All posts by : chebby

In the response post, critique the outline by providing strengths and areas of improvement based on the quality of the following:

• Introduction
• Body w/ transitions
• Conclusion
• Supporting materials – in-text references and APA citations
• Were you informed? How was it or was it not effective?
• Other suggestions for improvement
• Any suggestions you have for smoothing out the content.

Peers’ post:

Opioid use in Pregnancy and effects on Child later in life

Specific Purpose:   The effects of opioid use on the fetus in pregnancy and effects of opioid use on the child later in its life.

Central Idea:   To educate women on the serious effects of opioid use during pregnancy and how it can potentially affect the child.

INTRODUCTION

I. (Attention Getter) “According to 2019 self-reported data, about 7% of women reported using prescription opioid pain relievers during pregnancy. Of those, 1 in 5 reported misuse of prescription opioids, defined as getting them from a non-healthcare source or using them for a reason other than to relieve pain.” (cdc, 2020)

II. (Reveal Topic) We are going to be discussing about the effects on a fetus born to a woman who used opioids during pregnancy and what effects it may bring to the child when they are born.  

III. (Credibility Statement)

According to the CDC, ‘an estimated of 14%-22% of women filled an opioid prescription during pregnancy.’ And according to a 2016 data from the Healthcare Cost and Utilization Project, 7 newborns born out of every 1,000 newborns hospital stays, were diagnosed with Neonatal abstinence syndrome (NAS). NAS is a group of condition in which results when a newborn withdraws from certain drugs, most commonly opioids where he was exposed to in his mother’s womb before birth.

IV. (Preview) NAS may lead to long-term health and developmental problems for the child that may include hearing, vision and learning and behavioral problems later for a child born with NAS. NAS is most often caused when a woman takes opioid drugs in pregnancy but can also be caused by other medications such as antidepressants, barbiturates, or benzodiazepines. These drugs can pass through the placenta causing serious problems for the baby. The placenta grows in the uterus with pregnancy and supplies the baby with nutrition and oxygen through the umbilical cord. 

Transition: Drug use during pregnancy is an important pregnancy teaching topic. Especially for women who uses opioids and other medications. Patient education on the long term effects of opioid use on the child is an important matter to discuss with the expecting mother so ensure she understands the consequences that may come with using opioid during pregnancy. 

Body

(Main Point 1) Effects of opioid use in pregnancy.

A. (Subpoint) Opioid use in Pregnancy 

The effects on pregnancy in a woman using opioid drugs during pregnancy.  

a. In 2019, about 7% of women reported to using a prescription opioid pain reliver during pregnancy. 1 out of 5 women reported misuse (getting them from another source other than a healthcare provider) using them for other reasons other than to relieve pain 

b. Maternal death. About 700 women due each year in the United States from pregnancy or delivery complications.  

c. Stillbirth 

• Tobacco use—1.8 to 2.8 times greater risk of stillbirth, with the highest risk found among the heaviest smokers
• Marijuana use—2.3 times greater risk of stillbirth
• Evidence of any stimulant, marijuana, or prescription pain reliever use—2.2 times greater risk of stillbirth
• Passive exposure to tobacco—2.1 times greater risk of stillbirth 

Next, we will discuss about the long-term effects of opioid use on a child.

(Main Point 2) Effects on Child 

Opioid use during pregnancy and its effects on a child born with NAS. 

a. A child born with NAS may show symptoms within 72 hours/3 days of birth. 

b. Signs of NAS can vary for each baby

TRANSITION: Now we will talk about complications of NAS on a baby

NAS complications on the baby  

a. Signs and symptoms to look for in a baby with NAS  

Signs and symptoms to look for in a baby with NAS  

a. Tremors, convulsions, seizures, over reactive reflexes, fussiness, excessive crying, poor feeding, slow weight gain, breathing problems, fever……………. 

b. Complications: low birth weight, jaundice, sudden infant death syndrome. 

Long term Effects on Child 

a. developmental delays

b. Child may not reach developmental milestones— sitting, walking, talking, social and thinking skills.

c. Motor problems 

d. Speech and language problems 

e. Sleep problems 

f. Ear infections

g. Vision problems 

Conclusion

Patient education on the potential dangers of opioid use during pregnancy is vital to a healthy pregnancy and baby. Informing an expecting mother on the potential complications of using opioids during pregnancy can help to avoid these complications in both pregnancy and the newborn. Its important for a mother to understand the signs of possible NAS in their baby as these signs can present a little later after birth. Most babies born with NAS who receive proper treatment right away get better in 5-30 days.

(Summary Statement) Importance to seek medical attention right away if pregnant and using an opioid medication. Patient education is important in informing an expecting woman about the potential complications that may come with continuing use of opioids during pregnancy and what complications it may cause for the newborn when they are born. Avoiding a baby being born with NAS could be avoided with early detection and planning.

(Memorable Closing Statement) Patient education is a significant part of a healthcare providers job. Patient education may improve a patients health status. When patients are involved in their care, patients are more likely to engage in interventions that may increase their chances of positive outcomes.

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

Parts 6, 7, and 8 must be different. Different writing and perspective, but always answering questions objectively

              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:

Based on how you will evaluate your EBP project ( See file 1), 

1. Which independent and dependent variables do you need to collect? Why?

Part 2:

Not all EBP projects result in statistically significant results. 

1. Define clinical significance, and explain the difference between clinical and statistical significance. 

2. How can you use clinical significance to support positive outcomes in your project? (See File 1).

Part 3:

 A 49-year-old female is discussing age-related changes with the nurse practitioner. She states that she is having irregular periods and “hot flashes.”

1. What other assessment data would substantiate the diagnosis of menopause?

2. What type of therapy would you expect this patient to receive? Why?

Part 4:

Margo is a 49-year-old divorced woman who works as a bank teller. She tells her primary care provider (PCP) that she feels tired all the time and that she is gaining weight because she has no interest in her usual exercise activities, and that she has been overeating, even though she is often not really hungry. She notices that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings, without her alarm, and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern or event causing this problem. The PCP asks Angela to fill out a Beck’s Depression Scale, which indicates she has moderate depression.

1. Choose a pharmacologic intervention for Margo and explain its effects.

2. Provide Margo with written education regarding her prescription. (Include what she should expect when first taking the drug, appropriate activity warnings, when to expect improvement, side effects she may experience, and anything she should report to the provider).

Part 5:

A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.”

Please answer the following questions in a narrative format: 

1. Discuss the epidemiology of allergies.

2. What are your treatment options (consider pharmacoeconomic)? 

3. Compare first and second-generation antihistamines.

4. What education will you provide to the patient?

Part 6:

The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update 

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html 

The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available. 

After reading these recommendations answer the following questions.

1. what are the clinical interventions for patients unwilling to quit cigarette smoking?

2. According to the best practices what are the best strategies to help your clients quit smoking?

3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?

Part 7:

The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update 

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html 

The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available. 

After reading these recommendations answer the following questions.

1. what are the clinical interventions for patients unwilling to quit cigarette smoking?

2. According to the best practices what are the best strategies to help your clients quit smoking?

3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?

Part 8:

The U.S. Department of Health & Human Services released a comprehensive Clinical Practice Guideline for Treating Tobacco Use and Dependence–2008 Update 

https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html 

The goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health systems, insurers, and purchasers assist clinicians in making such effective treatments available. 

After reading these recommendations answer the following questions.

1. what are the clinical interventions for patients unwilling to quit cigarette smoking?

2. According to the best practices what are the best strategies to help your clients quit smoking?

3. are there any specific smoking cessation recommendations for especial populations such as teenagers or the elderly?

 Reflect back over the past 14 weeks of woman health and pediatric and describe how your achievements in this course have prepared you to meet the MSN program outcomes.

Read the following article:

https://www.mdedge.co m/clinicianreviews/artic le/152683/practicemanagement/whatareyou-worth-basicsbusiness-healthcare

Article:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347738/

• After reading the article,Transforming and Improving Health Care through Meaningful Use of Health Information Technology, discuss how meaningful use of data from electronic health records can be used to improve population health. Have you seen connections between data collection gathered from electronic health records and how you care for patients? Finally, reflect on your nursing experiences to an incidence where the electronic health record improved patient outcomes. How was the electronic health record used to improve outcomes? What negative impact have you seen using the electronic health record?
• 1 page include at least 1 reference 

SOAP NOTE

Name: N.C

Date: 10/26/2020

Time: 09.30 h

Age: 5-year-old

Sex: M

CC: “I have sore throat”

HPI: 

A 5 y/o Hispanic male presents to the clinic complaining of sore throat that started 3 days ago. Describes that occasionally feels like “piercing or burning” pain that it is constant. Also, that is very painful to swallow. Mother states patient developed cold symptoms (cough, sneezing) about 5 days ago, sore throat started 3 days ago, and fever of 101.5 F began 24h ago. Patient added that the pain varies in intensity, rated anywhere from 8 to 9 on a Wong-Baker scale when eating or drinking, but at this moment rated his pain at 5. Reports that pain is not radiating to any surrounded area and “is better when drinking sips of a cold liquids like water or Kool-Aid or takes Ice cream”. Mother also states that fever somehow is relieved by rest and Tylenol. Confirms that his appetite has decreased in the last 3 days.

Medications: 

Tylenol OTC PO PRN

PMH 

Allergies: NKDA

Medication Intolerances: None

Chronic Illnesses/Major traumas: None

Hospitalizations/Surgeries: None

Immunizations: 

– According to CDC for his age group, he is up to date with the following vaccines

•          Influenza 2019

•          Tdap 5th dose

•          MMR 2nd dose

•          Polio IVP 4th dose

•          Chickenpox (Varicella) 2nd dose

Family History:

Mother: Alive – no significant medical history

Father: Alive – HTN

Sister: 8 years old healthy

Brother: 2 days old healthy

Social History

Lives with both parents and siblings. Appears comfortable and happy with mother in the room. Neither parents smoke. Patient began kindergarten this year at local public school.

General 

Patient reports sore throat, but overall healthy, appropriate weight and height for age, usually very active but mostly lying around the past few days per mom.

Cardiovascular

Denies chest pain or palpitations.

Skin

Denies rash, inflammation, pain, tenderness, or skin lesion.

Respiratory

Denies any cough, wheezing, hemoptysis, dyspnea, pneumonia hx, TB exposure or symptoms per mom, or SOB.

Eyes

Denies use of corrective lenses or glasses, blurred vision, or visual changes of any kind.

ENT

Denies ear pain, hearing loss, ringing in ears, discharge. Reports no sinus problems, or nose bleeding. Complains of sore throat and aggravating pain when swallowing. Goes to dentist every 6 months per mom.

Gastrointestinal

Denies diarrhea, abdominal pain, or heartburn. He had his last bowel movement this morning and goes at least once a day.

Genitourinary

Denies urgency, frequency or burning and pain with urination. Reports no hematuria or change in color of urine. Denies penile pain.

Musculoskeletal

Denies back pain, joint swelling, stiffness, or muscle pain.

Heme/Lymph/Endo 

Denies fatigue. Mother states swollen/tender cervical lymph nodes. Patient is appropriate size and weight for his age.

Neurological

Denies any syncope, seizures, transient paralysis, paresthesia or black out spells per mom.

Psychiatric

Denies any nightmares; patient seems happy and answers questions appropriately when asked directly.

OBJECTIVE – 

Weight  47.6 lbs.    BMI 15.1          Temp 100.1F  BP 103/67

Height 47”     Pulse 108       Resp 18

General Appearance

Happy. Alert and oriented in all spheres; answers questions appropriately when asked directly, but otherwise shy. Cooperative.

Skin

Skin is warm, dry, no rashes or lesion noted.

HEENT

Head is normocephalic, atraumatic and without lesions. EYES: Extra ocular muscles intact, PERRLA. Ears: TM’s shiny, EAC clear, hearing intact, mild tympanic membrane bulging. Nose: Bilateral turbs red and swollen, septum midline. Throat: Posterior pharyngeal erythema, white pus pockets noted on swollen tonsils.

Cardiovascular

S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs.

Respiratory

Symmetric chest wall. Respirations regular and unlabored; lungs clear to auscultation in all fields bilaterally.

Gastrointestinal

Abdomen is flat, BS normoactive in all 4 quadrants. No hepatosplenomegaly, soft no tender on palpation. Bowel sound normoactive in all 4 quadrants.

Lymphatic

Swollen cervical nodes bilaterally, tenderness on palpation.

Genitourinary

Bladder is non-distended, non-tender. External genitalia normal, no lesions observed. Tanner Stage 1.

Musculoskeletal

Full ROM seen in all 4 extremities without any difficulties.

Neurological 

Speech clear. Good tone. Posture is erect, balance stable and gait is normal.

Psychiatric

Alert and oriented. Maintains good eye contact. Speech is soft, and clear and of normal rate and cadence for age. Answers questions appropriately when asked directly, otherwise shy. Displays no mood disorders.

Lab Tests

CBC, CMP: pending

Special Tests

Strep Swab: Positive

Culture and sensitivity of tonsils exudate: pending

Primary Diagnosis

•          J02.0 Streptococcal Pharyngitis: Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4°F (38°C), tonsillar exudates, and cervical adenopathy. Cervical node lymphadenopathy and pharyngeal or tonsillar inflammation or exudates are common signs. Palatal petechiae and scarlatiniform rash are highly specific but uncommon; a swollen uvula is sometimes noted. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly.

Differential Diagnoses: 

•          J03.90 Acute Tonsillitis: Tonsillitis is most often a viral infection caused by cold viruses and starts suddenly and lasts for a week or two. Patients with tonsillitis typically present with a sore throat, swollen tonsils that are erythematous, and have a yellowish coating, difficulty swallowing, fatigue, fever, and loss of appetite (IQWiG, 2019). The patient in this case study does not have any coating of the tongue, loss of appetite, or fatigue noted so this is not likely to be the primary diagnosis.

•          B27.9 Infectious mononucleosis: Mononucleosis is caused by the Epstein Barr Virus and it is common to have inflammation of the tonsils with exudates which can also present with a generalized abdominal pain (Ruppert, 2015). This patient is middle aged and therefore, it is less likely that this is the diagnosis as it is not commonly seen in adults, but rather in adolescent to young adults between 15 to 24 years old. There is a test for mononucleosis called the Monospot test; however, it takes several weeks for a positive result to appear. This often tends to be inconvenient and often it is treated based on symptoms alone (Lyden, 2017). This is not likely to be the diagnosis for this patient as patients with mononucleosis have severe malaise and fatigue, which this patient has not reported.

•          D24.1 Acute pharyngitis: Pharyngitis is caused by inflammation to the pharynx and can occur in both adults and children and is due to either infection or irritation (Lyden, 2017). This is a very common condition and can be either viral or bacterial in nature. Bacterial pharyngitis is most commonly a result of a group A strep infection and according to Lyden (2017), it presents with erythema of the tonsils or throat, exudate which can be discrete or patchy, white or yellow, pharyngeal petechiae, and tenderness in the anterior cervical adenopathy. Viral pharyngitis is almost always caused by the rhinovirus and presents with cough, mild erythema, nasal drainage or stuffiness, fever, but no tenderness or lymphadenopathy (Lyden, 2017). This patient most likely has bacterial pharyngitis as the neck is tender with enlarged anterior cervical lymph nodes.

Plan/Therapeutics/Referrals/Education

Plan: 

1.        Children’s Motrin Oral suspension q8h PRN for pain and fever

2.        Amoxicillin 400/5ml Oral suspension for 10 days

3.        Advised to follow-up in 1 week to ensure medication course was followed and was effective.

4.        Results of all tests to be reviewed with patient in 1-week follow-up appointment.

Referrals:

No referral currently.

Patient Education:

–          Stop Tylenol and start with the prescribed NSAID.

–          Take the prescribed antibiotics for full treatment even if symptoms seem better in a few days. Do not stop earlier.

–          Increase cold fluid intake.

–          Saltwater gargles at least 3 times daily.

–          Rest, and no school until fever free for 24 hours.

–          If symptoms worsen direct yourself to the nearest ER.

References

Institute for Quality and Efficiency in Health Care (IQWiG) (January 17, 2019). Tonsillitis: Overview. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK401249/

Lyden, E. A. (2017). Chapter 101: Pharyngitis and Tonsillitis. In T. Buttaro, J. Trybulski, P. Polgar-Bailey, & J. Sandberg-Cook (Eds.), Primary care: A collaborative practice (5th ed., pp. 413-416). St. Louis, MO: Elsevier

This week, reflect on your perception of healthcare delivery models and the nurse’s role in public health programs as it has evolved over the course of your RN-BSN program at WCU. Identify specific healthcare delivery models you support, and compare and contrast public health programs you are familiar with. How does your academic work support evidence of meeting the following?

Essential III: Scholarship for Evidence-Based Practice

• Outcome #2: Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice.
• Outcome #5: Participate in the process of retrieval, appraisal, and synthesis of evidence in collaboration with other members of the healthcare team to improve patient outcomes.
• Outcome #6: Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.
• Outcome #7: Collaborate in the collection, documentation, and dissemination of evidence.

Review your past academic work, evaluate your effectiveness at meeting this program essential, and ponder the impact that this proficiency will have on your future.

Identify how you met the essential by referring to the assignment(s) specifically in your response. Additionally, reflect on and make connections between your academic experience and real-world applications. 

Recommended: Refer to work you completed for NURS 561 Health Promotion and Disease Prevention and NURS 350 Research in Nursing, as well as other courses, to gather academic examples and evidence of having met this essential.

Your reflection should be 1-1/2  and APA formatted. Cite at least 1 reference .

ExploreHealthCareers.org has a partial listing of potential allied health careers. Medical Administrative Assistants, entry level Medical Billing and Coding, Medical Assistant, Electronic Health Records Specialist are all entry level positions. In 1-2 pages reflect on where you might like your career to go.

Include the following aspects in the assignment:

Ø  Convey two careers listed in either the link above or other links pertaining allied health careers.

Ø  Expand on the job outlook, responsibilities, and education requirements.

Ø  Demonstrate what skills you personally have that would make you successful in the field of Allied Health.

Ø  Explore your short and long-term goals in reference to Allied Health.

Identify two GCU Library scholarly databases that will help you find the best research articles to support your capstone project change proposal. Discuss why these two databases are better than Google Scholar or a general Internet search. (Grand Canyon University)( use any scholarly databases)

 Debate topic: Nursing curriculum needs an overhaul: Redesigning a nursing curriculum VS. Nursing education is providing the ultimate educational experience for nursing students and no adjustment is required

Given that you will be graduating very shortly, reflect back on your academic journey. Consider the courses that you took for your general education requirements and your nursing courses. Please answer the following questions:

1. What courses did you enjoy and why?
2. What courses did you not enjoy and why? Did the course meet the QSEN requirements?
3. What would you change regarding the nursing curriculum? What courses would you remove and/or add? Remember all courses added must adhere to the QSEN competencies and meet approval of the WSBON.
4. Has Covid impacted nursing education for the better in any way or has it provided a significant barrier to learning?

Come to class prepared to discuss these questions. Be prepared to discuss your rationales for any changes you would implement.

Please upload your answers to the above questions into Canvas.

Here is the link for the QSEN Institute to reveiw the QSEN competencies for pre-liscensure nursing education

https://qsen.org/competencies/pre-licensure-ksas/ (Links to an external site.)

Here is a link for the WBON self evaluation for approval of nursing curriculum. If you have suggestions for curriculum changes, use this tool to review if a suggestioned revision would meet the approval of the WSBON

https://dsps.wi.gov/Documents/fm3028.pdf

Here are a few articles that may be helpful on this topic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4796347/ (Links to an external site.)

https://www.ncbi.nlm.nih.gov/books/NBK209885/ (Links to an external site.)

https://www.researchgate.net/post/How-Will-COVID-19-Reshape-Nursing-Education-Globally

The following case study is worth 50 points. Complete the case study and submit it to the drop box. You can either type your answers directly into the study or you can write them, take a picture and upload it that way.

Case Study 3 [Document]