All posts by : chebby

Note: My topic is weight loss and weight management.

My client is an African woman who is obese. Because of her culture, she is not really a believer in exercise and it is hard for her to exercise and lose weight because of her cultural diet. 

For my teaching plan, I want to talk about steps to lose weight and how to maintain it.

My learning objectives:

1. Identify risk factors and diseases associated with overweight/obesity.
 

2.Identify genetic, biologic, and environmental contributors to weight status.

YOU WILL BE DOING PART A AND B

Review the feedback on the change proposal professional presentation and make required adjustments to the presentation. Present your evidence-based intervention and change proposal to an interprofessional audience of leaders and stakeholders. Be prepared to answer questions and accept feedback.

After presenting your capstone project change proposal, write a 250-350 word summary of the presentation. Include a description of the changes that were suggested by your preceptor before your presentation and how you incorporated that feedback. Describe how this interprofessional collaboration improved the effectiveness of your presentation. Include a description of the feedback and questions from your audience after your presentation, and how this experience will affect your professional practice in the future.

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

 clinical significance 

  To Prepare

• Review the resources related to Medicare Access and      CHIP Reauthorization Act of 2015 (MACRA) and meaningful use objectives.
• Review the Criteria for Attestation.
• Consider your current workplace or a former workplace      and reflect on how EHR implementation slows your work, including staffing      issues, medication barcoding, or any other issues that you might      encounter.
• Identify policy mandates and requirements and reflect      on how informatics and EHR implementation affect your ability to meet      those policy mandates and requirements. 
• Identify other mandates (e.g., quality, safety,      requirement of reporting) and reflect on how they may affect issues you      identified.

By Day 3 of Week 10

Post a response that analyzes how policy mandates and requirements you experience might affect the issues you encounter as a practicing nurse informaticist. Be specific and provide examples. Next, analyze how evolving policies that may be implemented might affect issues you encounter in nursing practice, and explain why.

McBride, S., & Tietze, M. (2019). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (2nd ed.). New York, NY: Springer Publishing.
Chapter 1, “Introduction to Health Information Technology in a Policy and Regulatory Environment” (pp. 2–17)
Chapter 12, “National Standards for Health Information Technology” (pp. 272–295)

Centers for Disease Control. (2017, January 18). Meaningful use. Retrieved from https://www.cdc.gov/ehrmeaningfuluse/introduction.html 

Lye, C. T., Forman, H. P., Daniel, J. G., & Krumholz, H. M. (2018). The 21st Century Cures Act and electronic health records one year later: Will patients see the benefits? Journal of the American Medical Informatics Association, 25(9), 1218–1220. 

Office of the National Coordinator for Health Information Technology. (2017, May 15). Standard nursing terminologies: A landscape analysis. Washington, DC: Author. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf

Office of the National Coordinator for Health Information Technology. (2019, February 20). Meaningful use and MACRA. Retrieved from https://www.healthit.gov/topic/meaningful-use-and-macra/meaningful-use-and-macra

Federal Register: The Daily Journal of the United States Government. (2016, May 5). Medicaid and Children’s Health Insurance Program (CHIP) programs; Medicaid managed care, CHIP delivered in managed care, and revisions related to third party liability. Retrieved from https://www.federalregister.gov/documents/2016/05/06/2016-09581/medicaid-and-childrens-health-insurance-program-chip-programs-medicaid-managed-care-chip-delivered

eCQI Resource Center. (2019a, May 10). eCQMs. Retrieved from https://ecqi.healthit.gov/ecqms

eCQI Resource Center. (2019b, May 10). Eligible hospital/critical access hospital eCQMs. Retrieved from  https://ecqi.healthit.gov/eligible-hospital/critical-access-hospital-ecqms

Leapfrog Hospital Safety Grade. (2019, April 25). Leapfrog hospital safety grade: Scoring methodology. Retrieved from https://www.hospitalsafetygrade.org/media/file/HospitalSafetyGrade_ScoringMethodology_Spring2019_FINAL.pdf
 

Apply information from the Aquifer Case Study to answer the following discussion questions:

• Discuss the Mr. Rodriquez’s history that would be pertinent to his gastrointestinal problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
• Describe the physical exam and diagnostic tools to be used for Mr. Rodriguez. Are there any additional you would have liked to be included that were not? 
• Please list 3 differential diagnoses for Mr. Rodriguez and explain why you chose them.  What was your final diagnosis and how did you make the determination?
• What plan of care will Mr. Rodriquez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

CASE STUDY: Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.

 – Considering the setting and the Omnibus Budget Reconciliation Act (OBRA) guidelines, what would you do to manage the situation???

Due date: Thursday, October 8, 2020. 

Mainpost

Case study:

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Discussion: Diversity and Health Assessments

Introduction

            Health care providers should exhibit knowledge of population diversity and treat all patients with respect regardless of their culture and belief system. This is essential in understanding patient’s lifestyle, and behavior which may affect their health care. Accepting patient’s culture in a nonjudgmental manner creates a unique relationship between the patient and the healthcare provider. Therefore, APRN’s should be cognizant of patient’s culture, beliefs, lifestyle, and socioeconomic status as it relates to healthcare. A culturally competent healthcare provider accustoms his/herself to the exclusive needs of patients with cultures that are different from his or her own. Being accustomed to the belief’s and values of a patient lays the foundation for a trusting patient-provider relationship (Ball et al., 2019).

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors Associated with the Patient

            The case study presents an 86-year-old Asian male that is physically and financially dependent on his daughter who is a single mother with little money to care for the patient’s healthcare needs.  Understanding the Asian culture is relevant to providing care to this elderly patient.  I will verify patient’s preferred language, ask about patient’s preference with a healthcare provider regarding race or ethnicity, gender, and age. Ensuring respect for this patient despite his financial and physical dependency will encourage a trusting relationship between the patient and the health care provider. Asian culture is known to teach respect for parents and family is a priority over self. Additionally, in Asian culture adult children are required to make financial, physical, and social sacrifices for their parents that are aging (Miyawaki, 2015). As a healthcare provider, I will welcome this patient, show respect by avoiding eye contact as some Asian countries consider making eye contact as rude. Maintaining eye contact is not done with individuals of East Asian cultural backgrounds. Also, the Japanese culture, teaches against maintaining   eye contact with others as it is believed to disrespectful (Uono & Hietanen, 2015).

            I will make the patient understand that I am familiar with culture of adult children caring for their aged parents. I will explain to the patient that he should not consider himself a burden to his daughter as the daughter is maintaining the requirement of their culture. This will encourage a relaxing environment that will enable the patient to feel accepted and ready to relate with the health care provider. Respect for the patient’s spiritual and religious belief is also vital. The patient should be asked about any spiritual belief that may affect his healthcare when sick or dying. Also, the APRN should inquire about spiritual or religious groups that the patient may belong that could be supportive in providing some assistance to his healthcare. Spirituality and faith help Asian-Americans manage the turmoil of adapting to a new country, by providing a safe environment where immigrants can socialize and be of assistance to one another (Lee & Eun-Kyoung, 2017).

Sensitive Issues

            I will inquire if the patient is compliant with taking his medications as prescribed and access for the use of over the counter, herbal, or traditional medications. This is especially important as the patient takes lisinopril 10mg QD, prilosec 20mg QD, B12 injections monthly, and cipro 100mg QD. To avoid drug interactions, it is important to ask about additional medications that the patient may be taking. Examples of Chinese herbal medicine include astragalus, ginger, licorice, panax ginseng, and schizandra. Traditional medicine is used across Asian societies for daily health maintenance, and treatment of certain medical conditions. Also, in China, Japan, and Korea, traditional medicine has become almost or equivalent to conventional medicine (Mu et al., 2020).

            Furthermore, the functionality of the patient will be accessed to determine the level of dependency on the daughter. Activities of daily living like feeding, bathing, wearing clothes, grooming will be accessed. Asking about financial assistance with purchasing medications, proper feeding and housing is vital to ensure the overall needs of the patient are catered for. Due to socioeconomic status and financial constraint of the patient and his caregiver (daughter), I will recommend the help of a social worker to provide the services of a home health nurse and home health nursing assistant. This will ensure that patients’ needs are met, and the patient takes his medications in a timely manner thereby relieving the responsibility on the patient’s daughter.  In addition, the services of physical and occupational therapy will be sorted to help strengthen any weak muscles or extremities to ensure some dependence with physical activities. I will explain to the patient that my recommendation for a social worker is to help him meet his daily needs and not to disrespect him. This will maintain patients pride and ego.

Targeted questions to assess health risks

1. Do you have health insurance, or do you pay out of pocket for your medications?
2. Do you take your medications as prescribed?
3. Do you check your blood pressure at home?
4. Would you want to receive help with feeding, clothing, bathing, or moving around your home?
5. Do you experience any pain or difficulty in urinating?
6. In the las two weeks have you experienced sleep disturbances, decreased appetite, feeling of sadness, hopelessness, or guilt, thoughts of committing suicide and poor concentration.
7. In what way do you think you are a burden to your daughter?
8. How often do you eat and what type of food do you eat?
9. Do you take any herbal, traditional or over the counter medications?

            The questions above are used to access the patient’s access to his medications and if he is compliant with taking his medications. The need to access for patient’s knowledge about checking his blood pressure due to his history of hypertension. Accessing patient’s willingness to receive outside resources like home health assistance is essential to providing the needed healthcare. Question about urinating accesses the history of prostatitis. Accessing for depression in the elderly is crucial to determine the patient’s mental state. Elderly Asian immigrants in the US are at risk of depression (Seungah & Eun-Kyoung, 2017). Evaluating the patients feeding habits and if the patient takes any medication outside his prescribed medications determines the patient’s health risk.

References

Ball, J., Dains, J., Flynn, J., Solomon, B., Stewart, R. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Lee, R., Eun-Kyoung, O. (2017). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920–931.    doi:10.1080/13674676.2017.1290593

Miyawaki, C. (2015). A review of ethnicity, culture, and acculturation among Asian caregivers of older adults. SAGE Journals. https://doi.org/10.1177/2158244014566365

 https://journals.sagepub.com/doi/full/10.1177/2158244014566365

Ryu, S., & Lee, O. E.-K. (2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920-931. https://doi- org.ezp.waldenulibrary.org/10.1080/13674676.2017.1290593

Uono, S., Hietanen, J. (2015). Eye contact perception in the West and East: A cross-cultural study. Plus One. https://doi.org/10.1371/journal.pone.0118094

Xin, B., Mu, S., Tan, T., Yeung, A., Gu, D., Feng, Q. (2020).  Belief in and use of traditional Chinese medicine in Shanghai older adults: A cross-sectional study. BMC Complement Medicine and Therapies 20 (128). https://doi.org/10.1186/s12906-020-02910-x. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020-  02910-x

Practice Change Simulation

Assignment Description:

Create a 7-9 minute video that reflects upon the clinical problem that you have identified in your area of nursing practice (as identified in Module 1). Critically appraise the research and summarize the knowledge available on the clinical problem (minimum requirement of 6 scholarly journal articles reviewed and appraised for application to practice problem). Outline a strategic plan for implementation of a practice change in your clinical practice environment based upon your findings. Describe how you intend to operationalize the practice change in your practice environment. What theoretical model will you use and how will you overcome barriers to implementation? What sources of internal evidence will you use in providing data to demonstrate improvement in outcomes? Describe evaluation methods of implementation clearly. Are there any ethical considerations?

The presentation should be a simulation of what you would present to your unit staff in an effort to gain buy-in as you initiate the practice change in your area of practice. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox. ***Please do not record as voice-over PowerPoint because this cannot be saved in mp4 format or a link.*** If you submit your assignment as a PowerPoint with voice over recording you will not receive credit for your assignment (or partial credit as you did not meet the full requirements of the assignment.)

If PowerPoint is used for the presentation, include the reference slide; if PowerPoint is not used in the presentation, please submit a list of the references in a Word document utilized to develop the presentation in APA format to the dropbox in a separate submission (be sure to orally cite your sources if no PowerPoint is used to identify the sources)

Assignment Expectations:

Length: 7-9 minute presentation (with or without PowerPoint slides); if no PowerPoint used submit APA Reference list separately
Structure: If PowerPoint is used: Include a title slide, objective slide, content slides, reference slide in APA format. There is no specific slide number required. 
References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of six (6) scholarly journal articles are required for this assignment. 

  As a team, select a current public health topic, such as: 

  Complete the following in your presentation: (Use headings in this paper and make sure there is a heading for each of the bulleted items below) 

Mental health and suicide prevention

• Explain the legal and ethical issues related to your public health topic.-250 words

• Now that you have  completed Lesson 23 & 24 and have thought about the factors that  affect the health of various communities, do the following:
   

1. Identify prevalent issues or diseases that affect the health of your community (the specific populations you serve).
2. Compare and contrast  two (2) specific populations in your practice that are affected by the  above issue(s) or disease(s) by listing their commonalities and their  differences.
3. Base on the information above, how can you change or refine your practice to meet each community’s specific needs?

• Your paper should: 
• be typed doubled-space.
• a total of 100 to 200 words (not counting your list of commonalities and differences). 
• Use factual information.
• be original work and will be checked for plagiarism.
• have required APA format if references are utilized – type references according to the APA Style Guide.