Read Chapter 9: Evidence-Based Professional Nursing Practice and Answer the question: How do I know what I know about nursing practice? Are my nursing decisions based on myths, traditions, experience, authority, trial and error, ritual, or scientific knowledge?
APA style (in text reference and citations)
Plagiarism FREE
Minimum of two references, not older than 2015.
1 discussion 510
2 discussion 521
2 discussion 561
Medications
All data addressed for medications your client received that day in clinical
Rationales appropriate for your client
Mrs. G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep.
Current medications: Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin PMH: Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to
date.
GYN hx: G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear.
FH: parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol.
SH: works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use
Allergies: NKDA, allergic to cats and pollen. No latex allergy Vital signs: BP 129/80; pulse 76, regular; respiration 16, regular
Height 5’2.5”, weight 185 pounds
General: obese female in no acute distress. Alert, oriented and cooperative. Skin: warm dry and intact. No lesions noted
HEENT: head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation bilaterally, respirations unlabored.
Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Labwork:
CBC: WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC
34 g/dl RDW 13.8%
UA: pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones
CMP:
Sodium 139
Potassium 4.3
Chloride 100
CO2 29
Glucose 95
BUN 12
Creatinine 0.7
GFR est non-AA 92 mL/min/1.73 GFR est AA 101 mL/min/1.73 Calcium 9.5
Total protein 7.6 Bilirubin, total 0.6 Alkaline phosphatase 72
AST 25
ALT 29
Anion gap 8.10
Bun/Creat 17.7
Hemoglobin A1C: 6.9 %
TSH: 2.35, Free T 4 0.7
Cholesterol: TC 230 mg/dl, LDL 144 mg/dl; VLDL 36 mg/dl; HDL 38mg/dl, Triglycerides 232
EKG: normal sinus rhythm
instructions: Introduction: briefly discuss the purpose of this paper. (no more than 5 sentences)
Assessment: review the provided case study information.
Identify the primary and secondary diagnosis for the patient. Each diagnosis will include the following information:
Plan: (there are five (5) sections to the management plan)
Assessment of Comorbidities: in this section students will review the ADA Standards of Medical Care in Diabetes (the guidelines) Assessment of Comorbidities section on comorbidities subsection and choose one listed comorbidity. Students will discuss the significance of and the relationship between the patient’s primary diagnosis and the chosen comorbidity, explaining how one diagnosis affects the other diagnosis. Any recommended screening, diagnostic testing, and referrals are also included.
Medication costs: in this section students will research the costs of all prescribed and OTC monthly medications that you have prescribed and that the patient is currently taking that you would like to continue. Students may use Good Rx, Epocrates or another resource (students may use local pharmacy websites) which provides medication costs. Students will list each medication, the monthly cost of the medication and the reference source. Students will calculate the monthly cost of the case study patient’s prescribed and OTC medications and provide the total costs of the month’s medications. Reflect on the monthly cost of the medications prescribed. Discuss if prescriptions were adjusted due to cost. Discuss if will you use medication pricing resources in future practice.
RUBRIC:
Assessment: Primary diagnosis
Presentation of the case study patient’s primary diagnosis includes the following required elements:
Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.
Assessment: Secondary diagnosis (es)
Presentation of the case study patient’s secondary diagnosis (es) include (s)the following required elements:
Diagnosis is consistent with the cited guideline recommendations or scholarly reference, ICD10 code is listed, rationale statement includes a one to two sentence paraphrased pathophysiology statement. The rationale statement includes pertinent positive and negative subjective and objective findings from the history and physical exam, which links this diagnosis to the case study patient. Pertinent lab results are included and interpreted within the rationale statement.
Evidence-Based Practice (EBP)
National guidelines are used to support all diagnoses and develop the management plan.
The American Diabetes Association Standards and Medical Care in Diabetes-2019 or later, (or article related to 2019 or later Guidelines) are used to support the primary diagnosis and develop the management plan.
Every diagnosis rationale must include an in-text citation to a scholarly reference as listed in the Reference Guidelines document. Each action step or order within all plan sections includes an in-text citation to an appropriate reference as listed in the Reference Guidelines document. Reference interpretation is accurate.
Plan: Diagnostics
All ordered diagnostics tests are linked to a diagnosis listed in the assessment section and include a paraphrased EBP rationale with citation and include date when test should be performed (ie: today, 1 week, 1 month). Further testing/diagnostics for the differential diagnosis is included. Plans are consistent with the cited guideline recommendations or scholarly reference.
Plan:Medications
The plan includes both prescribed and OTC medications written in prescription format. The plan includes a minimum of one OTC medication. Each prescribed and OTC medication is linked to a diagnosis listed in the assessment section
Diagnosis is clearly stated in the rationale statement. And includes a paraphrased rationale EBP rationale
Plan:Education
All education steps are linked to a diagnosis, paraphrased, and include an EBP rationale.
This section is written exactly how you would discuss the education to the patient. Use vocabulary which the patient can understand, not medical terminology.
Section includes personalized detailed education on diagnoses, medications, diet, exercise and any warning signs. Personalized diet and exercise recommendations are appropriate for the case study patient and include specific instructions for the case study patient such as a specific exercise- length of time to exercise and frequency/week. Any published diet recommendations, such as a Mediterranean diet, will include a rationale statement as to why this recommendation is beneficial for the case study patient.
Plans are consistent with the guideline recommendations or scholarly reference.
Plan:Referrals
All recommended referrals are appropriate for the patient diagnoses:
each referral is linked to a specific diagnosis each which was listed in the assessment section and includes a paraphrased EBP rationale. All referrals related to the primary diagnosis are obtained from the ADA guidelines.
Plans are consistent with the cited guideline recommendations or scholarly reference
Plan: Follow up
Follow up includes a specific time/date to return to PCP office. EBP rationale with in text citation is included. Only follow up information is listed in this section. Additional information, such as future testing, education or referrals are not listed in follow up but within the appropriate paper sections. Plans are EBP and consistent with the guideline recommendations.
Assessment of comorbidities
The ADA guidelines includes a Comprehensive Medical Evaluation and Assessment of Comorbidities section which includes comorbidities that providers should consider when managing disorders of glucose metabolism.
Choose one of the listed comorbidities from the ASSESSMENT OF COMORBIDITIES subsection*
Explain the significance of and the relationship between your primary diagnosis and your chosen comorbidity. Explain how one diagnosis affects the other diagnosis in no more than 3-5 sentences. Include any recommended screening, diagnostic testing, and referrals in no more than 2-3 sentences.
* the chosen comorbidity cannot be any secondary diagnosis already discussed in your paper’s assessment section.
Medication costs
All monthly medication costs are calculated, including the current medications the patient may be already taking.
A total cost for all the month’s medication is included.
All medications including OTCs are included.
Medication cost reference source is included. Summary/reflection statement regarding medication costs and any medications changes based on cost or polypharmacy concerns is included.
ASSIGNMENT FORMAT
Description
Grammar, Syntax, APA
APA format, grammar, spelling, and/or punctuation are accurate, or with zero to one error. All referenced information is cited, “according to” is not used. All cited information is paraphrased, no quotes are included in the paper.
Organization
Paper is developed in a logical, meaningful, and understandable sequence.
Provided assignment template is used to develop the paper. The rationale length does not exceed template directions. The paper length does not exceed 10 pages, excluding title page and references.
Research, compose, and type a scholarly paper based on the scenario provided by your faculty, and choose a conclusion scenario to discuss within the body of your paper.
Please consider the following Scenario when writing this assignment.
Here is the SCENARIO:
You receive a message from a peer at work that there is a big investigation being conducted at work due to a HIPAA violation and that it involved a celebrity who had been admitted to the hospital. As a case manager for the hospital you are given a company cell phone for hospital use because you are on call three days per week. You have pictures of this celebrity you took the other day. The word is that legal action is being taken against the hospital due to some photos that were sold to the Gossip Gazette. They ask to search your company cell phone.
P.S please follow the instructions in the instructions box images. This paper is very important. Thank you
NR 701 Week 3 Questions
· What are the potential benefits and harms related to your selected practice problem when considering a research-based intervention for your practice change project?
· Are there competing personal or professional values related to this research-based intervention that might impact the implementation of this intervention in your practice setting?
· What types of objections might be raised? How will you explain your decision to key stakeholders to address these objections?
In the past weeks, I have discussed the prevalence of obesity in the country and at the local level. Obesity is a growing epidemic especially in the United States and many other countries around the world. According to Dai, et al. (2020), in the years between 1990 and 2017, the obesity-related deaths and disability-adjusted life years have vastly increased for both men and women, globally. It is our job as DNPs to look into the various practice problems and, through research evaluation, ascertain the information needed to create research-based intervention and decrease the burden of disease.
I consider obese persons to be part of a vulnerable population. This conclusion is apparent in that: 1) there is a social stigma associated with personal appearance; 2) ridicule toward obese people is real; 3) personal appearance plays a large role in self-worth; and 4) because most obese people are desperate to lose weight, they can easily be taken advantage of. And of course, being pregnant also adds to the vulnerability of this subpopulation. Because of all this, it is important to remember that we must remain ethical when considering a research-based intervention. There are benefits and harms associated with almost all interventions; it is important to remember that risks must be minimalized. Respect for persons, beneficence, and justice are important ethical ideals when performing the research, and they must also carry over to the implementation of the findings (Favaretto, et al., 2020). The plan for my change project includes two steps. The first is to incorporate education of diet and exercise, including healthy eating choices and preparation demonstrations. The second part involves the patient tracking their exercise on a fitness tracker given to them at their first prenatal visit. They will be shown how to log their daily meals and exercise. Then at every prenatal visit, they can bring in their log so as to discuss their progress. We must remember to congratulate even the smallest improvement and encourage future improvement.
When introducing intervention for the pregnant, obese population, the benefits could be great. These include having a healthier pregnancy and baby, avoiding complications of pregnancy such as gestational diabetes and hypertension/preeclampsia, living a healthier lifestyle that can be carried over past the postpartum period, and lowering the risks of future weight-related problems such as cardiac disease and diabetes. But we must be careful about how we approach the patient so as to avoid harm. Obese patient care, especially when pregnant, can harbor great embarrassment and low self-esteem. Because of this, discussing weight is something that needs to be ethical and humane. One of the worst things that can happen in this situation is that the patient may be so embarrassed and upset that she may not return for prenatal care. That can have grave implications for both mother and fetus. This can also lead to depression and self-isolation, which as obstetrical providers, we know that this can lead to suicide ideations.
There are some personal and professional values that conflict when putting an intervention into place to help pregnant women with weight loss. As a professional nurse-midwife, I want my patients to be at the peak of health. I look past the pregnancy and down the lifespan of my patient. I truly care about each and every patient’s well-being just as if they were family or friends. And so, therefore, I want to push through with interventions on weight loss. But there is that part of me that makes me ambivalent about upsetting or hurting the feelings of my patients by bringing up sensitive issues like their weight. Of course, these women know they have weight problems, but I can be a source of embarrassment as many of these women are not happy with their appearance or are depressed because of it. In the end, it is important to address this sensitive issue with tact and empathy so that we can minimize the harms of this type of intervention.
I am anticipating that many questions would be raised especially by the organization administration including the chief financial officer, as well as the mesosystem of managers. One of the most important objections I anticipate is over the cost of implementing the program. Who will pay for the fitness trackers? What are the costs associated with teaching about sound dietary choices and demonstrations of healthy cooking? I would recommend a cost/savings analysis be performed. In addition, emphasis will be placed on the benefits of a healthier population, such as shorter hospital lengths of stay, fewer complications with procedures or surgery, improved patient satisfaction, and an increase in payments from third-party payors. We should also see a drop in readmissions of women with postpartum preeclampsia. In addition, the nursing load would be lighter with a healthier population. I would explain that as an option, we can involve the local health departments and ask for assistance with the healthier eating and cooking portion of the intervention as they have specialists that work with WIC programs and others of the like. In the end, the organization would be making money. We have an obligation as health care providers to help improve the health of the patients, community, and world. It is projected that by 2025, 20.5 million Americans will be morbidly obese and as this number increases, so does the expenditures. (Cecchini, 2018).
Cecchini, M. (2018). Use of healthcare services and expenditure in the US in 2025: The effect of obesity and morbid obesity. PLoS ONE, 13(11), 1-14: e0206703. https://doi.org/10.1371/journalpone.0206703
Dai, H., Aisalhe, T., Chalghaf, N., Ricco, M., Bragazzi, N., & Wu, J. (2020). The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: An analysis of the Global Burden of Disease Study. PLOS Medicine, 17(7), 1-19: e1003198. https://doi.org/10.1371/jounal.pmed.1003198 (Links to an external site.)
Favaretto, M., Clercq, E., Gaab, J., & Elger, B. (2020). First do no harm: An exploration of researchers’ ethics of conduct in Big Data behavioral studies. PLoS ONE, 15(11), 1-23: e0241865. https://doi.org/10.371/journal.pone (Links to an external site.).0241865
I NEED A COMMENT FOR THIS POST WITH AT LEAST TWO-THREE PARAGRAPH AND TWO SOURCES NO LATER THAN FIVE YEARS
Purpose: PICO questions are used by practicing nurses and researchers to focus research questions and develop an efficient literature search strategy. It is essential that future nurses learn how to do this to develop evidenced-based solutions to patient care problems in a healthcare organization.
https://libguides.resu.edu/c.php?g=755071&p=5411646 (library)
https://www.ncbi.nlm.nih.gov/mesh/
Public Service Announcement (110 points)
Review Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj and Umrah.
Then, create a Public Service Announcement (PSA) that discusses vaccination policies and recommendations for religious pilgrims entering the Kingdom. The PSA should be in the form of a brochure that will be distributed globally to relevant populations.
Be sure to discuss the following:
Your brochure should meet the following structural requirements:
Module 2 Assignment: Case Study Analysis
Scenario : 45-year-old woman presents with chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields.
I would like to find some documents with questions to prepare for the nursing advance adult health care final exam
