2017). Physical activity modulates common neuroplasticity substrates in major depressive and bipolar disorder. Neural Plast. 2017, 7014146. doi: 10.1155/2017/7014146

          Schimelpfening, N. (2021). What is the chemistry behind depression? Verywell Mind. https://www.verywellmind.com/the-chemistry-of-depression-1065137

          Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics Factors in Major Depression Disease. Frontiers in psychiatry9, 334.
          https://doi.org/10.3389/fpsyt.2018.00334

          Nursing

          NSGP 210 Case Studies in Pathophysiology – Concept map notes

          System: Condition

          Basic Concept

          Pathophysiology

          Risk Factors

          Etiology

          Pathophysiology (include different types here)

          clinical presentation (S&S)

          Diagnostic Test/Procedures

          Treatment

          Complications


          Nursing

          1. Do an assessment of the  an assisted living facility , a continuing care retirement community or the Nursing facility in which you work.  Write a report on your opinion of the services offered and improvements that could be made.

          2. Research and report the means for recording and reporting elder abuse in the community in which you work 

          Please answer each question using APA format . Each answer should be no less than 500 words and no more than 750 words. 

            • 5

            NURSING

            Project outline 1

            Project outline 3

            Project outline for Hypertension

            Rasmussen University

            Chukwuemeka Mbionwu F.

            01/30/2022

            Topic: Investigating dietary management in controlling Hypertension

            1. Role of nutrition in prevention of Hypertension

            This section provides an overview of nutrition and the relationship between nutrition and hypertension. A detailed connection between health and growth and how hypertension is related to the concepts will be provided.

            2. Etiology

            This section explains the process in which hypertension occurs. This includes the manner of causation based on scientific evidence available.

            3. Progression

            This section provides the process in which the symptoms of hypertension develops over time. In this section, a comparative analysis will be provided on how the hypertension progresses in different people particularly between male and females. Also, a detailed description will be provided in relation to when acceleration of the condition is expected based on different age ranges of different genders.

            4. Treatment

            In this section, the treatment process of hypertension is provided. This includes a brief outline of the recommended medications in treating the condition. Also, nursing interventions necessary in assisting the patient with hypertension treating and management is provided in this section.

            5. Recommended diets

            This section outlines the different meals that should be offered to the patient. Also, an explanation of the benefit realized from the use of every meal and components is provided.

            6. Nursing assessment

            This section outlines the evaluations done on patients with hypertension. Each assessment will be described in terms of the inputs or tests needed and the respective diagnosis such as risk of Heart attack or stroke among other factors.

            7. Nursing interventions

            This section will focus at strategies that can be used in assisting the patient with hypertension management. However, elements such as diets are briefly discussed as they have been discussed in length in the previous sections.

            8. Client education

            This section consists of information to be given to the patients particularly in relation to following the prescriptions and diet recommendations. Also, the section will focus at guiding the family members and relatives of the patient on areas to observe in relation to giving care to the patient.

            9. Adherence

            This section describes the patient compliance necessary to attain the treatment goals for the condition. This will include compliance to both medications and assistive devices.

            Nursing


            Health Conditions

            Hypo / hyper kalemia

            System Condition: Hypo / hyper kalemia

            Basic Concept

            Hypokalemia

            · Decrease in potassium levels in the blood.

            · Ka serum level: < 3.5 mEq/L(3.5 mmol/L)

            · Ka moderate serum level: 2.5-3.0 mEq/L

            · Severe: serum level <2.5 mEq/L.

            Hyperkalemia

            · increase in potassium levels in the blood.

            · Ka serum level > 5.0-5.5 mEq/L in adults.

            · Serum level: > 7 mEq/L can lead to severe complications such as hemodynamic and neurologic consequences.

            Pathophysiology

            Hypokalemia

            · Potassium is obtained through diet.

            · Excretion increased by aldosterone, diuretics, and negatively charged ions deposited into the collecting duct.

            · Excretion minimized by low serum and urination flow.

            Hyperkalemia

            · Triggered by minimal glomerular activity.

            Risk Factors

            Hypokalemia

            · Eating disorders

            · AIDS

            · Alcoholism

            · Bariatric surgery

            Hyperkalemia

            · ARBs or potassium-sparing diuretics.

            · Virilization

            · Adrenal gland suppression

            · Kidney problems

            Etiology

            Hypokalemia

            · Abnormal losses: medications, gastrointestinal losses, renal losses, hypomagnesemia, dialysis

            · Transcellular shift: medications, thyrotoxicosis.

            · Pseudo hypokalemia: extreme leukocytosis, delayed sample analysis

            · Starvation, dementia.

            Hyperkalemia

            · Pseudo hyperkalemia

            · Decreased renal excretion

            · Deficiency in insulin, mineral acidosis, cell injury

            Pathophysiology with different types

            Hypokalemia

            · Low levels of potassium will cause rise in sodium levels therefore causing hypernatremia.

            Hyperkalemia

            · high levels of potassium will cause drops in levels of sodium hence causing hyponatremia.

            Clinical Presentation

            Hypokalemia

            · Asymptomatic when mild (3-3.5 mmol/L)

            · Nonspecific symptoms (general weakness, lassitude, constipation) with more severe hypokalemia

            · Serum level of < 2.5 mmol/L leading to muscle necrosis

            · Serum level of < 2.0 mmol/L leading to ascending paralysis and impairment of respiratory functions.

            Hyperkalemia

            · Weakness which at times progresses to flaccid paralysis and hypoventilation.

            · Metabolic acidosis.

            · Altered heart electrical activity.

            Diagnostic Test/Procedures

            Hypokalemia

            · Repeated serum potassium measurements.

            · Measurements for magnesium and glucose.

            · Measurements for creatine and urine.

            · Acid-base balance.

            · If initial work-ups fail, perform thyroid and adrenal work-up.

            Hyperkalemia

            · Clinical history

            · Physical examination

            · Medications review

            · Assessment of cardiac functions

            · Assessment of hydration status

            · Electrocardiogram

            · Comprehensive laboratory workup

            Treatment

            Hypokalemia

            · Potassium tablets or infusion.

            · Increase intake of materials containing potassium.

            Hyperkalemia

            · Calcium chloride.

            · Insulin

            · Furosemide

            · Sodium polystyrene

            · Patiromer

            Complications

            Hypokalemia

            · Increases mortality in CKD or CHF

            · Symptoms dependent on severity

            · Severe hypokalemia may result in heart block.

            Hyperkalemia

            · Frequently asymptomatic

            · Can present irregular heart rhythms

            Hypo / hyper natremia

            System Condition: Hypo / hyper natremia

            Basic Concept

            Hyponatremia

            · Na+ serum level < 135 mEq/L

            · Common imbalance that is mostly seen in isolation

            · Mild; serum level 130-134 mmol/L

            · Moderate: serum level 125-129 mmol/L

            Hypernatremia

            · Rise in sodium concentration.

            · Level of concentrations exceeds 145 mmol/L

            · A water and not sodium problem

            Pathophysiology

            Hyponatremia

            · Water intake depends on thirst mechanism.

            · Thirst is stimulated by osmolality increase.

            · Hyponatremia occurs only when some conditions impair normal free water excretion.

            Hypernatremia

            · Cells become dehydrated after hypernatremia of any etiology occurs.

            · Increased sodium reacts and extracts the water.

            Risk Factors

            Hyponatremia

            · Older age >65

            · Use of pain medications

            · SSRIs for antidepressant therapy

            · Diuretics

            · Diets poor in sodium

            · Hypothyroidism

            Hypernatremia

            · Older age >65

            · Mental and physical disability

            · Hospitalization

            · Residence in nursing home

            · Inadequate nursing care

            · Diabetes insipidus

            · Diabetes mellitus

            · Diuretic therapy

            Etiology

            Hyponatremia

            · Kidney failure

            · Congestive heart failure

            · Diuretics

            · Pain medication

            · Severe vomiting or diarrhea

            · Excessive thirst

            Hypernatremia

            · Diabetes insipidus- Central, Nephrogenic

            · Diarrhea, emesis

            · Burns, excessive sweating

            · Premature infants, radiant warmers, phototherapy

            Pathophysiology with different types

            Hyponatremia

            · Low levels of sodium will cause an increase in potassium levels, thus causing hyperkalemia

            Hypernatremia

            · Subsequently, high levels of sodium will cause a drop in potassium levels causing hypokalemia.

            Clinical Presentation

            Hyponatremia

            · Headaches, seizures, confusion, coma

            · Weakness in muscles

            · Vomiting, diarrhea, pain in abdomen

            Hypernatremia

            · 50 % mortality rate due to encephalopathy

            · Coma, weakness, neurologic deficits

            Diagnostic Test/Procedures

            Hyponatremia

            · Physical examination

            · History examination

            · Radiologic imaging

            Hypernatremia

            · Thorough physical exam inclusive of volume status, mental status and neurologic assessment.

            Treatment

            Hyponatremia

            · Fluid restriction (0.5- 1 liter/day). Encourage water intake

            · Demeclocycline (600- 1200 mg/d). inhibits action of adh

            · Urea (30mg/d). osmotic diuresis

            · Lithium (up to 900mg/d). inhibits action of adh

            Hypernatremia

            · Reduce intakes rich in sodium.

            · Sodium chloride

            · Intravenous dextrose

            Complications

            Hyponatremia

            · Fatigue

            · Convulsions

            · Feeling weak

            · Coma

            · Low blood pressure

            · Confusion

            · Short temper

            Hypernatremia

            · Intense thirst

            · Fever

            · Nausea or vomiting

            · Intense thirst

            · Seizures

            · Labored respiration

            · Focal neurologic deficits

            Hypo / hyper calcemia

            System Condition: Hypo / hyper calcemia

            Basic Concept

            Hypocalcemia

            · Ca serum level: <8.8 mg/dL

            · Hereditary.

            Hypercalcemia

            · 90% of hypercalcemia cases caused by hyperparathyroidism.

            · Mild: Ca 10.5-11.9 mg/dL (2.5-3 mmol/L

            · Severe: Ca 14-16 mg/dL (3.5-4 mmol/L)

            Pathophysiology

            Hypocalcemia

            · Cased by numerous conditions: hypoparathyroidism, hungry bone syndrome, medications, infusion of phosphate, and kidney and liver diseases.

            Hypercalcemia

            · Calcium is crucial in intracellular and extracellular metabolism controlling many processes.

            · Ca metabolism regulated by hormones affecting entry into the intercellular space and controls its excretion from the kidneys.

            Risk Factors

            Hypocalcemia

            · Medications

            · Rapid citrated blood transfusion

            · Infusion of phosphate

            · Hungry bone syndrome

            · Altered vitamin D metabolism

            · hypoparathyroidism

            Hypercalcemia

            · Vitamin D intoxication

            · Vitamin A intoxication

            · AIDS

            · Drugs

            · Lithium

            · Thiazide diuretics

            · Mild alkali syndrome

            · Chronic renal insufficiency

            Etiology

            Hypocalcemia

            · Hypoalbuminemia

            · Hypomagnesemia

            · Hyperphosphatemia

            · Surgical effects

            · PTH deficiency or resistance

            · Vitamin D deficiency or resistance

            · Medication effects

            Hypercalcemia

            · Hyperthyroidism

            · Primary adenoma, hyperplasia, carcinoma

            · lithium therapy

            · tertiary hyperparathyroidism

            · familial hypocalciuric hypercalcemia

            Pathophysiology with different types

            Hypocalcemia

            · low levels of calcium may be caused by low or deficiency of magnesium.

            · A drop in calcium levels causes an increase in phosphate levels causing hyperphosphatemia

            Hypercalcemia

            · Too much calcium in the body will cause a decrease in potassium levels in the blood. Patients with severe hypercalcemia will always be hypokalemic.

            · An increase in calcium level in the blood will cause a drop in phosphate levels thus causing hypophosphatemia when hypercalcemia is not severe.

            Clinical Presentation

            Hypocalcemia

            · Paranesthesia around mouth, fingers and toes.

            · Muscle cramps

            · Tetany

            · Seizures

            · Latent hypocalcemia

            Hypercalcemia

            · Diabetes insipidus

            · Acute kidney injury

            · Hypertension

            · Nausea

            · Vomiting

            · Constipation

            · Fatigue

            · Coma

            Diagnostic Test/Procedures

            Hypocalcemia

            · Physical examination

            · History examination

            · Measurement of serum intact parathyroid hormone.

            Hypercalcemia

            · Blood test for high calcium levels in blood.

            · Mammogram

            · Chest x-ray

            · MRI

            · CT scan

            Treatment

            Hypocalcemia

            · Magnesium supplements

            · Intravenous IV calcium gluconate for acute hypocalcemia

            · Calcium and vitamin D supplements (oral) for chronic hypocalcemia

            Hypercalcemia

            · IV hydration with isotonic saline

            · Salmon calcitonin

            · Bisphosphonate

            Complications

            Hypocalcemia

            · Respiratory arrest

            · Cardiac arrest

            · Tetany

            · Seizures

            · Laryngospasm

            Hypercalcemia

            · Kidney stones

            · Kidney failure

            · Fractures

            · Hypertension

            · Pancreatitis

            · Osteoporosis

            Hypo / hyper phosphatemia

            System: Condition: Hypo / hyper phosphatemia

            Basic Concept

            Hypophosphatemia

            · Phosphate serum level:< 2.5 mg/dL (0.8 mmol/L) in adults.

            · Normal ranges of Phos in neonates are 4.8 – 8.2 mg/dL, 3.8 – 6.5 mg/dL in 1week to 3 years old children, 3.7 – 5.5 mg/dL in 3 to 12 year olds, and 2.9 to 5 mg/dL for adolescents to age 19 years.

            · A serum Phos < 2.5 mg/dL considered hypophosphatemia where < 1.5 is severe.

            Hyperphosphatemia

            · Abnormally high serum phosphate levels.

            · A serum Phos from > 4.5 mg/dL considered hyperphosphatemia.

            Pathophysiology

            Hypophosphatemia

            · Mainly caused by low intake of phosphate into the body, high excretion of phosphate.

            Hyperphosphatemia

            · Most common cause are decreased kidney function, and massive extracellular fluid phosphate loads.

            Risk Factors

            Hypophosphatemia

            · Severe malnutrition

            · Alcoholism

            · Severe burns

            · Fanconi syndrome

            · Chronic diarrhea

            · Vitamin D deficiency (in children)

            · Inherited conditions such as X-linked familial hypophosphatemia (XLH)

            Hyperphosphatemia

            · Excessive body fat

            · Diabetes mellitus

            · Hypercalcemia

            · Kidney infections

            · High cholesterol levels

            Etiology

            Hypophosphatemia

            · Malnutrition

            · Hyperparathyroidism

            · Starvation

            Hyperphosphatemia

            · Renal failure

            Pathophysiology with different types

            Hypophosphatemia

            · A drop in phosphate levels will cause a rise in calcium levels in the blood causing hypercalcemia.

            Hyperphosphatemia

            · A rise in phosphate levels in the blood will always cause a drop in calcium levels leading to hypocalcemia.

            Clinical Presentation

            Hypophosphatemia

            · Weakness in muscles.

            · Seizures

            · Blood issues

            · Getting numb

            · Alteration of mental state

            · Weakening of bones

            Hyperphosphatemia

            · Rashes

            · Soft bones thus weak

            · Pain in joints

            · Spasms

            · Numbness in the mouth

            Diagnostic Test/Procedures

            Hypophosphatemia

            · Measurement of blood phosphate.

            · Additional tests may also be done to determine underlying cause of disorder

            Hyperphosphatemia

            · Measurement of blood phosphate

            · Other tests to check to reason behind rise of phosphate.

            Treatment

            Hypophosphatemia

            · Phosphate supplements, orally.

            · Active vitamin D

            · Treatment for related disorders: cinacalcet, calcitonin, or dipyridamole, but in future.

            Hyperphosphatemia

            · Reduction of phosphate in diet.

            · Removal of extra phosphate with dialysis.

            · Lower amount of phosphate intestines absorbs using medication

            Complications

            Hypophosphatemia

            · Acute hypocalcemia

            · Tetany

            · Renal failure

            Hyperphosphatemia

            · Cardiac arrest

            · Valve calcification (heart)

            · Elevated PO4 due to lack of adequate binders.

            · Elevation of PO4 can still be caused by diets high in phosphorus.

            Hypo / hyper magnesemia

            System: Condition: Hypo / hyper magnesemia

            Basic Concept

            Hypomagnesemia

            · An electrolyte disturbance caused by low levels of serum magnesium.

            · While in low levels:< 1.46 mg/dL in the blood

            Hypermagnesemia

            · Serum concentration: Mg >2.6 mg/dL (> 1.05 mmol/L)

            Pathophysiology

            Hypomagnesemia

            · Magnesium is essential for biochemical reactions.

            · Affects sodium, calcium and potassium, mostly while is in low levels.

            · Magnesium homeostasis involves the kidney.

            · Hypomagnesemia occurs when something changes or interferes with magnesium homeostasis.

            · Deficiency in magnesium can cause other conditions such as hypocalcemia.

            Hypermagnesemia

            · Occurs mostly due to chronic kidney disease

            Risk Factors

            Hypomagnesemia

            · Diabetes mellitus

            · Poor nutrition

            · Heart failure

            · Potassium deficiency

            · Calcium deficiency

            Hypermagnesemia

            · Decreased renal function

            · Lithium therapy

            · Low thyroid activity

            · Diseases such as Addison’s

            · Syndromes such as milk-alkali

            · Drugs containing magnesium

            · Familial hypocalciuric hypercalcemia

            Etiology

            Hypomagnesemia

            · Mainly caused by starvation, alcoholism, and critical illness.

            · Can be secondary to medications such as proton pump inhibitors, digitalis, chemotherapeutic drugs, amphotericin, aminoglycoside antibiotics, loop and thiazide diuretics.

            Hypermagnesemia

            · Renal failure.

            · Low renal excretion caused by depletion of salt.

            · Drug abuse (antacids and laxatives)

            · Rhabdomyolysis

            · Endocrinopathies

            Pathophysiology with different types

            Hypomagnesemia

            · When magnesium levels in the blood are low (hypomagnesemia) the patient will suffer from hypocalcemia and hypokalemia.

            Hypermagnesemia

            · Having too much magnesium in the blood is uncommon.

            Clinical Presentation

            Hypomagnesemia

            · Hypocalcemia, prolonged QT and QU interval, tremors, weakness in muscles.

            Hypermagnesemia

            · Confusion, weakness in muscles, paralysis in the bladder, lethargy

            Diagnostic/Test Procedures

            Hypomagnesemia

            · Physical exam

            · Symptoms

            · Medical history

            · Blood test

            Hypermagnesemia

            · Blood test

            Treatment

            Hypomagnesemia

            · Supplements for magnesium (oral)

            · Increased intake of foods containing magnesium

            · Magnesium intravenously for severe cases

            Hypermagnesemia

            · First identify and stop the production of extra magnesium.

            · To reduce symptoms, administer intravenous (IV) calcium.

            · Diuretics

            · Water pills

            · Dialysis for patients with kidney failure or if other medications are failing.

            Complications

            Hypomagnesemia

            · Seizures

            · Sudden death

            · Cardiac arrhythmias

            · Coronary artery vasospasm

            Hypermagnesemia

            · Hypotension

            · Cardiac arrhythmia

            · Confusion

            · Lethargy

            · Coma

            · Cardiac arrest

            Nursing

             

              • Review your FNP or AGPCNP Clinical Skills and Procedures Self-Assessment Form you submitted for your Week 1 Assignment 2 and think about areas for which you would like to gain application-level experience and/or continued growth as a nurse educator. How can your experiences in the practicum help you achieve these aims?  This is your opportunity to refine and finalize your goals and objectives for your practicum experience.
              • Review the information related to developing objectives provided in this week’s Learning Resources.  Your practicum learning objectives that you want to achieve during your practicum experience must be: 
                • Specific  
                • Measurable  
                • Attainable  
                • Results focused  
                • Time bound 
                • Reflective of the higher order domains of Bloom’s taxonomy (i.e., Application level and above)  
              • Note: Please make sure your objectives are outlined in your Professional Experience Plan (PEP).  

                • Discuss your professional aims and your proposed practicum objectives with your Practicum Preceptor to ascertain if the necessary resources are available at your practicum site.  

                Assignment:    

                Record the required information in each area of the Practicum Experience Plan, including 3-4 practicum learning objectives you will use to facilitate your learning during the Practicum experience

            Objective 1: <write your objective here> (Note:
            This objective should relate to a specific skill you would like to improve from
            your self-assessment.)

             

            Planned Activities:

            Mode of Assessment: (Note: Verification will be documented
            in Meditrek.)

             

            PRAC
            Course Outcome(s) Addressed:

            ·      
            Develop professional plans in advanced nursing practice
            for the practicum experience

            ·      
            Assess clinical skills of various types of
            procedures

             

             

            Objective 2: <write your objective here> (Note:
            This objective should relate to a specific skill you would like to improve from
            your self-assessment.)

             

            Planned Activities:

             

            Mode of Assessment: (Note: Verification will be documented
            in Meditrek.)

             

            PRAC
            Course Outcome(s) Addressed:

             

            ·      
            Develop professional plans in advanced nursing
            practice for the practicum experience

            ·      
            Assess clinical skills of various types of
            procedures

            Objective 3: <write your objective here> (Note:
            This objective should relate to a specific skill you would like to improve from
            your self-assessment.)

             

             

            Planned Activities:

            Mode of Assessment: (Note: Verification will be documented
            in Meditrek.)

             

            PRAC
            Course Outcome(s) Addressed:

            ·      
            Develop professional plans in advanced nursing
            practice for the practicum experience

            ·      
            Assess clinical skills of various types of
            procedures

              • 12

              Nursing

              APA format, 2 pages, 2 references. Attach the 3 PDFs that are needed.

              Qualitative research offers a different set of processes to explore phenomena of interest to nursing, compared to quantitative processes. Both are necessary to advance the profession of nursing. To learn why, discuss how the steps in the research process are different between quantitative and qualitative studies. You should include the following:

              • Select 2 key differences between qualitative and quantitative research and describe. Use examples to illustrate.
              • Are there terms used in quantitative processes that are not used in qualitative processes, and vice versa?
              • How is qualitative research used in evidence-based practice?
              • Select a topic of clinical interest to you. It should be very broad in nature (e.g., cancer pain, psychiatric inpatient anxiety, etc.). Conduct a literature search to select 3 research reports: one using a quantitative approach, one using a qualitative approach, and one using a mixed methods approach to study the selected topic. In your own words, summarize the differences. Describe how you would determine if these studies could be applied to your clinical practice.
              • Attach the following 3 documents as PDFs to your initial post: mixed method report, quantitative report, and qualitative report. 

              NURSING

              In this written assignment, you have the opportunity to share your thoughts about how to deliver client-centered culturally competent care and work collaboratively with others.

              The Case of Mrs. G.

              Mrs. G. is a 75 year old Hispanic woman who has been relatively well all of her life. She had been married for 50 years and had five children. Her children are grown with families of their own. All but one of her children live in other states. Mrs. G.’s husband passed away last year, which was devastating for her. She had been very close to him and relied upon him for everything. He was “the life of the party” she always said and was a loving and caring man. Since his passing, Mrs. G. has continued to live in the house they shared for 35 years. In the last month, Mrs. G. has fallen twice sustaining injuries, though minimal. Her home health nurse comes weekly to check in on her. Mrs. G. likes her very much and wishes she could come more often. Mrs. G.’s daughter who lives in the next town over, has been worried and decided with the urging of her siblings and the doctor to start looking for an assisted living facility for her mother. She found one last week and talked with the Director who said she would be happy to help in whatever way was best. The daughter decided to tell her mother that it was time for her to move, so she can be cared for and be safe. When she told her mother, Mrs. G. cried and said, “This will not happen ever. I plan to stay in this house of loving memories for the remainder of my life.”

              In 3 – 4 pages answer the following questions:

              1. How would you best describe Mrs. G.’s feelings about her life, her family, her traditions, and her future?

              2. Did Mrs. G.’s response to her daughter surprise you? Please explain your answer.

              3. In what way do you believe her culture might be influencing her decision?

              4. If you were Mrs. G.’s daughter what would you say to her that shows you are caring and have compassion for her situation? What nonverbal communication would support that level of communication?

              5. Suppose Mrs. G. stands firm about not leaving her house. What resources and collaborations might be available and helpful so the daughter and other healthcare providers can keep her mother safe and make the most effective decision?

              Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.


              Nursing!

              APA FORMAT. 2 REFERENCES, 1.5 PAGES

              At the beginning of the course, you explored differences and similarities between research-related terms. In this final week of class, discuss how you’ve come to understand those terms, your role in research and evidence-based processes, and how you plan to apply the knowledge acquired in this course in your clinical practice. You should include the following:

              • How has your understanding of nursing research, research utilization, evidence-based practice, and your role in these changed since the start of the course?
              • Do you have a different picture in your mind of how research and evidence-based practice fit together?
              • How would you determine whether research literature is appropriate in supporting your nursing practice? How confident do you feel in your ability to do this?
              • There are several strategies, resources, and tools available to help you select appropriate literature to build your evidence-based practice. For example, you should be aware of Journal Clubs, the Joanna Briggs Institute (JBI), top-tier nursing research journals (e.g., Applied Nursing Research, Western Journal of Nursing Research, etc.), appraisal tools, how to ask a focused clinical question (i.e., PICO), etc. Select a strategy, resource, or tool to explore and describe it. Feel free to select something outside of these examples. Explain how it can help you select the best evidence to support your evidence-based practice.

              NURSING

               

              • Why is it important to articulate your Personal Philosophy of Nursing?
              • What is the relationship between your Personal Philosophy of Nursing and your professional practice?
              • What theories of nursing have you studied?
              • Does your nursing practice follow any particular theorist(s)? Explain.
              • Initial response due Wednesday at 2359pm CST.
              • Two peer responses due Saturday at 2359 pm CST.
                • 10

                Nursing

                Name- Oyewamide Akinro

                Nursing Interventions

                Client Education

                Medication Administration (Dose and Route)

                Medication Name and Type

                Drug Class

                Therapeutic Uses (Indications)

                Complications

                Interactions

                Contraindications

                Expected Pharmacological Mechanism of Action (How it Works)

                ____________________________________________

                Evaluation of Medication Effectiveness

                © 2021 Chamberlain University. All Rights Reserved

                nursing

                Partial Listing of Nurse Residency Programs in Texas

                ▪ Baylor University Medical Center at Dallas: Nurse Internship Programs **


                Nursing Careers | Baylor Scott & White Health (bswhealth.com)

                ▪ Cook Children’s Medical Center, Ft. Worth: Pediatric Nurse Residency Program **


                Nurse Residency Program | Cook Children’s (cookchildrens.org)

                Memorial Hermann Hospital, Houston, Beaumont, Woodlands: Nurse Internships **

                https://jobs.memorialhermann.org/nurse-residency-programs

                ▪ Methodist Hospital System, Houston: Nurse Residency Program **

                https://www.methodisthealthsystem.org/careers/nursing-at-methodist/nursing-externships-and-residencies/

                ▪ Parkland Hospital and Health System, Dallas: New Graduate Programs

                https://www.parklandcareers.com/go/Internships-and-Fellowships/8619100/

                Seton Healthcare Family, Central Texas: Versant RN Residency **

                http://www.seton.net/employment/nursing/rn_residency/

                ▪ HCA Healthcare Careers& Hospitals – Nurse Residency Program

                https://careers.hcahealthcare.com/pages/hca-healthcare-careers-for-new-graduate-nurses

                ▪ St. Luke’s Episcopal Hospital, Houston: Graduate Nurse Residency Program **

                http://www.chistlukeshealth.org/careers

                • Texas Health Resources, Arlington, Versant RN Residency

                http://www.texashealth.org/Nursinginternship

                · UT Southwestern University & Medical City


                UT Southwestern Medical Center Nurse Residency 2021

                nursing

                Factors to consider when selecting the right role for the New Nurse



                From the listing of available nurse training programs, choose a hospital you are interesting in. Research the following hospital placement programs to determine the best value and benefits for perspective employment.

                Name of Hospital __________________________________ Type of Training Program(s): ________________________________

                New Nurse Hospital Program Placement Factors


                Respondents’ Research & Survey Findings

                1. Type of program: residencies, fellowships, preceptorship, internships, and externships.

                2. Length of program; weeks, months, semester

                3. Full Time or Part Time work

                4. How the program is administered: preceptorship, clinical rotation, classroom, and/or didactic study.

                5. Specialties program offered : ICU, Operating Room, pediatrics, ER, Oncology etc.,

                6. Hospital Entity ROC – Return on commitment: payback in terms of contract, work promissory, time commitment ,etc.

                7. Educational Benefits: CEU, certifications, CPR, ACLS, PALS, $$ for advance schooling

                8. Benefits: insurance, discounts, uniforms, location, childcare, EAP, in-house medical, education reimbursement , etc.,

                9. Hospital affiliation, recognition, status, parent corporation, county, state, private, nonprofit, number of hospitals, clinics etc.,

                10. Pay, salary, bonuses

                Other/additional:

                NURSING

                In a PowerPoint® presentation (no more than five slides not including the title and reference slides), include the following information:

                 

                · Describe the issue you chose- Client Access to Care

                ·

                · Discuss two significant facts about the issue.

                · Support the facts identified with at least one credible source.

                · Include the credible source(s) with your PowerPoint®.

                 

                Resource:


                How do I know if a source is credible?


                nursing

                ACTIVE LEARNING TEMPLATES TherapeuTic procedure A1

                Basic Concept
                STUDENT NAME _____________________________________

                CONCEPT ______________________________________________________________________________ REVIEW MODULE CHAPTER ___________

                ACTIVE LEARNING TEMPLATE:

                Related Content
                (E.G., DELEGATION,
                LEVELS OF PREVENTION,
                ADVANCE DIRECTIVES)

                Underlying Principles Nursing Interventions
                WHO? WHEN? WHY? HOW?

                1. STUDENT NAME:
                2. CONCEPT:
                3. REVIEW MODULE CHAPTER:
                4. Related Content:
                5. Underlying Principles:
                6. Nursing Interventions:

                nursing

                ACTIVE LEARNING TEMPLATES TherapeuTic procedure A11

                System Disorder
                STUDENT NAME _____________________________________

                DISORDER/DISEASE PROCESS __________________________________________________________ REVIEW MODULE CHAPTER ___________

                ACTIVE LEARNING TEMPLATE:

                ASSESSMENT SAFETY
                CONSIDERATIONS

                PATIENT-CENTERED CARE

                Alterations in
                Health (Diagnosis)

                Pathophysiology Related
                to Client Problem

                Health Promotion and
                Disease Prevention

                Risk Factors Expected Findings

                Laboratory Tests Diagnostic Procedures

                Complications

                Therapeutic Procedures Interprofessional Care

                Nursing Care Client EducationMedications

                1. STUDENT NAME:
                2. DISORDERDISEASE PROCESS:
                3. REVIEW MODULE CHAPTER:
                4. Pathophysiology Related to Client Problem:
                5. Health Promotion and Disease Prevention:
                6. Risk Factors:
                7. Expected Findings:
                8. Laboratory Tests:
                9. Diagnostic Procedures:
                10. Nursing Care:
                11. Therapeutic Procedures:
                12. Medications:
                13. Client Education:
                14. Interprofessional Care:
                15. Alterations in Health:
                16. Safety Considerations:
                17. Complications:

                nursing

                Complete the following topics and use each template to answer it.

                1. Enteral Nutrition: Actions Prior to Administering Intermittent Tube Feeding (RN QSEN – Safety, Active

                a. Learning Template – Nursing Skill,

                2. Total Parenteral Nutrition: Evaluation of Client Response to Therapy (RN QSEN – Patient-centered Care, Active Learning Template – Therapeutic Procedure

                3. Cultural, Ethnic, and Religious Influences: Modifying Diet to Prevent Cardiovascular Disease. Active Learning Template – Basic Concept.

                Complete the following active learning templates:

                1. Respiratory Acidosis –System disorder templates

                2. Respiratory Alkalosis System disorder templates

                3. Metabolic Acidosis system disorder templates

                4. Metabolic Alkalosis system disorder templates

                5. IM Injection including deltoid, vastus lateralis & ventrogluteal injection – Nursing skill templates

                6. Medication: 2 medication templates

                Morphine

                Enoxaparin

                nursing

                ACTIVE LEARNING TEMPLATES TherapeuTic procedure A13

                Therapeutic Procedure
                STUDENT NAME _____________________________________

                PROCEDURE NAME ____________________________________________________________________ REVIEW MODULE CHAPTER ___________

                ACTIVE LEARNING TEMPLATE:

                Description of Procedure

                Indications

                Outcomes/Evaluation

                CONSIDERATIONS

                Nursing Interventions (pre, intra, post)

                Potential Complications

                Client Education

                Nursing Interventions

                1. STUDENT NAME:
                2. PROCEDURE NAME:
                3. REVIEW MODULE CHAPTER:
                4. Description of Procedure:
                5. Outcomes/Evaluation:
                6. Potential Complications:
                7. Client Education:
                8. Indications:
                9. Nursing Interventions:
                10. Nursing Interventions (pre, intra, post):

                nursing

                Factors to consider when selecting the right Training Program for the New Nurse

                Student Name: ______________________________________ Hospital Organization / Entity _________________________________

                Perform a Self-assessment of a Nurse Training Program of your choice. Rate the factors based on importance, value and availability.

                New Nurse Hospital Program Placement Factors

                Not applicable

                N/A (1)

                Not Important/

                or Needed (2)

                Neutral /

                Optional (3)

                Appealing /

                Added Benefit (4)

                Very Important/

                Must Have (5)

                1. Type of program: residencies, fellowships, preceptorship, internships, and externships.

                Ο

                Ο

                Ο

                Ο

                Ο

                2. Length of program; weeks, months, semester

                Ο

                Ο

                Ο

                Ο

                Ο

                3. Full Time or Part Time work

                Ο

                Ο

                Ο

                Ο

                Ο

                4. How the program is administered: preceptorship, clinical rotation, classroom, and/or didactic study.

                Ο

                Ο

                Ο

                Ο

                Ο

                5. Specialties program offered : ICU, Operating Room, pediatrics, ER, Oncology etc.,

                Ο

                Ο

                Ο

                Ο

                Ο

                6. Hospital Entity ROC – Return on commitment: payback in terms of contract, work promissory, time commitment ,etc.

                Ο

                Ο

                Ο

                Ο

                Ο

                7. Educational Benefits: CEU, certifications, CPR, ACLS, PALS, $$ for advance schooling

                Ο

                Ο

                Ο

                Ο

                Ο

                8. Benefits: insurance, discounts, uniforms, location, childcare, EAP, in-house medical, education, etc.,

                Ο

                Ο

                Ο

                Ο

                Ο

                9. Hospital affiliation, recognition, status, parent corporation, county, state, private, nonprofit, number of hospitals, clinics etc.,

                Ο

                Ο

                Ο

                Ο

                Ο

                10. Pay, salary, bonuses

                Ο

                Ο

                Ο

                Ο

                Ο

                Other/additional:

                Add Totals

                Comments:

                nursing

                ACTIVE LEARNING TEMPLATES TherapeuTic procedure A7

                Medication
                STUDENT NAME _____________________________________

                MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________

                CATEGORY CLASS ______________________________________________________________________

                ACTIVE LEARNING TEMPLATE:

                PURPOSE OF MEDICATION

                Expected Pharmacological Action

                Complications

                Contraindications/Precautions

                Interactions

                Medication Administration

                Evaluation of Medication Effectiveness

                Therapeutic Use

                Nursing Interventions

                Client Education

                1. STUDENT NAME:
                2. MEDICATION:
                3. REVIEW MODULE CHAPTER:
                4. CATEGORY CLASS:
                5. Therapeutic Use:
                6. Complications:
                7. Contraindications/Precautions:
                8. Interactions:
                9. Evaluation of Medication Effectiveness:
                10. Expected Pharmacological Action:
                11. Nursing Interventions:
                12. Medication Administration:
                13. Client Education:

                nursing

                1

                Week 1 SOAP Note ADHD

                United State University

                Primary Health of Acute Client/Families Across the Lifespan-Clinical Practicum

                FNP: 594


                Subjective

                ID: Tony Gray, Age: 6 years, Race: Caucasian, Gender: Male, Date of Birth:

                January 5, 2016.

                CC: The mother of the six-year-old child says that her son’s conduct is strange since he is always moving and cannot focus on any one thing for a long period of time. Additionally, she has been told by thechilds teacher that the he is often disrupting classes and is unable to complete assignments.

                HPI: In this case, the patient is a 6 -year-old Caucasian boy who has been experiencing increasing levels of irritability, hyperactivity, and impulsivity over the past month. It is not related to the child’s inability to comprehend instructions. Moreover, the child’s mother claims that the child is not truly defiant. His teacher had previously reported these symptoms three times, so his mother decided to take him to the hospital to be tested because she had tried talking to him and even punishing him, but he did not appear to improve his rebellious behavior. Mother also notes that the child has been experiencing these symptoms since he was two years old, and she initially felt it was due to a developmental milestone, but because the symptoms have persisted, she believes her son is experiencing a problem. My son has never been diagnosed with any chronological disorders.

                Current Medications: There are currently no drugs prescribed for the youngster.

                Allergies: Penicillin causes an allergic reaction in him. Her son has no other known allergies or sensitivities, as far as her mother is aware.

                Past Medical History: When he was three years old, he contracted pneumonia, which was treated successfully as an in-patient. BCG, tetanus/diphtheria/pertussis, and measles vaccines, as well as influenza and pneumonia vaccines, were given to the children. His mother states that he has never had any meningitis and that he is healthy. His son have never been in a traumatic situation before.

                Family History: No medical history of mental disease on either the mother’s or father’s side of the family.

                Social History: Despite the fact that his parents have two other children, the youngster is the middle child in a large family. The oldest sister is a twelve-year-old girl who is free of physical or mental difficulties at this time. The father works as a computer technician, and the mother works as a nurse in the family business. The father smokes and occasionally drinks, although he is not a heavy drinker. The mother does not consume alcohol or smoke.

                Constitutionals: The patient claims that he is not feeling hot or warm. The boy’s mother also disputes that he has lost many weight. She, on the other hand, complains of extreme impulsivity, hyperactivity, and inattention, which are not supported by a lack of understanding. He does not have any sleep problems.

                Respiratory: He is not having any difficulties breathing, and he is not coughing or producing any phlegm.

                HEET: There are no complaints of dry eyes, irritation, or pain from the boy. He is not afraid of bright lights. Neither hearing loss nor tinnitus has been reported, nor has he reported any sneezing. His nose is likewise clear, and there is no pain in the throat.

                Cardiovascular: He is not experiencing any discomfort or pain in his chest.

                Genitourinary: During peeing, the youngster claims that he does not experience any burning. Neither polyuria nor hematuria was present

                Gastrointestinal: There has been no vomiting, dehydration, or diarrhea reported by the mother.

                Musculoskeletal: He claims that he has no muscle soreness or rigidity.

                Psychiatric: An abnormal lack of attention and hyperactivity have been reported by the child’s mother. There are no indications of depression or anxiety in him, according to her.

                Neurologic: He reports having no headache, experiencing instability when walking, experiencing numbness, or experiencing changes in bladder or bladder control.

                Lymphatic: Neither the mother nor the son claims to have experienced any unusual bleeding or exhaustion. There are no swollen nodes.

                Allergic: Eczema or asthma are not mentioned in the family history, according to mom. No additional seasonal allergies have been mentioned by the narrator, as well.

                Endocrine: No one in the family claims to suffer from polyuria or excessive water consumption (polydipsia). As for increased perspiration or heat intolerance, they reject this as well.

                Objective

                Both the boy’s appearance and his nutrition are excellent. Physiological data: Pulse rate: 90; respiration rate: 20; temp: 37°C; blood pressure is 110/70; weight is 25.4kg; height is 51 inches; BMI is 15.1. The child has a normal body weight.

                HEENT: The head is normocephalic and atraumatic, and its contours are typical. Both pupils are equal in size, circular in shape, and responsive to light and adaptation. Extraocular muscles are still in place and functioning. No tenderness is felt while palpating the nasal sinus canals. The tympanic membrane is intact and is neither discharged nor irritated. I do not have any bad breath. In the neck, there are no exudates at all.

                Psychiatric: A state of mind that is in harmony with the information being processed. Fast, yet suitable, answers. Groomed to the highest standards. Restless and fidgety. Inability to focus and maintain eye contact for an extended period of time.

                Neurological: The patient’s cranial nerves and symmetrical reflexes are normal. Being aware of one’s surroundings, including time, space, other people, and the physical location of one’s own body. Motor, sensory, and focus deficits have not been found. 

                Differential Diagnosis

                Combined presentation ADHD: ICD-10-CM-F90.2 As a result of the child meeting the DSM-5 criteria for ADHD, this is the most likely primary diagnosis (Liu et al., 2020). The patient reported signs of the mainly inattentive subtype of ADHD, including trouble paying attention to a specific task, issues organizing chores, careless blunders, losing staff frequently, and appearing as if he is not listening when someone speaks to him. Additionally, the neuropsychological test was carried to rule out the presence of any other cognitive problems, and the results validated the initial diagnosis of ADHD.

                Oppositional defiant disorder: ICD-10-CM-F91.3. This is another differential diagnosis because it generally affects younger children; it is largely characterized by rebellious, disobedient, and disruptive behavior that does not provide delinquent behaviors or more intense kinds of hostile or dissocial behavior but does not exclude these (Liu et al., 2020). Interestingly, the patient did not show up with any symptoms at all. In addition to antagonistic behavior, his actions were not directed at a specific event.

                Autism spectrum disorder: ICD-10-CM-F84.0. This is another likely disorder because the disorder is linked to brain evolution and affects how individuals perceive and interact with other people, producing difficulties with social interaction. (Liu et al., 2020). It was found, through the neuropsychological test, that the youngster is inattentive in every topic, not just one, therefore, ruling out autism disorder.

                PLAN

                Diagnostic lab

                Complete blood count (CBC) to rule out the possibility of anemia due to iron deficiency

                Lead level, thyroid tests are performed to rule out any other organic issues.

                Administer the National Institute for Children’s Health Quality (NICHQ), EEG could be a viable option. A magnetic resonance imaging (MRI) scan may be used to rule out an organic diagnosis (Cash et al., 2017).

                Treatment Plan

                Children’s psychotherapy, as well as the mother’s cognitive behavior therapy and psycho-education, are all options within this umbrella of mental health care (Stoll et al., 2018). Methylphenidate HCL (Ritalin) is a first-line drug with a rapid onset and short duration.Children aged 6 years and up should begin by taking 5 mg before breakfast and 5 mg before lunch. Increase the dose by 5 to 10 mg monthly, up to a maximum of 60 mg per day (Cash et al., 2017). Incorporating an Omega-3 supplementation into one’s diet as an alternative treatment is also a viable option (Chang et al., 2020).

                Health Promotion

                The overall goal of ADHD therapy is to improve a child’s perception of competence and ability to perform. It is recommended that the mother attend a support group for parents of children who have ADHD in order to avoid feeling like an outlier in her situation, Online ADHD resources were also suggested, and the mother was given ADHD pamphlets. (Wong et al., 2019). When she takes medication, she should be aware of the possible adverse effects and be able to report them immediately if they arise (Lankford & Silva, 2021). She should speak with her son’s instructors at school and inform them about the illness that he is suffering from, as well as the fact that he is receiving medicine and counseling.

                Follow-Up

                An evaluation of the medication and therapy regimen will take place after four weeks.

                Constititional/Referral

                Refer to a psychologist for a psychological evaluation of IQ, social/emotional adjustment, and learning impairments. Consult with the psychiatric specialist, to assist with medication coordination, Consult a school psychologist, if additional information is needed (Cash et al., 2017).


                References

                Cash, J., & Glass, C (2017). Family practice quideline (4th ed.). Springer Publishing Company, LLC.

                Chang, J. G., Cimino, F. M., & Gossa, W. (2020). ADHD in children: common questions and answers. American family physician102(10), 592-602.

                Lankford, A., & Silva, J. R. (2021). The timing of opportunities to prevent mass shootings: a study of mental health contacts, work and school problems, and firearms acquisition. International review of psychiatry33(7), 638-652.

                Liu, L., Chen, W., Sun, L., Cheng, J., Su, Y., Rudaizky, D., … & Wang, Y. F. (2020). The characteristics and age effects of emotional lability in ADHD children with and without oppositional defiant disorder. Journal of attention disorders24(14), 2042-2053.

                Stoll, K., Swift, E. M., Fairbrother, N., Nethery, E., & Janssen, P. (2018). A systematic review of nonpharmacological prenatal interventions for pregnancy‐specific anxiety and fear of childbirth. Birth45(1), 7-18.

                Wong, I. Y., Hawes, D. J., & Dar-Nimrod, I. (2019). Illness representations among adolescents with attention deficit hyperactivity disorder: associations with quality of life, coping, and treatment adherence. Heliyon5(10), e02705.

                Nursing

                Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

                1. Complete one Medication Concept Map for the selected drug classes (faculty will pick class of medication based on

                personalized learning platform (PLP) opportunities for improvement from completed PLP concepts).

                2. Include the following sections for each Medication Concept Map. (50 points/100%)

                • Medication – Medication Type

                • Category Class – Drug class

                • Expected Pharmacological Mechanism of Action

                • Therapeutic Uses

                • Contraindications

                • Medication Administration

                • Complications

                • Nursing Interventions

                • Interactions

                • Client Education

                • Evaluation of Medication Effectiveness

                • Fewer than three unique errors in grammar, capitalization, punctuation, and/or spelling are present and if handwritten information is legible.

                3. Concept map template is on page 4 of this guideline.

                For writing assistance (APA, formatting, or grammar) visit the Writing Center.

                nursing

                ACTIVE LEARNING TEMPLATES TherapeuTic procedure A9

                Nursing Skill
                STUDENT NAME _____________________________________

                SKILL NAME ____________________________________________________________________________ REVIEW MODULE CHAPTER ___________

                ACTIVE LEARNING TEMPLATE:

                Description of Skill

                Indications

                Outcomes/Evaluation

                CONSIDERATIONS

                Nursing Interventions (pre, intra, post)

                Potential Complications

                Client Education

                Nursing Interventions

                1. STUDENT NAME:
                2. SKILL NAME:
                3. REVIEW MODULE CHAPTER:
                4. Indications:
                5. Outcomes/Evaluation:
                6. Client Education:
                7. Potential Complications:
                8. Description of Skill:
                9. Nursing Interventions:
                10. Nursing Interventions (pre, intra, post):

                nursing

                Nurse Residency Programs

                Click the blue URL to review a listing of current graduate nurse residency training programs in the state. This list is not inclusive as some openings may have been filed or application deadlines passed.



                20 Best nurse residency program jobs in Texas (Hiring Now!) | SimplyHired


                Methodist Health System NURSE RESIDENT – EMERGENCY DEPARTMENT – JULY 2022 COHORT

                Graduate from an accredited school of nursing; BSN preferred.

                Current American Heart Association Healthcare Provider BLS certification

                Current license to practice professional nursing in the state of Texas by beginning of the residency required.


                Texas Children’s Hospital – Nurse Residency Program (April 2022)

                Our innovative program assists graduate nurses transition from student nurse to professional nurse through a variety of opportunities and an ongoing network of…

                Estimated: $54,000 – $76,000 a year



                RN Intern Nurse Residency

                Medical City Denton – Denton, TX 3.7

                Under supervision, the RN Intern is a new graduate nurse or RN changing specialty that provides safe and effective patient care in accordance with established…

                Estimated: $55,000 – $75,000 a year


                CHRISTUS Health – San Antonio, TX RN, Registered Nurse, Pedi Operating Room

                The Registered Nurse provides clinical supervision for entry level nurses and assists in their development. CHRISTUS Children’s Hospital of San Antonio needs a…



                Nurse Residency Program – Texas Health Huguley – Summer 2021

                Texas Health Huguley Hospital – Burleson, TX 4.2

                Nurse Residents and experienced nurses entering a training program will be under the direct supervision of a preceptor for all principal duties and…



                Graduate Nurse Residency July 2021

                CHI St. Luke’s Health – The Woodlands Campus – The Woodlands, TX 3.5

                The program is designed to be one year in length. The Nurse Residency Program (NRP) is designed to support the new graduate during the transition from the…



                RN Residency – New Graduate Nurse (ICU)

                Ascension – Kyle, TX 3.7

                Become a confident and competent professional nurse. Diploma from an accredited school/college of nursing required OR a bachelors level degree not in nursing,…

                Estimated: $72,000 – $110,000 a year



                RN Residency – New Graduate Nurse (Emergency Department)

                Ascension – Austin, TX 3.7

                Become a confident and competent professional nurse. Diploma from an accredited school/college of nursing required OR a bachelors level degree not in nursing,…

                Estimated: $65,000 – $83,000 a year



                Registered Nurse LDRPN


                CHRISTUS Health
                 – New Braunfels, TX 3.8

                Provides clinical supervision for entry level nurses and assists in their development. An individualized learning plan will be developed through completion of…

                Estimated: $62,000 – $80,000 a year



                RN Intern Nurse Residency

                Medical City Heart and Spine Hospitals – Dallas, TX 
                +2 locations
                3.7

                Under supervision, the RN Intern is a new graduate nurse or RN changing specialty that provides safe and effective patient care in accordance with established…



                RN Nurse Residency

                Valley Regional Medical Center – Brownsville, TX 4.1

                Texas RN License is required to start the residency program. This program will allow new graduates to obtain experience through an intensive internship program…

                Today



                RN Residency Program – October 2021 Cohort

                UT Southwestern – Dallas, TX 3.9

                The residency program begins October 11, 2021. Experience and Education Candidates are new nurse graduates with a minimum of a Bachelor’s degree who have…

                Estimated: $63,000 – $87,000 a year

                7d



                RN Residency- New Graduate Nurse – Pediatric ICU (PICU)

                Ascension – Austin, TX 3.7

                Become a confident and competent professional nurse. Achieve the knowledge, skills, and attitudes required for safe, quality care.

                Estimated: $64,000 – $88,000 a year

                3d



                RN Intern Nurse Residency Behavioral Health

                Medical City Healthcare – McKinney, TX 3.7

                Under supervision, the RN Intern is a new graduate nurse or RN changing specialty that provides safe and effective patient care in accordance with established…

                Estimated: $50,000 – $68,000 a year



                PACU Clinical Nurse Coordinator

                St. David’s Round Rock Medical Center – Round Rock, TX 3.6

                Currently licensed as a registered professional nurse in the state(s) of practice and/or has an active compact license, in accordance with law and regulation.

                Estimated: $64,000 – $88,000 a year



                RN Intern Nurse Residency

                Medical City Heart and Spine Hospitals – Dallas, TX 
                +2 locations
                3.7

                Under supervision, the RN Intern is a new graduate nurse or RN changing specialty that provides safe and effective patient care in accordance with established…



                RN Nurse Residency

                Valley Regional Medical Center – Brownsville, TX 4.1

                Texas RN License is required to start the residency program. This program will allow new graduates to obtain experience through an intensive internship program…



                RN Residency Program – October 2021 Cohort

                UT Southwestern – Dallas, TX 3.9

                The residency program begins October 11, 2021. Experience and Education Candidates are new nurse graduates with a minimum of a Bachelor’s degree who have…

                Estimated: $63,000 – $87,000 a year



                RN Residency- New Graduate Nurse – Pediatric ICU (PICU)

                Ascension – Austin, TX 3.7

                Become a confident and competent professional nurse. Achieve the knowledge, skills, and attitudes required for safe, quality care.

                Estimated: $64,000 – $88,000 a year



                RN Intern Nurse Residency Behavioral Health

                Medical City Healthcare – McKinney, TX 3.7

                Under supervision, the RN Intern is a new graduate nurse or RN changing specialty that provides safe and effective patient care in accordance with established…

                Estimated: $50,000 – $68,000 a year



                New Grad RN

                St. David’s South Austin Medical Center – Austin, TX 3.6

                POSITION SUMMARY: The Graduate Nurse Resident is a registered nurse participating in a specified training program which is standardized based on area of…

                Estimated: $70,000 – $90,000 a year



                Registered Nurse Surg General


                CHRISTUS Health
                 – New Braunfels, TX 3.8

                Provides clinical supervision for entry level nurses and assists in their development. An individualized learning plan will be developed through completion of…

                Estimated: $70,000 – $91,000 a year



                RN Nurse Residency

                HCA Healthcare – Webster, TX 3.6

                Texas RN License is required to start the residency program. This program will allow new graduates to obtain experience through an intensive internship program…

                Estimated: $57,000 – $79,000 a year



                PA Residency Program

                DOC Corporate Group LLC – Addison, TX 

                The TOBJSM residency program was created by Direct Orthopedic Care (DOC) to develop the clinical and business skills of physician assistants in order to build a…

                Estimated: $64,000 – $87,000 a year



                RN Graduate Residency Program Med/Surg 3

                Lake Granbury Medical Center – Granbury, TX 3.3

                Our Registered Nurses integrate standards of care into our daily practice that includes: commitment, effective communication, customer service, responsiveness,…

                Estimated: $64,000 – $85,000 a year



                RN Residency – New Graduate Nurse – Labor and Delivery

                Ascension – Austin, TX 3.7

                Become a confident and competent professional nurse. Achieve the knowledge, skills, and attitudes required for safe, quality care.

                Estimated: $65,000 – $82,000 a year



                Womens Services RN Nurse Residency

                HCA Houston Healthcare West – Houston, TX 

                Texas RN License is required to start the residency program. This program will allow new graduates to obtain experience through an intensive internship program…



                Woman’s Services – RN Residency

                HCA Houston Healthcare Conroe – Conroe, TX 
                +3 locations
                3.6

                Texas RN License is required to start the residency program. This program will allow new graduates to obtain experience through an intensive internship program…


                4199 Professional Role Development Summer 2021

                Nursing

                1. Common Nurse Residency Programs 

                A listing of the common hospital training and nurse residencies has been provided for your review.  Review the entire document to select a training program of interest. Click the link to go to the hospital or entity of choice.  Additional internet research may involve contacting the hospitals’ HR or acquisition and talent office to inquire about information. 

                TX Nurse Residency Listing-3.docx

                Actions  

                Current Nurse Residency Programs in TX.docx  

                Actions

                2. Self Assessment of Nurse Training Programs 

                Use the Self- Assessment tool to evaluate prospective  Nurse Training Programs. Your self-assessment will help determine which training program, benefits, and type of specialty will work best for you.   Rate the factors based on importance, value, education, and availability. 

                RN Training Program Self-Assessment-1.docx

                Actions 

                3. Survey /Critique of Nurse Training Programs: 

                Perform a survey and critique of the Nurse Training Program of your choice. Use the hospital training program factor worksheet (Survey-Critique of Nurse Training Programs) to collect data on the various types of training programs available to new nurses.  Collect and fill in each factor to assist in the evaluation of values and attributes important to you when determining the best hospital placement program to fit your prospective career aspirations and role as a professional nurse.  

                Survey-Critique of Nurse Training Programs-1.docx

                Actions 

                3.  Upload your findings from the Survey-Critique of Nurse Training programs and the RN Training Program Self-Assessment to the Assignment area in Canvas.  Be sure to express what values and options were most important to you based on the types of training programs available.  

                Nursing

                NONVERBAL COMMUNICATION

                This book is dedicated to Sherri, one of the smartest people I’ve ever met.

                Sara Miller McCune founded SAGE Publishing in ���� to support the dissemination of usable knowledge and
                educate a global community. SAGE publishes more than ���� journals and over ��� new books each year,
                spanning a wide range of subject areas. Our growing selection of library products includes archives, data, case
                studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a
                charitable trust that secures the company’s continued independence.

                Los Angeles | London | New Delhi | Singapore | Washington DC | Melbourne

                NONVERBAL COMMUNICATION
                An Applied Approach

                Jonathan M. Bowman

                Copyright © ���� by SAGE Publications, Inc.

                All rights reserved. Except as permitted by U.S. copyright law, no part of this work may be reproduced or
                distributed in any form or by any means, or stored in a database or retrieval system, without permission in writing

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                BRIEF CONTENTS
                Preface
                Acknowledgments
                About the Author
                Chapter � Nonverbal Communication Origins
                Chapter � Nonverbal Communication Features
                Chapter � Identity and the Nonverbal Codes
                Chapter � Kinesics: Engaging Motion and Gestures
                Chapter � Proxemics: Engaging Personal Space and Interpersonal Distance
                Chapter � Haptics: Engaging Physical Contact and Touch
                Chapter � Oculesics: Engaging Gaze and Other Eye Behaviors
                Chapter � Vocalics: Engaging the Voice and Other Vocalizations
                Chapter � Physical Appearance: Engaging Identity and Physical Features
                Chapter �� Environmental Elements: Engaging Fixed and Semi-Fixed Features
                Chapter �� Chronemics and Olfactics: Cultural Codes of Time and Scent
                Chapter �� Nonverbal Communication Moving Forward
                Glossary
                References
                Index

                DETAILED CONTENTS
                Preface
                Acknowledgments
                About the Author
                Chapter � Nonverbal Communication Origins

                Models of Communication
                Linear Model of Communication
                Transactional Model of Communication

                Defining Nonverbal Communication
                Why Isn’t ASL Considered Nonverbal?
                Nonverbal Communication Primacy

                Primacy of Species
                Primacy of Individual
                Primacy of Interaction

                Nonverbal Communication Channels
                Channel Reliance

                A Summary of Nonverbal Communication Origins
                Closing Questions
                Key Terms

                Chapter � Nonverbal Communication Features
                Principles of Nonverbal Messaging

                Nonverbal Messaging Is Ubiquitous
                Nonverbal Messaging Functions in Many Ways
                Nonverbal Messaging Is Widely Used
                Nonverbal Messaging Impacts Meaning-Making
                Nonverbal Messaging Has Primacy
                Nonverbal Messaging Is Ambiguous
                Nonverbal Messaging Is Accepted

                Digital vs. Analog Representations
                Message Processing

                The Attention Stage
                The Comprehension Stage

                Dialogic Comprehension
                Empathic comprehension
                Analytic comprehension

                The Memory Stage
                Nonverbal Communication—Our Innate Ability
                A Summary of Nonverbal Communication Features
                Closing Questions
                Key Terms

                Chapter � Identity and the Nonverbal Codes
                Managing Identities

                Sex and Gender
                Race

                Culture
                Personality
                Other Identities

                Identity, Relationships, and Nonverbal Codes
                Prominent Nonverbal Codes

                Kinesics
                Proxemics
                Haptics
                Oculesics
                Vocalics
                Physical Appearance
                Environment
                Olfactics
                Chronemics

                A Summary of Identity and the Nonverbal Codes
                Closing Questions
                Key Terms

                Chapter � Kinesics: Engaging Motion and Gestures
                Kinesics
                Communication, Movement, and the Face

                Affect Displays
                Neurocultural Theory
                Ekman and Friesen’s microexpressions
                Social signaling

                Communication, Movement, and the Hands and Body
                Illustrators
                Regulators
                Adaptors
                Body Orientation

                A Summary of Kinesics: Engaging Motion and Gestures
                Closing Questions
                Key Terms

                Chapter � Proxemics: Engaging Personal Space and Interpersonal Distance
                Proxemics

                Intimate Zone
                Personal/Casual Zone
                Social/Consultative Zone
                Public Zone

                Proxemic Violations
                Physiological Arousal
                Perceptions and Expectancy Violations Theory

                Deviation
                Valence
                Threat Threshold

                Interactional Motivations
                Similarity
                Difference

                Proximity
                A Summary of Proxemics: Engaging Personal Space and Interpersonal Distance
                Closing Questions
                Key Terms

                Chapter � Haptics: Engaging Physical Contact and Touch
                Haptics and Human Development

                Early Influences
                The Harlow Monkey Experiment

                Classifying Touch
                Types of Touch
                Functions of Touch

                Ritualistic Touch
                Positive Affect Touch
                Control Touch
                Playful Touch
                Task-related Touch
                Hybrid Touch

                Diverse Attitudes Toward Touch
                Affection Exchange Theory
                Attachment Theory
                A Summary of Haptics: Engaging Physical Contact and Touch
                Closing Questions
                Key Terms

                Chapter � Oculesics: Engaging Gaze and Other Eye Behaviors
                Oculesics

                Looking Toward
                Gaze
                Mutual Gaze and Eye Contact

                Eye Movement
                Pupil Dilation

                Oculesics and Emotional Displays
                Attraction/Interest
                Affection/Interest
                Threat

                A Summary of Oculesics: Engaging Gaze and Other Eye Behaviors
                Closing Questions
                Key Terms

                Chapter � Vocalics: Engaging the Voice and Other Vocalizations
                Vocal Characteristics

                Vocal Properties
                Vocal Qualities
                The Use of Silence

                Communication Accommodation Theory
                Principles of CAT
                Strategies of CAT

                Convergence
                Divergence

                A Summary of Vocalics: Engaging the Voice and Other Vocalizations
                Closing Questions
                Key Terms

                Chapter � Physical Appearance: Engaging Identity and Physical Features
                Identity and Self-Esteem
                Theories of Identity
                Group Membership

                Identity Badges
                In-Groups and Out-Groups
                Appearance and Identity

                Natural Features
                Body Shape
                Facial Attractiveness

                Artifacts and Adornments
                Artifacts
                Adornments

                Body Modifications
                Tie-Signs and Expressions of Uniqueness
                A Summary of Physical Appearance: Engaging Identity and Physical Features
                Closing Questions
                Key Terms

                Chapter �� Environmental Elements: Engaging Fixed and Semi-Fixed Features
                Environmental Elements
                Fixed-Feature Environmental Elements
                Use and Volume of Space

                Materials
                Lines and Curves

                Semi-Fixed-Feature Environmental Elements
                Artifacts
                Visual Continua

                Light
                Color

                Environmental Noise
                Sounds
                Temperature

                A Summary of Environmental Elements: Engaging Fixed and Semi-Fixed Features
                Closing Questions
                Key Terms

                Chapter �� Chronemics and Olfactics: Cultural Codes of Time and Scent
                Codes and Culture

                Created by Culture
                Creating Culture

                Group Membership Revisited
                Chronemics

                Biological Chronemics
                Conceptualizations of Time

                Olfactics

                Active Scents
                Passive Scents

                A Summary of Chronemics and Olfactics: Cultural Codes of Time and Scent
                Closing Questions
                Key Terms

                Chapter �� Nonverbal Communication Moving Forward
                Nonverbal Communication in Review

                Communication Potential of the Codes
                Absorbing Popular Media, Moving Forward
                Examining Ethical Behavior, Moving Forward
                Recognizing Diverse Perspectives, Moving Forward
                Assessing the Self, Moving Forward
                Applying Nonverbal Principles Across Contexts, Moving Forward
                A Summary of Nonverbal Communication Moving Forward
                Closing Questions

                Glossary
                References
                Index

                PREFACE
                Aren’t you tired of treating a textbook like an optional feature of a course? I know I am! Nonverbal messaging is
                one of the most exciting topics in the study of human communication, and yet the structure of most course
                textbooks has students disinterested within the first few weeks. It’s not that the entire course is filled with dull
                material; instead, the way that the nonverbal communication course has been constrained by texts has
                underserved students by under-engaging them from the very beginning. As students, teachers, and scholars of
                nonverbal messaging, we are likely familiar with scholarly literature that describes the importance of first
                impressions. Why, then, are we subjected to texts that initially lead to disengaged students, when we know about
                the importance of those first interactions with a course?

                By choosing Nonverbal Communication: An Applied Approach , an instructor can scaffold learning to the pace of
                their own course while taking advantage of the narrative style that keeps students interested. In addition, the
                writing style meets the needs of current students who otherwise disengage with the very material that may aid in
                better navigating those daily experiences in a diverse world. While the nonverbal communication course continues
                to be taught as a foundational course at the advanced sophomore or junior level, most of the textbooks have been
                written at the advanced undergraduate or graduate level and follow a formulaic style. Rather than being written by
                teachers and scholars who have immersed themselves in the lived experience of students, many of these books
                focus on the minutia of nonverbal codes to the exclusion of the relational contexts that best demonstrate an
                application of nonverbal communication research. Indeed, often a text only gains momentum and finally becomes
                a truly engaging read in the last couple chapters.

                Rather than waiting until the end of the semester to get students’ and teachers’ attention, Nonverbal
                Communication: An Applied Approach has taken a narrative style and applied approach that is informed by the
                important theories and research-driven knowledge of our interdisciplinary area of study. At times, such a text may
                need to sacrifice a focus on the minutiae of a particular researcher’s advanced theoretical assumptions and
                comprehensive treatment of a theory in order to better convey the larger goals of that researcher’s work. To be
                sure, most scholars teaching nonverbal communication long for a book that can better engage students and cut
                back on unnecessary complications in what can be read as relatively parsimonious theories. In order for a
                nonverbal communication course textbook to be seen as practical, applied, and worth purchasing, the text must
                take complex course material and breathe life into the work, targeting material to the complex technology-driven
                lives of today’s undergraduates. By covering the same synthesized scholarship with a new narrative style and a
                more consistent structure, the material comes alive without losing the summative knowledge of decades of
                interdisciplinary research.

                ENGAGING THE AUDIENCE
                The textbook Nonverbal Communication: An Applied Approach is aimed primarily at sophomore- and junior-level
                courses in nonverbal communication, regardless of the specific discipline in which the course is taught (e.g.,
                communication studies or psychology). In addition, honors-level faculty could also assign a weekly scholarly
                reading from among the chapter references to supplement the text. Such a course typically has an introductory
                human communication course as a prerequisite that not only introduces human communication but also previews
                the exciting content in nonverbal communication courses, depending upon the institution. At the same time, this
                book is written in such a way as to highlight the needed foundational material so that it can even be taught as a

                stand-alone core or general education course with great facility. Regardless of institution or discipline, the
                nonverbal communication course is typically taken by a major or minor in communication (one of the faster
                growing majors at colleges and universities in North America) or a major or minor in psychology, or perhaps even
                by a student with an interest in marketing or advertising because of the added value of understanding some
                nonverbal communication patterns across contexts.

                STRUCTURE AND FEATURES OF THE BOOK
                While the switch to Nonverbal Communication: An Applied Approach should completely change the level of
                student engagement with the material, the structure of the book is consistent enough with the overall nonverbal
                communication market so as to not require a complete reworking of instructors’ lesson planning. Indeed, the book
                starts off with an overview of both nonverbal messaging and the communication contexts and human behaviors in
                which this universal form of messaging occurs. Moving next to the most significant nonverbal codes, theory-driven
                conversations begin to emerge as students discover those codes in applied situations that they are likely to
                encounter in their own lives. Finally, a few intentional relational contexts at the end of the book allow the student to
                really explore the application of nonverbal course materials in a narrative way.

                The main pedagogical devices for Nonverbal Communication: An Applied Approach include integrated box
                features found in each chapter of the book that highlight important content for the work (rather than serving as
                additional extraneous information, as so often occurs in many academic textbooks). The foci of these boxes will
                include the important application and integration of material, designated by a specific action verb often used in
                nonverbal messaging research. Each chapter includes a box called Measure that focuses on the measurement of
                a nonverbal construct, using methods from nonverbal research to illustrate operationalization. An important series
                of boxes in each chapter that focus on issues of diversity and social justice content are titled Engage, highlighting
                nonverbal communication by including practical, real-world examples of nonverbal communication in diverse
                contexts. Next, a feature in each chapter called Examine includes opportunities for personal reflection as well as
                the consideration of the ethics of nonverbal communication as it relates to each chapter. To illustrate course
                material using modern applications, the Absorb feature references YouTube video clips from current television or
                film to explore a nonverbal communication behavior in an example from recent media. Finally, each chapter
                includes Apply scenarios that help students consider how to practice content related to each section within their
                own social worlds, encouraging students to become more fluent in navigating unique contexts.

                In addition to these newer and innovative pedagogical features, many tried-and-true textbook features are also
                included in Nonverbal Communication: An Applied Approach to ensure that students are able to successfully
                navigate such important course content. These include the use of learning objectives and guiding questions at
                the start of each chapter following an application-based opening vignette, many key terms throughout each
                chapter, an end-of-chapter summary with closing questions, a glossary, and finally, line drawings or
                photographs that help to illustrate essential course content or show contexts in which that content emerges.

                ACKNOWLEDGMENTS
                I’d like to thank my beautiful family (Sherri, Michael, and Nala) who always offer encouragement and prayer
                support. They mean the world to me. I’d also like to thank the incredible team at SAGE led by my editor, Lily
                Norton, and all the people who have made my time at SAGE so lovely: Jen Jovin-Bernstein, Sarah Wilson, Monica
                Eckman, Terri Accomazzo, Gagan Mahindra, and the rest of the group that has been working so diligently behind
                the scenes. Finally, I’d like to acknowledge the hundreds of students both current and former who have made my
                career so incredibly joyful over the years. I can’t wait to see what we accomplish for the world together!

                A COMMUNITY OF SCHOLARS
                Many scholars and teachers came together to ensure that this text more than met the needs of students and
                instructors as they come together to learn about nonverbal communication. Your work and commitment to our
                discipline is without peer. Thanks to the following individuals for their comments on earlier drafts of Nonverbal
                Communication: An Applied Approach:

                Raymond Blanton, The University of the Incarnate Word

                Maria Brann, IUPUI

                Stellina M. A. Chapman, State University New York at New Paltz

                Monica L. Gracyalny, California Lutheran University

                Trey Guinn, The University of the Incarnate Word

                L. Jake Jacobsen, University of Nebraska at Kearney

                Lynn Meade, University of Arkansas

                Sara N. Morgan, Old Dominion University

                Diana Karol Nagy, University of Florida

                Kekeli K. Nuviadenu, Bethune-Cookman University

                Naomi Bell O’Neil, Clarion University of Pennsylvania

                Jillian K. Pierson, University of Southern California

                Robyn Rowe, Missouri State University

                Sheida Shirvani, Ohio University–Zanesville

                Lisa J. van Raalte, Sam Houston State University

                Robin N. Williamson, University of St. Thomas-Houston

                Cheryl Wood, The George Washington University

                ABOUT THE AUTHOR
                Jonathan M. Bowman, PhD,

                professor of communication studies, teaches courses in human communication processes and the methods
                through which we obtain that knowledge about communication. He is heavily involved in the National
                Communication Association where he currently serves as the chair of the Nonverbal Communication Division.
                Bowman’s research focuses on communication processes associated with intimacy and close relationships, with
                publications addressing nonverbal messaging, male friendships, and small-group communication. He has
                authored, coauthored, or edited four books, and his most recent book Masculinity and Student Success in Higher
                Education can be purchased anywhere books are sold. He was the recipient of the National Communication
                Association Ecroyd Award for Outstanding Teaching in Higher Education, the highest teaching honor in the
                discipline internationally, as well as the national Western States Communication Association Distinguished
                Teaching Award. Bowman has also received a Keck Faculty Fellowship for his focus on undergraduate research,
                an Innovations in Experiential Education Award for his commitment to high-impact practices, as well as an
                Outstanding Preceptor Award for excellence in teaching and advising. He serves as a mentor to undergraduates
                in multiple capacities, particularly those students involved in student government, Greek life, academic honors,
                and campus faith-based organizations.

                � NONVERBAL COMMUNICATION ORIGINS

                iStock.com/gorodenkoff

                Learning Objectives
                After reading this chapter you will be able to do the following:

                Explain types of nonverbal primacy

                Compare models of communication

                Define nonverbal communication

                Understand the impact of channel on messaging

                Mika wasn’t thrilled about attending a friend’s start-of-semester get-together, but his new roommate dragged him
                along to the location a few blocks from campus. Mika didn’t know most of the attendees and wasn’t particularly
                motivated to meet someone new, so he spent a lot of time looking at memes on his mobile device or pretending to
                take a few phone calls. After someone spilled a drink on his shoes for what must have been the third time, Mika
                decided to call it a night and head home. Just as he was headed toward the door, he locked eyes with the most
                attractive person he had ever seen. After feeling frozen for what seemed like an eternity, he nodded his head and
                gave a shy smile right as the other person started to turn away. Resigned to leave again, he suddenly saw a smile
                in response out of the corner of his eye. Mika decided to stick around and give the evening another chance as he
                switched his phone to airplane mode and ran his fingers through his hair.

                From the first impressions that we form about one another to the lifelong social interactions that shape and guide
                our lives, communication is the primary social process. Without communication, it would prove nearly impossible
                to navigate our daily lives. Communication allows us to signal a variety of things to one another, from letting our
                caregivers know we are hungry to warning each other about dangerous predators.� Indeed, most living creatures
                engage in some form of communication, from the ants marking a trail toward a picnic basket, to the pride of lions
                using a sophisticated group hunting strategy to avoid starvation. Communication allows groups of creatures—both
                human and nonhuman—to navigate a complex environment that otherwise may be difficult to survive on one’s
                own.� Human communication includes the most complicated forms of messaging, as humans use systems of
                established rule-driven strategies to send messages among themselves for a variety of reasons. Just as we read
                in the story of Mika above, messaging can be subtle; from indicating interest to avoiding interaction, a variety of
                verbal and nonverbal messages help us to move throughout our social world.

                Guiding Questions

                What kinds of messages help form a first impression in a context like the one above?

                How do nonverbal signals impact our social experiences?

                MODELS OF COMMUNICATION
                When considering how humans send messages to one another, it is first helpful to ensure that everyone has a
                similar shared understanding of the basic models of communication. In order to establish a shared vocabulary
                about the process of communication, we begin with the linear model of communication, which focuses on the
                transmission of messages to an audience. Then, we will expand that model to include a more transactional
                understanding of human interaction.

                Linear Model of Communication

                Over �� years ago, scholars Shannon and Weaver came up with a model of communication messaging that is still
                one of the most widely known models of communication today.� As can be seen in Figure �.�, this linear model of
                communication focuses on the transmission of a verbal or nonverbal message to another person or persons.
                Because of that focus on one-way transmissions, the linear model starts with the person who originates the
                message, called the sender. The sender begins the process of encoding, converting his or her thoughts into a
                specific message that he or she hopes an audience will understand. By sending that message through one or
                more channels, or ways of transmitting a message like a phone call or a written document or even a gesture, he
                or she can convey that message directly to the target person, also known as the receiver. Once the receiver has
                heard or seen the message, he or she then begins decoding the meaning from the message and trying to
                understand the intent of the sender. When Cheance receives a text “Starving! Must eat now LOL” from her new
                girlfriend Annabelle, as the receiver she needs to decode the message in an attempt to try to understand what
                Annabelle’s intent was; are they canceling their later reservation and eating separately on their own, or are they
                getting together earlier than they had previously planned?

                Description

                Figure �.� Linear Model of Communication

                Although perhaps not a comprehensive model thus far, we now have a working set of vocabulary terms about
                messaging, as well as a basic understanding of how people send messages to one another. Still, the Shannon
                and Weaver model goes a couple steps further than this general approach, including in the model the concepts of
                context and noise. Context is defined as the setting in which communication occurs, not only the physical location
                but also the time and social situation wherein messaging happens. This context influences both the creation and
                the transmission of a message for a variety of reasons (i.e., influencing the sender’s mood and even restricting the
                channels that they find available to them.) For example, Evan may be interested in sending a particularly funny
                meme to his best friend when he’s in church on Sunday morning, but may not do so, in part because of the
                emotional experience that he’s having or because of his inability to get to his cell phone without offending the
                other congregants around him. As such, that funny text may have to wait until later that day. That being said, if he
                looks across his church congregation and sees Ryan in another pew, he might find himself making a funny face or
                at least trying to catch his best friend’s eye, despite being situated in a context that would suggest other more

                reverent behaviors. The concept of noise, on the other hand, describes any barrier to hearing or understanding
                that detracts from the successful transmission of a message.� Noise might be as simple as a physical sound that
                stops you from perceiving a message (e.g., physical noise), to a mental state that distracts someone from
                correctly understanding a message (e.g., psychological noise). In addition, noise could also be a receiver’s
                physical state like hunger or sleepiness that interrupt his or her ability to decode a message (e.g., physiological
                noise), or even may include a situation where individuals don’t understand these symbols that are being used in
                the message due to specific words or pronunciations (semantic noise). The more noise present in a
                communication context, the more difficult it will be for a receiver to successfully decode the message that a sender
                has encoded. Take a look at an example of one possible effect of noise in this chapter’s Apply feature, next.

                iStock.com/FatCamera

                Box �.� Apply
                Impacts of Noise on a Homecoming Conversation

                Clarice and Sarah had been fighting for a long time. Not only had their mutual friends noticed the lack of
                respect that they had shown to one another at a variety of social events over the past year, but they often
                commented upon the disrespectful eye rolls and sighs that each exhibited when the other walked into the
                room or tried to join the conversation. Finally, Clarice decided that “enough was enough.” At the
                homecoming football game, Clarice finally decided that she and Sarah needed to have a conversation to
                talk over their issues with one another. Right before the halftime show on their way to order food, Clarice
                dragged Sarah away from their mutual group of friends over to a patch of grass away from the snack bar.
                She started a long monologue about their friendship and how they used to be close, taking responsibility
                for her own contribution to the deterioration of their relationship. As they both sat side by side watching the
                marching band on the field, Clarice suddenly realized that Sarah didn’t even know that Clarice was talking.
                With all the distractions on the field, combined with the sounds and the sights of the homecoming
                festivities, Sarah was just enjoying the evening breeze, oblivious to the relational goals of Clarice.
                Discouraged, Clarice decided to stop talking and watch the halftime show herself, vowing to maybe try
                again some other time if she ever got an opportunity.

                Even with the most detailed messaging plan, features of the context or of the relationship can impact our
                communication attempts. The ability of one person to effectively understand the message of another
                person is influenced by a variety of factors.

                APPLY: Consider the features of the context in which Clarice and Sarah just interacted. What were all the
                individual types of noise that impacted the quality of this communication situation? What should Clarice try
                to avoid the next time that she wants to try to reach out to Sarah? How have you had noise disrupt your
                own attempts as messaging?

                Transactional Model of Communication

                The linear model of communication is a relatively decent way to think about how one person might send a
                message to someone else. That being said, most communication is perhaps not quite as one sided as this model

                may suggest. In most situations, people are sending messages at the same time to each other, with each person
                serving as both a sender and a receiver of messages throughout the interaction. The transactional model of
                communication better captures our understanding of that back-and-forth between people, as seen in Figure �.�.�
                In this model, we are able to add in the concept of feedback, which is the verbal and nonverbal responses that
                someone gives in reaction to a message that they are receiving—a set of responses that influence future
                messaging. When Brooke and Adam were discussing restaurants in trying to decide where to have dinner, Adam’s
                funny facial expressions helped her adapt her messaging on the fly; Adam’s happy or sad faces each time that
                she suggested a different cuisine type or location helped her eventually decide that they should order some pizza
                and chill on the couch with a good movie.

                Description

                Figure �.� Transactional Model of Communication

                Besides the addition of feedback, you’ll notice that the transactional model of communication also goes beyond
                simple unidirectional messaging, or one-way messaging in which people take turns alternating between sender
                or receiver. Instead, this model highlights that people take on roles as both sender and receiver at the same time
                (e.g., transactional messaging), with messages and feedback being sent and received simultaneously
                throughout most communication interactions. When Derek got back from a campus retreat having decided that he
                wanted to pursue a calling to become a priest, he knew that it would involve some difficult conversations with
                people he cared about—most of all, his girlfriend Jae-Min. In the conversation, he tried to explain his reasons for
                breaking up with her, while at the same time expressing his love for her and managing the fact that he was
                causing her quite a bit of pain. For her own experience, Jae-Min was working hard to manage her own emotions
                about losing Derek, while also trying to keep alive the spark of hope that Derek seemed to express about his new
                ambitions. Both Derek and Jae-Min sent verbal and nonverbal messages to one another, from their discussions of
                hope to their smiles, anger, and tears. As they have difficult conversations like these, couples are often able to
                manage and adapt their messaging to one another. The tone and manner of these messages can strongly impact
                how people interpret both nonverbal and verbal messages, as evidenced in the popular media highlighted in this
                chapter’s Absorb feature.

                iStock.com/slavemotion

                Box �.� Absorb
                Sarcasm on Popular Media

                Jimmy Fallon is known for his character Sara on The Tonight Show’s popular recurring bit, “Ew!” In the clip
                below, Sara’s friend Addison (played by John Cena) drops by after a long absence, a

                nursing

                Assessment Description

                Advanced registered nursing graduates are entering the profession at dynamic time when

                roles and scope of practice are shifting based on developments in legislation and policy in

                response to the evolving needs of the health care system. Professional nursing

                organizations play an important role in making sure the perspectives of advanced

                registered nurses are heard, and in supporting nurse specialties in their efforts to expand

                their scope of practice and their full participation throughout the health care system.

                For this assignment, you will conduct research on the current scope of practice for your

                specialty and efforts that are being made to expand that scope and the role of the

                advanced registered nurse in positively influencing the health care system. Write a 1,250-

                1,500 word paper that includes the following:

                1. A discussion of the scope of your future role as an advanced registered nurse,

                including any regulatory, certification, or accreditation agencies that define that

                scope.

                2. A discussion of three professional nursing organizations that you think are most

                influential in advancing the scope and influence of advanced nursing. Of these

                organizations, evaluate the one that you would most like to join. How do its goals

                and mission fit in with your worldview and philosophy of care? How might

                membership in this organization improve your practice?

                3. A discussion of a controversial or evolving issue that is most likely to affect your

                scope of practice or role in the next few years. How do you think this issue could

                influence the profession and other stakeholders and why does it matter to the

                advanced registered nurse?

                You are required to cite five to 10 sources to complete this assignment. Sources must be

                published within the last 5 years and appropriate for the assignment criteria and nursing

                content.

                Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and

                formatting criteria and general guidelines for academic writing. Include the completed

                checklist as an appendix at the end of your paper.

                Prepare this assignment according to the guidelines 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 LopesWrite. A link to the LopesWrite

                technical support articles is located in Class Resources if you need assistance.

                Benchmark Information

                This benchmark assignment assesses the following programmatic competencies:

                MBA-MSN

                MSN-Nursing Education; MSN-Acute Care Nurse Practitioner-Adult-Gerontology; MSN-Family

                Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-

                Leadership in Health Care Systems; MSN-Public Health Nursing

                5.3 Evaluate professional organizations and activities that improve one’s practice and influence

                advanced nursing practice.

                Attachments

                MSN-APA Writing Checklist-Student.docx

                nursing

                Comprehensive SOAP Exemplar

                Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.

                Patient Initials: _______ Age: _______ Gender: _______

                SUBJECTIVE DATA:

                Chief Complaint (CC): Coughing up phlegm and fever

                History of Present Illness (HPI): Eddie Myers is a 58 year old African American male who presents today with a productive cough x 3 days, fever, muscle aches, loss of taste and smell for the last three days. He reported that the “cold feels like it is descending into his chest and he can’t eat much”. The cough is nagging and productive. He brought in a few paper towels with expectorated phlegm – yellow/green in color. He has associated symptoms of dyspnea of exertion and fatigue. His Tmax was reported to be 100.3, last night. He has been taking Tylenol 325mg about every 6 hours and the fever breaks, but returns after the medication wears off. He rated the severity of her symptom discomfort at 8/10.

                Medications:

                1.) Norvasc 10mg daily

                2.) Combivent 2 puffs every 6 hours as needed

                3.) Advair 500/50 daily

                4.) Singulair 10mg daily

                5.) Over the counter Tylenol 325mg as needed

                6.) Over the counter Benefiber

                7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms

                Allergies:

                Sulfa drugs – rash

                Cipro-headache

                Past Medical History (PMH):

                1.) Asthma

                2.) Hypertension

                3.) Osteopenia

                4.) Allergic rhinitis

                5.) Prostate Cancer

                Past Surgical History (PSH):

                1.) Cholecystectomy 1994

                2.) Prostatectomy 1986

                Sexual/Reproductive History:

                Heterosexual

                Personal/Social History:

                He has never smoked

                Dipped tobacco for 25 years, no longer dipping

                Denied ETOH or illicit drug use.

                Immunization History:

                Covid Vaccine #1 3/2/2021 #2 4/2/2021 Moderna

                Influenza Vaccination 10/3/2020

                PNV 9/18/2018

                Tdap 8/22/2017

                Shingles 3/22/2016

                Significant Family History:

                One sister – with diabetes, dx at age 65

                One brother–with prostate CA, dx at age 62. He has 2 daughters, both in 30’s, healthy, living in nearby neighborhood.

                Lifestyle:

                He works FT as Xray Tech; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. He is a college grad, owns his home and financially stable.

                He has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. He has medical insurance but often asks for drug samples for cost savings. He has a healthy diet and eating pattern. There are resources and community groups in his area at the senior center but he does not attend. He enjoys golf and walking. He has a good support system composed of family and friends.

                Review of Systems:

                General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.

                HEENT: no changes in vision or hearing; he does wear glasses and his last eye exam was 6 months ago. He reported no history of glaucoma, diplopia, floaters, excessive tearing or photophobia. He does have bilateral small cataracts that are being followed by his ophthalmologist. He has had no recent ear infections, tinnitus, or discharge from the ears. He reported no sense of smell. He has not had any episodes of epistaxis. He does not have a history of nasal polyps or recent sinus infection. He has history of allergic rhinitis that is seasonal. His last dental exam was 1/2020. He denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. He has had no difficulty chewing or swallowing.

                Neck: Denies pain, injury, or history of disc disease or compression..

                Breasts:. Denies history of lesions, masses or rashes.

                Respiratory: + cough and sputum production; denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; he has history of asthma and community acquired pneumonia 2015. Last PPD was 2015. Last CXR – 1 month ago.

                CV: denies chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient.

                GI: denies nausea or vomiting, reflux controlled, Denies abd pain, no changes in bowel/bladder pattern. He uses fiber as a daily laxative to prevent constipation.

                GU: denies change in her urinary pattern, dysuria, or incontinence. He is heterosexual. No denies history of STD’s or HPV. He is sexually active with his long time girlfriend of 4 years.

                MS: he denies arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. denies history of trauma or fractures.

                Psych: denies history of anxiety or depression. No sleep disturbance, delusions or mental health history. He denied suicidal/homicidal history.

                Neuro: denies syncopal episodes or dizziness, no paresthesia, head aches. denies change in memory or thinking patterns; no twitches or abnormal movements; denies history of gait disturbance or problems with coordination. denies falls or seizure history.

                Integument/Heme/Lymph: denies rashes, itching, or bruising. She uses lotion to prevent dry skin. He denies history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties or history of transfusions.

                Endocrine: He denies polyuria/polyphagia/polydipsia. Denies fatigue, heat or cold intolerances, shedding of hair, unintentional weight gain or weight loss.

                Allergic/Immunologic: He has hx of allergic rhinitis, but no known immune deficiencies. His last HIV test was 2 years ago.

                OBJECTIVE DATA

                Physical Exam:

                Vital signs: B/P 144/98, left arm, sitting, regular cuff; P 90 and regular; T 99.9 Orally; RR 16; non-labored; Wt: 221 lbs; Ht: 5’5; BMI 36.78

                General: A&O x3, NAD, appears mildly uncomfortable

                HEENT: PERRLA, EOMI, oronasopharynx is clear

                Neck: Carotids no bruit, jvd or thyromegally

                Chest/Lungs: Lungs pos wheezing, pos for scattered rhonchi

                Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial

                ABD: nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound

                Genital/Rectal: pt declined for this exam

                Musculoskeletal: symmetric muscle development – some age related atrophy; muscle strengths 5/5 all groups.

                Neuro: CN II – XII grossly intact, DTR’s intact

                Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes

                Diagnostics/Lab Tests and Results:

                CBC – WBC 15,000 with + left shift

                SAO2 – 98%

                Covid PCR-neg

                Influenza- neg

                Radiology:

                CXR – cardiomegaly with air trapping and increased AP diameter

                ECG

                Normal sinus rhythm

                Spirometry- FEV1 65%

                Assessment:

                Differential Diagnosis (DDx):

                1.) Asthmatic exacerbation, moderate

                2.) Pulmonary Embolism

                3.) Lung Cancer

                Primary Diagnoses:

                1.) Asthmatic Exacerbation, moderate

                PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]

                © 2021 Walden University Page 4 of 4

                © 2021 Walden University Page 3 of 4

                nursing

                1

                2

                Social Media Campaign

                (B) Community Health Nursing Diagnosis Statement

                Format:

                Increased risk of (identification of health problem or risk) among (affected aggregate or community) related to (etiological to causal statement) as demonstrated by (evidence or support for diagnosis).

                Example:

                Community Health Nursing Diagnosis: Social Isolation of the Elderly: Increased risk of social isolation among the elderly population of xyz county (your county or city) related to lack of social activities due to the current pandemic as demonstrated by above average depression rates among the elderly.

                            This statement clearly identifies the population of interest and the problem, but also gives clues to potential experience activities: Would more interactive activities available on social media be a solution? Or are there safe methods for the elderly to attend activities in the community? Is there adequate bus or transportation for the elderly?

                Refer to:

                · Unit 2 Module 2 of the course for the role of nurses in community health promotion and prevention.

                · Unit 3 Module 3 of the course to understand assessment of the community.

                · Unit 4 Module 4 of the course to assist with identifying the target population.

                (B1) Health Inequity/Disparity

                For the section on
                health inequities/disparities
                , you will identify imbalances of service within your community and provide data to support these imbalances or inequities.  Think about your general population and populations at risk related to your health concern.  For
                health disparity
                you will explain why your
                target population
                is more at risk, being left out, or in need of attention compared to other groups. For example, from your Field Experience did you identify any vulnerable populations of the community who were at a disadvantage for services?  Was insurance, access to services, income, location, lack of understanding contributes to some individuals not receiving higher levels of resources?  You will back up your findings with data from your community.  The data can include statistics supporting poverty levels, transportation services, insurance or lack of insurance, organizations available to community members, etc.……

                Refer to:

                · Unit 3 Module 3 (page 14) of the course for sources and data to assist with the community assessment and identify the inequity/disparity leading to the topic.

                · Unit 3 Module 3 (page 16) of the course for Healthy People 2020 Topics and Objectives.

                (B1a) Primary community and Prevention Resources

                 In this section you will discuss the significant resources you found in your community during the field experience to support prevention/promotion of the health concern.

                Refer to:

                ·
                Unit 3 Module 3 of the course to understand assessment of the community.

                 (B1b) Underlying Causes

                Accurately and logically discuss the underlying causes that contribute to the selected primary health concern. (This may be similar from the information you included in section B1).

                Refer to:

                · Unit 3 Module 3 of the course to understand assessment of the community.

                · Unit 4 Module 4 of the course to assist with identifying problems within vulnerable populations.

                (B2) Evidence-Based Practice

                Logically and appropriately include evidence-based practice article(s) relevant to the selected primary prevention field experience topic. Look for 1 or more articles that provide evidence for strategies, best practices, or guidelines that have been used to improve the problem within communities

                Refer to:

                · Unit 5 Module 5 of the course for Essential Reading to assist with applying evidence-based practice associated with primary prevention.

                · Unit 3 Module 3 (page 16) of the course for Healthy People 2020 Topics and Objectives.

                ·
                WGU library
                for peer-reviewed scholarly article(s) concerning your primary prevention topic

                This is not a section to discuss the reason for the problem in your community. Instead, you should discuss the best practices (EBP) for prevention/promotion of the health concern. Discuss and in-text cite and reference scholarly journal article(s) to support the practices for the primary prevention topic.

                (B2a) Identification of Data

                In this section include relevant data relating to selected field experience topic at the local, state, or national level and discuss your findings. This should include supportive data that your prevention topic is a true problem in your community.

                Refer to:

                · Unit 3 Module 3 (page 14) of the course for sources and data to assist with the community assessment and identify the inequity/disparity leading to the topic.

                *Prior to developing your social media campaign, we recommend reviewing Unit 6 Module 6 of the course Essential Readings and Learning Explorations

                for review of best practices for implementing social media in healthcare. Be sure to download and review the Full CDCynergy pdf from the web link found in the Task Overview of the course.

                (C1) Social Media Campaign Objective

                The description presents a measurable objective of what you hope to accomplish to improve the health concern for your population using the social media campaign.

                Components of the social media campaign objective should include

                · improving what,

                · for whom (target population)

                · by what percent

                · in what time frame.

                Refer to:

                · Unit 3 Module 3 of the course Essential Readings Chapter 12 Foundations for Population Health in Community/Public Health Nursing (page 215)

                (C2) Social Marketing Interventions

                Provide 2 specific population focused social marketing interventions to aid in meeting your objective in section C1. Describe how each intervention would improve the health message related to the selected field experience topic.

                Refer to:

                · Unit 3 Module 3 of the course Essential Reading Chapter 12 Foundations for Population Health in Community/Public Health Nursing (page 215)

                · CDCynergy pdf (page 12, 14) link found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (C3) Description of Social Media Platform

                Describe applications you will use to implement your interventions (e.g. Facebook, Twitter, YouTube, Blogs, Snapchat, Instagram and others) that enable users to create and share content or to participate in social networking (electronic dissemination of ideas).

                Refer to:

                · Unit 6 Module 6 of the course Learning Exploration CDC Social Media Tools

                · Unit 6 Module 6 of the course Essential Reading Chapter 4 Social Media for Nurses: Educating Practitioners and Patients in a Networked World (page 87-103).

                (C3a) Benefits of Social Media Platform

                Discuss how each platform will support preventative healthcare in your target population for your identified health problem.

                Refer to:

                · Unit 6 Module 6 of the course Learning Exploration CDC Social Media Tools

                · Unit 6 Module 6 of the course Essential Reading Chapter 4 Social Media for Nurses: Educating Practitioners and Patients in a Networked World (page 87-103).

                · CDCynergy pdf (page 11) link found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (C4) Benefit to Target Population

                You will Discuss how your
                target
                population will benefit from the social media campaign. Discuss how your target population would benefit from using social media to receive the health care message.

                Refer to:

                · Unit 6 Module 6 of the course Learning Exploration CDC Social Media Tools

                · Unit 6 Module 6 of the course Essential Reading Chapter 4 Social Media for Nurses: Educating Practitioners and Patients in a Networked World (page 87-103).

                · CDCynergy pdf link found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (D) Best Practices for Social Media

                Discuss the general principles for best practice in implementing
                all types
                of social media tools for healthcare marketing.

                Refer to:

                · Unit 6 Module 6 of the course Essential Readings for best practices of social media.

                (E1) Stakeholder Roles and Responsibilities

                stakeholder is someone who has an interest in the health problem and whose support is required for the social media campaign to be successful. Stakeholders have a special connection to you and your involvement in the prevention of the health problem Identify the
                role
                and
                responsibilities
                for each stakeholder

                · They are or could be affected by the social media campaign

                · They are interested in how the social media campaign will impact them

                · They may know what you need to know for the campaign to be successful

                · Points of view from community perspective

                · Communicates your message (e.g. Advertises your campaign)

                Refer to:

                · CDCynergy pdf (pages 20-22) link found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                · Unit 3 Module 3 of the course Essential Reading Chapter 16 Foundations for Population Health in Community/Public Health Nursing (page 267-271)

                (E2) Potential Public and Private Partnerships

                Partners have a working relationship to you and collaborate in an official capacity on the social media campaign. Discuss potential public partnerships relative to implementing your campaign (Public partners are comprised of organizations that are owned and operated by the government and exist to provide services for a community (e.g. law enforcement, healthcare agencies, emergency medical service (EMS), schools). Discuss potential private partnerships relative to implementing your campaign (Private partners is usually composed of organization that are privately owned and not part of the government (e.g. businesses, independently owned institutions, grocery stores).

                Partners:

                · are interested in fulfilling their role in the campaign and staying informed

                · they work together with you to benefit everyone involved

                · help to solve problems by seizing opportunity or sharing resources

                Refer to:

                · Unit 3 Module 3 of the course Essential Reading Chapter 12 Foundations for Population Health in Community/Public Health Nursing (page 209-210)

                · Unit 3 Module 3 of the course Essential Reading Chapter 28 Foundations for Population Health in Community/Public Health Nursing (page 498-500)

                (E3) Timeline

                Discuss in detail the timeline with dates (week 1, week 2, etc.) for implementing the campaign.

                Consider benchmarks (time points) from the planning phase to the evaluation phase.

                Refer to:

                · CDCynergy pdf found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (E4) Evaluation

                Explain how you will evaluate the effectiveness of meeting your measurable objective for the social media campaign. Include a measurement tool.

                Refer to:

                · Unit 3 Module 3 of the course Essential Reading Chapter 12 Foundations for Population Health in Community/Public Health Nursing (page 211-213, 216-217)

                · Unit 7 Module 7 of the course resource links

                · CDCynergy pdf link found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (E5) Cost of Implementing the Campaign

                Discuss the estimated direct/indirect costs of planning, implementing, and evaluating your campaign.

                Refer to:

                · CDCynergy pdf (page 15, 18, 26) found in the Web Links of the Task Overview. Pdf link at the bottom of the page

                (F) Reflection on Social Media Marketing

                Reflect on how the community health nurse can use social media marketing to promote healthier populations (provide one or more examples).



                Refer to:

                · Unit 3 Module 3 of the course Essential Reading Appendix C. Foundations for Population Health in Community/Public Health Nursing (page 594)

                (F1) Reflection on Future Nursing Practice


                Reflect on how you can apply a social media campaign to your future nursing practice (provide one or more examples).

                References

                Centers for Disease Control and Prevention. (2018). The CDC guide to strategies to decrease       smoking in the community. Retrieved from          http://www.cdc.gov/smoking/downloads/PA_2011_WEB.pdf

                Checklist: (see below in red)

                Did you upload your time log with your paper (separately)?

                Did you acknowledge sources, use in-text citations and references for content that is quoted, paraphrased, or summarized?

                Did you demonstrate APA professional communication in the content and presentation of your submission?

                If you need assistance with APA or citations/references please check out the writing center: writingcenter@wgu.edu

                Revised 9/14/2021

                Revised 9/14/2021

                Nursing

                Select a nurse that historically contributed to the advancement of the profession.

                In a 2–3-page paper (not including the title page or reference page), include the following information:

                 

                · Describe the background of the nurse you selected.

                · Discuss the major social issues occurring at the time this nurse lived.

                · Describe two contributions this nurse made to the nursing profession including an explanation of how these two unique contributions influenced current nursing practice.


                ANA Hall of Fame


                American Association for the History of Nursing


                Museum of Nursing History – Slide Show Gallery

                Strout, K. (2012). Wellness promotion and the institute of medicine’s future of nursing report: Are nurses ready? Holistic Nursing Practice 26(3), 129-136.

                nursing

                12

                PATIENT PROFILE AND ASSESSMENT

                Student Name: ________________________________

                Date: _____________________

                I. PATIENT PROFILE: (subjective data)

                Patient Name (initials):_______ Date of Birth: _____________ Birthplace: _______________

                Occupation: ________________________________ Highest grade of formal education: _________

                Age: ______
                Sex: ______

                Race: _______________
                Marital Status: _______________

                Statement of Present Problem and Duration:

                (Reason for seeking medical attention & when problem started)

                A. PATIENT: (Use the words in italic as a prompt for system specific illness/disease, previous hospitalizations that the student should inquire about.

                State what, when, and outcome. Do not leave any section blank. If no problems, state none or patient denies problems.)

                Neurological: (headaches, migraines, weakness, ataxia, tics, tremors, seizures, vertigo, syncope, diminished sense of smell, touch, sensation, taste, numbness, tingling, head injury, LOC)

                Psychological: (depression, anxiety, eating disorder, schizophrenia, bipolar disorder)

                Integumentary: (eczema, seborrhea, alopecia, skin cancer, hives, dryness)

                Eyes: (glaucoma, cataract, vision problems, wears corrective lens)

                Ears/Nose/Throat & Neck: (
                difficulty hearing, use of hearing aid, dental caries, bleeding gums, sinus problems, nose bleeds)

                Respiratory: (COPD, emphysema, asthma, bronchitis, sarcoidosis, pneumonia, tuberculosis, shortness of breath, cough)

                Cardiovascular:
                (heart problems, hypertension, chest pain, palpitations, myocardial infarction, coronary artery disease, valvular disorder, atherosclerosis, thrombophlebitis, varicose veins, edema)

                Gastrointestinal: (indigestion, ulcer, gastric reflex disease, dysphagia, gallbladder disease, pancreatitis, bowel disorders, hemorrhoids, constipation, diarrhea, incontinence, meal pattern, special needs, cultural restrictions, appetite)

                Urinary: (kidney disease, incontinence, kidney stones, nocturia, hematuria, urgency, retention, dialysis, end stage renal disease)

                Musculoskeletal: (muscle weakness, decreased range of motion/mobility, joint pain/stiffness/swelling, leg cramps, back pain, history of trauma, arthritis)

                Male Reproductive:

                (testicular mass/cancer, erectile dysfunction, impotence, undescended testicle, prostate disease/cancer, dysuria)

                Female Reproductive: (labial/vulvular pain/swelling, painful intercourse, uterine/ovarian problems, PID, dysmenorrhea, irregular menses, menopause, breast disease)

                Endocrine: (diabetes, thyroid disease, goiter)

                Lymph Nodes: (lymphoma, Hodgkin’s disease)

                Hematological: (leukemia, anemia, hemophilia, bruising, blood transfusions~when and why)

                Immunological: (frequent infections, diminished immune status, human immunity virus (HIV) infection)

                Surgical History: (what for, when, any complications or adverse reaction to anesthesia)

                Current Medications
                : (use attached medication list form)

                Prescription:

                Over-the-counter (OTC):

                Herbals:


                Vitamins

                Allergies:

                Drugs:


                Food:


                Environment
                :

                Immunization status: (tetanus, diphtheria, pneumonia, influenza)

                Disabilities/Handicaps/Impairments:

                Functional abilities related to: (I = Independent; P = Partial assist; C = Complete)

                Identify ability to perform:

                · Bathing

                · Dressing

                · Toileting

                · Mobility

                · Eating

                · Bowel & bladder function

                B. FAMILY:
                (any serious, chronic or recurring illness or disease among immediate family members:


                1st generation = parent, child, sibling, or 2nd generation= grandparent, aunt, uncle)

                III. HUMAN DIMENSIONS:

                A. Social:

                Alcohol use:

                Tobacco use:

                Illicit drug use:

                Caffeine consumption:

                Work environment, past & present: (outdoor, office, healthcare, industrial, chemical exposure, heavy equipment)

                Home Environment:

                Psychosocial: (lives alone, roommate, family)

                Physical: (single family home, apartment, nursing home, is there adequate space & privacy)

                Support systems: (Interpersonal relationships/communication with others)

                Characteristic Patterns of Daily Living: (usual daily routine)

                B. Spiritual:

                Life Values: (what is important in life):

                Advance Directives / End of life Issues (patient’s feelings and beliefs about heroic measures to
                prolong life, life support through artificial means, and/or organ donation)

                C. Cultural:

                Perception of health & illness: (what is seen as a state of being healthy, to what degree must health be altered for one to be considered ill)

                Beliefs about illness: (curse, punishment, need for medications, blood product)

                Reliance on folk medicine or home remedies: (Are such measures routinely used in lieu of conventional healthcare, what are some common practices if any)

                Communication:

                First Language: English_____ Other (name) ______________________________

                If English is not 1st language, is the patient able to express him/herself? _________

                D. Emotional:

                Recent experience and effects of significant loss (death, divorce, relocation)

                Coping (strategies used and effectiveness)

                Patient’s presentation: (sad, angry, anxious, flat, apathetic, optimistic, happy, etc.)

                E. Prevention and Health Maintenance Activities:

                Sleep pattern: (how many hours/24hour period, feel rested afterward, use of sleep aids)

                Nutrition: (daily consumption of fruits, vegetables, whole grain foods, food storage and shopping practices)

                Exercise: (type and frequency)

                Stress Management: (what techniques are used and effectiveness)

                Use of Safety Devices: (walker, cane, seat belts, motorcycle/bicycle helmet, sports equipment etc)

                Health Check-ups: (self breast or self testicular exams, PSA, Pap smear, vision and dental exams)

                F. Developmental Stage:

                Anticipated:

                Actual:

                G. Learning Needs:

                Education needs (diet, activity, and medications: ________________________________

                Factors that might influence ability to learn: _____________________________________

                Readiness and motivation to learn: _____________________________________________

                Potential barriers to learning: __________________________________________________

                Source and Reliability of Information: (patient, family/significant other, chart)

                1V. DIAGNOSTIC TESTS and LABORATORY DATA

                Diagnostic Test

                Patient Value

                Normal Range

                Interpretation

                V. Physical Examination: (objective data)

                General appearance:

                Height: ___________
                Weight: _________lbs.
                _________kg

                Vital Signs: Temp: ______ Pulse: ______ Respirations: _______ Sa02_________

                BP: (lying) _____________
                (sitting)____________
                (standing) ____________

                Pain: On 0 – 10 scale = __________

                Body movements/tremors:

                Breath odor:
                Alcohol_____
                Fruity_____
                Bad breath_____ Normal______

                Fingernails:
                Clean __ Dirty __ Filed__
                Rough__ Evidence of biting__

                Hygiene/grooming: Clean__ Body odor__
                Neat__
                Disheveled__

                Speech: Clear__ Unclear__
                Loud__ Soft__ Spontaneous__
                Halting ___

                Neurological Status:

                Glascow Coma Scale

                Best Eye Response

                Spontaneously

                4

                To speech

                3

                To pain

                2

                No response

                1

                Best Motor Response

                Obey verbal command

                6

                Localizes pain

                5

                Flexion-withdrawal

                4

                Flexion-abnormal *

                3

                Extension-abnormal **

                2

                No response

                1

                Best Verbal Response

                (record “T” if intubated or has a tracheostomy)

                Oriented x 3 ***

                5

                Conversation-confused

                4

                Speech-inappropriate

                3

                Sounds-incomprehensible

                2

                No response

                1

                *Abnormal flexion-decorticate rigidity

                ** Abnormal extension- decerebrate rigidity

                *** Appropriate conversation

                Score

                Jarvis, C. (2000). Physical Examination and Health Assessment. W.B. Saunders Company: Philadelphia.

                Pupils: Equal ___Unequal ___ Reaction to Light:

                Pupil size: ______________

                1

                2

                3

                4

                5

                6

                7

                8

                (

                (

                (

                (

                (

                (

                (

                (

                Movement of Extremities: Spontaneous ____
                Painful Stimuli _____
                None _____

                Equal _____
                Unequal ____ Purposeful _____ Non-purposeful _____

                Cranial Nerve Assessment: Smile: equal unequal Gag: present absent

                Cough: present absent

                Shoulder shrug: equal unequal Hand grasp: strong equal unequal flaccid

                Cardiovascular Status:

                Heart sounds: S1S2 ____ S3 _____ S4 ___ Murmur: ____ JVD: ____ cm

                Pulses:
                Apical ______
                Radial _____ Brachial _____ Popliteal ______ Pedal ______

                Pulse grading: 3+- full bounding 2+ normal 1+- weak, thready 0-absent D-Doppler

                Capillary Refill: Normal (2 sec) _____ Slow (> 2 sec) _____ BP:_____ CVP: _____

                Edema: Yes No If yes: Non-pitting ____ Pitting:____ 1+ ___ 2+ ___ 3+ ___ 4+ ___ Location:______________________________

                IV access (circle all that apply): Peripheral IV PICC Triple lumen catheter

                port-a-cath Quinton AV fistula AV graft Other(describe): ______________________

                Location of access device(s): _______________________________________________

                Intravenous Solution infusing ______________________________@ __________ml/hr

                Respiratory Status: (Include oxygen administration)

                Pulse Ox ______%

                Oxygen Therapy (circle): None Nasal Cannula Venti-mask Simple mask 100% non-rebreather mask

                Breath Sounds: Present: R / L Absent: R / L

                C

                Clear

                CR

                Crackles

                RH

                Rhonchi

                W

                Wheeze

                RUL: ________
                LUL: _______

                RML: ________
                LLL: _______

                RLL: ________

                Clears with suctioning: yes no Chest movement: Equal ___Unequal ____

                Secretions: Yes/ No If Yes: Color ___________
                Amount _______ Consistency __________

                Chest Tube(s): Number________ Suction________ Gravity _______

                Tracheostomy: Yes____ No ____

                Gastrointestinal Status:

                Abdomen: Soft ___ Flat ____ Obese ___ Firm ___ Distended ___ Round ___ Tender ___

                Non-tender ___

                Bowel Sounds: Present ____
                Hypoactive _____ Hyperactive ______ Absent ______

                If bowel sound(s) absent identify which quadrant(s)______________________

                Date of Last Bowel Movement _________________
                Consistency ______________

                Blood in stool ___ Diarrhea ____ N/V ______

                Diet: Type _______________
                Amt Consumed _________% NPO _____

                Nasogastric or Gastrostomy Tube: Type _________________ To Suction __________

                Nasogastric or Gastrostomy Output: Amount________
                Color __________

                Nasogastric or Gastrostomy feeding:
                Type, Amount, Freq. _______________________________

                Genitourinary Status:

                Self voiding ____ Incontinent _____ Indwelling Foley Catheter _____ Size____

                Urine Color ___________
                Clarity ________Sediment _________

                Bladder Irrigation _____
                Color: ___________ Clots ______

                Intake and Output _______/_______

                Musculoskeletal Status:

                Pain ___ Swelling ___
                Deformity ____ ROM: Limited _____________ Full ____

                Ambulation: self______ assist_____ assistive device______/type______________________

                Integumentary Status:

                Intact ____
                Lesions ___
                Warm ___
                Cool ____
                Dry ____
                Diaphoretic _____

                Turgor: Normal ____
                Decreased ___

                Edema: Absent ____ Present ____ Site __________________________ Degree __________

                Color: Normal ___
                Pale ___ Cyanotic ___ Mottled ___
                Jaundiced ___
                Flushed ___

                Mucus Membranes: Dry ___ Moist ____

                VII. Risk Assessments

                A. Fall (1 yes = slight fall risk, 2 = moderate fall risk, 3+ = high fall risk)

                (Fall precautions must be instituted for any patient with at least 2 risk factors)

                Above age 65

                Y / N

                Abnormal mental status

                Y / N

                CNS Depressants

                Y / N

                Needs Assistance with elimination

                Y / N

                Protective Devices (restraints)

                Y / N

                Braden Pressure Ulcer Risk Assessment (Skin Breakdown)

                Sensory Perception

                1. Completely Limited:

                Unresponsive (does not moan, flinch or grasp) to painful stimuli due to diminished level of consciousness or sedation. Or limited ability to feel pain over most of body surface.

                2. Very Limited:

                Responds only to painful stimuli. Cannon communicate discomfort except by moaning or restlessness. Sensory impairment limits the ability to feel pain or discomfort over ½ of body.

                3. Slightly Limited:

                Responds to verbal commands but cannot always communicate discomfort or need to be turned. Or has some sensory impairment which limits ability to feel pain or discomfort in 1 or 2 extremities.

                4. No Impairment:

                Responds to verbal commands, has no sensory deficit which would limit ability to feel or voice pain or discomfort.

                Score

                Moisture

                1. Constantly Moist:

                Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned.

                2. Very Moist:

                Skin is often, but not always, moist. Linen must be changed at least once a shift.



                3. Occasionally Moist:

                Skin is occasionally moist, requiring an extra linen change approximately once a day.

                4. Rarely Moist:

                Skin is usually dry, linen only requires changing at routine intervals.



                Activity

                1. Bedfast:

                Confined to bed.

                2. Chairfast:

                Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair.

                3. Walks Occasionally:

                Walks occasionally during the day, but for very short distances, with or without assistance. Spends majority of each shift in bed or chair.

                4. Walks Frequently:

                Walks outside the room at least twice a day and inside room at least once every 2 hours during waking hours.



                Mobility

                1. Completely Immobile:

                Does not make even slight changes in body or extremity position without assistance.

                2. Very Limited:

                Makes occasional slight changes in body or extremity position but unable to make frequent or significant changes independently.

                3. Slightly Limited:

                Makes frequent though slight changes in body or extremity position independently.

                4. No Limitations:

                Makes major and frequent changes in position without assistance.



                Nutrition

                1. Very Poor:

                Never eats complete meal. Rarely eats more than 1/3 of any food offered. Eats 2 servings or less of protein (meat or dairy products) per day. Takes fluids poorly. Does not take a liquid dietary supplement. Or is NPO and/or maintained on clear liquids or IV’s for more than 5 days.

                2. Probably Inadequate:

                Rarely eats a complete meal and generally eats only about ½ of any food offered. Protein intake includes only 3 servings of meat or dairy products per day. Occasionally will take a dietary supplement. Or receives less than optimum amount of liquid diet or tube feeding.

                3. Adequate:

                Eats over half of most meals. Eats a total of 4 serving of protein products per day. Occasionally will refuse a meal, but will usually take a supplement if offered. Or is on a tube feeding or TPN regimen which probably meets most of nutritional needs.

                4. Excellent:

                Eats most of every meal. Never refuses a meal. Usually eats a total of 4 or more servings of meat or dairy protein products. Occasionally eats between meals. Does not require supplementation.



                Friction and Shear

                1. Problem:

                Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring repositioning with maximum assistance. Spasticity, or agitation lead to almost constant friction.

                2. Potential Problem:

                Moves feebly or requires minimum assistance. During a move, skin probably slides to some extent against sheets, chair, restraints, or other devices. Maintains relatively good position in chair or bed most of the time but occasionally slides down.

                3. No Apparent Problem:

                Moves in bed and in chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair at all times.

                Note: Patients with a total score of 18 or less are considered to be at risk of developing pressure
                Total Score = ulcers.

                (19 – 23 = no risk. 15 – 18 = low risk, 10 – 12 = high risk, < 9 = very high risk)

                Source: Perry and Potter page 1288-1289

                Indicate on Anatomical diagram any amputations, presence of wound(s), bruises, skin tears, rashes, or other types of skin impairments.

                image1.png

                IX. Discharge Planning Needs

                X. Prioritized List of Nursing Diagnoses (Based on Preceding Assessment Data) at least 3.

                Prince George’s Community College

                Department of Nursing

                NUR 1020 – Foundations of Nursing Practice

                Medication Sheet to Accompany Patient Profile and Assessment

                Name & Classification

                Actions of the drug & Why is your patient receiving this drug

                Patient Dosage

                &

                Safe dose range

                Common Side Effects

                Nursing Implications

                Generic:

                Brand:

                Functional

                Classification:

                Generic:

                Brand:

                Functional

                Classification:

                Nursing

                Good afternoon,

                Please I want you to write on the informatics this time around. I have uploaded the rubric for what we supposed to write. A page note with AP format.

                Please I want you to relate what you are writing to the patient we are working with in clinical. You have not been doing this since you have been writing the QSEN for me which gives me more work to do.

                A reference should be cited as well.

                Please do a great work for me, I don’t want to be doing any extra work.

                Nursing

                Drugs Affecting the Blood

                NSG 220

                This Photo by Unknown Author is licensed under CC BY-SA-NC

                1

                Types of Drugs

                Thrombolytics

                “Clot Busters”

                Highest Bleed Risks

                Anticoagulants

                Treat and prevent thrombosis “clot”

                MOA (mechanism of action)- Inhibits Vit. K in the liver that interferes with the blood clotting mechanism by blocking thrombin

                Antiplatelets

                Lower platelet aggregation

                Mechanism of action- prevent platelets from clogging up

                2

                Antiplatelets

                Indicated for: Ischemic strokes, TIA (transient ischemic attacks), unstable angina, coronary stenting, Acute MI, previous MI & prevention of MI

                Aspirin “salicylic acid” ASA

                PO, IV and rectal preparations

                Too much “ASA toxicity”

                Tinnitus- ringing in ears- high doses or long-term use

                Elevated blood pressure and tachycardia –possible bleed

                Contraindicated for patients with thrombocytopenia

                Clopidogrel (Plavix)- po only

                Indicated for: Strokes (CVA), prevent stenosis of coronary stents

                Takes effect with 2 hrs. of the first dose, peak effect 3-7 days of treatment

                Administered with PPI (proton-pump inhibitors) such as Omeprazole to prevent GI bleeding, however, can also reduce the efficacy of Clopidogrel

                Discontinue at least 5 days before surgery d/t bleeding risk

                Dipyridamole (po & IV)

                Indicated for prevention of thromboembolism following heart valve replacement

                given w/other antiplatelets- Aspirin

                Aside effects- headache, dizziness, & GI disturbances

                Ticlopidine (po)

                Indication: CVA prevention and coronary artery occlusion

                Can be given with aspirin or for patients who can not take aspirin

                Platelets (thrombocytes) are cells in the blood that clump together to begin the clotting process. They are the first responders when there is injury. They also initiate the inflammatory response of the innate immune system. The four main platelet functions are:

                3

                Antiplatelets

                Prevent platelets from forming clots, DO NOT decrease the number of clots

                Indication: post MI/ACS or to prevent MI, CVA, TIA, PAD (peripheral artery disease) & prevent re-occlusion of vessels

                Before you administer the medication

                Monitor labs

                Hemoglobin- if less than 7

                Platelets – (150,000-400,000)

                ***less than 150K- Call the provider, *less than 50K- Urgent

                Hold the medication for abnormal labs, Notify the provider

                Anticoagulants

                Drugs used to prevent and treat “thrombosis”

                Venous thrombi “stagnate” develop when blood flow is slow – when blood settles, fibrin is produced causing the red blood cells and platelets to form a thrombus.

                Thrombosis- 2 types

                Venous-blood clot in the vein

                Venous thrombus has a tail that can break off causing an embolus

                Embolus can travel to the lungs causing a pulmonary embolism

                Arterial- blood clot in the artery.

                Harmful effects are local causing blockage and decrease perfusion to area or organ(s)

                Anticoagulants

                Used for: prevention growth of “existing clots and/or new clots”

                Do not dissolve clots

                Indicated for: prevention of DVT

                MOA: blocks the formation of fibrin (forms seals on clots)

                Administration: IV or subcutaneous

                Monitor Labs: pTT (46-70)

                (the lower the number the thicker the blood, the higher the number the thinner the blood)

                **Dosage of medication will be based on these labs.

                Anticoagulant Drugs

                Heparin (Administered IV or subcutaneous

                MOA: Activation of antithrombin, resulting in the activation of factor Xa and thrombin

                Prescribed short-term (days to weeks)

                Works quickly within minutes (usually 20mins)

                Usually given for DVTs or after MI (heart attack) to prevent clots from growing

                Low Molecular Weight heparin (Enoxaparin and Dalteparin)

                MOA: Activation of antithrombin, resulting in the activation of factor Xa and thrombin and some activation of thrombin

                Administered subcutaneous only (never aspirate or rub the site)

                Patient can administer this medication at home

                Assess H & H (hemoglobin and hematocrit) and blood pressures that drop by 20 points

                Monitor platelets – ***HIT**

                Warfarin (po only)

                MOA: Activation of antithrombin, resulting in selective inactivation of factor Xa

                Takes days to take effect (usually 5 days) but last a long time once taken

                Life-long therapy – Most patients have to take it rest of their life was started

                Monitor labs for frequently (daily for 5 days) for therapeutic ranges (INR, but also Prothrombin time (PT)

                Clinical Pearl- A patient who is started on heparin in the hospital can start taking coumadin. They CAN be taken at the same time.

                Patients who take warfarin will often be referred to coumadin clinics. Where there labs are monitored frequently

                Monitor for HIT (half of the platelets are decreased with 24 hours after starting heparin/low molecular heparin

                7

                Monitor

                Labs

                Heparin – monitor aPTT

                If ptt is over 70 stop the heparin drip

                Any signs of bleeding (iv site, urine) stop the infusion- notify provider

                Antidote – protamine sulfate

                Warfarin- monitor INR

                Antidote – Vitamin K ***do not give Vit K unless the patient has had warfarin for 5 days (after switching from IV Hep)

                Teach patient to eat vit K in moderation when eating.

                Eat leafy green vegetables and foods such as liver.

                Bacteria in the intestine produces vitamin K. When antibiotics are taken, they kill the bacteria and

                Antibiotics increase INR.

                8

                Thrombolytics

                Used to treat emergency conditions: CVA (cerebral vascular accident), MI (myocardial infarction, PE (pulmonary embolism) & other conditions (i.e., clot removal from central line or dialysis catheter)

                Medications: Alteplase, Reteplase, Tenecteplase

                MOA: break down, or lyse of fibrin in thrombi (usually dissolve newly formed clots)

                Administration: IV only

                **only drug that dissolves clot**

                Usually given within 3-4.5 hours from onset of symptoms

                No new injections at all. The IV’s (usually 2) is what you will use. No other injections. Never through central lines

                If you make the H for heparin it looks like 2 tt’s crossed. You can use this to remember which lab to watch

                9

                Memory Tricks

                Anticoagulants

                Platelets 150K-400K

                <150 K

                <50 K critical low = “Thrombocytopenia”

                Heparin

                pTT – “2 t’s make the letter H”

                46-70 pTT

                Warfarin (in=“IN”r)

                INR 2-3 Therapeutic Range

                Antiplatelets – monitor “platelets”

                clopidogrel

                Aspirin

                Abciximab

                Memory Tricks (cont.)

                AVOID any patients with active bleeding

                with liver problems because liver makes coagulation factors (vitamin K). No vitamin K (clotting factor= risk of bleeding)

                Peptic ulcers (bleeding)

                Think about any situations that can cause or a concern for bleeding (i.e., medications, disease process, sign or symptoms of bleeding)

                Patient teaching

                Safety

                Environment (situations in which patient can injure themselves) rugs, dim rooms

                Patient care

                Soft bristle toothbrushes, no razors, no flossing, avoid constipation, no alcohol-based mouth wash,

                Always wear a medical alert bracelet

                Avoid trauma where injuries can occur

                Nursing

                Power point presentation  Topic is : Endometriosis 

                 

                Assignment Prompt

                For this assignment you will create an engaging, 20-minute recorded presentation of a common health problem related to a particular body system. Presentations topics will be assigned by the end of Week 1. This assignment may be completed alone or in groups of 2-3 people. 

                Your presentation should include an overview of the health problem identified, an in-depth review of the associated anatomy and physiology, an overview of treatment methodologies, and information related to the needs of the patient and/or family related to the problem. Your presentation should be prepared in PowerPoint, and recorded with voice over narration.

                The presentation will be graded in two areas; in the dropbox by your instructor for the content and other items on the rubric, and the second grade will come from posting it as a discussion and responding to your peers’ presentations. 

                You need to post your presentation to the D2L Discussion Forum as an attachment in a new thread. You will also submit the assignment to the dropbox.  Since the presentation is also a discussion, the initial post will be due on Thursday in the discussion board. If the student wishes to incorporate feedback from their peers, they may improve their presentation, and the final product will be submitted to the dropbox by Monday night. 

                Expectations

                • Due: Monday, 11:59 pm PT
                • Length: 10-12 slides in length (excluding title and reference slides, with a maximum recording length of 20 minutes)
                • Format: PPT titled as follows:
                  • Last name_DiagnosisPresentation1_mmddyyyy
                  • Example: Billingsley_DiagnosisPresentation1_01172015

                Nursing

                Good evening Dr.

                Please I want you to write a page of clinical journal. I sent to the format which we will follow to write the journal.

                I will like you to write on teamwork and collaboration for this week. I was assigned to Tech staff that assisted the patient with their ADL activities. I was assisting her given shower, changing patient, feeding the patient, making bed and so on, I also assist the other tech too.

                I have to back it up with an example which we can site the citation but if you didn’t use any, please don’t site it.

                It should be a page with APA format.

                This is call QSEN, I think you should be familiar with that.

                Please I need to submit all this tomorrow. Please this is my first clinical which is due every Sunday.

                nursing


                Clinical Documentation Template


                Directions:
                Students may use this general SOAP note template or their own. Save a copy to your device to alter the document. Use APA when called for by the rubric or assignment prompt. The APA title page will be the first page, and the template will start on the second page. End with your APA formatted references. Keep in mind this template is structured for an average, problem-focused visit. This template will not be adequate for some special populations and situations (newborns/pregnancy visits/child wellness, etc.). Students need to use good clinical judgment and make additional headings and sections when needed and remove others as applies.

                Consider viewing the EMS documentation guidelines from the US Department of Health and Human Services/CMS:


                Documentation Guidelines – Reimbursement


                Delete all text in red – these are instructions and not part of the SOAP document.

                Student Name and clinical course: (If no title page): ______________________

                ID:

                Client’s Initials*:_______Age_____ Race__________Gender____________Date of Birth___________

                Insurance _______________ Marital Status_____________

                *It is recommended to include false initials and use Jan 1, XXXX (correct year) to protect client confidentiality. Include brief statement on whether the patient came to the clinic alone or accompanied, and if so by whom, and whether they are a reliable historian.


                Subjective:



                CC: Patient’s own words, a few words, a sentence or less. Example: “cough and fever”

                HPI:

                In paragraph format, including at the minimum OLDCARTS. Please start with demographics: AA, a 29 y.o. Asian female presents to the clinic alone with complaint of _____________.

                Onset, Location, Duration, Characteristics/context, Aggravating factors or Associated symptoms, Relieving Factors, Treatment, and Timing, Severity. Include any pertinent positives or negatives.

                ROS (write out by system): Comprehensive (>10) ROS systems for wellness exams or complex cases only. Do not include all 14 systems for every SOAP unless needed – review and document the
                pertinent systems.
                Do not include diagnoses – those belong in PMH. The below categories are per CMS guidelines.

                Constitutional:

                Eyes:

                Ears/Nose/Mouth/Throat:

                Cardiovascular:

                Pulmonary:

                Gastrointestinal:

                Genitourinary:

                Musculoskeletal:

                Integumentary & breast:

                Neurological:

                Psychiatric:

                Endocrine:

                Hematologic/Lymphatic:

                Allergic/Immunologic:

                Past Medical History:

                · Medical problem list

                · Preventative care: (if applicable to the case – Paps, mammography, colonoscopy, dates of last visits, etc.)

                · Surgeries:

                · Hospitalizations:

                · LMP, pregnancy status, menopause, etc. for women

                Allergies:

                Food, drug, environmental

                Medications: include names, doses, frequency, and routes, and reason in parenthesis if off-label or secondary use

                Family History:

                Social History:

                -Sexual history and contraception/protection (as applies to the case)

                -Chemical history (tobacco/alcohol/drugs) (ask every pt about tobacco use)

                Other: -Other social history as applicable to each case (diet/exercise, spirituality, school/work, living arrangements, developmental history, birth history, breastfeeding, ADLs, advanced directives, etc. Exercise your critical thinking here – what is pertinent and necessary for safe and holistic care)


                Objective

                Vital Signs: HR BP Temp RR SpO2 Pain

                Height Weight BMI (be sure to include percentiles for peds)

                Labs, radiology or other pertinent studies: be sure to include the date of labs – might be POC tests from today

                Physical Exam (write out by system):

                Start with a general survey:




                Assessment

                (you will often have more than one diagnosis/problem, but do the differential on the main problem)

                Differentials (with a brief rationale for each):

                1.

                2.

                3.

                Diagnosis (may have more than one, include ICD-10 if rubric or as your instructor specifies)


                Plan
                (4 pronged-plan for each problem on the problem list)



                Diagnostics:

                Treatment:

                Education

                Follow Up:

                List plan under each Diagnosis.

                Example

                1: Hypertension (I10)

                A: Lisinopril/HCT 20/12.5 Daily #90, refills 3

                B: BMP in 6 months

                C: Recheck BP in 2 Weeks

                D: Low Sodium Diet and lifestyle modifications discussed

                2: Morbid Obesity BMI XX.X (E66.01)

                A: Goal of 5% weight reduction in 3 months

                B: Increase exercise by walking 30 minutes each day

                C: Portion Size Education

                3: T2 Diabetes with diabetic neuropathy (E11.21)

                A: Repeat A1C in 3 months

                B. Increase Metformin to 1000mg BID #180, refills: 3

                C: Annual referral to diabetic educator, ophthalmology, and podiatry (placed X/X)

                D: Daily blood glucose check in the am and when sick

                E. Return to clinic in 3-4 months to reassess

                Nursing

                It is important to understand the role of research in professional nursing.Imagine a scenario in which you are discussing nursing research and the role it plays in nursing practice with a colleague from another profession who has little knowledge of the topic. In this conversation, you should include the following:

                • What is the purpose of nursing research?
                • The following are terms you might use in the discussion with your colleague: research, evidence-based practice (EBP), research utilization (RU), and quality improvement (QI)
                  • How are they related?
                  • How are they different?
                  • Are they interchangeable?
                  • Why are these relevant to professional nursing practice?
                • What is the role of the BSN-prepared nurse in research, EBP, RU, and QI processes? How is this different from the MSN-, PhD-, and DNP-prepared nurse?
                • You are already familiar with problem solving and nursing processes. You are learning about research and EBP processes. Explain the EBP process to your colleague by comparing and contrasting it with problem solving, nursing, and research processes.

                2 pages APA format, 2 references ,

                Nursing

                After reviewing the Nursing Standards of Practice, describe three reasons why these are important to nursing practice, safety, and achieving good client outcomes.

                Nursing

                A patient is diagnosed with pelvic fracture, trauma intracranial subdural, hematoma with loss of consciousness, sequela due to the fact that he had an accident where he was struck on pedestrian MVA,

                Please I want you to give an SBAR for this and a nursing diagnosis. The nursing diagnosis should specify what the diagnosis is related to and evidence of what?

                I will upload the SBAR form and nursing diagnosis form. It should be brief and well detailed.

                Please it’s a much assignment and I need it by this afternoon.

                Thanks

                nursing

                This criterion is linked to a Learning OutcomeIntroduction

                Required criteria:
                1. Offer a detailed description of the purpose statement for the paper.
                2. Identify the priority concept (topic) from the Individual Student Comprehensive Assessment Trends: Longitudinal Performance Table drawn from one (1) of the four (4) main categories of the NCLEX-RN examination blueprint:
                a. Assurance of a safe and effective care environment
                b. Health promotion and maintenance of health
                c. Preservation of the patient population’s psychosocial integrity
                d. Preservation of the patient population’s physiological integrity
                3. Provide a detailed description of the relationship between the category from the NCLEX-RN examination blueprint and the priority concept (topic).

                20 pts

                Highest/High Level of Performance

                Includes all 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                This criterion is linked to a Learning OutcomeImportance

                1. Describe the importance of the priority concept (topic) to professional practice
                2. Describe the importance of the priority concept (topic) to the health status of a patient population.
                3. Include the potential negative effect(s) to professional practice if the priority concept (topic) is unresolved.
                4. Include the potential negative effect(s) to the patient population if the priority concept (topic) is unresolved.

                20 pts

                Highest Level of Performance

                Includes all 4 requirements for section.

                18 pts

                High Level of Performance

                Includes no fewer than 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                This criterion is linked to a Learning OutcomeHealthcare Disparities, Inequalities, and Interventions

                Required criteria:
                1. Identify patient populations that may be negatively influenced by the priority concept (topic) if unresolved.
                2. Identify healthcare resources to support evidence-based practice related to the priority concept (topic).
                3. Summarize potential priority concept (topic) healthcare disparities and inequalities related to diverse populations.
                4. Propose an evidence-based solution for the priority concept (topic) related to healthcare disparities.
                5. Identify three (3) evidence-based practice interventions.
                6. Prioritize the identified evidence-based practice interventions and provide rationale.
                7. Discuss two (2) patient education considerations related to the priority concept (topic).

                70 pts

                Highest Level of Performance

                Includes all 7 requirements for section.

                63 pts

                High Level of Performance

                Includes no fewer than 5-6 requirements for section.

                54 pts

                Satisfactory

                Includes no fewer than 3-4 requirements for section.

                21 pts

                Unsatisfactory

                Includes no fewer than 1-2 requirements for section.

                0 pts

                Section not present

                No requirements for this section presented.

                70 pts

                This criterion is linked to a Learning OutcomeLegal & Ethical Considerations and Intervention Challenges

                Required criteria:
                1. Identify at least one (1) ethical and one (1) legal implication for addressing the priority concept (topic) in professional practice.
                2. Discuss at least one (1) strategy in prevention of an ethical dilemma related to the priority concept (topic) in professional practice.
                3. Discuss at least one (1) strategy in prevention of legal consequences related to the priority concept (topic) in professional practice.
                4. Identify one (1) anticipated challenge to the success of preventing the priority concept (topic) in professional practice.
                5. Identify one (1) anticipated challenge to the success of resolving the priority concept (topic) in professional practice.

                40 pts

                Highest Level of Performance

                Includes all 5 requirements for section.

                36 pts

                High Level of Performance

                Includes no fewer than 4 requirements for section.

                31 pts

                Satisfactory

                Includes no fewer than 3 requirements for section.

                12 pts

                Unsatisfactory

                Includes no fewer than 1-2 requirements for section.

                0 pts

                Section not present

                No requirements for this section presented.

                40 pts

                This criterion is linked to a Learning OutcomeParticipants and Interdisciplinary Approach

                Required criteria:
                1. Identify all the parties who will be involved in the implementation of the priority concept (topic) interventions.
                2. Discuss the role of each member in the intervention implementation for the priority concept (topic).
                3. Identify a minimum of two (2) members of a discipline outside of nursing.
                4. Discuss the benefit of including the identified interdisciplinary member from disciplines outside nursing to promote evidence-based professional practice.

                20 pts

                Highest Level of Performance

                Includes all 4 requirements for section.

                18 pts

                High Level of Performance

                Includes all 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                This criterion is linked to a Learning OutcomeQuality Improvement

                Required criteria:
                1. Provide at least one (1) benefit in patient outcomes from addressing the priority concept (topic) within the clinical environment.
                2. Provide at least one (1) benefit to the nursing profession that will result from addressing this priority concept (topic) in clinical professional practice.
                3. Discuss at least one (1) resource utilized to promote improved patient outcomes in the clinical environment.
                4. Discuss at least one (1) resource utilized to increase professional nurse knowledge promoting improved clinical professional practice.

                20 pts

                Highest Level of Performance

                Includes all 4 requirements for section.

                18 pts

                High Level of Performance

                Includes all 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                This criterion is linked to a Learning OutcomeConclusion

                Required criteria:
                1. Provide a thorough recap of the purpose to promote increased evidence-based professional practice knowledge related to the priority concept (topic) deficiency.
                2. Summarize resources identified to support improved evidence-based professional practice related to the priority concept (topic).
                3. Include a complete statement describing why addressing the priority concept (topic) matters for patient outcomes and evidence-based professional practice.

                20 pts

                Highest/High Level of Performance

                Includes all 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                This criterion is linked to a Learning OutcomeAPA Format, Grammar, and Punctuation

                Required criteria
                1. References are submitted with paper.
                2. Uses current APA format and is free of errors.
                3. Grammar and mechanics are free of errors.
                4. At least three (3) scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided. Each section should have a cited source to support information provided.

                20 pts

                Highest Level of Performance

                Includes all 4 requirements for section.

                18 pts

                High Level of Performance

                Includes all 3 requirements for section.

                16 pts

                Satisfactory

                Includes no fewer than 2 requirements for section.

                8 pts

                Unsatisfactory

                Includes no less than 1 requirement for section.

                0 pts

                Section not present

                No requirements for this section presented.

                20 pts

                Total Points: 230


                Previous


                Next

                NURSING

                Part 3 – Next Steps

                Balancing School and Life – My Quality of Life Self-Care Plan. The purpose of developing this Plan is to set a framework and a plan to maintain wellness and to stay motivated and engaged throughout your Program. Doing this will help you achieve success during your coursework and as a professional nurse.

                The goal of the Project is to help you become self-aware and reflective as a means of identifying personal self-care strategies that will increase your energy and help you manage your stress. The Project will give you a chance to learn how this is accomplished as you will be doing similar work with clients during the Program and as a professional nurse to assist them in the same way.

                Continue to use the quality of life self-assessment tool you selected to reassess and identify strategies you can use throughout your nursing program to maintain a desired quality of life. 

                In a 2–3-page paper (not including the title page or reference page), include the following information:

                You’ll need to reassess yourself in all of the areas (submit completed form) and then write a 2-3 page paper about what you are going to do for the rest of your nursing program to stay balanced. APA title page is required. Your paper should discuss your current scores and how they have changed since your first self-assessment. You will also need to discuss what your plans (intentions or commitments) are to stay balanced through the program. You need to list 1 plan and 1 action for each dimension. Lastly, you will need to identify any new strategies that you are implementing and why they will work better than what you are doing now.


                nursing

                1

                Week 3 SOAP Note- Sexually Transmitted Disease

                United States University

                FNP xxx: Common Illness Across the Lifespan -Clinical Practicum

                Dr. xxxxxxxxx

                SOAP Note- Sexually Transmitted Disease

                SUBJECTIVE DATA:

                Patient Name: C.K

                Age: 41-years old,

                Gender: Female,

                Date of Birth: 03/15/1981

                Chief Complain “I have had some pain and burning sensation, especially during urination. The urination has been accompanied by discharges that have been there for the last ten days.”

                HPI: This is a 41-year old female patient who visits the facility with the complaints of experiencing lower abdominal pain and some burning sensation during urination. She reported that the problem started four days ago and has been experiencing occasional urges and urgency to urinate for the last three days. According to her, her visits to the toilet can be approximately ten times daily, and whenever she pees, she sees some brown discharge with a funky smell. The problem began after she had unprotected sex with her previous boyfriend. These problems have interfered with her work routine and messed up her focus while in the office where she is employed as an accountant. She reported to have used some painkillers to help in the reduction of the pain, but the pain never disappeared. She also admits that the pain worsens during urination, and it is neither sharp nor dull. She rates the pain as 8/10 and denies any factors that alleviates or relieves the pain. She reported being sexually active and has slept with more than one partner after the death of her husband. She has a regular menstrual cycle and had it a week ago and reported pain during intercourse. She denies fever, nausea, constipation, and vaginal bleeds.

                Past medical history: She reported being diagnosed with sexually transmitted infections such as gonorrhea and chlamydia. She is also reported having had asthma disease.

                Surgical: She admits to having undergone medical surgery during childhood and adulthood. At a young age, she had tooth removal, while in adulthood, she had a cesarean procedure.

                LMP: her last menstrual cycle was on 28th December, 2021

                Medications: She has been on Advil OTC as needed to manage her pain.

                Allergies: she denies allergic reactions to food, drugs, and the environment in her adulthood. However, she admits experiencing some allergic reactions to dust and changes to the environment during her younger age.

                Immunization: Her immunization is up to date, and she was recently vaccinated against flu and covid-19 on April last year.

                Family History: The paternal father is alive and healthy at the age of 90 years. The paternal mother is deceased at the age of 84 due to some age-associated comorbidities such as diabetes and Alzheimer’s illness. The maternal grandparents are already dead and did not have any health issues, and the daughter is also healthy.

                Social History: She is a widow following her husband’s death for five years ago. She is not having husband yet and is living with daughter in the rental apartments. The patient is active in sexually activities with different boyfriends and uses condom even though this does not usually happen. She is working as an accountant in local investment and financial organization. She admits to being drinking three beers and not using any recreational drug. She is a Christian and always attends Sunday masses in the company of her daughter.

                Review of System:

                General: Denies any changes to body weight. Denies fatigue, nausea, chills, night sweating, and generalized body weakness.

                HEENT: Head; denies any headache. Eyes: She is wearing sunglasses due to the light and denies having any eye examination every four months. Ears; denies any hearing loss. Nose; denies congestion of the nose or bleeding. She has a live olfactory delight and denies epistaxis. Throat and Mouth; the patient denies gingivitis, bleeding of the gums, or dental issues. She admits experiencing some challenges in chewing or swallowing and visits the dental clinic every four months.

                Skin: she denies the presence of rashes, bruises, bleeds, lesions, and discoloration of the skin.

                Respiratory: Denies coughing, wheezes, breathing difficulties, and seasonal allergies.

                Cardiovascular: Denies experiencing chest pain, increased heart rate, and edema.

                Gastrointestinal: Admits an increase in the lower abdominal pain within her hypogastric area. Denies experiencing changes in appetite, constipation, nausea, and vomiting.

                Genitourinary/ Gynaecological: she admits a burning sensation and frequency in urination. Admits to being using contraceptives or condoms and many sexual partners. Admits vaginal discharges after sexual intercourse.

                Musculoskeletal: Denies any stiffness of the joints, back pain, and dislocation of the joints.

                Neurologic: Denies any seizures, paralysis, changes in the memory, or syncope.

                Lymph/Hematology: She denies an increase in thirst or hunger, irregular temperature, and the presence of swollen glands.

                Psychiatric: denies any depression, difficulty sleeping, anxiety, and mood changes.

                OBJECTIVE DATA

                Physical Examination Vital Signs: Temperature- 99.2, Pulse- 70 beats/minute, Respiration-16, Oxygen Saturation Rate2- 97 percent RA, Blood pressure- 120/75, wt-140 lb., ht- 6’ 1”, Body Mass Index-23.1.

                General Appearance: She is a well-nourished female adult and denies distress. She is well well-groomed, alert, and oriented X 4. She is responding well to the questions asked.

                HEENT: Eyes; there is intact PERRLA and EOMS. There is clear conjunctiva clear. Ears; there is grey or pearly TMs. Nose; there is pinkish nasal mucosa and typical turbinates. Neck: there is an absence of bruit or carotids. Mouth and Throat; there is pinkish and moistened oral mucosa with oropharynx that is clear.

                Skin: The skin is cleaner, dry, intact, and skin color representing her ethnicity.

                Cardiovascular: It is expected, regular, and rhythm S1 and S2. There is an absence of murmur in a heartbeat.

                Respiratory: there is a symmetric chest wall with easy and regular respiration. There is clear bilateral lung to auscultation.

                Gastrointestinal: There is flat, soft, non-tender, non-distended. There is active bowel sounds in all the four quadrants. There is some tenderness within the hypogastric area upon palpitation.

                Genitourinary: Non-distended bladder, suprapubic tenderness, irritation within the labia majora, minora, and vaginal region. There is no ulceration of the lesion. There are non-palpable lymph nodes. There is a pinkish vagina with a funky smell of the vaginal discharge. The bimanual examination reveals a friable cervix and position for the CMT. There is the uterus is regular in terms of size and shape.

                Musculoskeletal: The motion in all the extremities are in full range.

                Neurological: There is clear and sound speech with an excellent tone. The gait is expected with some stability in balance and erected posture.

                Psychiatric: She is alert and oriented ×4 and can maintain eye contact during the conversation. She is appropriately dressed for the occasion and responds to questions.

                Lab Tests

                · Urinalysis- the test is essential since it assists in determining the possibilities of kidney infections and reflecting on the possibilities of other diseases like diabetes, liver illness, and kidney illness.

                · A urine culture test helps reveal the microorganism responsible for the urinary tract infection of the patient.

                · A dipstick urinalysis test reveals a positive outcome for the nitrates and leukocyte esterase.

                · Vaginal discharge culture- the test is pending so that the presence of the Gram-negative diplococci and Neisseria gonorrhoeae can be confirmed. The sensitivity test is also pending. There is a positive test outcome for the monoclonal AB for Chlamydia.

                · A Pap smear- the test was used to determine the problem with lower abdominal pain. The test outcome was negative.

                · Further laboratory tests for the STDs are ordered to confirm the presence of gonorrhea, syphilis, hepatitis B and C, HIV/AIDs, and chlamydia.

                ASSESSMENT

                Differential Diagnoses


                Chlamydia ICD-10-CM-A56.8: It is a disease that is caused by the presence of the bacteria known as Chlamydia trachomatis (Witkin et al., 2017). The condition is detected in the latest stages since it tends to manifest in the advanced stages. It is caused by having unsafe sex practice with the partner who is already affected (Witkin et al., 2017). The symptoms presented by the patients point to the possibilities of chlamydia. It occurs as a result of having more than one partner, previous diagnosis with the disease, engaging in unsafe sex practices, and having other STDs. The client was confirmed to be having dysuria and pain in her lower abdomen, which are the main signs of the disease. The condition is also further confirmed by the positive outcomes for chlamydia based on the monoclonal AB test.

                Acute vaginitis ICD-10-CM- N76.0: This condition leads to inflammation or infection of the vagina. Its etiology is linked to several microorganisms such as yeast or irritations caused by the chemicals or sprays. It is associated with the inflammation of the external female sexual organs, i.e., the vulva and vagina (Mann et al., 2019). It is also caused by the organism that is passed between the partners. It manifests in the form of a slight foul-smell of the urine, irregular menses that occur with heavy flow, burning sensation, itches, and symptoms that worsen after engaging in sexual activities (Mann et al., 2019). Nevertheless, the condition is ruled out since the patient never reported pain symptoms during intercourse.

                Gonorrhea ICD-10-CM-A54.9: This is a STI condition caused by Neisseria gonorrhoeae, and it mainly interferes with warm and moist body regions for example urethra and eyes among others (Kirkcaldy et al., 2019). The commonly affected regions are the vagina and the anu. It is spread from one person to another through sexual intercourse, either orally, anal, or vaginal. The symptoms presented by the male patient tend to differ from those represented by the female patient. The manifestation of the disease involves discharges, fever, heavy abdominal pain, production of heavy menses, pain and burning sensation during urination, and pain at copulation (Kirkcaldy et al., 2019). The condition is ruled out because the patient never reported the history of the condition and did not have a sore throat.

                TREATMENT PLAN AND EDUCATION

                Based on the symptoms presented by the patient, the potential medication that can be described is Azithromycin 1g, which is taken through the oral route as a single dose. The patient can also be given Doxycycline 100mg twice each day. The patient uses the medicines for a period of two weeks (Phillips et al., 2019). The Food and Drug Administration has confirmed Azithromycin as an excellent antibiotic to help in treating genital chlamydia (Phillips et al., 2019). The drug is helping in preventing the multiplication of bacteria. The patient also requires health education, and, in this case, the patient is informed about the importance of balancing the sexual life through engaging in safe sex practices by having not more than one partner. The patient also undergoes a counseling process to ensure that she is protected through effective contraceptives like condoms. Abstinence is another approach to ensure that the patient completes the prescribed medication before sex.

                Follow Up

                The patient must be monitored throughout the treatment duration. Therefore, the follow-up process will be maintained for the next three months while the patient’s situation is monitored and she adheres to the prescribed medication and instructions.

                References

                Kirkcaldy, R. D., Weston, E., Segurado, A. C., & Hughes, G. (2019). Epidemiology of gonorrhoea: A global perspective. Sexual Health16(5), 401. 
                https://doi.org/10.1071/sh19061

                Mann, A., Mehta, S., & Grover, A. (2019). Acute vaginitis: A rare cause of labial adhesions. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
                https://doi.org/10.7860/jcdr/2019/42259.13271

                Phillips, S., Quigley, B. L., Aziz, A., Bergen, W., Booth, R., Pyne, M., & Timms, P. (2019). Antibiotic treatment of chlamydia-induced cystitis in the koala is linked to expression of key inflammatory genes in reactive oxygen pathways. PLOS ONE14(8), e0221109. 
                https://doi.org/10.1371/journal.pone.0221109

                Witkin, S. S., Minis, E., Athanasiou, A., Leizer, J., & Linhares, I. M. (2017). Chlamydia trachomatis: The persistent pathogen. Clinical and Vaccine Immunology24(10). 
                https://doi.org/10.1128/cvi.00203-17

                nursing

                Last updated: Fall 2020

                Care Plan Tips and Examples

                *Follow exactly what is on the Care Plan Grading Rubric. Section by section, line by line.

                Patient Introduction

                o Remember to avoid identifiers to maintain patient confidentiality: No initials, no

                birthdate, decade for age, do not give name of facility or hospital. Stage age in

                designated range as listed on the rubric.

                o Write in paragraph narrative format, following APA format, and complete sentences.

                o Include every section in the rubric.

                Patient Introduction (Specific Example)

                Patient is (give age group 66-74, 75-85, >85 years) Caucasian female. Patient was

                admitted to the skilled nursing facility on 9/21/12 after suffering an acute CVA the day after she

                had surgery for a hip fracture to her right femoral neck which was required due to a fall at

                home. Patient suffers from mild expressive aphasia as a result of the CVA. Her memory of the

                events surrounding the fall are not clear. She states that she was not with anyone at the time of

                the fall and she does not remember if she blacked out or lost consciousness. She states that

                someone found her in her apartment and she was taken to Hospital where she said she had a

                “rod” put in her hip.

                Patient has a past surgical history of hemiarthroplasty for her right femoral neck

                fracture, back surgery, lumpectomy for breast cancer, and tonsillectomy. She also has a past

                history of HTN, DM, high cholesterol and glaucoma. Patient’s father and mother died of

                natural causes. Some diabetes in the family.

                Patient has lived in the DC area all her life. She attended college and graduate school and

                states that she got a degree in food service management and she “fully enjoyed” that. She was

                never married and does not have any children. However, she states that she has many friends

                who she sees and visits with often. She enjoys visiting with all her friends and spending time

                with people.

                She expects to be able to return home to her apartment at an assisted living facility within

                the next week. She says that she has a lot of friends who will help her. She also has a cousin who

                is a surgeon who has been helping with everything.

                Patient does not have any known allergies.

                Code: Attempt CPR

                Last updated: Fall 2020

                Assessment and Interpretation

                *Physical Assessment: Use your textbook! Problems identified are stated as NANDA Diagnosis and

                follow the assessment. Include all body systems.

                Example:

                Assessment: 10/26/2025 and 11/2/2025 Problems:

                G-U: 10/26/25

                Patient denies problems with urination. Patient states that she urinates 4-5

                times a day and states that her urine appears “clear with nothing

                abnormal”. When asked about fluid intake, patient states that she should

                “probably drink more water” and she then proceeded to drink some of her

                water at her bedside.

                When the patient showed me the scar on her right hip from her hip surgery,

                I noticed she also was wearing depends. I should have asked her if she had

                any problems with incontinence after noticing the depends.

                -Risk for deficient fluid volume

                r/t decreased intake AEB

                patient’s report that she

                should “probably drink more

                water” (Doenges, Moorhouse,

                & Murr, 2010, p. 379-380).

                DocuCare Documentation: Ensure that you patient documentation is complete, accurate, and submitted
                for instructor review. Document your assessment and any interventions conducted.

                *Individualize each lab result to the specific patient.

                For example: Labs, why is it normal or why would it be high/low according to the patient’s

                history and current condition. The patient has low hemoglobin and hematocrit because they are

                anemic. This is the same for meds. Ask yourself “Why is this patient taking this medication?”

                The patient is taking Norvasc because they have a history of high blood pressure.

                *You may make charts for labs and meds. For Labs, split, normal range, patient’s result, and

                significance. For medications, split medication, dose/route/frequency, drug class and Mechanism of

                Action (MOA,) indication for YOUR patient. Don’t forget to cite your lab and medication chart (ie: where

                did you find the information for normal values, drug class, MOA, and significance).

                Examples

                Lab Normal Value* Patient’s Result Significance*

                RBC 3.90 – 5.40mil/uL 3.46 Low

                Expected finding based on patient’s

                diagnosis of anemia

                *Citation for lab table

                Last updated: Fall 2020

                Medication

                Generic and Trade

                Name

                Drug

                Classification

                and MOA*

                Patients

                Dose/Route/Frequency

                Indication

                (Purpose specific to this
                patient)*

                Calcium Carbonate

                and Cholecalciferol

                (Caltrate Plus D)

                Calcium

                supplement and

                vitamin D

                Hormone.
                MOA: Essential
                component and
                participant in
                physiologic
                systems and
                reactions.

                Calcium Carbonate 600mg

                Cholecalciferol 400mg

                1 tab PO daily

                Calcium for low levels of calcium

                in the blood and Vitamin D to

                prevent muscle pain with statins.

                *Citation for Medication table

                Other Diagnostic

                Tests

                Results Significance*

                Chest X-ray

                (12/25/2025)

                No evidence of active cardiopulmonary disease.

                Reveals peripheral lung fields are clear of lobar

                infiltrates and effusions. Cardiac silhouette and

                pulmonary vascularity are normal.

                Expected finding based on

                patients history of no lung or

                cardiac problems.

                *Citation for diagnostic table

                Last updated: Fall 2020

                Pathophysiology Flowchart

                *You need 4 pathophysiologic factors affecting this patient’s condition and needs to be described. Also

                illustrate interrelationships among the factors. Will need to use a flowchart.

                *It is best to create your flowchart in another document and insert a screenshot/image of your

                flowchart versus creating it within the body of your care plan paper. If you create it in your care plan

                paper it will easily become distorted as your instructor gives feedback on your paper.

                Example:

                Last updated: Fall 2020

                -Morbidity and mortality statistics: risk factors, population groups affected, resulting morbidity and

                mortality. You will need to search journal articles and/or the CDC to find this data.

                Diagnosis

                When identifying 2 physical and 2 psychosocial diagnoses, use nursing diagnosis. Problem (diagnosis)

                related to etiology (contributing factor) as evidence by symptom (signs and symptoms). R/T, AEB

                Label diagnoses according to priority

                Plan

                A plan is written for one physical and one psychosocial diagnosis -Goals with characteristics

                3 short term goals, and 1 long term goals that are patient centered, measurable behavior, specific in

                content and time, attainable, and address the diagnosis. The goals must be MEASUREABLE!

                Example:

                EXPECTED OUTCOME NURSING INTERVENTIONS EVALUATION/

                CHANGE IN PLAN

                SHORT TERM GOAL(S)

                By the end of the shift,
                the patient will
                smoothly transfer from
                sitting in the wheelchair
                to standing.

                By the end of the shift,
                the patient will walk 50
                feet with a walker.

                By the end of the shift,
                patient will demonstrate
                active range of motion
                (ROM), isotonic, and
                isokinetic exercises to
                perform while in the bed
                or wheelchair to
                strengthen muscles and
                increase joint
                ROM.

                The nurse will:

                Consult with physical and occupational therapists
                to “develop individual exercise and mobility
                program, and identify appropriate mobility
                devices” (Doenges,
                Moorhouse, & Murr, 2010, p. 530). Rationale –
                physical and occupational therapists are specially
                trained to develop and implement appropriate
                exercises and goals for patients who have physical
                disabilities.

                Encourage and assist patient to perform
                strengthening exercises of the left arm. Rationale
                – patient has decreased strength in her right arm
                so this impairs her to push up when trying to get
                out of the wheelchair.

                Encourage client to practice transferring from
                sitting in the wheelchair to standing 1-2 times for
                every program she watches on television or 1-2
                times every hour.

                Demonstrate use of and help patient become
                comfortable with use of the walker. Rationale – if
                patient has never used a walker before, she needs
                to be shown the proper way to ambulate with one.

                Goal – By the end of the shift, the
                patient will smoothly transfer from
                sitting in the wheelchair to standing.

                • Goal was partially met.
                Patient performed
                strengthening exercises of the
                left arm and reported that the
                left arm felt a little bit
                stronger when she used it to
                get up from the wheelchair.
                Patient was still somewhat
                shaky and wobbly when
                transferring to a standing
                position from the wheelchair.
                Patient should continue to
                perform strengthening
                exercises for the left arm to
                further strengthen it to get
                out of the wheelchair.

                Goal – By the end of the shift, the

                patient will walk 50 feet with a walker.

                • Goal was exceeded. Patient

                was able to quickly master the

                use of the walker and was

                able to ambulate up and down

                Last updated: Fall 2020

                the hallway 75 feet. I will

                modify the goal by increasing

                the distance to 100 feet with

                the walker.

                Goal- By the end of the shift, patient
                will demonstrate active range of
                motion (ROM), isotonic, and isokinetic
                exercises to perform while in the bed
                or wheelchair to strengthen muscles
                and increase joint
                ROM.

                Goal met. Patient demonstrated active
                range of motion (ROM), isotonic, and
                isokinetic exercises to perform while
                in the bed or wheelchair to strengthen
                muscles and increase joint
                ROM.

                LONG TERM GOAL

                By discharge, the
                patient will ambulate
                100 feet without
                assistance of the
                walker and without
                assistance of another
                person and only using a
                cane.

                Schedule specific times to practice walking down
                the hallway with the walker “with adequate rest
                periods during the day to reduce fatigue”
                (Doenges, Moorhouse, & Murr, 2010, p. 530).
                Rationale – time for practice should be scheduled
                around physical therapy, meals, and other
                activities and patient should be provided
                adequate time to rest between practice sessions
                and after physical therapy to prevent
                overworking the muscles and to prevent
                exhaustion and fatigue.

                Goal- By discharge, the patient will
                ambulate 100 feet without assistance
                of the walker or another person; and
                only using a cane.

                • Goal met. Patient was able to
                walk > 100 feet using the cane
                only.

                (Doenges, Moorhouse, & Murr, 2010)

                Intervention

                Any direct care nurse performs on behalf of patient.

                Evaluation of the patient’s status, of patient’s progress toward goal achievement, of the care plan’s

                status, suggestions to improve.

                Use APA format. You can make an appointment with the Writing Center to correct grammar and proper

                APA format.

                • Care Plan Tips and Examples
                • Patient Introduction
                • Assessment and Interpretation
                • Pathophysiology Flowchart
                • Diagnosis
                • Plan
                • Intervention

                Nursing

                 How Do You Plan To Use Your Eyes More Intentionally In Sending And Receiving Clear Messages From Your Friends And Family Members? 

                nursing

                Directions:

                For this discussion, reflect on this week’s content related to the history of nursing, theories, caring, and evidence-based practice. How does nursing history, theories, caring, and evidence-based practice assist with developing yourself as a nursing professional?

                Use at least one credible resource to support your initial discussion post. For example, a credible resource could be the State Board of Nursing website, a textbook, or a journal article.

                Use in-text citations and list your references in APA format at the end of your initial discussion post and response posts.

                nursing

                1

                2

                SOAP Note Patient with UTI

                United State University

                FNP xxx: Common Illness Across the Lifespan -Clinical Practicum

                Dr. xxxx

                SOAP Note Patient with UTI

                ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.

                Client’s Initials: L.U

                Age :65 years.

                Race: African American

                Gender: Female

                Date of Birth: 08

                Insurance: BlueCross BlueShield .

                Marital Status: Married

                Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.

                CC: Pain and burning during urination.

                HPI:

                Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.

                ROS

                Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.

                Eyes: Denies double vision, change in vision factors, or blurry vision.

                Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.

                Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.

                Pulmonary: Denies

                Gastrointestinal: c/o moderate to severe pain in the abdominal area.

                Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.

                Musculoskeletal: Denies any kind of pain

                Integumentary & breast: Denies issues

                Neurological: Denies issues

                Psychiatric: Denies any kind of depression or mood swing

                Endocrine: Denies having any problem

                Hematologic/Lymphatic: Denies

                Allergic/Immunologic: No Known allergy

                Past Medical History:

                · Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.

                · Denies history of chronic medical problems with father or mother.

                · Preventative care: None indicated

                · Surgeries: Denies

                · Hospitalizations: Denies

                · LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.

                Allergies: No known food or drug allergy

                · Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too and takes a similar treatment approach as his wife. Patient has four younger siblings who report not cases of physical conditions.

                · Social History: Patient lives with her partner who is five years older than her. She works with an agency as janitor t where she has been working for the past ten years. Patient denies any illicit drug use. She said she has great support system surrounded with family and friends

                Sexual history: Patient is sexually active has only one partner and they do not use kind of protection.

                .

                Other:

                Vital Signs: HR:70 BP:122/77 Temp:98.5 RR:18 SpO2:98% Pain:8/10

                Height: 5ft 8 inches Weight: 150lb. BMI: 22.81.

                Physical Exam

                General Survey: Patient afebrile , no chest pain , no breathing problems or general weakness

                A test indicated that patient had CVA tenderness upon palpitation. There was a suprapubic tenderness on the patient. A deep abdominal palpitation on the patient indicated tenderness.


                Assessment

                Diagnosis:

                Assessment shows a clinical outcome of dysuria, suprapubic tenderness, and frequency and urgency of urination which indicates UTI (Sabih & Leslie, 2021). Noted no evidence of vaginal discharge, so therefore not consistent with vaginitis

                Differential:

                1. 2. Pyelonephritis (ICD-9 code 590.80). Pain in the lower abdomen especially increased due to urination. Pyelonephritis got eliminated since the patient did not have myalgia, nausea, vomiting, fever, or flank pain (Beahm et al., 2017

                2. ). Overactive bladder (ICD 9-596.51). Suitable since patient reports highly frequent urination. An overactive bladder got eliminated since the urine dipstick gave a different result.

                3. Vaginitis (ICD-9-616.10). Pain around the vagina area and lower abdomen. Ruled after dip stick urine.

                Diagnosis:

                Assessment shows a clinical outcome of dysuria, suprapubic tenderness, and frequency and urgency of urination which indicates UTI (Sabih & Leslie, 2021). Noted no evidence of vaginal discharge, so therefore, not consistent with vaginitis


                Plan

                Diagnostics/ Labs : To rule out UTI are urinalysis and urine culture.

                A dipstick urine test shows presence of nitrite and leukocyte esterase

                Treatment:

                Double strength prescription of trimethoprim 160 mg and sulfamethoxazole 800 mg 2 times daily for three days. Patient can also take cranberry juice as studies has shown that it is very good to treat UTI because of its acid base properties.

                Education:

                · Instruct patient to avoid spermicidal products that increase risk of a UTI occurring.

                · Teach patient to wipe the genital area from front to back after urination to avoid getting bacteria from anus to her virgina

                · Teach patient to adhere to all treatment directions

                · Teach patient and make sure patient understands the course of treatment which is 5 days, and to take all medication same time each day.

                · Teach patient on the importance of drinking minimum of eight glasses of water per day. Add that this will help the body to fight bacteria..

                · Teach patient to always urinate after sexual intercourse since that would flush out every bacterium from her urethra

                · Teach patient to engage in physical exercises since this would improve her wellbeing and connection to proactive physical behavior. The patient should take note that both her parents have hypertension and should thus get her blood pressure reading taken during many intervals since this would allow detection of hypertension.

                · Teach patient to reduce sexual intercourse with her partner especially since she is not aware if she is the only sexual partner her boyfriend has.

                · Teach patient to always get routine vaccination against common illnesses since the technique would allow her to have proper wellbeing and management of her condition. .

                · Teach patient to make a timetable of taking water since such fluids would increase urine and thus, that would flush out bacteria through the urethra.

                · Teach patient to avoid sexual intercourse during the time she is taking medication to prevent any new infections. This will prevent patient from further getting affected in their ability to receive full bacterial treatment.

                Follow Up And Recommendations

                1. Return to the clinic within 7 days if symptoms persist.

                2. Pap smear every 3 years for ages 21- 65.

                3. Cranberry Juice can also be helpful it is rich in vitamin C and potent immune system booster, studies indicate that it balances the PH of the body with its acidic properties that helps fight infection.

                References

                Beahm, N. P., Nicolle, L. E., Bursey, A., Smyth, D. J., & Tsuyuki, R. T. (2017). The assessment and management of urinary tract infections in adults: Guidelines for pharmacists. Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC, 150(5), 298–305.
                https://doi.org/10.1177/1715163517723036
                .

                Sabih, A. & Leslie, S.W. (2021). Complicated Urinary Tract Infections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436013/

                NURSING

                3

                NUR2058 Section 08 Dimensions of Nursing Practice

                Chukwuemeka Mbionwu F.

                Rasmussen University

                Christie Vasquez

                01/16/2022

                Quality of Life

                The selected tool is personal development and relationships from the self-care wheel. The primary reason is that having significant relationships in one’s life has a great impact. For instance, close friends are an essential support system and help make life better because of reassurance and love (Ogbeiwi, 2021). Such connection makes an individual feel safe and gives one a belonging sense to their immediate environment. Therefore, the individual will create a specific life purpose with significant life support.

                https://www.popsugar.com/fitness/Parts-Self-Care-Wheel-44872040

                The first significant strength related to my quality of life selection is that I will always have friends and family to support me through difficult periods. Hard times and inevitable can be smooth with enough support, believing in your ability to rise above all the odds. Therefore, personal relationships are a foundation of excellent life quality because interactions are inevitable in the present world (Ogbeiwi, 2021). The second strength witnessed from the life quality is that I have people to make long-lasting memories with. Time is not a constant factor, and many experiences can be retained through meaningful connections.

                Furthermore, various strategies can be used to maximizing on the identified strengths. The first strategy is to be more outgoing and supportive towards other people’s activities. Being outgoing means that one is easily relatable to individuals in their immediate environment. The individual comprehends that people have different character traits thus will learn to accommodate and adjust their perspectives (Ogbeiwi, 2021). Another mechanism is to be an open-minded individual, and different welcome opinions. Interacting with people and developing relationships is one way to gain more practical knowledge.

                Using the SMART objectives, I should be more specific regarding the type of relationship I want to form. I should avoid relationships that would cause unnecessary chaos within my life and settle on those that would help build each other’s dreams (Ogbeiwi, 2021). Therefore, I have to specify the desirable characteristics to form meaningful connections. Additionally, the references should help me achieve my objectives. They should bring a significant contribution to my career and personal life, thus ensuring I have walked through the right path.

                Weaknesses can also be identified in my selected life quality. For instance, conflict is inevitable among people working towards creating a relationship. We will face various competitions, which will slow down my growth process. It is a weakness because it will consequently change my objectives towards public life (Ogbeiwi, 2021). Additionally, developing a connection with individuals having different opinions and focus is quite challenging. The difficulty is experienced, especially when I fail to receive the anticipated support.

                The strategy I will incorporate is to develop friendships with people with similar interests. That is an excellent move because it means that I will receive enough support and have a place to learn new exciting factors (Ogbeiwi, 2021). Additionally, I will ensure that I have excellent conflict solving strategies to find solutions in all the disagreements. That way, I do not waste time in agreements and focus more on life opportunities.

                I would implement the strategies using SMART objectives by ensuring that the solutions are relevant and fit in the provided context. Relevancy saves one from experiencing time wastage and loss of opportunity (Ogbeiwi, 2021). Therefore, I should measure using my results to identify whether the solutions have added more life value.

                Reference

                Ogbeiwi, O. (2021). General concepts of goals and goal-setting in healthcare: A narrative review. Journal of Management & Organization27(2), 324-341.

                nursing

                Week 4

                Skin Comprehensive SOAP Note Template

                Patient Initials: _______ Age: _______ Gender: _______

                SUBJECTIVE DATA:

                Chief Complaint (CC):

                History of Present Illness (HPI):

                Medications:

                Allergies:

                Past Medical History (PMH):

                Past Surgical History (PSH):

                Sexual/Reproductive History:

                Personal/Social History:

                Health Maintenance:

                Immunization History:

                Significant Family History:

                Review of Systems:

                General:

                HEENT:

                Respiratory:

                Cardiovascular/Peripheral Vascular:

                Gastrointestinal:

                Genitourinary:

                Musculoskeletal:

                Neurological:

                Psychiatric:

                Skin/hair/nails:

                OBJECTIVE DATA:

                Physical Exam:

                Vital signs:

                General:

                HEENT:

                Neck:

                Chest/Lungs:.

                Heart/Peripheral Vascular:

                Abdomen:

                Genital/Rectal:

                Musculoskeletal:

                Neurological:

                Skin:

                Diagnostic results:

                ASSESSMENT:

                PLAN:
                This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.

                © 2021 Walden University Page 2 of 3

                Nursing

                Name____________________________________

                Nursing Interventions

                Client Education

                Medication Administration (Dose and Route)

                Medication Name and Type

                Drug Class

                Therapeutic Uses (Indications)

                Complications

                Interactions

                Contraindications

                Expected Pharmacological Mechanism of Action (How it Works)

                ____________________________________________

                Evaluation of Medication Effectiveness

                © 2021 Chamberlain University. All Rights Reserved

                Nursing

                F E AT U R E S

                Wellness Promotion and the Institute of
                Medicine’s Future of Nursing Report
                Are Nurses Ready?

                ■ Kelley Strout, MSN, RN

                This article highlights the gap between wellness in nursing practice and the mission statement of the Institute of
                Medicine’s Future of Nursing Report. It explores wellness from 3 philosophical arguments, provides a historical
                evolution of wellness, and explores nurses’ current understanding of wellness. Future directions for implementing
                wellness in nursing practice are provided for science, education, and leadership. KEY WORDS: disease prevention,
                Institute of Medicine Future of Nursing Report, health promotion, wellness in nursing Holist Nurs Pract 2012;26(3):129–136

                The Future of Nursing Report published by the
                Institute of Medicine (IOM) symbolizes a paradigm
                shift in health care delivery from sick care to well
                care.1 The IOM envisions a health care system where
                nurses intentionally promote wellness and disease
                prevention and improve health care outcomes
                throughout the lifespan.1 The nursing profession is
                well recognized for the role of disease prevention and
                health promotion as established in the seminal article
                of Donaldson and Crowley2 to the recent Future of
                Nursing Report from the IOM.1 Within the scope of
                nursing practice, the words “health,” “health
                promotion,” and “wellness” appear to be used
                interchangeably. Florence Nightingale, Virginia
                Henderson, and Margaret Newman developed
                frameworks that conceptualize wellness; however,
                wellness is not clearly defined within these theories.3–6

                Nurses’ ability to achieve the mission of the IOM and
                intentionally promote wellness is limited by the
                absence of a universally recognized understanding of

                Author Affiliation: School of Nursing, Bouvé College of Health Sciences,
                Northeastern University, Boston, Massachusetts.

                The author thanks Elizabeth P. Howard, PhD, RN, ACNP, associate pro-
                fessor, School of Nursing, Bouvé College of Health Sciences, Northeastern
                University, for her time and support in editing the manuscript for publication.

                The author has disclosed that she has no significant relationships with, or
                financial interest in, any commercial companies pertaining to this article.

                Correspondence: Kelley Strout, MSN, RN, c/o Elizabeth P. Howard, School
                of Nursing, Bouvé College of Health Sciences, Northeastern University, 360
                Huntington Ave, Boston, MA 02115 (Kelley.A.Strout@gmail.com).

                DOI: 10.1097/HNP.0b013e31824ef581

                the concept of wellness and a common paradigm to
                promote wellness in nursing practice.7 The purpose of
                this article is to conceptualize the historical evolution
                of wellness and highlight the gap in nursing practice
                between knowing and promoting wellness.

                THE CONCEPT OF WELLNESS

                The absence of a universally recognized concept of
                wellness in the nursing profession is better understood
                after examining the complexity of wellness through 3
                philosophical arguments: ontology, realism, and
                empiricism.

                Plato’s ontological argument establishes wellness
                as a state of being. Patient lives represent diversity and
                ever-changing circumstances; patients will define
                what it means to be well based on their changing
                world. Their perception of wellness will generate from
                their current circumstances and will continuously
                change.8 Thus, the concept of being well is not static,
                but fluid. According to Plato, all living things aim and
                aspire to “good being.” From this perspective, all
                people naturally hope to gravitate toward a state of
                wellness, or “good being.” As people experience
                enhanced wellness, they will become more self-aware
                and learn about additional experiences that will
                promote wellness. Wellness is a process of becoming,
                a process that does not have an end point; therefore,
                every person strives for wellness throughout life.
                Wellness expands beyond health and does not simply
                apply to people in poor health, or people who need to

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                129

                130 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

                prevent certain diseases. Every person continues on a
                journey to achieving his or her full potential and
                maximizing his or her wellness.8

                The philosophical argument of realism aligns with
                the concept of wellness. Realism explains the reality
                of a phenomenon. Wellness from a realist perspective
                asks, “What is the reality of wellness? What does
                wellness look, act, and feel like? Wellness will look,
                act, and feel different for every patient. Realities are
                unique to individuals’ environments, genetics, and
                experiences.9 Patients’ realities will influence their
                views and perception of wellness.

                Wellness embraces an empirical philosophy;
                however, this philosophy differs from empirical
                research and practice and expands to the patient’s
                experience. John Locke, a philosophical empirical
                thought leader, proclaims that knowledge is derived
                through experience.8 Personal patient experiences will
                determine his or her definition of wellness. Nurses
                cannot possibly acquire the experience of each
                individual patient. Every patient who interacts with a
                nurse will possess different knowledge compared with
                the previous patient. Knowledge creates worlds for
                patients, worlds that translate into unique and diverse
                definitions and understandings of wellness.

                Wellness is difficult to conceptualize, which may
                explain the omission in definition and paradigm
                development within the nursing profession. In the
                absence of a universal, clearly defined understanding
                of the word and concept of wellness, the National
                Wellness Institute10 provides this clear definition of
                wellness: wellness is a multidimensional and holistic
                state of being that is conscious, self-directed, and
                constantly evolving to achieve one’s full potential.
                Wellness is an ever-changing process that
                encompasses multiple dimensions, known as the Six
                Dimensions of Wellness: intellectual, spiritual,
                emotional, physical, occupational, and social
                dimensions.10,11 The Six Dimensions of Wellness
                reflect unique characteristics that interconnect with
                one another to represent the person as a whole. Table 1
                provides the definition for each of the Six Dimensions
                of Wellness.

                HISTORY OF WELLNESS IN NURSING

                According to the National Wellness Institute,10 a
                professional can determine whether he or she practices
                within a wellness approach if he or she answers “yes”
                to the following 3 questions: “Does this help patients

                TABLE 1. Definitions of the Six Dimensions of
                Wellnessa

                Dimension of
                Wellness Definition

                Occupational
                wellness

                Ability to contribute unique skills to
                personally meaningful and
                rewarding paid or unpaid work

                Social wellness Ability to form and maintain positive
                personal and community
                relationships

                Intellectual
                wellness

                Commitment to lifelong learning
                through continuous acquisition of
                skills and knowledge

                Physical wellness Commitment to self-care through
                regular participation in physical
                activity, healthy eating, and
                appropriate health care utilization

                Emotional
                wellness

                Ability to acknowledge personal
                responsibility for life decisions and
                their outcomes with emotional
                stability and positivity

                Spiritual wellness Having purpose in life and a value
                system

                aBased on definitions from Hettler.11

                achieve their full potential? Does this recognize and
                address the whole patient? Does this affirm and
                mobilize positive qualities and strengths?”10 The
                nursing frameworks of Florence Nightingale, Virginia
                Henderson, and Margaret Newman are examined for
                congruency with wellness profession guidelines of the
                National Wellness Institute.

                Florence Nightingale’s theory supports wellness by
                addressing the whole patient and affirming his or her
                positive qualities and strengths.6 Nightingale believed
                that patients should be placed in optimal environments
                that allow nature to act. Her theory promoted nature as
                the ultimate cure for any disease process. According to
                Nightingale’s theory, environments are
                multidimensional. The air people breathe, the food
                people eat, the company people keep, and the
                conditions people live will interact to promote or
                prevent healing.6

                Nightingale believed that nurses should work to
                prevent disease and care for well patients with the
                same approach as caring for sick patients.6 She
                explained that diseases proliferate for years before
                manifesting into clinical symptoms. Therefore, nurses
                can improve the environment of well patients to
                prevent disease. Improving the environment could be

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                Wellness Promotion 131

                as simple as helping a patient create a healthy menu
                plan to helping a community improve air quality.
                Nightingale encouraged nurses to empower society to
                improve environments outside hospitals such as
                schools, homes, and communities in order to prevent
                disease.6

                Nightingale’s theory represents affirming and
                mobilizing positive qualities within patients.6 She
                believed that the patient, whether sick or well, is the
                best person to care for his or her own health. She
                encouraged nurses to view patients in the moment.
                She warned nurses not to judge patients with
                condescending thoughts or words. Nightingale
                believed that nurses should recognize that patients
                would do better in a supportive environment.6

                Nightingale’s theory of placing the patient in an
                optimal environment for healing and preventing
                disease promotes a wellness approach by addressing
                the patient positively and holistically. However,
                Nightingale does not define well, or wellness. Through
                her descriptions, the state of wellness is reflected by
                the absence of disease. Nightingale’s theory does not
                support the concept of assisting patients to achieve
                their full potential. Patients who are not sick are not
                necessarily achieving their full potential.6 The absence
                of disease is not reflective of full potential.10

                Henderson’s theory supports wellness by
                addressing the patient from a multidimensional
                perspective and encourages them to provide their own
                care.3 In Henderson’s complex, multidimensional
                model, she defines health as a person’s ability to
                perform 14 activities independently.3 Although the
                word “wellness” is not used in Henderson’s theory, her
                activities align with the Six Dimensions of Wellness
                framework.11 Table 2 organizes Henderson’s theory in
                the Six Dimensional Framework.

                Henderson believes that the nurses’ role is to assist
                patients with the 14 activities when they lack the
                strength, knowledge, or will. At the same time, she
                emphasizes that nurses should care for all patients; she
                believes that basic human needs exist in patients who
                are sick and patients who are well. She believes
                that nurses should promote health and prevent
                disease.3

                Henderson’s theory affirms and mobilizes the
                strength of patients. She further states that nurses must
                encourage and empower patients to care for
                themselves.3 Nurses should not do everything for a
                patient; the best care is the care that the patient gives
                himself or herself. Nurses should recognize that health
                is multidimensional and affected by variables such as

                TABLE 2. Henderson’s Definition of Health and the
                Six Dimensions of Wellness Frameworka

                Dimension of
                Wellness

                Fourteen Activities
                That Define Health

                Occupational
                wellness

                Work at something that provides
                sense of accomplishment

                Social wellness Avoid dangers in environment and
                avoid injuring others

                Play or participate in various forms of
                recreation

                Intellectual
                wellness

                Learn, discover, or satisfy the curiosity
                that leads to “normal” health

                Physical wellness Eat/drink adequately
                Move and maintain desirable posture
                Sleep/rest

                Emotional
                wellness

                Communicate with others in
                expressing emotions, fears, and
                needs

                Spiritual wellness Worship according to his or her faith

                aBased on definitions from Henderson3 and Hettler.11

                age, environment, genetics, culture, emotional
                balance, and intellectual abilities.3

                Henderson encourages nurses to also care for well
                people. She defines health as the ability to perform 14
                functions independently. Although Henderson
                encouraged and believed that nurses should provide
                care to well patients, not just sick patients, she never
                provided an explanation for how the nurse would care
                for a patient who could independently perform the 14
                functions. Her theory addresses patients holistically
                and promotes affirmation; however, similar to
                Nightingale, her theory does not address helping the
                person achieve his or her full potential or maximal
                level of wellness. She defined health and even
                emphasized the nurses’ role in caring for well patients,
                but she did not define wellness, nor did she provide a
                framework to promote wellness.

                Newman’s theory, Health as an Expanding
                Consciousness, supports 3 wellness approaches:
                addressing the whole patient; assisting the patient to
                rise to his or her full potential; and affirming the
                qualities within a patient.4 In Newman’s theory,
                disease is an underlying manifestation of an imbalance
                within a patient. Health is more than the absence of
                disease; health is the expansion of consciousness, or
                personal growth. Newman’s theory supports the idea
                that even in the face of illness, a patient can grow and
                make progress. Although disease appears negative,
                Newman believes that disruption eventually

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                132 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

                transforms a patient’s life into a higher state of being,
                or consciousness.4

                Health as a state of consciousness, according to
                Newman, is represented through the quality and
                interaction of a patient with his or her environment.
                Newman addresses the complexities that exist between
                every individual and his or her environment. Every
                patient’s relationship with his or her environment will
                generate different reactions. The reflections on
                experiences that occur within the environment provide
                growth or expanded consciousness. Newman stresses
                that for nurses to promote expanded consciousness,
                they must provide highly individualized care to every
                patient. She also believes that the process of
                expanding consciousness can occur anywhere,
                anytime. The process is not limited to a specific health
                care setting, or the presence or absence of a disease.4

                Nurses’ responsibility in promoting consciousness
                reflects the wellness approach of affirming and
                addressing the whole person. Newman believes that to
                promote consciousness, nurses need to look at patients
                as a whole, greater than the sum of their physiologic
                systems. Health is not something someone achieves or
                loses. Patients can have consciousness even in the face
                of illness and disease; you cannot lose consciousness
                or achieve consciousness. Illness or diseases create an
                opportunity for growth.4

                For optimal effectiveness of Newman’s model, the
                relationship and environment created between a
                person and a nurse are essential. Nurses must provide
                individualized care focused on listening attentively to
                the person’s life, and rhythm. Nurses need to embrace
                uncertainty and not focus on fixing the patient but,
                instead, listen and promote what is working well.
                People’s lives are not certain, they are all different and
                unique; disequilibrium is necessary for growth. Nurses
                need to give patients the opportunity to reflect, think,
                and generate their own growth. Nurses cannot
                manipulate and control patients; the partnership
                between nurses and patients is essential to expanding
                consciousness.12

                Newman’s theory embraces the concept that
                wellness is a state of being, ever changing and
                continuously evolving. Newman does not use the word
                “wellness” to describe her theory; however, her theory
                suggests that nurses cannot define wellness for
                patients because wellness will mean something
                different to every patient. Nurses need to promote
                wellness by accepting uniqueness and developing a
                deep understanding for each patient’s environment and
                experience.

                Although each of the theorist believe that caring for
                patients who are well is essential to the nurses’ role,
                none clearly define the concept of wellness or provide
                a framework for nurses to practice and promote
                wellness.3,4,6,12 To examine the relationship between
                the theoretical foundations of wellness and current
                nursing practice, a review of the literature was
                completed using CINHAL. Literature examining the
                role of wellness in nursing practice was notably
                absent. The CINHAL thesaurus suggested using the
                search terms “health promotion.” Five qualitative
                research studies aiming to explore nurses’ perceptions
                of the definition of health promotion, how they
                promote health in practice, and barriers to promoting
                health in practice were included in the review. The
                sample sizes ranged from 8 to 20. Nurses working in
                acute care, geriatrics, advanced practice, academia,
                community, and mental health care were represented.
                Because of the expanded search, a definition of health
                promotion is provided in the following text.

                HEALTH PROMOTION

                The World Health Organization13 defines health
                promotion as a process to help individuals increase
                control of their health with the desired outcome of
                physical, mental, and social well-being. The World
                Health Organization distinctly emphasizes that before
                health promotion can occur, a patient must recognize
                his or her aspirations, satisfy his or her needs, and
                change or cope with his or her environment. Health
                and wellness promotion is a fundamental role within
                the nursing profession, yet a review of the literature
                highlights a gap in nursing knowledge about how and
                when to promote health and wellness.

                NURSES DEFINITION OF HEALTH
                PROMOTION

                The results of 5 qualitative research studies suggest
                that nurse’s definition of health promotion is
                ambiguous and uncertain.14-18 The common definition
                of health promotion among nurses, in a variety of
                health care settings, refers to providing health
                education and advice about healthy life styles.15-18 For
                example, nurses believed that health promotion is
                telling someone why he or she should change his or
                her behavior or life to protect or improve his or her

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                Wellness Promotion 133

                health.18 Nurses with more experience commonly
                perceived health promotion as empowerment.17

                Advanced practice nurse practitioner students with
                at least 2 years of nursing experience participated in a
                research study that evaluated their perceptions of
                health promotion. The students completed qualitative
                questionnaires before and after a health promotion
                course. Before the health promotion course, the
                students described health promotion as advice giving
                and health education. After the health promotion
                course, the student’s views of health promotion
                evolved to empowering the patient.18

                HOW NURSES PROMOTE HEALTH

                In the research studies included in the review, the most
                common theme about how nurses promote health is
                giving information about healthy lifestyles to patients
                with specific health conditions.16-18 For example, if a
                patient presented to the hospital post–myocardial
                infarction, the nurse would encourage the patient to
                exercise more frequently and eat more fruits and
                vegetables.16 Some nurses believe that they promote
                health without any deliberate efforts because
                promoting health is a natural and automatic
                component to their work. Consequently, they are
                unable to recall specific examples about the last time
                they promoted health.15

                BARRIERS TO HEALTH PROMOTION

                The most common perceived barrier to promoting
                health in nursing practice is time,15,17,18 followed
                closely by not enough education and training.15,17

                Some nurses believe that they needed more evidence
                that health promotion is an effective method for
                helping patients improve their health.17

                Nurses perceive patients as barriers to promoting
                health. Some nurses believe that patients are unwilling
                to accept health promotion.15 More than half of nurses
                who perceived that patients should not have a choice
                to receive health promotion believed that patients
                frequently ignore advice given to them.17 Patients’
                knowledge deficit about healthy lifestyles and
                patients’ unwillingness to change emerged as health
                promotion barriers for nurses.18

                The health care system and work environments do
                not support nurses in the role of health
                promotion.14,15,18 Some nurses believed that nursing

                management does not empower nurses to promote
                health and daily nursing tasks are burdensome and
                prevent them from practicing health promotion.15 The
                percentage of nurse practitioner students who
                perceived the work environment as a barrier to
                practicing health promotion increased at the
                completion of a health promotion course.18

                DISCUSSION

                The literature included in the review contains
                limitations. The most notable limitation is the absence
                of literature examining nurses’ perception of wellness
                in practice. The vision of the IOM is for nurses to
                intentionally promote wellness. Before this can occur,
                research that examines nurses’ current understanding
                of wellness and how to promote wellness in practice is
                needed. Research in this review contained small,
                convenience samples of nurses who were required to
                answer questions about health promotion while being
                recorded by the interviewer. Nurses interested in
                health promotion may be overrepresented using
                convenience samples. Furthermore, the use of tape
                recorders may lead some nurses to withhold
                information or exaggerate information due to concerns
                about confidentiality, or social desirability.
                Acknowledging the limitations, however, this review
                provides insight about the gap between wellness
                promotion and nursing practice.

                Nurses believe that health promotion is at the core
                of nursing practice.15-18 Currently, nurses promote
                wellness by promoting health. Nurses cannot
                intentionally promote wellness and achieve the vision
                of the IOM1 if they are unable to confidently define
                and provide specific examples of health and wellness
                promotion. Nurses should have time to promote health
                and wellness if they believe that it is the core of the
                profession.

                Nurses believe that patients are barriers to the
                practice of health promotion.15-18 Nurses’ belief that
                patients are unwilling to accept health promotion
                warrants further examinations. How can patients have
                knowledge deficits about their own perception of
                health and wellness? If a patient is unwilling to
                change, should he or she be considered a barrier?
                Reflecting on each question philosophically reminds
                us that patients’ health and wellness are their own
                state of being. Their experiences and perceptions
                define how wellness and health will look, act, and feel
                for them.8,19 According to ontology, every patient is

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                134 HOLISTIC NURSING PRACTICE • MAY/JUNE 2012

                on a journey to optimal wellness.8 Reflecting on each
                question through the lens of nursing theorists suggests
                that nurses may be the true barriers in promoting
                health. Nightingale warns against judging patients who
                are unwilling to change. She would say that patients
                would do better if their environment supported them
                better.6 Henderson3 would argue that the patient does
                not have the strength, knowledge, or will to accept
                health promotion how the nurse desires, but this does
                not mean that the patient never wants to promote his
                or her health. Newman12 posits that the nurse is not
                asking the right questions, not listening with her
                whole heart, and not getting into the patient’s life.

                WELLNESS AND THE ART AND
                EPISTEMOLOGY OF NURSING

                The review of the literature highlights a gap between
                nurses’ perception of health and wellness promotion
                in nursing practice and how and when to promote
                health and wellness in practice. The subjective nature
                of wellness, the absence of a clear and universal
                wellness definition, and the absence of a wellness
                framework in nursing practice create fundamental
                challenges to achieving the IOM’s vision.1 Nurses
                need to know how to assess, design, document, and
                validate wellness outcomes. Carper’s20 seminal work,
                The Four Fundamental Patterns of Knowing in
                Nursing, provides a framework to address the art and
                epistemology of wellness in nursing.

                Empirical understanding of wellness

                Nurses need an empirical understanding of the
                concept of wellness. To intentionally promote
                wellness, nurses need to know in what context the
                phenomena of wellness are to be viewed. Nurses need
                to develop an abstract and theoretical explanation for
                wellness in nursing practice. Nurses need to know
                what questions are to be raised about wellness, and the
                methods of study to examine evidence of wellness
                promotion.2 For nurses to intentionally promote
                wellness in nursing practice, they need the knowledge
                to describe and explain wellness to patients, society,
                and other health care professionals.

                In nursing practice, the essence of wellness may lie
                within an understanding of the realities, experiences,
                and world of the patient. Nurses, therefore, will need
                to know how to empower, encourage, and inspire
                patients to realize their own visions of wellness. Nurse

                researchers need to design empirical studies to
                examine techniques to promote wellness in nursing
                practice. Nurse educators need to develop frequent
                continuing educational activities about when, how,
                and why to promote wellness in practice. Nursing
                administration needs to examine nursing tasks to
                ascertain whether health and wellness promotion, a
                core value in nursing, is not absent in practice because
                of time constraints. Nursing practice needs to develop
                a documentation system that captures the patient’s
                empirical view of wellness and tracks wellness
                outcomes from the patient’s perspective. Most
                importantly, nursing education needs to develop an
                evidenced-based curriculum that provides nurses with
                a strong foundation for promoting wellness in nursing
                practice. Currently, clinical prevention and population
                health are essential education requirements for
                baccalaureate prepared nurses.21 These requirements
                do not aim to prepare all nurses for the role of
                intentional wellness promoters. First, clinical
                prevention, as defined by the American Association of
                Colleges of Nursing, is disease focused. Nurses
                practicing clinical prevention will demonstrate
                knowledge around immunizations, screenings, and
                counseling aimed to prevent disease or disease
                escalation. Second, population health aims to improve
                the health at the community, or aggregate, level.
                However, since the baccalaureate degree is the
                minimum level of education required to practice and
                promote population health, half of the nursing
                workforce who hold an associate degree in nursing is
                not adequately trained or qualified to perform this
                role21,23 The absence of wellness as an essential
                requirement in nursing education is evident. To
                achieve the vision of the IOM, all licensed nurses
                require education and training about the meaning of
                wellness and how to promote wellness to all patients
                in all care settings.

                Esthetic understanding of wellness

                An esthetic understanding of how to promote wellness
                in nursing practice is needed. Wellness is intimate to
                the person experiencing the phenomenon. Successful
                wellness promotion in nursing practice will depend on
                how nurses ask patients questions about what wellness
                means to them. Patients’ responses will depend on how
                nurses listen to the words the patients speak and how
                nurses insert themselves into the patients’ world.4,20

                The patients’ growth will depend on nurses’ ability to

                Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

                Wellness Promotion 135

                be in the moment; nurses will express empathy, joy,
                and heart ache with the patients to promote wellness.20

                Personal understanding of wellness

                Nurses need a personal understanding of how to
                promote wellness in nursing practice. Personal
                knowledge in wellness promotion will require nurses
                to relinquish the authoritarian role and accept that
                patients are free to create their meaning and
                experience of wellness.20 Carper20 states, “An
                authentic personal relation requires the acceptance of
                others in their freedom to create themselves and the
                recognition that each person is not a fixed entity, but
                constantly engaged in the process of becoming.”(p155)

                Nursing practice needs to develop dynamic
                relationships with policy makers and interdisciplinary
                health care professionals to design a wellness
                infrastructure within the community and the health
                care system. The new system should capitalize on
                nurses’ personal knowledge and ability to promote
                wholeness and integrity.20

                Ethical understanding of wellness

                Nurses need an ethical understanding of how to
                promote wellness in nursing practice. Patients’
                perception of wellness will depend on their
                experiences and values. Only patients can determine
                what is good and bad for them. However, nurses need
                the knowledge to recognize behavior that is harmful or
                dangerous. Nurses need to adhere to moral obligations
                when promoting wellness in nursing practice.20

                FUTURE DIRECTION FOR SCIENCE
                AND NURSING

                Nurses are recognized for their unique ability to care
                for patients holistically.23 The goal of nursing practice
                is to foster behavior that leads to health and wellness.2

                However, nurses cannot rise to their full potential and
                realize the vision of the IOM1 to intentionally promote
                wellness based on this premise.2,23 Nurses need a
                clear understanding of the phenomenon of wellness.
                Nursing science needs to develop a universal wellness
                paradigm to promote wellness in nursing practice.7

                Finally, the pivotal change that needs to occur is a
                shift in the percentage of nurses working in acute care
                hospital settings to nurses promoting wellness within
                the community. Currently, 62.2% of nurses work in

                hospitals compared with 7.8% in public health and
                community settings.22 Patients in acute care settings
                are in a new environment. Before optimal health and
                wellness promotion can occur, patients must cope with
                the new environment, a process that may not occur
                before patient discharge.13

                Nurses’ role in the community is multidimensional.
                Nurses have an opportunity to apply empirical,
                aesthetic, personal, and ethical wellness knowledge in
                schools, businesses, prisons, day care centers, and any
                other place people gather. Removing the barrier of the
                hospital environment14,15,18 may prove the best
                method for nurses to assume their role as intentional
                promoters of wellness.

                CONCLUSION

                The Future of Nursing Report from the IOM1

                symbolizes a turning point for change in health care
                delivery. Nurses are prepared to rise to the challenge
                and embrace changes that promote positive health
                outcomes for society. However, to realize a vision that
                explicitly emphasizes the contribution of intentional
                wellness promotion to positive patient outcomes,
                nurses are challenged to develop a universal
                understanding and paradigm to promote wellness in
                nursing practice. Before nurses can value their role as
                wellness promoters, nursing education, nursing
                research, and nursing administration need to work
                together to make wellness a priority. Without proper
                education about how and why to promote wellness,
                without research to provide evidence-based wellness
                guidelines, and without administration to monitor
                wellness promotion practice and outcomes, nurses
                cannot truly value their role as intentional wellness
                promoters.

                REFERENCES

                Nursing

                Week 3: Drugs To Treat Pain

                Drug

                Drug Class

                Mechanism of Action

                Adverse Effects

                Nursing Implications

                Naloxone Hydrochloride

                Naltrexone (ReVia)

                ____1___

                ____2_______

                Anxiety, irritability, chills, hot flashes, rhinorrhea, diarrhea, confusion, abdominal cramps, nausea vomiting

                Use with caution in patients with cardiac disease – Monitor for cardiac arrythmias.

                ****After the nurse had administered to a patient to reverse opioid effect, what should they look for ____3_____

                Gabapentin, Venlafaxine, Bupivacaine, Baclofen, Cyclobenzaprine, Ketamine, Duloxetine, Nortriptyline

                ___4_____

                Activate innate immune responses to create a local immuno-competent environment at the injection site. 

                respiratory depression,

                sedation,

                constipation

                urinary retention

                nausea

                Depending upon the medication used. **

                Aspirin, Diclofenac, Ibuprofen, Ketoprofen, Ketorolac, Meloxicam, Naproxen, Celecoxib

                Non-Opioid analgesics

                NSAIDS-Inhibits COX-1 and COX-2, inhibits prostaglandins.

                ASA- causes irreversible inhibition of COX (different from NSAIDs)

                GI distress

                Peptic Ulcer disease

                Kidney and liver impairment

                Tarry stools

                Blood dyscrasias: thrombocytopenia, leukopenia, neutropenia, hemolytic anemias Bone marrow depression and impaired coagulation

                Monitor (labs): __5___ & __6___

                (hint: look at Adverse effects)

                Teach Patient:

                Take with meals or milk to reduce GI irritation

                Avoid drinking alcohol, smoking and aspirin when taking other NSAIDs

                Morphine

                Fentanyl

                Hydromorphone

                Codeine Sulfate

                Meperidine (do not use in elderly)

                Methadone

                ____7___

                ___8_____

                1. ___9_____*

                2. ___10____*

                3. ____11___*

                4.Cough suppression

                5. Itching

                6. Pupil Constriction

                7. Diaphoresis and flushing


                Antidote

                : ___12________

                1. Monitor vital signs (_13_ & _14__)

                2. Teach patient to rise slowly.

                3. Monitor for constipation

                Administered: IV, Transdermal, Transmucosal, Nasal Spray, PO, Sublingual spray

                Antidote: 15. ______ (opioid antagonist)

                “Morphine is the opioid of choice for decreasing pain from myocardial infarction. “

                Drug

                Drug Class

                Mechanism of Action

                Adverse Effects

                Nursing Implications

                Acetaminophen

                16. ____ and 17. ___ (not anti-inflammatory)

                Inhibits prostaglandin synthesis

                · Can cause 18___ (which main organ) damage

                · Dark urine

                · rash

                · Clay colored stools

                Antidote: 19. ____

                Monitor: 20. _______

                Teach:

                Careful when taking with other medications that already contains 21. ____ (i.e., Percocet)

                Buprenorphine

                (used to treat opioid addiction)

                Agonist-antagonist

                Indicated for:

                Used an 22. ___ and to treat 23. _____ addiction

                1. Headache

                2. Drowsiness

                3. Nausea, vomiting

                4. Increased sweating

                5. Inability to sleep

                Avoid driving or drinking when taking this medication.

                Do not take with other narcotics

                Pentazocine (nalbuphine, butorphanol

                Agonist-antagonist

                Antagonist: Acts on opioid receptor sites

                Agonist: produces an antagonistic effect when given to patients taking opioids

                · Respiratory depression**

                · Nausea, vomiting diarrhea

                · 24. _____*

                · Tachycardia

                · 25. _____

                Monitor vitals especially: (hint adverse reaction column) ___26__and ___27___

                Naloxone (Narcan)

                ___28__

                Blocks and reverses effects. Binds to receptors in the brain

                · _29__

                · _30___

                Administration: IV, intranasal, IM, subQ

                *if administered before opioid -blocks effects, if administered after opioid, it will reverse the effects of drug

                Adjuvant Medications

                Drug

                Drug Class

                Mechanism of Action

                Adverse Effects

                Nursing Implications

                Lidocaine (Lidoderm)

                Topical analgesic

                 Local anesthetic used to relieve neuropathic pain (postherpetic neuralgia)

                · Redness or irritation to skin

                · Dizziness

                · Confusion

                · Cautioned in patients who are taking Class I antiarrhythmic drugs

                Treat: neuralgia due to herpetic

                Wash hands after handling

                Apply to area that is painful.

                Gabapentin (Neurontin)

                Treats: Neuropathic Pain

                Antiseizure

                31._______

                · Drowsiness

                · Dizziness

                · Tiredness

                · Tremors

                Indication (Used to Treat)

                32. _______

                1. Teach patient medication is used to alleviate pain and not for the Rx’s original purpose.

                Pregabalin (Lyrica)

                Indicated for: neuropathic pain associated with diabetic neuropathy, postherpetic neuralgia

                Antiseizure/Antidepressant

                 binds to calcium channels and decreases the inflow of calcium at nerve endings.

                · dizziness*

                · Somnolence* which often persist as long as the drug is being taken.

                · 3. Blurred vision may develop during early therapy, but resolves with continued drug use”

                · Pregabalin (33)does/does not interact with oral contraceptive.

                · Does not alter any antiseizure drugs studied (carbamazepine, lamotrigine, phenobarbital, phenytoin, topiramate, valproic acid, and tiagabine)”

                Glucocorticoids

                Drug

                Drug Class

                Mechanism of Action

                Adverse Effects

                Nursing Implications

                Prednisone

                Prednisolone

                Glucocorticoids

                Decrease Inflammation

                Short term:

                Weight gain, hyperglycemia

                Long term: bone loss, adrenal suppression, exogenous glucocorticoid- Cushing Syndrome

                Monitor: __34___ in clients with diabetes

                Methotrexate

                Other DMARDS

                Hydroxychloroquine

                Leflunomide

                Sulfasalazine

                Non-biologic

                DMARDS

                Slows disease progress and decreased joint destruction

                (Methotrexate Only)

                Contraindicated in pregnancy.

                Can cause fetal death and congenital abnormalities.

                Blackbox Warning (Methotrexate):

                ______36_______

                (Methotrexate Only)

                Should be taken with __35___(vitamin?) to reduce GI and hepatic toxicity.

                Teach:

                Patient should receive annual influenza.

                Avoid people who are sick and perform frequent handwashing

                Answer Key

                1. 21. 36.

                2. 22.

                3. 23.

                4. 24.

                5. 25.

                6. 26.

                7. 27.

                8. 28.

                9. 29.

                10. 30.

                11. 31.

                12. 32.

                13. 33.

                14. 34.

                15. 35.

                16.

                17.

                18.

                19.

                20.

                Nursing

                The discussion forum should be written in a scholarly/professional writing style. Be sure to use APA formatting with references. Be sure to cite any ideas that is not your original work. Your discussion post should be 3-5 paragraphs in length with 5-6 sentences per paragraph. Response post should be 2 paragraphs in length (5-6 sentences per paragraph). The first response should be made by Friday and 2 responses by Sunday. You should have at least 4-6 references for each of your post, this will help add evidence based content to your discussion.

                When discussing your ideas add concrete examples to defend your argument. The examples should include ideas and concepts identified in the literature. For example, if I am discussing pressure ulcers and how they impact patient outcomes, I would search for articles on that topic and analyze what are consistent themes or ideas in the literature and state them in the discussion. All of your work should be supported by evidence-based literature. Be creative. 

                Response post should not just agree/disagree with a student’s post. They should elaborate on the ideas and provide more insight on the topic discussed with examples from the literature

                In Chapter 2 of the course text book “Toward Healthy Aging” the topic of transition of care is a leading problem in the older adult population that leads to hospital readmissions. Read this section of the text on “transitions across the “continuum: the role of nursing.” 

                Identify some of the major causes of hospital readmissions and the role of the gerontological nurse in improving and preventing readmissions. Read the following article on “The Prevention of Hospital Readmissions in Heart Failure.” The Prevention of Hospital Readmissions in Heart Failure (nih.gov)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783289/

                In this discussion include 4-5 paragraphs (5-6 sentences each paragraph) in which you will address the following:

                1. Summarize the contents of the article: The Prevention of Hospital Readmissions in Heart Failure. Be sure to include the: who, what, and why (be specific) For example: what population is affected and why. What are the key stakeholders involved. What are the goals to improve the issue. Be sure this is only a summary. Give examples. Cite sources in APA format.

                2. What are some of interventions addressed in your text and evidence-based resources that can be used to prevent hospital readmissions. Use additional sources to support your work. Cite your sources in APA format.

                3. What care setting interest in your future role as a nurse (pediatrics vs adults, outpatient vs inpatient vs community) and why? Be sure to use a professional writing style. Identify articles that provide information on your area of interest (what is the patient population, why type of illness/disease specialty care is required, what nursing training is required).

                4. Be sure to include in-text references and a reference summary.

                5. Be sure to proof-read your work. You will be graded on the style of your work. Be sure that your structure has smooth transitions and correct use of APA syntax. Be sure the writing is organized in a way that introduces the topic, defends your argument, and concludes. 

                NURSING

                2

                Balancing School and Life

                Name

                Institutional Affiliation

                Professor

                Date

                To create a balance between school, life, and work, one focused on the task they have at hand and not worry about any of their studies while spending quality time with family too. Set a schedule to meet the expectations and get an organized life. Planning segments of all the required activities in one’s life ensure exercising balance between study, family, and work. Through the involvement of activities to maintain physical fitness while staying motivated throughout any of the programs, success is guaranteed at work as a professional nurse and in coursework. Understanding self-care strategies that will boost energy and help in the management of stress levels. Therefore, after the application of management and planning strategies to put life events into an expected manner, results will be expected. The results however are dependent on the success of applied strategies.

                Achieving SMART goals while managing course work and professionalism have to be set out through reflective means and in the identification of balance to reduce stress levels in the vent of work. A positive change will be impacted after striking a balance between the two; work and study. Through this energy is maintained to be able to handle all tasks equally and meet set goals and expectations of each in timely and specific times without having to be stressed (Ramos & Galleto,2020). Stress comes in when one cannot account for different life responsibilities which must be undertaken both within the same time frame to ensure life goes on well. The goal is to ensure to involve self-awareness strategies to help increase energy to be used in coursework and that at work. This is why a positive change is expected with the application of set strategies.

                Availability of progress towards my SMART goals can be predicted through the processes strategized in between to ensure execution of goals. The common strategies and rules used towards meeting goals are setting specific ones, finding the connections, and meeting them whin specific time frames. The set goals must be measurable in that they can be accounted for when the need arises. The goal is to improve on-course final grades while attending to professional needs. This can be done by utilizing available resources from the university, through the setting of realistic goals. Each Sunday will be dedicated to the listing of readings as well as scheduling specific times to meet the target to complete the assignments per unit. Ticking off the read parts will be done after completion. I shall do self-assessment tests each Thursday to test the understanding of previous topics. I shall also plan to visit the instructor for additional coursework materials to access additional coursework for readings. To strike a balance in my profession I plan to be attending group meetings and workshops which are set out every Saturday. Through the continuous practice of the set objectives, I shall accomplish the goal by the final examinations period to pass. Additionally, the other strategy to pass my final examination as well as take part in my profession as a nurse is to practice all past papers each day and keep track of progress in terms of years and hence passing.

                References

                Ramos, D. S., & Galleto, P. G. (2020). The Interplay between Work-Life Balance Practices and Productivity among Public Secondary School Teachers: Basis for Guidance and Counseling Program. American Journal of Multidisciplinary Research & Development (AJMRD)2(3), 45-55.

                NURSING

                NEWSIn the

                12 AJN ▼ March 2022 ▼ Vol. 122, No. 3 ajnonline.com

                Nursing Shortage or Exodus?

                A new report claims that hospital practices are
                undermining nursing.

                A recent report by National Nurses United (NNU) claims that methods used
                by the hospital industry to maxi-
                mize revenue are driving nurses
                from the bedside.

                Among examples cited by the
                report—Protecting Our Front
                Line: Ending the Shortage of Good
                Nursing Jobs and the Industry-
                Created Unsafe Staffing Crisis—is
                the pursuit by health care organiza-
                tions of high customer satisfaction
                scores at the expense of authentic
                nurse–patient relationships. Few
                patients realize that nurses—often
                to their dismay—are told to im-
                prove these scores through repeated
                use of specific words such as “ex-
                cellent” and “thank you” to con-
                dition patients to rate the hospital
                as “excellent” on surveys. In turn,
                the positive surveys are used by
                health systems to maximize in-
                centive payments by the Cen-

                ters for Medicare and Medicaid
                Services.

                The NNU report also questions
                the oft-cited shortage of nurses in
                the United States, concluding that
                it may not be due to a dearth of
                nurses so much as a lack of good
                nursing jobs. As of November
                2021, there were 4.4 million li-
                censed RNs in the United States,
                but only 3.2 million employed
                as RNs and 1.8 million work-
                ing in hospitals, according to the
                report, which faults poor work-
                ing conditions such as understaff-
                ing for driving nurses away from
                acute care.

                Also cited are systemic fail-
                ures by health care organizations
                to invest in measures to protect
                nurses from health and safety haz-
                ards such as workplace violence,
                infection, and musculoskeletal
                injury. RNs have also reported ex-
                periencing moral distress, physi-
                cal exhaustion, and such mental
                health issues as stress, anxiety,
                depression, and posttraumatic
                stress disorder, which the NNU
                report attributes to overwork and
                inadequate resources to support
                safe, high-quality nursing care.

                The report recommends several
                federal remedies, including pas-
                sage by Congress of the Nurse
                Staffing Standards for Hospital
                Patient Safety and Quality Care
                Act, which would establish min-
                imum RN-to-patient ratios, and
                the Workplace Violence Preven-
                tion for Health Care and So-
                cial Service Workers Act, which
                would mandate workplace safety
                protections. Both bills have been
                referred to Senate committees for
                study. In addition, the NNU re-
                port urges Congress to fund
                nursing programs at public com-

                munity colleges so students from
                underserved minority commu-
                nities can attend tuition-free,
                thereby augmenting and diversi-
                fying the nursing workforce.

                Some states have already
                moved to implement the recom-
                mended measures. As early as
                2004, California implemented
                specific nurse-to-patient ratios.
                Massachusetts did so in 2014,
                but only in ICUs. New York
                passed a law last year requiring
                hospitals to include nurses on
                staffing committees; it also
                launched a program that will
                cover tuition for 1,000 nursing
                students at state and city univer-
                sities. And Kentucky governor
                Andy Beshear in December is-
                sued an executive order allowing
                nursing schools with sufficient
                resources to open new campuses
                and those at full capacity to refer
                qualified applicants to other
                schools with vacancies.

                Also in December, the NNU
                participated in a virtual brief-
                ing of Congress to present its re-
                port and offer testimony from
                several nurses—among them
                Kelly Anaas, RN, from Minne-
                apolis, who told the lawmakers
                that nurses were running out of
                stamina. “Does everyone remem-
                ber when the pandemic arrived
                on our doorstep and we imple-
                mented all these mitigation efforts
                to make sure that we, as a soci-
                ety, did not get to the point where
                we are rationing care?” she asked.
                “Well, the truth is that we’ve been
                rationing care in this country for
                a long time. Short staffing leads to
                the rationing of care. Just because
                we are not pulling names out of
                a hat to see who gets a ventilator
                and who doesn’t, doesn’t mean

                National Nurses United held a candlelight vigil in Washington,
                DC, in January to honor the nurses who lost their lives to
                COVID-19 and to demand the hospital industry invest in safe
                staffing. Photo by Rick Reinhard / Courtesy of National Nurses
                United.

                ajn@wolterskluwer.com AJN ▼ March 2022 ▼ Vol. 122, No. 3 13

                Health care workers are at greater risk than the general population for
                COVID-19 infection, and nurses
                providing direct care to patients
                have the highest risk of all, ac-
                cording to several studies. For
                that reason, the results of a recent
                study in the New England Jour-
                nal of Medicine should be reas-
                suring for nurses on the front
                lines who are fully immunized.

                According to the study, the
                Moderna (mRNA-1273) and
                Pfizer–BioNTech (BNT162b2)
                vaccines are highly effective at
                protecting health care workers in
                real-world settings, not just in the
                controlled conditions of a clinical
                trial. The study included 4,931
                health care workers at 33 acute
                and long-term care sites across
                the United States. Effectiveness
                against symptomatic infection
                after two doses was 96% for the
                Moderna vaccine and 90% for
                Pfizer–BioNTech. After adjusting
                for possible confounders, such as
                age, race, and ethnic group; un-

                derlying conditions or risk factors
                for severe disease; and commu-
                nity or workplace behaviors, ef-
                fectiveness was 90% after two
                doses for both vaccines and 80%
                after one dose. Effectiveness was
                the same regardless of the health
                care worker’s level of patient con-
                tact. Yet, according to a study of
                over 3 million hospital-based
                health care workers in the Ameri-
                can Journal of Infection Control,
                as of September 2021, only 70%
                of health care workers were fully
                vaccinated—defined at the time
                of the study as two doses.

                The percentage has likely in-
                creased since that time, as vaccine
                mandates that went into effect
                later in 2021 propelled many
                health care workers to get vacci-
                nated. And, in January, the U.S.
                Supreme Court upheld the federal
                vaccination mandate for health
                care workers who treat Medicare
                and Medicaid patients, making it
                harder for people to refuse and still
                keep their jobs. The study by Pil-
                ishvili and colleagues adds to the

                evidence that vaccination protects
                against COVID-19 illness, rein-
                forcing the need for continued ef-
                forts to improve vaccination rates
                among nurses and other health
                care workers.—Karen Roush,
                PhD, RN, FNP-BC, news director

                Pilishvili T, et al. N Engl J Med 2021;385(25):
                e90; Reses HE, et al. Am J Infect Control
                2021;49(12):1554-7.

                MRNA Vaccines Are Effective at Preventing
                COVID-19 in U.S. Health Care Personnel

                But vaccination rates, including among nurses, still lag.

                News Director: Karen Roush, PhD, RN, FNP-BC
                E-mail: ajnNews@wolterskluwer.com

                Nurse Elyse Isopo receives the Pfizer vaccine booster at Long
                Island Jewish Medical Center in New Hyde Park, New York.
                Photo by Lev Radin / Sipa USA / AP Images.

                we haven’t been making awful de-
                cisions about the level and quality
                of care people receive.”

                To read the NNU report, go
                to www.nationalnursesunited.
                org/sites/default/files/nnu/

                documents/1121_StaffingCrisis_
                ProtectingOurFrontLine_
                Report_FINAL.pdf.—Dalia Sofer

                NewsCAP
                ƒ Americans are finding it increasingly difficult to pay for health care. According to the West Health–
                Gallup 2021 Healthcare in America Report, the percentage of Americans who report not having access to
                affordable health care increased from 18% in February 2021 to 30% in October 2021, based on a survey sam-
                ple of 6,600 adults. The percentage of people who reported forgoing health care because of cost tripled
                from 10% to 30% from March to October. This surge was not confined to lower-income households; among
                those earning more than $120,000 a year, the percentage of people who said they were forgoing care
                jumped from 3% to 20%. The authors cite increased use of health care services and greater out-of-pocket ex-
                penses due to decreasing government assistance for COVID-19–related care as major contributing factors.

                • 20220300.0-00007.pdf
                  • 20220300.0-00007.pdf

                NURSING

                Locate one peer reviewed evidence-based article that describes a “best practice” being used in delivering client centered care and promoting health. It can be for any client across the life span. Discuss the best practice and give two reasons why this practice is important and “best” and how it affects care and the promotion of health. Provide the reference for the article (use APA Editorial format).


                Nursing

                Drugs for Deficiency Anemia

                Hematinic Agents
                NSG 220

                This Photo by Unknown Author is licensed under CC BY-SA

                1

                Anemia (Overview)

                Deficiency in the number of red blood cells or in the quality and amount of the hemoglobin. Low hemoglobin level decrease oxygen-carrying capacity to mee the physiologic needs of the body.

                Causes:

                Decreased number, size or hemoglobin RBCs.

                Loss of blood (acute or chronic)

                Hemolysis- destruction of RBC’s

                Poor dietary intake of iron, Vit. B, folic acid

                Chemotherapy

                bone marrow dysfunction or deficiency of substances for RBC production or maturation.

                2

                IRON DEFICIENCY ANEMIA

                Most common type of anemia

                Cause: Slow, chronic blood loss (GI bleeding, peptic ulcers, heavy menstrual bleeding, etc.), impaired absorption of iron, diet (lack of)

                Drug Treatment

                Ferrous Sulfate

                IV Dextran

                Ferrous fumarate

                Ferrous succinate

                Administered: IV, PO

                Action: Used to treated the production of normal hemoglobin and the RBCs for transportation and utilization of oxygen

                Iron Supplements

                Adverse Effect- GI related- constipation*, nausea*, diarrhea, dark green to black stools, teeth staining (liquid preparations)

                Can be toxic if given in large doses (accidental or intentional)

                Patient Teaching:

                Take with Vitamin C (ascorbic acid) to promote the absorption of iron*

                Do not give with antiacids or tetracyclines*

                Liquid preparations can stain teeth (dilute with a liquid, rinse mouth afterwards)

                Encourage to eat food rich in iron- liver, eggs, meat, fish

                4

                Vitamin B12 Deficiency

                Cause

                Impaired Absorption

                Pernicious Anemia

                Megaloblastic Anemia

                Neurological Damage

                GI disturbances

                Severe B12 anemia

                Mortality due to hypoxia to peripheral and cerebral hypoxiaHF and dysrhythmia

                Drug Treatment

                Vitamin B12 (Cyanocobalamin)

                Hydroxocobalamin

                Methylcobalamin

                Administered: intranasal, subQ, or PO –never IV

                Nursing Implications

                Treatment duration is usually life long

                Use with caution in patients who receive folic acid.

                Hypokalemia can develop during early therapy.

                Monitor serum potassium levels

                Teach patient s/s of hypokalemia and instruct them to contact provider immediate.

                Vitamin B12 is essential for the synthesis of DNA- required for the growth and division of cells.

                Lack of Vit B12 causes anemia and injury to the nervous system.

                Causes of B12 anemia is due to impaired absorption and rarely due to diet. Pernicious anemia (due to absence of intrinsic factors) is one you may remember in pathophysiology. Megaloblastic Anemia due to oversized erythroblasts (megaloblasts) and oversized erythrocytes (macrocytes) due to impaired DNA synthesis. I can also be cause by neurologic damage –when there is demyelination (damage) to the neurons of the spinal cord and brain. GI disturbances – autoimmune diseases such as Chron’s where uncontrolled inflammation if the terminal ileum can lead to this deficiency.

                5

                Folic Acid Deficiency

                Required for DNA synthesis. Identical to vitamin B12 deficiencies.

                Cause

                Poor diet*

                Malabsorption

                Sprue- intestinal disease which decreases folic acid uptake

                ETOH use (acute or chronic)*

                Indicated:

                Prophylactic- pregnancy women

                Severe deficiency – Megaloblastic anemia.

                Treatment: Folic Acid

                Administered: IV,PO, subQ and IM* (only for patients with impaired GI absorption only)

                Identical to Vitamin B12 deficiencies. Megaloblastic anemia is the most common. However, the provider must determine which one is he cause- Vitamin B12 deficiency or Folic Acid deficiency.

                “lack of folic acid may result in leukopenia, thrombocytopenia, and injury to the oral and GI mucosa. It can also case neural tube defects in early pregnancy which is many women are encouraged to take during pregnancy.

                6

                Hematopoietic Agents

                Hematopoiesis is the process by which our bodies make red blood cells, white blood cells, and platelets.

                RBC production occurs in the bone marrow

                The actual process “erythropoiesis occurs in the bone marrow”

                Erythropoietin “hormone” is produced and secreted in the proximal tubules of the kidney (& liver). It stimulates RBC production

                See process below

                When there is anemia or hypoxia, levels of erythropoietin rise and trigger increase of erythrocytes synthesis (erythropoiesis= production of red blood cells)

                Bone Marrow is the site of hematopoiesis- hemato means “blood” and poiesis means “to make”.

                Erythropoietin is a hormone that is produced predominantly in the kidneys. Erythropoietin is made to protect RBCs from destruction. They also stimulate stem cell of the bone marrow to increase RBC production.

                When there is sufficient oxygen in the blood circulation, the production of erythropoietin is reduced, but when oxygen levels go down, the production of erythropoietin goes up.

                7

                Erythropoietin Alfa

                MOA: Stimulate RBC production in bone marrow and erythropoietin in the kidneys

                Indication:

                Anemia due to chronic renal failure

                chemotherapy

                HIV patietns and takig zidovudine (Retrovir)

                Treatment:

                Erythropoietin alfa*

                Darbepoetin alfa (Aranesp)

                Long-acting

                Administered: IV or subQ

                Nursing implications:

                Monitor H&H as well as iron levels

                Monitor blood pressure before therapy

                Due to increase hematocrit

                Do not administer if hemoglobin >11 gm/dL (twice a week)

                Do not agitate (shake) the vial

                When there isn’t’ enough of red blood cells then medications are prescribed to increase the production of red blood cells. Remember red blood cells are produced in the marrow, the kidneys produce erythropoietin to protect the RBCs. When there isn’t enough RBC’

                Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)

                Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit

                In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.

                8

                High risk populations

                Cancer Patients- accelerate tumor progression

                Postoperative patients not given an anticoaugulant- increased risk of developing DVT’s

                Dialysis patients- increased risk of cardiovascular events.

                Monitor h & h – do not give for hemoglobin levels higher than 10 to 11 mg/dl

                Filgrastim

                MOA: Stimulate neutrophil production kidneys reduce neutropenia

                Indication:

                Chemotherapy – myelosuppressive reduce risk of infections

                Patients undergoing bone marrow transplantation

                Severe chronic neutropenia

                Administered: IV or subQ

                Can not be taken orally due

                Adverse Effects

                Bone pain

                leukocytosis

                Nursing implications:

                “Filgrastim is given to reduce the risk of infection in patients undergoing cancer chemotherapy. Many anticancer drugs act on the bone marrow to suppress production of neutrophils, greatly increasing the risk of infection. By stimulating neutrophil production, filgrastim can decrease infection risk.

                Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)

                Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit

                In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.

                10

                11

                nursing

                Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting

                criteria and general guidelines for apa.can you write assignment in apa styler with writing checklist

                nursing

                NR452 Capstone Course

                Capstone Evidence-Based Paper Guidelines

                PRIORITY CONCEPT TOPIC IS ( SAFETY AND INFECTION CONTROL)

                Purpose

                The student previously analyzed their performance on the integrated comprehensive assessments and reflected on areas of opportunity and strategies to promote NCLEX-RN success and transition into practice. The student will now apply the priority concept (topic) to evidence-based professional practice upon which nurses have the ability to resolve or have a positive impact. There is a focus on the healthcare disparities of the individual, as well as ethical and legal implications to professional practice. The student will discuss how an interdisciplinary approach promotes quality improvement for the patient and evidence-based professional practice, driving positive outcomes.

                Course outcomes: This assignment enables the student to meet the following course outcomes:

                CO # 1: Synthesize knowledge from sciences, humanities, and nursing in managing the needs of humans as consumers of healthcare in a patient-centered environment. (PO#1)

                CO # 2: Integrate communication and relationship skills in teamwork and collaboration functioning effectively with health team members and consumers of care. (PO#3)

                CO # 3: Utilize information technology to manage knowledge, mitigate error, and support decision making with health team members and consumers of care. (PO# 8)

                CO # 4 Integrate critical thinking, clinical reasoning skills, best current evidence, clinical expertise, and patient/family preferences/values in the implementation of the nursing process. (PO# 4)

                CO # 5: Explore the impact of professional standards, legislative issues, ethical principles, and values on professional nursing, using data to monitor outcomes and improve quality and safety. (PO# 5, 6)

                Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment.

                Total points possible: 230 points

                Preparing the assignment: Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.

                In this paper the student will provide a detailed description of the relationship between the category from the NCLEX-RN examination blueprint, the priority concept (topic) selected based on assessment performance, and professional practice.

                1) Write a 4-6 page paper (not including the title page or reference page) using APA format

                2) Include the following sections:

                a. Introduction- 20 points/8%

                · Offer a detailed description of the purpose statement for the paper.

                · Identify the priority concept (topic) from the Individual Student Comprehensive Assessment Trends: Longitudinal Performance Table drawn from one (1) of the four (4) main categories of the NCLEX-RN examination blueprint:

                · Assurance of a safe and effective care environment

                · Health promotion and maintenance of health

                · Preservation of the patient population’s psychosocial integrity

                · Preservation of the patient population’s physiological integrity

                · Provide a detailed description of the relationship between the category from the NCLEX-RN examination blueprint and the priority concept (topic).

                b. Importance – 20 points/8%

                · Describe the importance of the priority concept (topic) to professional practice.

                · Describe the importance of the priority concept (topic) to the health status of a patient population.

                · Include the potential negative effect(s) to professional practice if the priority concept (topic) is unresolved.

                · Include the potential negative effect(s) to the patient population if the priority concept (topic) is unresolved.

                c. Healthcare Disparities, Inequalities, and Interventions- 70 points/28%

                · Identify patient populations that may be negatively influenced by the priority concept (topic) if unresolved.

                · Identify healthcare resources to support evidence-based professional practice related to the priority concept (topic).

                · Summarize potential priority concept (topic) healthcare disparities and inequalities related to diverse populations.

                · Propose an evidence-based solution for the priority concept (topic) related to healthcare disparities.

                · Identify three (3) evidence-based practice interventions.

                · Prioritize the identified evidence-based practice interventions and provide rationale.

                · Discuss two (2) patient education considerations related to the priority concept (topic).

                d. Legal & Ethical Considerations and Intervention Challenges- 40 points/16%

                · Identify at least one (1) ethical and one (1) legal implication for addressing the priority concept (topic) in professional practice.

                · Discuss at least one (1) strategy in prevention of an ethical dilemma related to the priority concept (topic) in professional practice.

                · Discuss at least one (1) strategy in prevention of legal consequences related to the priority concept (topic) in professional practice.

                · Identify one (1) anticipated challenge to the success of preventing the priority concept (topic) in professional practice.

                · Identify one (1) anticipated challenge to the success of resolving the priority concept (topic) in professional practice.

                e. Participants and Interdisciplinary Approach – 20 points/8%

                · Identify all the parties who will be involved in the implementation of the priority concept (topic) interventions.

                · Discuss the role of each member in the intervention implementation for the priority concept (topic).

                · Identify a minimum of two (2) members of a discipline outside of nursing.

                · Discuss the benefit of including the identified interdisciplinary members from disciplines outside nursing to promote evidence-based professional practice.

                f. Quality Improvement– 20 points/8%

                · Provide at least one (1) benefit in patient outcomes from addressing the priority concept (topic) within the clinical environment.

                · Provide at least one (1) benefit to the nursing profession that will result from addressing this priority concept (topic) in clinical professional practice.

                · Discuss at least one (1) resource utilized to promote improved patient outcomes in the clinical environment.

                · Discuss at least one (1) resource utilized to increase professional nurse knowledge promoting improved clinical professional practice.

                g. Conclusion – 20 points/8%

                · Provide a thorough recap of the purpose to promote increased evidence-based professional practice knowledge related to the priority concept (topic) deficiency.

                · Summarize resources identified to support improved evidence-based professional practice related to the priority concept (topic).

                · Include a complete statement describing why addressing the priority concept (topic) matters for patient outcomes and evidence-based professional practice.

                h. APA Style and Organization– 20 points/8%

                · References are submitted with paper.

                · Uses current APA format and is free of errors.

                · Grammar and mechanics are free of errors.

                · At least three (3) scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided. Each section should have a cited source to support information provided.

                For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online Chamberlain library.


                NR452 Capstone Course

                RUA- Capstone Evidence-Based Practice Paper Guidelines

                NR452 Capstone Course

                Capstone Evidence-Based Practice Paper Guidelines

                NR452_RUA- Capstone Evidence-Based Guidelines Revised: 03/2022 1
                © 2021 Chamberlain University. All Rights Reserved

                NR452_RUA- Capstone Evidence-Based Guidelines Revised: 03/2022 2
                © 2021 Chamberlain University. All Rights Reserved

                Grading Rubric

                Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.

                Assignment Section and

                Required Criteria

                (Points possible/% of total points available)

                Highest Level of Performance

                High Level of Performance

                Satisfactory Level of Performance

                Unsatisfactory Level of Performance

                Section not present in paper

                Introduction

                (20 points/8.7%)

                20 points

                16 points

                8 points

                0 points

                Required criteria

                1. Offer a detailed description of the purpose statement for the paper.

                2. Identify the priority concept (topic) from the Individual Student Comprehensive Assessment Trends: Longitudinal Performance Table drawn from one (1) of the four (4) main categories of the NCLEX-RN examination blueprint:

                a. Assurance of a safe and effective care environment

                b. Health promotion and maintenance of health

                c. Preservation of the patient population’s psychosocial integrity

                d. Preservation of the patient population’s physiological integrity

                3. Provide a detailed description of the relationship between the category from the NCLEX-RN examination blueprint and the priority concept (topic).

                Includes all 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                Importance

                (20 points/8.7%)

                20 points

                18 points

                16 points

                8 points

                0 points

                Required criteria

                1. Describe the importance of the priority concept (topic) to professional practice

                2. Describe the importance of the priority concept (topic) to the health status of a patient population.

                3. Include the potential negative effect(s) to professional practice if the priority concept (topic) is unresolved.

                4. Include the potential negative effect(s) to the patient population if the priority concept (topic) is unresolved.

                Includes all 4 requirements for section.

                Includes no fewer than 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                Healthcare Disparities, Inequalities, and Interventions (70 points/30.4%)

                70 points

                63 points

                54 points

                21 points

                0 points

                Required criteria

                1. Identify patient populations that may be negatively influenced by the priority concept (topic) if unresolved.

                2. Identify healthcare resources to support evidence-based practice related to the priority concept (topic).

                3. Summarize potential priority concept (topic) healthcare disparities and inequalities related to diverse populations.

                4. Propose an evidence-based solution for the priority concept (topic) related to healthcare disparities.

                5. Identify three (3) evidence-based practice interventions.

                6. Prioritize the identified evidence-based practice interventions and provide rationale.

                7. Discuss two (2) patient education considerations related to the priority concept (topic).

                Includes all 7 requirements for section.

                Includes no fewer than 5-6 requirements for section.

                Includes no fewer than 3-4 requirements for section.

                Includes no fewer than 1-2 requirements for section.

                No requirements for this section presented.

                Legal & Ethical Considerations and Intervention Challenges

                (40 points/17.4%)

                40 points

                36 points

                31 points

                12 points

                0 points

                Required criteria

                1. Identify at least one (1) ethical and one (1) legal implication for addressing the priority concept (topic) in professional practice.

                2. Discuss at least one (1) strategy in prevention of an ethical dilemma related to the priority concept (topic) in professional practice.

                3. Discuss at least one (1) strategy in prevention of legal consequences related to the priority concept (topic) in professional practice.

                4. Identify one (1) anticipated challenge to the success of preventing the priority concept (topic) in professional practice.

                5. Identify one (1) anticipated challenge to the success of resolving the priority concept (topic) in professional practice.

                Includes all 5 requirements for section.

                Includes no fewer than 4 requirements for section.

                Includes no fewer than 3 requirements for section.

                Includes no fewer than 1-2 requirements for section.

                No requirements for this section presented.

                Participants and Interdisciplinary Approach

                (20 points/8.7%)

                20 points

                18 points

                16 points

                8 points

                0 points

                Required criteria

                1. Identify all the parties who will be involved in the implementation of the priority concept (topic) interventions.

                2. Discuss the role of each member in the intervention implementation for the priority concept (topic).

                3. Identify a minimum of two (2) members of a discipline outside of nursing.

                4. Discuss the benefit of including the identified interdisciplinary member from disciplines outside nursing to promote evidence-based professional practice.

                Includes all 4 requirements for section.

                Includes no fewer than 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                Quality Improvement

                (20 points/8.7%)

                20 points

                18 points

                16 points

                8 points

                0 points

                Required criteria

                1. Provide at least one (1) benefit in patient outcomes from addressing the priority concept (topic) within the clinical environment.

                2. Provide at least one (1) benefit to the nursing profession that will result from addressing this priority concept (topic) in clinical professional practice.

                3. Discuss at least one (1) resource utilized to promote improved patient outcomes in the clinical environment.

                4. Discuss at least one (1) resource utilized to increase professional nurse knowledge promoting improved clinical professional practice.

                Includes all 4 requirements for section.

                Includes no fewer than 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                Conclusion

                (20 points/8.7%)

                20 points

                16 points

                8 points

                0 points

                Required criteria

                1. Provide a thorough recap of the purpose to promote increased evidence-based professional practice knowledge related to the priority concept (topic) deficiency.

                2. Summarize resources identified to support improved evidence-based professional practice related to the priority concept (topic).

                3. Include a complete statement describing why addressing the priority concept (topic) matters for patient outcomes and evidence-based professional practice.

                Includes all 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                APA Format, Grammar, and Punctuation

                (20 points/8.7%)

                20 points

                18 points

                16 points

                8 points

                0 points

                Required criteria

                1. References are submitted with paper.

                2. Uses current APA format and is free of errors.

                3. Grammar and mechanics are free of errors.

                4. At least three (3) scholarly, peer reviewed, primary sources from the last 5 years, excluding the textbook, are provided. Each section should have a cited source to support information provided.

                Includes all 4 requirements for section.

                Includes no fewer than 3 requirements for section.

                Includes no fewer than 2 requirements for section.

                Includes no fewer than 1 requirement for section.

                No requirements for this section presented.

                Total Points Possible = 230 points

                NR452_RUA- Capstone Evidence-Based Guidelines Revised: 03/2022 4
                © 2021 Chamberlain University. All Rights Reserved

                4

                Nursing

                 In a Microsoft Word document of 4-5 pages formatted in APA style, address each of the following criteria.

                • Two focused health assessment histories
                  • One assessment related to the tympanic membrane and the other focused on the thyroid gland.
                  • The assessments can be hypothetical patients or patients you have had in the past (remember HIPAA if you are describing a previous patient).
                • A description of the normal and abnormal findings of the tympanic membrane.
                • Information on how to examine the thyroid gland using both the anterior and posterior methods.
                • A concise note in the subjective, objective, assessment (be sure to include the NANDA diagnosis as well as the medical diagnosis), and plan (SOAP) format with each patient’s encountered findings.
                • Information about laboratory/diagnostic tests used for screening clients with tympanic membrane or thyroid gland issues.
                  • Include the expected normal results for each test.

                Nursing

                Research Article Critique Grading Rubric
                A research article critique is not merely a review or summary of a study but rather a careful, critical appraisal of the strengths and limitations of research report. A written critique should serve as a guide to researchers and practitioners while they appraise the evidence to improve nursing practice. The ideal critique should suggest possibilities for improving the design of replication efforts and should thus help to advance a particular area of knowledge. The critique should also help those who are practicing nursing decide if or how the findings from the study can best be incorporated into their practice, if at all.


                Article:

                Aktaş, Y. Y., & Karabulut, N. (2015). The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. Nursing in Critical Care, 21(1), 44-52

                KEY ITEMS TO BE INCLUDED IN CRITIQUE

                Research Problem and Purpose
                1. Does the introduction demonstrate the need for the study?
                2. Is the problem clearly identified?
                3. Is the purpose of the study clearly stated?
                4. Does the study have the potential to help solve a current clinical
                problem?

                Literature Review
                1. Is the review of literature relevant to the problem?
                2. Is the literature review adequate in terms of range, scope of ideas, and
                points of view relevant to the problem identified?
                3. Is the review of literature well organized and synthesized?

                Methods
                1. What research design was used?
                2. Is the design appropriate for the study’s purpose?
                3. Was the protection of human subject considered?
                4. What key variables are examined?
                5. Are the details of data collection clearly and logically presented?
                6. Are the instruments described sufficiently in terms of content, structure,
                validity, and reliability?
                7. Is the population and the method of selecting the sample adequately
                described?
                8. Is the selection of the sample appropriate?
                9. Is the sample size sufficient?
                10. What are the limits to generalizability in terms of external validity?

                Results
                1. Is the presentation of data clear?
                2. Are the characteristics of the sample described in result section?
                3. Was the best method(s) of analysis selected?
                4. Are the tables, charts, and graphs pertinent?
                5. Are the significant and non-significant findings explained?
                15
                Discussion
                1. Is the evidence sufficient to draw conclusions?
                2. Are the results interpreted in the context of the problem/purpose,
                hypothesis, and theoretical framework/literature reviewed?
                3. Are the conclusions and generalizations clearly stated?
                4. Are the limitation of the findings clearly delineated?
                5. Does the study contribute to nursing knowledge?
                6. Can the study be replicated by other researchers?

                Formal Paper/Style
                1. APA format correctly utilized overall, including title page, references in
                text, and reference page.
                2. Proper spelling and grammar utilized overall.
                3. Required number of references are utilized.

                nursing

                Instructions:

                PATHOPHYSIOLOGY OF

                Hyperthyroidism

                Hypothyroidism

                Cushing disease

                Addison disease

                Similarities and different between hyperthyroidism and hypothyroidism

                Similarities and different between Cushing disease and Addison disease

                Your paper should be:

                · (4) pages

                · Typed according to APA style for margins 7 edition, formatting and spacing standards. Please include RUNNING HEAD ON THE PAPER

                · PLEASE INCLUDE
                Abstract. 5 REFERENCES NO OLDER THAN 5 YEARS

                Nursing

                1. Common Nurse Residency Programs 

                A listing of the common hospital training and nurse residencies has been provided for your review.  Review the entire document to select a training program of interest. Click the link to go to the hospital or entity of choice.  Additional internet research may involve contacting the hospitals’ HR or acquisition and talent office to inquire about information. 

                2. Self Assessment of Nurse Training Programs 

                Use the Self- Assessment tool to evaluate prospective  Nurse Training Programs. Your self-assessment will help determine which training program, benefits, and type of specialty will work best for you.   Rate the factors based on importance, value, education, and availability. 

                3. Survey /Critique of Nurse Training Programs: 

                Perform a survey and critique of the Nurse Training Program of your choice. Use the hospital training program factor worksheet (Survey-Critique of Nurse Training Programs) to collect data on the various types of training programs available to new nurses.  Collect and fill in each factor to assist in the evaluation of values and attributes important to you when determining the best hospital placement program to fit your prospective career aspirations and role as a professional nurse.  

                3.  Upload your findings from the Survey-Critique of Nurse Training programs and the RN Training Program Self-Assessment to the Assignment area in Canvas.  Be sure to express what values and options were most important to you based on the types of training programs available.  

                nursing

                EVALUATION OF DEPRESSION CLINICAL PRACTIE GUIDELINES 3

                Evaluation of Depression Clinical Practice Guidelines

                Name

                United State University

                Common Illness Across the Lifespan:

                Professor xxxxxx

                Date

                Abstract

                Depression is a mental disorder characterized by chronically depressed mood and by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home. It is highly prevalent in the US. Despite its increased prevalence, its management has been controversial in the US, with the recommendation that its treatment, both pharmacologic and non-pharmacologic, is effective for about 60 percent of the affected individuals. This underscores the possibility of concluding whether the available guideline is trustworthy. Therefore, it needs further revision to direct the delivery of care to depression patients effectively.

                Healthcare Problem

                1. Description of Depression

                Depression (major depressive disorder) is a common and significant clinical condition characterized by impaired mood, thinking, and behavior. Fortunately, it can be treated. Depression leads to feeling of sadness accompanied by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home (Goldman, 2019). Depression is a kind of mood illness characterized by chronic sorrow and lack of interest. It is distinct from the mood swings that individual encounter on a daily basis. Significant life experiences, such as grief or job loss, may trigger depression. However, psychiatrists consider grieving to be a component of depression only when it persists. Depression signs vary in severity from moderate to severe and the manifestations are as follows

                · Depressed mood

                · Loss pleasure in previously appreciated activities

                · increase or reduced appetite

                · increased or reduced sleep

                · Energy loss or excessive weariness

                · feeling of extreme guilt

                · impaired though process, decision making and concentration

                · Suicidal or self-harm ideations

                Depression is a chronic condition, not a transitory one. It is composed of series lasting at least two weeks. Depression may endure weeks, months, or even years (Goldman, 2019).

                2. Epidemiology of Depression

                Between 2013 and 2016, 8.1percent of American adults aged 20 and older experienced depression over a two-week period. Women (10.4 percent) were nearly twice as likely to suffer depression as males (5.5 percent). Depression was much less prevalent among non-Hispanic Asian people than it was among Hispanic, non-Hispanic black, or non-Hispanic white individuals (CDC, 2019). Depression prevalence reduced as family wealth grew. Around 80% of persons with depression reported experiencing at least some difficulties at work, at home, or in social situations as a result of their depression. Between 2007–2008 and 2015–2016, the proportion of American adults diagnosed with depression remained stable. Additionally, depression has been to affect the Hispanic and African American communities more than the rest of the United States population. Women have been found to suffer from depression more than their male counterparts. according to the Center for Disease Control (2019), depression has high prevalence in individuals whose income is below the poverty line, and that the prevalence for depression decreases as the amount of income increase (NIMH, 2020).

                3. Pathophysiology of depression

                I. Stress

                Psychological stress and traumatic life experiences early in life are both significant intermediate indicators of depression’s development. While stress response suggests consistency or preservation of homeostasis, chronic stimulation of the stress response system may have detrimental or even deadly implications by increased risk of overweight, cardiovascular disorders, depression, as well as other illnesses (Ormel, et al., 2019). The hypothalamic–pituitary–adrenal axis (HPA) and its three major components —hypothalamic neurosecretory cells, pituitary gland, and adrenal cortex—function together to ensure successful adaptation to altered environmental circumstances and activation of the organism’s reserves in response to various types of stress. To begin, traumatic situations in one’s life are the most powerful triggers of depression. Second, depressive individuals usually have higher cortisol (the human endogenous glucocorticoid) and corticotropin (ACTH) levels in their plasma, urine, and cerebrospinal fluid (Ormel, et al., 2019). Additionally, depressed people have an enlarged hypophysis and suprarenal glands, as well as impaired corticosteroid receptors activity. Increased HPA axis stimulation is reported in 50percent of depressed individuals, and continued antidepressant treatment tends to reduce this stimulation.

                II. Genetics

                Depression is a highly varied condition. Some genetic variability is intrinsic to polygenicity; afflicted people may have diverse configurations of susceptible alleles and healthy persons may also have some of these variations (Ormel, et al., 2019). Depression is a polygenic condition originating from the combined action of multiple genetic variations with separately tiny effect sizes. Defects at particular loci affect strictly defined systems such as conduction of dopamine in the prefrontal brain (Shadrina, et al., 2018). Owing to these mutations, succeeding offspring’s have significant likelihood of experiencing depression.

                III. Neurotransmitter Imbalances

                a) Norepinephrine

                In individuals with Depression, Norepinephrine deficiency is related with a loss of positive emotional resources, including decreased enjoyment, motivation, pleasure, attention, vigor, and passion, as well as a loss of self-belief. Depression patients showed impaired Norepinephrine function in the lobar NE, which resulted in anhedonia, a lack of vigor and desire, and other associated depressive manifestations (Liu, et al., 2018).

                b) serotonin

                5-HT deficit in the brain may exacerbate unpleasant feelings associated with Depressive disorders, such as depression, self-criticism, anger, worry, anxiety, aggressiveness, irritation, and isolation. Previous investigations discovered that blood 5-HT levels were considerably lower in individuals with MDD than in control subjects, implying a 5-HT deficit in people with MDD (Phillips, 2017). Similarly, postmortem investigations revealed decreased 5-HT and 5-HIAA levels in the central nervous system of depressive and suicidal individuals (Liu, et al., 2018). Reduced serotonin production over time may add to the increased vulnerability to MDD. Increasing scientific and clinical data establishes a relationship between antidepressant treatments and brain 5-HT systems, indicating that perturbation of central 5-HT systems plays a critical role in the pathogenesis of MDD. The serotonergic malfunction that contributes to the etiology of MDD is mostly due to decreased neuronal 5-HT production and aberrant 5-HT receptor activity.

                c) dopamine

                Dopamine (DA) is a neurotransmitter found in the hypothalamus and pituitary gland that serves as a critical neurobiological substrate for pleasure, focus, desire, psychomotor speed, and the capacity to perceive pleasure, all of which may contribute to human emotion regulation. Depression is characterized by impairments in all of these processes (Liu, et al., 2018). Furthermore, instantaneous bidirectional modulation (suppression or stimulation) of specific midbrain DA neurons modifies several distinct depressed symptoms generated by chronic stress, indicating that mechanisms impacting symptoms of depression modify the limbic DA neuronal programming of action. Additionally, impaired DA neuron activity may result in depressed symptoms such as despair and lack of interest. In individuals with MDD, the amount of DA compounds in the CSF was significantly lower than in control subjects. Inadequate DA receptor activity may culminate to a breakdown of regulation from the prefrontal cortex to the amygdala, leading in amygdala hyperexcitability and the development of stress and abnormal anxiety.

                4. Clinical Practice Guideline

                Depression management requires a thorough examination and accurate diagnosis. The evaluation should be depended on a thorough history, physical exam, and investigation of the patient’s mental status. History should be gathered from all possible sources, most notably family. The diagnosis should be made using the most up-to-date diagnostic criteria (Gautam, et al., 2017). The process of developing a therapeutic plan includes agreeing on the therapy environment, drugs, and psychological therapies that will be employed. Patients and carers may be contacted actively throughout the therapy plan’s development. A reasonable, practical, and adaptable therapy plan may be developed to meet the demands of clients and caregivers. Additionally, the treatment plan may be analyzed and updated on a continual basis. A thorough evaluation of the client’s suicide risk must be conducted. During the history taking process, suicidal thoughts and other adverse outcomes for suicide such as manic episodes, extreme anxiety, panic disorder, and alcohol or drug misuse must be assessed (Gautam, et al., 2017). In older individuals, it has been shown that the degree of depressive symptoms is a major predictor of suicide thoughts over time. Additionally, the evaluation covers a history of prior suicide tries, as well as the type of previous attempts. Additionally, patients’ family histories of suicide should be elicited. Apart from inquiring about suicidal ideations, it is critical to inquire about the extent to which the patient wants to act on the suicidal thoughts as well as the extent to which the individual has formed plans or started to commit suicide during mental status tests.

                Many patients who suffer from depression recur. As a result, patients and, if necessary, their relatives may be taught about the danger of recurrence. They may be taught to recognize the warning indications and manifestations of recurrent episodes. Additionally, individuals might be urged to seek appropriate therapy as soon as feasible during a new episode to reduce the probability of a complete recurrence or consequence. Electroconvulsive therapy (ECT), psychosocial therapies and antidepressants, and are the primary treatment choices for depression. Other therapies that are less often used or are utilized in individuals with depression that is resistant to treatment include light therapy, repeated transcranial magnetic stimulation (rTMS), ,transcranial direct stimulation, deep brain activation, vagal nerve activation, and sleep deprivation treatment (Gautam, et al., 2017). Benzodiazepines are often used in conjunction with other medications, particularly during the early period of therapy. Additionally, thyroid supplements and lithium may be utilized as adjunctive therapy in rare circumstances when a patient does not react to antidepressants.

                The fact that this guideline begins with assessment of the patient and monitoring, I believe it adequately addresses depression, given the diverse methods of treatment and assessment of the client. Involvement of caregivers and family and education to all of them regarding the management of depression is key of key importance. Management of depressive patients based on this guideline has been effective in controlling the disease. However, this management is rarely found in primary care. This means that individuals are not able to access the care until it is too late and the symptoms too adverse. Using this guideline laid by the American Psychological Association, clinicians and other care providers can follow a stepwise methodology for caring and treatment of depression patients, from assessment, through diagnosis and education to treatment and follow ups. This enables complete recovery of the patient as well as preventing relapse.

                Management of depression patients is based on trial methods. this means that different antidepressants are prescribed to manage the disease in trial for which works best for the patient. I feel that this is not effective to try patients on several drugs before they are finally given the drug they could tolerate. This is because the drugs could have adverse effects that can be prevented by secure and selective prescription. Additionally, the effectiveness of nonpharmacological intervention of managing depression is highly depended on the psychotherapist, owing much to their character and personality, as well as skills and expertise acquired during practice. Due to this, it can be difficult to ascertain its effectiveness in managing depression. However, it has been found that medications do not work for all depressive patients, and that only 60 percent of the depressive patients can be treated with drugs (Schimelpfening, 2021)

                5. Analysis of the guideline

                As mentioned previously that depression medication only account for about 60 percent recovery, it is important to revise the clinical guideline in quest to get a solution that can adequately cure depression. Additionally, non-pharmacologic interventions are not reliable since their effectiveness are dependent on the psychotherapist. There is a need to establish a dependable drug for treatment of depression. This will help to eliminate the try and error practice that is currently being used to manage depression patients. Also, there is need to in cooperate mental health screening in primary care as method of health promotion, in order to identify and treat depression early enough. This calls for a collaborative approach to manage the patient to ensure that the depression is done away with, and that relapses are eliminated. Furthermore, there are several antidepressants used despite the weak evidence for us. it would be important that these drugs are cleared so that only drugs with strong recommendations for use are utilized to manage depressive patients. The new guideline will ensure that there is a standard treatment of depression, and that following this treatment, clinicians are able to manage their patients well, to prevent recurrence of the condition and enhance patient satisfaction

                6. Evaluation

                It is critical to examine the efficacy of a new or amended clinical practice guideline to ascertain how it influences patient care, practitioner behavior and knowledge, and the variables that lead to non-compliance, if any. The evaluation findings indicate whether the updated clinical practice guideline achieved the anticipated care outcomes and is helpful in treating and managing depression. The following methodologies are used to assess the updated depression clinical practice guideline’s efficiency:

                · The first stage in determining the amended guideline’s efficacy is to examine potential modifications in care service and practice as a result of the new guideline criteria. This is accomplished by analyzing the conversion of clinical practice and health outcomes in regions with very high levels of guideline promotion to the change in places with low levels of guideline implementation.

                · The next stage is to compare the change of healthcare outcomes in regions with a high rate of guideline adoption to those with a low rate of guideline adoption. This may be accomplished by conducting a focus group to highlight the primary factors that affected the guideline’s adoption.

                7. Learning points

                · Depression is a significant psychological disorder facing a large population in the United States, especially the Hispanic population, African American communities, and those whose income is low.

                · The current guidelines are not sufficiently addressing the problem of depression since it has been discovered that the current therapeutic measures are only helpful to about 60% of the affected individuals.

                · It is important to integrate mental health screening for susceptible individuals in to primary care to facilitate early detection and treatment of depression.

                Conclusion

                To conclude, depression (major depressive disorder) is a common and significant clinical condition characterized by impaired mood, thinking, behavior and feeling of sadness accompanied by a lack of pleasure in initially pleasurable activities. It may result in a variety of psychological and physical complications and reduce the ability to operate at work and at home. Its pathophysiology ca be explained in terms of neurotransmitter imbalances, genetics and stress. the current guidelines do not adequately address the issue since it is only effective in some people and therefore, they should be revised to ensure that the treatment is effective to all individuals.

                References

                CDC. (2019, June 7). Products – Data briefs – Number 303 – February 2018. Centers for Disease Control and Prevention.
                https://www.cdc.gov/nchs/products/databriefs/db303.htm

                Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian journal of psychiatry59(Suppl 1), S34.

                Goldman, L. (2019). Depression: What it is, symptoms, causes, treatment, and more. Medical and health information.
                https://www.medicalnewstoday.com/articles/8933

                Liu, Y., Zhao, J., & Guo, W. (2018). Emotional roles of mono-aminergic neurotransmitters in major depressive disorder and anxiety disorders. Frontiers in psychology9, 2201.

                NIMH » major depression. (2020). NIMH » Home.
                https://www.nimh.nih.gov/health/statistics/major-depression

                Ormel, J., Hartman, C. A., & Snieder, H. (2019). The genetics of depression: successful genome-wide association studies introduce new challenges. Translational psychiatry9(1), 1-10.

                Phillips, C. (2017). Physical activity modulates common neuroplasticity substrates in major depressive and bipolar disorder. Neural Plast. 2017, 7014146. doi: 10.1155/2017/7014146

                Schimelpfening, N. (2021). What is the chemistry behind depression? Verywell Mind. https://www.verywellmind.com/the-chemistry-of-depression-1065137

                Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics Factors in Major Depression Disease. Frontiers in psychiatry9, 334.
                https://doi.org/10.3389/fpsyt.2018.00334

                Nursing

                Medications That Treat Pain

                Chapter 28-30

                NSG 220

                1

                What we will review:

                What is Pain?

                Types of Pain

                Drugs used to Treat Pain

                Adjuvant Analgesics

                Non-Opioids

                Opioids

                Narcotic Agonist

                Definitions of the class of medications

                Anti-Rheumatic RX-

                RX to treat inflammation/pain

                Gout (meds)

                Clinical Pearls

                Pain

                Pain- Universally unpleasant emotional and sensory experience that occurs in response to actual or potential tissue trauma or inflammation

                5th vital sign that should be assessed in all patients

                Influenced by multiple factors

                Emotional

                Physical

                Psychologic status

                Subjective: “whatever the client says”

                3

                Pain

                Can further be classified according to its sources.

                Most common:

                Somatic Pain- Originates from skeletal muscles, ligaments, and joints

                visceral pain –originates from organs and smooth muscles

                superficial pain originates from the skin and mucous membranes

                deep pain –occurs in tissue below skin level

                They may be appropriately treated when the source of the pain is known. For example, visceral and superficial pain usually require opioids for relief, whereas somatic pain including bone pain usually respond better to non opioid analgesics such as non steroidal anti inflammatory drugs .

                4

                Types of Pain

                5

                Acute pain

                Mild to severe

                lasting 6 months usually due to injury

                ↑ pulse rate, ↑ b/p, respirations, ↑ glucose levels (sympathetic nervous system responses)

                Chronic pain

                Mild to severe

                Lasts longer than 6 months

                Parasympathetic nervous system responses

                May not demonstrate symptoms associated with acute pain symptoms

                May lead to depression and decreased functional status

                Types of Pain (cont.)

                Nociceptive pain- due to an injury or damage to the body tissue

                External Injury- hitting part of the body against something or procedure (surgery)

                Joints, muscles, skin, bones, tendons

                Described as achy, throbbing or sharp

                Inflammation- due to an abnormal immune response

                Ex: cellulitis

                Neuropathic- due to nerve irritation

                Shingles/neuropathy (feet/hands-diabetics)

                Burning, shooting, pins and needles, sensitive to touch

                Radicular- compressed or inflamed spinal nerve

                Radiates from the back & hips into the legs (sciatica-sciatic nerve)

                Aggravated when walking, sitting and other activities

                Types of Drugs that Treat Pain

                Definitions

                Analgesics- Medications that relieve pain without causing loss of consciousness.

                Agonist- drugs that activates opioid brain receptors giving full effect (heroin, methadone, morphine). Initiates a specific response.

                Antagonist- drugs that block opioids drugs from attaching/activating opioid receptors (Naloxone/Narcan)

                Partial agonist- activates opioid receptors in the brain, but does give have the full effect (buprenorphine, tramadol, pentazocine). They can also block agonist drugs (buprenorphine, butorphanol, nalbuphine, pentazocine) – “antagonist effect”.

                Meds have a limited effect “Ceiling”.

                Can have a withdrawal effect on patient who are opioid-dependent patients

                8

                Agonist/Mixed/Antagonist

                Agonist- a full response (initiates a response)

                Antagonist – blocks response

                Agonist/Antagonist mixture- while under other conditions, behaves as an antagonist- a substance that binds to a receptor but does not activate and can block the activity of other agonists.

                Ex: Works to relief pain without the full side effect. Less effect on respirations. Not much of an pain relieving effect.

                Agonist-Antagonist Opioids (Pentazocine, Butorphanol, Nalbuphine, Buprenorphine)

                MOA: Blocks access of the pure agonist to mu receptors. They also prevent receptor activation, thereby triggering withdrawal. “

                Also called a partial agonist or a mixed agonist, binds to a pain receptor and causes a weaker pain response that does a full agonist.

                Not a first-line analgesic. Sometimes useful in pan management of OB patients.

                Medications have an analgesic effect

                Can cause a withdrawal effect if given to people who are physically dependent on pure agonist

                NOT A REVERSAL MEDICATION

                Advantages:

                Low potential for abuse

                Have less effect on respiratory depression

                Disadvantage

                Less powerful analgesic effect

                **Buprenorphine- used to treat opioid addiction.

                10

                Opioids
                Morphine, Fentanyl, Hydromorphone, Hydrocodone, Oxycodone, Oxymorphone, Methadone

                Advantages

                MOA- bind to An opioid pain receptor in the brain and causes an analgesic response. The reduction of pain sensation

                Forms: Injectable, patches, tablets, capsules (long and short acting)

                Indications:

                Used to alleviate moderate to severe pain

                Surgical/post-operative pain.

                1st line analgesics for immediate post-op settings.

                Disadvantages

                Constipation

                Excessive sedation and respiratory depression*

                Some can produce metabolites that can accumulate and produce toxicity (morphine 3-glucuronide)

                Screening for appropriateness

                Ongoing monitoring via therapeutic relationship with patient and prescriber are required for safe and effective long-term therapy

                Can be highly addictive

                Tolerance can develop

                11

                Non-Opioid
                (Aspirin, Diclofenac, Ibuprofen, Ketoprofen, Ketorolac, Meloxicam*, Naproxen, Celecoxib)
                Acetaminophen-antipyretic & analgesic)

                Advantage

                Versatile with multiple agents, formulation, and routes of administration available

                Can be given in combination with opioids

                Flexible and useful for a wide variety of mild to moderate nociceptive (injury to tissue)-type pain conditions

                Disadvantage

                Ineffective neuropathic pain

                NSAIDs- caution in pts with CV and/or GI risk factors, bleeding disorders and impaired kidney fx

                Not exceed daily maximum daily dose

                Acetaminophen- monitor hepatic status

                Side Effects

                Vary according to the medication type

                12

                Opioid Schedule

                5 Scheduled Drug Classes

                Schedule I*- not seen or administered in the U.S.

                Schedule II- high likelihood of abuse; Risk of developing a severe physiological addiction (Percocet, OxyContin, Codeine)

                Schedule III- likelihood of abuse is lower than that of schedule one or two (Lortab, Vicodin)

                high risk of developing physiological dependence

                Moderate to low- risk for developing a physical dependence

                Schedule IV- Likelihood of abuse or developing a physiological or physical dependence is lower than Schedule III

                Schedule V- likelihood of abuse or developing a physiological or physical dependence is lower than Schedule or IV (Codeine cough medications)

                13

                Nursing Implications

                Always count this drug**

                Witness any waste**

                Do not leave medication alone with patient. Watch them take it!

                Do not walk around with the RX in your pocket! Return it immediately. __________________________________________

                Assess patient first! Assess pain level and administer as ordered (if groggy, lethargic, vitals abnormal, low saturations?)

                Reassess patient one after administering.

                May need to administer RX before pain to improve pain control (give exactly on schedule, don’t wait until the patient asks**

                But do not give before scheduled time (example: PRN 3 hours)

                *** Physical dependence is extremely rare when given in hospital for short term therapy.

                Narcotic Antagonist
                (Naloxone*, Relistor, Naloxegol, Alvimopan, Naltrexone)

                Action: Opioid antagonist block (or antagonize) opiate-receptor sites. Principal use is the treatment of opioid overdose.

                Uses: Reverse the opiate effects of narcotic overdose and respiratory depression

                **The drug of choice when there is an uncertainty of type of overdose.

                Side Effect:

                Return of the symptoms the narcotic was used for.

                Watch for ↑ B/P

                Tremors

                Hyperventilation

                Severe diarrhea**

                15

                Adjuvant Analgesics
                (Gabapentin, Venlafaxine, Bupivacaine, Baclofen, Cyclobenzaprine, Ketamine, Duloxetine, Nortriptyline)

                Advantages

                Drugs that are not primarily identified as a primary analgesic but can have analgesic (pain relieving effects) or complimentary analgesic effect when used in combination with opioids.

                help manage concurrent symptoms that exacerbate pain

                treat side effects caused by opioids

                Useful for neuropathic pain

                Disadvantages

                Pain relief is limited and less predictable

                Pain relief is usually slow

                16

                Anti-Rheumatic Drugs (treat cancers & pain)

                Rheumatoid Arthritis

                Autoimmune, inflammatory immune disease

                Joint stiffness, swelling, and pain

                Can develop at any age, usually found amongst men and women 60 years and older

                Drugs can slow down disease progression

                Drug Treatment

                Nonsteroidal anti-inflammatory drugs (NSAIDs)

                Provide relief but do not slow disease progression

                Glucocorticoids

                Slow down disease progression

                Given short term because they can cause serious toxicity

                Disease-modifying antirheumatic drugs (DMARDs)

                Reduce joint destruction and slow down disease progression

                Recommended to start within 3 months of RA diagnosis

                Medications

                Methotrexate- interferes with growth of certain cells of the body (quick growing)

                Treats inflammatory response (in arthritis)

                Category X – contraindicated in pregnancy, can cause miscarriage/teratogenic effects causing deformities/ interrups the grown and division of a fertilized egg.

                ———————————

                Prednisone*

                Prednisolone* (*Most common used)

                NSAIDS (1st and 2nd generation)

                Nursing Implications

                Methotrexate should be taken with folic acid to reduce GI and hepatic toxicity.

                DMARD- disease modifying anti-rheumatic drug/ antineoplastic (cancer drugs)

                17

                Gout

                Inflammatory condition caused by elevated levels of uric acid (>6 mg/dL)

                High uric acid leads to accumulation in joint spaces

                Commonly found in hands and feet (redness, swelling, extreme tenderness to palpitation

                Pharmacologic treatment can be used during acute episodes and/or for prophylactic therapy if symptoms occur more than 3 times a year.

                Antigout Medications
                (Colchicine, Allopurinol, Probenecid, Indomethacin, Prednisone)

                Therapeutic Goals

                Decrease inflammation in joints during acute attacks

                Decrease uric acid levels for long-term prevention of flares

                Medications

                Acute phase

                Indomethacin

                1st choice for gout flare

                Used for short term

                Colchicine (take every 1 hour) *

                Can be used alone or with NSAID

                Decreases inflammation

                Take until the symptoms resolve or until they have diarrhea.

                Maintenance

                Allopurinol (take for a life time)

                Chronic

                Prevents uric acid formation

                Probenecid

                Chronic

                Lowers uric acid by Increases excretion of uric acid in urine

                **Can also be used in the acute phase

                19

                Definitions to know:

                Acute pain – pain that is sudden in onset, usually subsides when treated, and typically occurs over less than a six months.

                Chronic pain- persistent or recurring pain that is often difficult to treat usually more than 6 months.

                Adjuvant analgesic drugs –drugs that are indicated for other purposes but also have an analgesic effect. Usually added for combined therapy with a primary drug.

                Breakthrough pain- pain that occurs between doses of pain medication.

                Patient Controlled Analgesic (PCA)- Narcotic will be on a pump. Examples: Morphine, Dilaudid,

                Family members nor the nurse are not allowed to press the button to give the patient a dose.

                Routes of Administration

                Oral (preferred route of administration)

                Rectal

                Transdermal (if you put one on, take the other off)

                Intraspinal

                Intraventricular- delivered via external infusion pump through a catheter to the cerebral ventricles or through a subcutaneous reservoir (intermittent administration).

                Intravenous/Subcutaneous- used when unable to administer (oral, rectal, transdermal)

                Works fastest

                Allow for rapid administration and increasing dosage

                IM –least preferred route

                Unable to adjust or give repeat doses due to inconsistent absorption from IM sites.

                Patient-Controlled Analgesia (PCA)- On demand deliver of medication

                Delivered vial IV ipr subQ in which the patient can control the amount of medication administered to them

                21

                Clinical Pearls

                A large number of anti-inflammatory medications are enteric-coated or extended release. Do not crush or split these medications.

                Be careful when administering aspirin to certain patients

                children – could develop Reye’s syndrome

                Patients due to have surgery- will need to stop medication up to 1 week to reduce risk of bleeding (NSAIDS)

                Asthma patients –could develop adverse reactions such as bronchospasms, angioedema and urticaria (NSAIDs)

                Nursing

                Drug

                Drug Class

                Mechanism of Action

                Adverse Effects

                Nursing Implications

                heparin

                #1. ________

                Inactivates clotting factors thrombin and factor Xa through the increased activity of antithrombin

                Criti