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Goal:

Analyze and evaluate a middle range theory.  You will select a middle range theory and identify application of nursing theories into clinical practice.

Content Requirements:

1. Components of the theory
   • Discuss the major concepts of the theory
   • Philosophical basis or worldview change, advancing health
2. Structural aspects of the theory
   • Discuss the framework of the theory.
3. Identify an area of your practice where this theory could be applicable
   • What question does the theory help to answer?
   • Describe the area of interest in relationship to the theory/theoretical model.
   • Is it appropriate for the practice setting and is it applicable?
   • Discuss the strength and weakness of the theory. If there is weakness, discuss what makes it difficult to be used in practice.
4. Use of theory in clinical practice.
   • Performing a literature review is essential to completing this section. If there is no literature available about the application of this theory in practice, address reason(s) why based on your findings.
5. Evaluation of theory
   • Is this theory used to understand and apply into practice?
   • What difficulties did you encounter or would anticipate encountering in using this theory?
   • What would make this theory more usable or applicable to practice?

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions.)
• The paper is to be 3 – 5 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to current APA style.

*this assignment will be submitted by turnitin

COMMUNITY HEALTH ASSESSMENT/WINSHIELD SURVEY

GUIDELINES:

1.  Community description.

2.  Community health status (can be obtain from the department of health).

3.  The role of the community as a client.

4.  Healthy people 2020, leading health indictors in your community.

5.  Conclusion.

Also, you must present a table as an appendix with the following topics and description;

Housing

Transportation

Race and ethnicity

Open space

Service centers

Religion and politics

Requirements:

APA style ( includes references, no less than 3 references not older than 2016 and intent citation).

Listed below is the requirements for the Paper:

Mental Health Reflection Paper Assignment 

This paper should be written based on your clinical experience during your clinical rotation. Reflect back on a patient, situation and/or diagnosis that you were exposed to. All of the following must be followed to receive credit: 

3 references from journals, textbooks, or from .edu and .gov websites 

APA formatting must be used for all cites 

Proper grammar & punctuation 

Title page, body, reference page 

Cultural considerations for this patient. 

Include any culturally related biases that you may have and how you may have to adjust your thinking or how you speak to a patient 

Minimum 5 pages (not including title page, reference page & abstract)

Please include: *Describe the situation *Define any meds and diagnosis that you talk about, remember to cite *How did you feel about what you are describing? *How does this experience influence your thoughts or feelings regarding this situation, the meds, the diagnosis? *How does this experience affect your path through nursing school? *How does this experience affect your future as a registered nurse? 

1.Read the article, understand it, interpret it, and create a summary in APA style in your own words clearly and succinctly (two pages double spaced)
2.In-text citations used accurately in summary including the last name of the author(s), year, and page numbers if direct quote. No other errors noted.
3.At the end of the summary, type the reference to your article in correct APA style. 

Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation based on the Teaching Work Plan and present the information to your community.

Options for Delivery

Select one of the following options for delivery and prepare the applicable presentation:

1. PowerPoint presentation – no more than 30 minutes
2. Pamphlet presentation – 1 to 2 pages  
3. Poster presentation

Community Setting (HOSPITAL)

General Requirements

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.

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

 Please react to this student post. APA style, and less than 10 % similarity

The social determinants of health (SDOH)are generally answerable for health disparities. SDH are the conditions wherein individuals are conceived, develop, work, live, and age, and the more extensive arrangement of powers and frameworks forming the states of day by day life. These powers and frameworks incorporate monetary arrangements and frameworks, improvement plans, accepted practices, social approaches, and political frameworks (Rodriguez,2015).

For Healthy people 2020 the social determinants of health are: Social and Community context, Education, Health and Health Care, Economic Stability, and Environment. Social and physical determinants influence a wide scope of wellbeing, working, and personal satisfaction results. can influence in health and personal satisfaction results some time before we need clinical consideration, and these variables clarify to a limited extent why a few people are more advantageous than others. One social determinant has the potential to be a barrier to home care or care management service is the is the language and communication. Even when both client and nurse speak the same language, communication problems may occur because of varying cultural contexts in which words have different meanings to different people.

The level of education we have, the access to health care, our working status, and the environmental conditions we live influence our health. People living in slums are in risk drink contaminated water and get any waterborne disease. Communities with lower average incomes are disproportionately affected by poor environmental circumstances(Masto,2020).Many people without economic stability and low level education may cannot afford medical treatments or not really understand the medical information , others don’t even have transportation accessibility.

References

Masto, L. (2020). Why social determinants of health matter in clinical care. Retrieved from https://diatribe.org/why-social-determinants-health-matter-clinical-care

Rodriguez. (2015). Social determinants of health. Retrieved from https://www.who.int/social_determinants/health.

You have been hired as the manager of a community health center. This health center provides medical care to children.  One of your first tasks is to develop a static annual budget for the health center.  In fact, the Board of Directors wants to see your budget by Saturday at midnight. 

In order to develop an accurate static budget you know you need to get some facts.  You ask around to see what kind of information you can gather. This is what you find out:

• The center pays rent of $12,000 per month.
• The center has a number of full-time staff members:  4 physicians, 6 clinical staff members and 8 administrative staff members.
• The center has to occasionally use part-time workers or pay overtime when patient volume is high.
• The center sees about 3,000 patients per month.
• Medical supply costs seem to run about $2 per patient.

Unfortunately, that’s all that you can find out on such short notice.  Nobody seems to have any more information.  You know that this is not enough information to build a proper static budget, so you will need to make some assumptions to get the job done.  You are comfortable with making assumptions because you know that it is OK to incorporate assumptions into a budget as long as you clearly identify the assumptions when you present the budget.  You also know that it is important to make assumptions that are based on reliable information.  Luckily, you recall that you have an HFMA membership and access to a variety of online databases with credible information!

You go home to review your old Health Services Finance text to see if there is anything there that can help you.  You find Chapter 16 and begin to read.  Luckily, you come across Table 16-4 (page 185) which shows you what a typical static budget looks like. It’s all coming back to you now!….You need to show your Revenue, your Expenses, and your Net Income.  You open a new Excel file and begin.

Requirement:  Create an annual static budget for the health center described above using Excel.  Submit the budget using the link provided below.

Scenario 1: Polycystic Ovarian Syndrome (PCOS)

A 28-year-old woman presents to the clinic with a chief complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 12 years of age. She began to develop dark, coarse facial hair when she was 14 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. 

Question 1 of 2:

What is the pathogenesis of PCOS?

Question 2 of 2:

How does PCOS affect a woman’s fertility or infertility?

Scenario 2: Pelvic Inflammatory Disease (PID)

A 20-year-old female college student presents to the Student Health Clinic with a chief complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 4 days. She denies nausea, vomiting, or difficulties with defecation. Last bowel movement this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular. Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having pelvic inflammatory disease (PID). 

Question:

What is the pathophysiology of PID?

Scenario 3: Syphilis

A 27-year-old male comes to the clinic with a chief complaint of a “sore on my penis” that has been there for 3 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. Social history: works as a bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms. Physical exam within normal limits except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis. 

Question:

Describe the 4 stages of syphilis

Scenario 4: Genital Herpes

A 19-year-old female presents to the clinic with a chief complaint of “fluid filled bumps” and intense pruritis of her vulva. She states these symptoms have been present for about 10 days, but she thought she had a yeast infection. She self-medicated with over the counter (OTC) metronidazole (Flagyl™) intravaginally but the symptoms got worse. No other complaints except for fatigue out of proportion to her activity level. Past medical history noncontributory. Social history: sexually active with several men and did forget to use a condom during one sexual encounter. Physical exam negative except for pelvic exam which revealed multiple fluid filled (vesicular) lesions on the vulva and introitus. Positive lymph nodes in inguinal areas. The APRN diagnoses the patient with herpes simplex virus-type 2 known as genital herpes.

Question:

  What is the pathophysiology of HSV-2?

Scenario 5: Epididymitis

A 27-year-old male presents to the clinic with a chief complaint of a gradual onset of scrotal pain and swelling of the left testicle that started 2 days ago.  The pain has gotten progressively worse over the last 12 hours and he now complains of left flank pain. He complains of dysuria, frequency, and urgency with urination. He states his urine smells funny. He denies nausea, vomiting, but admits to urethral discharge just prior to the start of his severe symptoms. He denies any recent heavy lifting or straining for bowel movements. He says the only thing that makes the pain better is if he sits in his recliner and elevates his scrotum on a small pillow. Past medical history negative. Social history + for sexual activity only with his wife of 3 years. Physical exam reveals red, swollen left testicle that is very tender to touch. There is positive left inguinal adenopathy. Clean catch urinalysis in the clinic + for 3+ bacteria. The APRN diagnoses the patient with epididymitis. 

Question:

Discuss how bacteria in the urine causes epididymitis. 

Scenario 6: Prostatitis

A 42-year-old male presents to the clinic with a chief complaint of fever, chills, malaise, arthralgias, dysuria, urinary frequency, low back pain, perineal, and suprapubic pain. He says he feels like he can’t fully empty his bladder when he voids. He states these symptoms came on suddenly about 12 hours ago and have gotten worse. He noticed some blood in his urine the last time he voided. He tried to have a bowel movement several hours ago but could not empty his bowel due to pain. Past medical and social history noncontributory. Physical exam reveals an ill appearing male. Temperature 101.8 F, pulse 122, respirations 20, BP 108/68. Exam unremarkable apart from left costovertebral angle (CVA) tenderness. Rectal exam difficult due to enlarged and extremely painful prostate.  Complete blood count revealed an elevated white blood cell count, elevated C-reactive protein and elevated sedimentation rate. Urine dip in the clinic + for 2+ bacteria. 

Question:

Explain the differences between acute bacterial prostatitis and nonbacterial prostatitis

Scenario 7: Endometriosis

A 32-year-old woman presents to the clinic with a chief complaint of pelvic pain, excessive menstrual bleeding, dyspareunia, and inability to become pregnant after 18 months of unprotected sex with her husband. She states she was told she had endometrioses after a high school physical exam, but no doctor or nurse practitioner ever mentioned it again, so she thought it had gone away. She has no other complaints and says she wants to have a family. Past medical history noncontributory except for possible endometriosis as a teenager. Social history negative for tobacco, drugs or alcohol. The physical exam is negative except for the pelvic exam which demonstrated pain on light and deep palpation of the uterus. The APRN believes that the patient does have endometriosis and orders appropriate laboratory and radiological tests. The diagnostics come back highly suggestive of endometriosis.   

Question:

Explain how endometriosis may affect female fertility.

Scenario 8: Platelets

An APRN working in an anticoagulation clinic has been asked by the local college to present a lecture on platelets and their role in blood clotting to the graduate pathophysiology nursing students. 

Question:

What key concepts should the APRN include in the presentation?

Scenario 9: Iron Deficient Anemia (IDA)

A 36-year-old woman presents to the clinic with complaints of dyspnea on exertion, fatigue, leg cramps on climbing stairs, craving ice to suck or chew and cold intolerance. The symptoms have come on gradually over the past 4 months. The only thing that make the symptoms better is for her to sit or lie down and stop the activity. She denies bruising or bleeding and states this is the first time this has happened. Past medical history noncontributory except for a new diagnosis of benign uterine fibroids 6 months ago after experiencing heavy menstrual bleeding every month. Social history noncontributory and she denies alcohol, tobacco, or drug use. Physical exam: pale, thin, Caucasian female who appears older than stated age. Physical exam remarkable for a soft I/IV systolic murmur, pallor of the mucous membranes, spoon-shaped nails (koilonychia), glossy tongue, with atrophy of the lingual papillae, and fissures at the corners of the mouth. The APRN suspects the patient has iron deficient anemia (IDA) secondary to excessive blood loss from uterine fibroids. The appropriate laboratory tests confirmed the diagnosis. 

Question:

Discuss iron deficiency anemia and how the patient’s menstrual bleeding contributed to the diagnosis.

Scenario 10: Pernicious Anemia

A 67-year-old woman presents to the clinic with complaints of weakness, fatigue, paresthesias of the feet and fingers, difficulty walking, loss of appetite, and a sore tongue. These symptoms have been present for several months but the patient thought they were due to her recent retirement and geographic move from the Midwest to New England. The symptoms have gotten worse over the past few weeks and she has noticed that she is much more forgetful. This is of great concern as she worries she might have the beginning stages of Alzheimer’s Disease. Past medical history significant for Hashimoto thyroiditis that she developed in her early 20s. The rest of PMH and social history non- contributory. Physical exam reveals an average sized female whose skin has a sallow appearance. BP 128/74, Pulse 120, respirations 18 and temperature 99.0F orally. Examination of the head and neck reveals a smooth and beefy red tongue. Abdominal exam negative for hepatomegaly or splenomegaly.  

The APRN recognizes these symptoms and physical exam indicate the patient has pernicious anemia. After appropriate laboratory data received, the definitive diagnosis of pernicious anemia was made.

Question 1 of 2:

How does pernicious anemia develop?

Question 2 of 2:

How does pernicious anemia cause the neurological manifestations that are often seen in patients with PA?

Scenario 11: Anemia of Chronic Disease (ACD)

A 49-year-old man with a 22-year history of severe rheumatoid arthritis (RA) presents to clinic for his preadmission testing (PAT) and medical clearance for a planned right total hip arthroplasty. The patient had been severely limited in ambulation due to the RA. Current medications include prednisone 20 mg po qd and methotrexate 7.5 mg Thursdays, 5mg Fridays, and 7.5 mg Saturdays.  The patient had a complete blood count (CBC) with manual differentiation and red blood cell indices, complete metabolic panel (CMP) and coagulation studies (prothrombin time [PT], international normalized ratio [INR] and activated partial thromboplastin time [aPTT]). All the laboratory studies come back within normal limits except for the red blood cell indices. The hemoglobin and hematocrit were low along with mean corpuscle volume, plasma iron and total iron binding capacity, and transferrin also being low. There was a normal reticulocyte count, normal ferritin, serum B12, folate and bilirubin. 

The APRN in the PAT clinic recognizes that the patient has anemia of chronic disease (ACD). 

Question 1 of 2:

What is ACD and how does it develop?

Question 2 of 2:

Why do patients with chronic kidney disease (CKD) develop ACD?

Scenario 12: Immune Thrombocytopenia Purpura (ITP)

A 14-year-old female is brought to the Urgent Care by her mother who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. These bruises were first noticed about 2 weeks ago and are not related to trauma. Past medical history not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl noticed that her gums were slightly bleeding when she brushed her teeth that morning. 

Labs at Urgent Care demonstrated normal hemoglobin and hematocrit with normal white blood cell (WBC) differential. Platelet count of 100,000/mm3 was the only abnormal finding. The staff also noticed that the venipuncture site oozed for a few minutes after pressure was released. The doctor at Urgent Care referred the patient and her mother to the ED for a complete work up of the low platelet count including a peripheral blood smear for suspected immune thrombocytopenia purpura (ITP).

Question:

What is ITP and why do you think this patient has acute, rather than chronic, ITP?

Scenario 13: Heparin Induced Thrombocytopenia (HIT)

A 22-year-old male is in the Surgical Intensive Care Unit (SICU) following a motor vehicle crash (MVC) where he sustained multiple life-threatening injuries including a torn aorta, ruptured spleen, and bilateral femur fractures. He has had difficulty maintaining his mean arterial pressure (MAP) and has required various vasopressors. He has a triple lumen central venous catheter (CVC) for monitoring his central venous pressure, administration of medications and blood products, as well as total parenteral nutrition. Per hospital protocol, he is receiving an unfractionated heparin 1:1000 flush after administration of each of the triple antibiotics that have been ordered to maintain patency of the lumens.  Seven days post injury, the APRN in the SICU is reviewing the patient’s morning labs and notes that his platelet count has dropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. The APRN suspects the patient is developing heparin induced thrombocytopenia (HIT). 

Question 1 of 2:

What is underlying pathophysiology of heparin induced thrombocytopenia?

Question 2 of 2:

The APRN assesses the patient and notes there is a decreased right posterior tibial pulse with cyanosis of the entire foot. The APRN recognizes this probably represents arterial thrombus formation. How does someone who is receiving heparin develop arterial and venous thrombosis?

Scenario 14: Thrombotic Thrombocytopenic Purpura (TTP)

A 33-year-old female is brought to Urgent Care by her husband who states his wife has gotten suddenly confused and complains of a severe headache. He also noticed large bruises on her legs which were not there yesterday. Only significant past medical history is that the patient developed herpes zoster 2 weeks ago and was given acyclovir for treatment. Physical exam revealed well developed female who is only oriented to person. Large areas of ecchymosis noted on both arms and legs. Stat CBC revealed a platelet count of 18,000/mm3, hemoglobin of 8 g/dl and hematocrit of 24%. The patient was immediately transported to the Emergency Room by Emergency Medical Services (EMS) where further work up demonstrated idiopathic thrombotic thrombocytopenic purpura (TTP).  

Question:

What is the pathophysiology of TTP?

Scenario 15: Heparin Induced Thrombocytopenia (HIT)

A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection that was found on the preoperative urine culture and sensitivity (C & S). The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately transferred to the surgical intensive care unit (SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were: 

CBC with markedly decreased platelet count, peripheral blood smear showed decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin time. The d-dimer was markedly elevated, and fibrinogen level was low. The diagnosis of disseminated intravascular coagulation (DIC) was made based on clinical picture and laboratory data. 

Question 1 of 2:

What is DIC and how does it develop?

Question 2 of 2:

What factors contribute to the development of DIC? 

 Discussion 3 paragraphs

• Explain the diagnostic criteria for your assigned substance-related and addictive disorder.
• Explain the evidence-based psychotherapy and psychopharmacologic treatment for your assigned substance-related and addictive disorder.
• Describe clinical features that you would expect to observe in a client that may have the substance-related and addictive disorder you were assigned. Align the clinical features with the DSM-5 criteria.
• Support your rationale with references to the Learning Resources or other academic resources.

Discussion – Week 6-THIS IS REPLY TO AN STUDENT TO THE INFORMATION BELLOW

COLLAPSE

Top of Form

          Walden University’s web-based learning has information that is fairly easy to locate by searching their website for assistance. Searching for scholarly, peer review articles on the main Internet can be tedious and tasking and sometimes pertain to inadequate information. In order to successfully find these particular articles, I went to the Academic Skills Center (ASC) on Walden University’s website and searched how to obtain said articles (Walden University Academic Answers). The ASC recommended using the Walden Library and researching by the subject. Once you decide on your subject in which you are searching, you then check the box that says Peer-Reviewed Scholarly Journals Only on the page.

           Since I work in a critical care setting, I chose Nursing as my subject then searched for ICU nursing and burnout. COVID-19 has been the main struggle for us, as nurses, and we are emotionally, physically, and mentally exhausted in the critical care setting. Intensive care employees are subject to many liabilities on a day to day basis, which in turn can have an effect on patient care. Fortunatti & Palmeiro-Silva define burnout as emotional fatigue that is job-related, detached relationships and defiance toward clients and colleagues, and a decrease in professional achievements and worth (2017). This study used nurses (RNs) and nurse assistants (NAs) to determine whether or not there was a relationship between unrewarded work, burnout, and patient care were correlated. The researchers found that positive work appreciation showed not only a decrease in burnout but also an increase in an exceptional level of patient care (Fortunatti & Palmeiro-Silva, 2017).

           Walden University’s online Library was very straightforward and timesaving, which seems to be the most effective way for me to find scholarly, peer-reviewed articles when searching for them.  Walden University’s Library Database (Academic Guides) was another simple way to research certain articles in alphabetical order in which you can distinguish peer review articles versus articles that are not peer-based. In my opinion, I would highly recommend both of these resources to all of my classmates due to the user-friendliness and ease in order to find their