All posts by : chebby

This assignment has new comments and instructions from the professor and it requires for the comments to be incorporated into the project. You can also see the professor’s comments in the attached 10 Strategic Points.

Areas Needing corrections are as follows: It must be updated in the 10 Strategic Points and in the main project ATTACHED.

1. Interventions

a. This has to be for Diabetes. Currently, it is not the right methodology

b. The intervention is what will be done for each patient which should be based on educating the patients on lifestyle changes. It should be like this: –

i. Diet Teaching Education- what type of education will be used for teaching the patients. Where are you going to get the materials from? You must explain the Therapy in full. This must be rearranged in the project.

2. Lifestyle Changes Education must be addressed as follows: –

a. Discuss Medication Nutrition Education Therapy in full

b. Discuss Medication Adherence Education in full

c. It must specify Disease Education on Diabetes

d. It must indicate who is doing it e.g. RN, Nurse Practitioner etc.? How are they doing it? How long is it going to take or for long?

3. You must indicate what the expected result is going to be. 

4. How do you plan to measure Medication Adherence and the tools that will be used to measure it.

5. The Problem Statement must now change based on these new listed additions. It must start with “It is not known the extent to which………………

6. SAMPLE:

a. Explain why you are picking the specific number of patient population

b. Use population of adults 18 and above. Don’t limit to 45 and older.

7. Inclusion Criteria

a. Adult 18 – above with Type 2 Diabetes

b. It should state who identified it in the home health setting such Physicians since they are the ones that refer patients to the home health care for non-compliant or non-adherent to medication

8. Exclusion Criteria

a. It should state that you will exclude patients with cognitive impairment

9. Data Collection and Data Analysis

a. You must adjust both of them by using an existing method of Data Collection-please, do not make up your own

Please make corrections in all the chapters including 1, 2 and 3.

APPENDIX A is the 10 Strategic Points

PLEASE DO NOT INCLUDE THE CRITERION TABLES.

Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.

Include the following:

1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.

You are required to cite to a minimum of three 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 Technical Support articles for assistance. 

RUBRIC

Attempt Start Date: 05-Oct-2020 at 12:00:00 AM

Due Date: 11-Oct-2020 at 11:59:59 PM

 3 page essay reproducing your understanding and capability to apply the readings to your critical thinking. 12 point font, double spaced with standard margins. Follow APA and reference page. 

Please see the attached Case study.

All Case studies /assignments must be done in APA format with a separate sheet for references. 

Managing care in a Culturally Considerate manner

CASE STUDY 2

Patient Profile
F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.

Subjective Data

• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated
• His father died of a heart attack at age 62
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary

Objective Data

Physical Examination

• Blood pressure 180/96, pulse 98, temperature 99.8° F, respirations 20
• Height 5’11”, weight 210 lbs, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation

Diagnostic Studies

• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial infarction (NSTEMI)

Collaborative Care

• 9% NaCl infusing into IV catheter at 75 mL/hr
• Nitroglycerin and morphine given with relief of pain

1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction?
3. What are diagnostic studies indicated for F.M.?
4. F.M. is diagnosed as having a myocardial infarction (MI).
5. What is the priority nursing care for F.M.?
6. What other interventions do you anticipate for F.M. at this time?

Gastrointestinal & Endocrine

42 year old, African American Female patient with a chief complaint of neck swelling that has progressively gotten worse over a period of a year.  She also confirms that she has loss weight without any changes to her diet.  Patient is tachycardic with a pulse of 102, anxious but no acute distress.

What other subjective data would you obtain?

 Subjectively we know the patient has complaints of neck swelling, weight loss, and difficulty swallowing.  Additional questions should be asked to gather additional information to aid in reaching a proper diagnosis for this patient.  Initial questions should be general such as any changes in bowel habits, how they feel in hot or cold weather and any changes in energy.  The most common thyroid diseases are Hypothyroid and Hyperthyroid.  These two diseases manifest with opposite symptoms.

What other objective findings would you look for?

 With the documented weight loss, tachycardia and anxiety.  Additional questions and testing should be geared towards Hyperthyroidism.  Key objective assessment findings for Hyperthyroidism include tachycardia, palpitations, weight loss, elevated T4 and T3, decreased TSH and diaphoresis.  When you have hyperthyroidism, your body is producing excessive amounts of the thyroid hormones T3 and T4. Since these hormones regulate your metabolism (how your body processes and uses energy), having too high a level will cause symptoms related to a high metabolism (Milas, 2019).

What diagnostic exams do you want to order?

 Diagnostic testing includes blood tests, iodine uptake scan and thyroid scan.  Blood tests are preformed to measure the levels of thyroid hormones. T4 and T3, must be high to diagnosis a patient with hyperthyroidism.  Thyroid stimulation hormone (TSH) is also measured and is low in hyperthyroidism.  The iodine uptake scan is used to measure the thyroid function by determining how much iodine is taken up by the thyroid gland.  Normal values are up to 25% in a 24-hour period.  If the percentage is above 35% in 24 hours the abnormal results could indicate hyperthyroidism, hashimoto’s or goiter.  Hyperthyroidism speeds up some of your body’s processes.  Thyroid scan is typically done at the same time as the iodine uptake test.  Thyroid scans use the emissions of gamma rays from radioactive iodine to obtain a picture of the thyroid (UCLA Health, n.d.).

Name 3 differential diagnoses based on this patient presenting symptoms? Give rationales for each differential diagnosis.

 Hyperthyroidism is an excessive concentration of thyroid hormones in tissues.  The most common causes of excessive production of thyroid hormones are Graves’ disease, toxic multinodular goiter, and toxic adenoma.  Graves’ disease is an autoimmune process in which antibodies stimulate the TSH receptor leading to overproduction of thyroid hormones.  With Graves’ symptoms include anxiety, moist skin, weight loss, enlarged thyroid gland, bulging eyes and palpitations.

References

Milas, K. (2019). Hyperthyroidism Symptoms. Retrieved November 20, 2020, from https://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-symptoms (Links to an external site.)

UCLA Health. (n.d.). Radioactive Iodine Uptake Test. Retrieved November 20, 2020, from https://www.uclahealth.org/endocrine-center/radioactive-iodine-uptake-test

1) Minimum 8 full pages (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: Minimum 1 page

              Part 2: minimum 1 page

              Part 3: minimum 1 page

              Part 4: minimum 1 page 

              Part 5: Minimum 1 page

              Part 6: minimum 1 page

              Part 7: minimum 1 page

              Part 8: minimum 1 page

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

         Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

5) Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1: 

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. 

1. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. 

2. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. 

3. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. 

Part 2: 

The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. 

Review the following topic materials

“About the Affordable Care Act”

“Health Care Transformation: The Affordable Care Act and More”

1. What are the most important elements of the Affordable Care Act in relation to community and public health? 

2. What is the role of the nurse in implementing this law?

Part 3: ( INFECTION CONTROL AND PREVENTION )

1. Discuss one personal strength and one weakness you have regarding professional presentations (project capstone about  INFECTION CONTROL AND PREVENTION  ). 

2. Name one method for improvement for each of these 

3. Discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

Part 4:  ( INFECTION CONTROL AND PREVENTION)

Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. 

1. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.

Part 5:

Fifty-four-year-old Fred is complaining of a headache that started about 2 weeks ago. For the past 2 days, the headache has increased in severity, and he is photophobic and has uncial rigidity and projectile vomiting. CT scan results show an arteriovenous malformation in the basal artery and a small hemorrhagic bleed in the middle meningeal artery.

1. How is the concept of “disorders of brain function” related to Fred’s presenting symptoms?

2. What aspects of cerebral circulation would come into play in Fred’s case?

Part 6:

Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.    According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.    Does he need medication(s) given his history of MI?

3.   Considering that you have a case study, you only need 2 posts for this discussion board, 1 initial and 1 reply. As usual, all posts must be supported by at least 2 peer reviewed references and all paragraphs must be cited.

Part 7: Community Nursing

There is a planned community health project to decrease the incidence of human papilloma virus (HPV).

1.  Who is/are the target population? Why?

2. What are some key factors to consider when planning an HPV prevention program?

Part 8:

 1. What is meditation? 

      a. Discuss the benefits of meditation? (mention at least 3).

2. Indicate any research study that support the benefits  of meditation 

3. Have you ever practiced meditation? (Yes)

      a . Discuss your experience? 

2-page case study analysis

Scenario 1: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.

Labs: CBC-WBC 18, Hgb 16, HCT 44, Plat 325, ­ Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP within normal limit

Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2

99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with a reddened cervix and + bilateral adnexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram-negative diplococci.

In your Case Study Analysis related to the scenario provided, explain the following:

• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.

As for all the case studies please focus on the following elements:

A detailed explanation of the pathophysiology

Clinical manifestations due to the pathophysiology

Genetic/ethnic considerations

Use research, current sources less than 5 years, and analysis to support your answers

rubric attached

THIS IS A POWER POINT PRESENTATION, ABOUT THE PANDEMIC OF THIS CENTURY: THE COVID-19, ITS CAUSATIVE AGENT; AS YOU KNOW IS : SARS-CoV-2,  YOU SHOULD REVIEW THE STATISTIC FACTS, THE CLINICAL PRESENTATION OF COVID-19, AND MAINLY THE PHARMACOLOGICAL MANAGEMENT OF THIS PANDEMIC. 

1. Analyse how existing health and social policies influence resources that affect the delivery of patient care.

2. Discuss how national and local policies govern patient safety and facilitate the standardisation of care to reduce inequalities.

3. Analyse the nurse’s role and contribution to policymaking and implementation.

4. Analyse models designed to identify and support staff to develop self-awareness, resilience, self-well-being and management in their role.

Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:

1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.

Three peer-reviewed, scholarly or professional references are required.