All posts by : chebby

You have a patient who only has Medicare Part A and B. She has limited income most of which is used to pay for Medicare Part B. She is in dire need of placement into a nursing home as she can no longer care for herself at home. You gleaned from your reading that long-term care needed by low-income elderly people is paid by Medicaid, and you feel your patient meets the criteria. What are the steps you would take to advocate for your patient while she is still in the acute care setting? Who are some of the other health care professionals you would collaborate with to ensure your patient receives the additional healthcare coverage she needs? Analyze the role Medicaid plays in supporting long-term care for the elderly and disabled.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

A. Choose a current medical procedure, medication, or therapy. Discuss the scientific/medical rationale for its effectiveness, history of its development, the research related to its safety and effectiveness, and any controversies over its use.

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REQUIREMENTS: 

Your essay must cite at least 3 sources (all independent: none from the class reading list).

— No Wikipedia or general encyclopedias (on-line or print)

— Try to find articles designed for the general reader, as opposed to articles in professional medical journals.

–Be sure to consistently (in every paragraph) document your sources (APA Style) as we have learned to do throughout our work during the semester.

–All sources must be listed on the References page according to standard APA guidelines.

–Note the proper formatting for direct quotations in your text.

–Paraphrase and quote accurately. All drafts will be screened for plagiarism. Plagiarism on this project will result in your failing this course (as noted on the syllabus).  Be especially scrupulous in using Internet sources. Websites offering ready-made research papers are absolutely off-limits; using them in any manner will be considered plagiarism.

–You may be required to submit links to your source materials.

–Use the Model Research Essay, “Are Organic Foods Healthier Than Conventional” (on Canvas/Files) as a model to your writing, documentation, and formatting.

THE COMPLETED PROJECT: The final draft is expected to display writing skills worthy of a second-semester college student, including competence with APA style of documentation and formatting. (For a guide to APA Style, see your handbook or a website such as the Purdue Owl). The finished essay should be 4-5 pages of text, not including the References page. 

Consider the following scenario: 

During the second week of your internship, the CIO approaches your team and says, “I need you to prepare a briefing on the process of selecting and acquiring an information system for our health care organization. Include how the goals of our organization and stakeholders affect the selection process. I must have this briefing this week so I can prepare for several meetings I must attend.” 

 Describe the process for selecting and acquiring an information system. 250 – 300 words with 1 reference, APA format

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

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. Refer to the LopesWrite Te

1-Mention the types of budgets that you know and give examples of then?2- What is budgeting?3- What is directed and indirect cost?4- Give examples of productive and non-productive hours?5- What does HMO, PPO, POS means?A) Mention one example of each of then in your city, or state?6- What is DRGs.?7- Give some examples of strategies for Cost-conscious nursing practice that your Nursing unit use to lower medical care cost? 

250 words or more

APA citation 

3 references 

A patient has been coming into a clinic for the last 5 years. His medical history includes DM type II, hypertension, and obesity.  Previously his blood sugars and blood pressures were well controlled with diet, exercise, and antihypertensive.  However in the last 2 years, the patient has had uncontrolled blood sugars, and his blood pressure is consistently in the severe range, regardless of how medications are prescribed.  You are assigned to this patient, and on entry to the clinic the patient looks to be sad, and disheveled. 

While taking the patient’s vital signs, the patient shares with the nurse that “this medical stuff is just too hard, my wife use to take care of it for me, but she died two years ago, and now I just don’t understand it all.”  As a nurse, you use your therapeutic communication with the patient and find that he has not been taking his medications as ordered, and has not been reading food labels on how to eat a healthy diet.  The patient states again,  “Well my wife always did all that stuff for me, she took care of the bills, and all of the documents, and all that stuff, and now I just don’t know what to do anymore.” After further questioning, you find that the patient is not able to read more than just a few words, and had been “non-compliant” because he hasn’t been able to read his medication labels and by extension doesn’t know how to read nutrition labels.  

What can you do for this patient?  What types of patient teaching would be useful for this patient? What resources could you use in his care? Write a nursing diagnosis for this patient, and create a teaching plan for this patient, including expected learning outcomes for this patient. 

I NEED A RESPONSE TO THIS ASSIGNMENT
1 PAGE

ZERO PLAGIARISM

I believe this patient to have Oppositional Defiant Disorder.  This patient is within the guidelines of the DSM-5 criteria.  According to Criteria A, the patent must display a pattern of an angry or irritable mood, a behavior that displays defiance or argumentativeness, as well as vindictiveness (American Psychiatric Association, 2013). Criterion B states this disturbance is in correlation with the individual’s distress or that it impacts the person negatively (American Psychiatric Association, 2013). Lastly, Criterion C states these behaviors cannot be contributed to a psychotic episode, or other disorder (American Psychiatric Association, 2013).  

            This patient displays anger and irritability and verbalizes being resentful of being there.  She is defiant and is argumentative with the provider who is typically viewed as an authoritative figure. She also refuses to comply with treatment and the rules.  She displays vindictiveness in the form of withholding information from the therapist.  Her symptoms are moderate in that they are present in at least two different settings.

Therapeutic Approaches

 Through combined approaches, this disorder can be addressed with parenting modifications, social-emotional skills training, and if needed, psychiatric medication (Treatments for Oppositional Defiant Disorder in Children, 2020). Parenting modifications include fostering a healthy and loving relationship between the parent and child; creating healthy boundaries and rules; being consistent in ignoring annoying behaviors while praising good behaviors (Treatments for Oppositional Defiant Disorder in Children, 2020). The Social-emotional skills training includes implementing skills for the identification and management of feelings, and strategies for decision making that are not based on emotions (Treatments for Oppositional Defiant Disorder in Children, 2020).

            Lastly, if necessary, I would trial a psychiatric medication for the patient.  There are not medications for ODD specifically, but the symptoms are treated (Treatments for Oppositional Defiant Disorder in Children, 2020). There are stimulants such as methylphenidate or dextroamphetamine for ADHD (Treatments for Oppositional Defiant Disorder in Children, 2020). There are also escitalopram or fluoxetine for depression and anxiety (Treatments for Oppositional Defiant Disorder in Children, 2020). Other medications that can aid with disruptive behaviors include guanfacine, clonidine, or aripiprazole (Treatments for Oppositional Defiant Disorder in Children, 2020). Medication should not be used as a standalone treatment (Treatments for Oppositional Defiant Disorder in Children, 2020).

            For this patient specifically, I would implement the first two interventions prior to adding in a psych medication.  I would like to gauge the family dynamic and the patient’s emotional skills prior to adding a medication.  But, if at the second appointment she still had such aggressive symptoms, I would begin the patient on escitalopram 5mg, PO daily for three days then titrate to 10mg PO daily.  I would then recheck the patient in two weeks to make sure she wasn’t having any significant side effects.  

Expected Outcomes

The expected outcomes for this patient would benefit the entire family.  The family may benefit from stronger stability and healthier boundaries, less chaos, or a more caring environment. This can be seen or reflected in children’s behaviors.  I would also expect that with proper tools, social factors such as disagreements with other children, would also be overcome for the benefit of the patient (ODD, 2020).  It was once believed that a child could “outgrown” ODD , however this has been unfounded and symptoms can occur up to an individual’s later years (ODD, 2020). If the patient needs to have medication on board to help, I would expect at least a partial remission if not a full remission of symptoms. 

Reference

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental    disorders (5th ed.). Washington, DC: Author.

ODD (2020). Retrieved 23 October 2020, from             https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_c            enter_odd_guide.pdf

Treatments for Oppositional Defiant Disorder in Children | Boston Children’s Hospital. (2020).    Retrieved 23 October 2020, from https://www.childrenshospital.org/conditions-and-            treatments/conditions/o/oppositional-defiant-disorder/treatments

1.In one-two paragraphs, summarize at least one healthcare policy that was adopted and implemented at the organizational level. (Please refrain from  discussions on HIPAA regulations in this forum). 

2. create a potential scenario where the policy you selected can benefit a population or healthcare institution. Your scenario should be applicable to one of the policies we learned this week or in other scholarly readings.

Direct Practice Improvement (DPI) Project Proposal Chapter 3 – Methodology

TOPIC: Improving Medication Adherence in Diabetic Patients in Home Health Care Settings

Chapter 3 of the Direct Practice Improvement (DPI) Project, titled “Methodology,” will expand upon the content and concepts presented in the “10 Strategic Points Final Draft” (Appendix A) document you completed in its final iteration in Topic 1.

General Requirements:

Use the following information to ensure successful completion of the assignment:

SAMPLE CHAPTER 3 METHODOLOGY (ATTACHED)

· Locate the “DPI Proposal Template” in the PI Workspace of the DC Network. ATTACHED

· Locate the 10 Strategic Points Final Draft assignment completed earlier in this course. ATTACHED

· Doctoral learners are required to use APA style for their writing assignments.

· You are required to submit this assignment to LopesWrite.

Directions:

Use the “DPI Proposal Template” and the “10 Strategic Points Final Draft” document, to develop a draft of (Chapter 3) Methodology that describes the methodology you are utilizing in your DPI Project Proposal. Sections in Chapter 3 include:

1. Chapter 3 Methodology

2. Introduction and Statement of the Problem

3. Clinical Question(s)

4. Project Methodology

5. Project Design

6. Population and Sample Selection

7. Instrumentation

8. Validity

9. Reliability

10. Data Collection Procedures

11. Data Analysis Procedures

12. Ethical Considerations

13. Limitations

14. Summary