All posts by : chebby

 Discussion 5 

Gastrointestinal Function:
R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.

Case Study Questions

1. In your own words define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have.
2. Based on the clinical manifestations on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
3. Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?

Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.

Case Study Questions

1. In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
2. If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
3. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

Submission Instructions:

• You must complete both case studies.
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

 Discussion 6

Musculoskeletal Function:
G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

1. Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
2. Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
3. Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
4. How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.

Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

1. Name the most common risks factors for Alzheimer’s disease
2. Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
3. Define and describe explicit and implicit memory.
4. Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
5. What would be the best therapeutic approach on C.J.

Submission Instructions:

• You must complete both case studies.
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources.

 Description

The Health Insurance Portability and Accountability Act (HIPAA) is a major regulatory aspect of health care information technology (IT). Complete the following for this assignment:

• Identify 1 type of healthcare information system, and explain the steps that would be required to conduct a HIPAA audit of the system within your organization.
• Explain what a gap analysis is and why it would be useful for the organization conducting the audit.
• Your goal is to ensure that the organization remains compliant and to identify any potential compliance gaps.

This assignment is about creating a plan for the audit, not implementing the actual audit. Make sure you include recent changes to HIPAA as a result of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA).

Note: Use APA style 7th edition to cite at least two scholarly sources from the last 5 years.

 Opportunities for Improvement: APA standards require a URL for webpages or a DOIs when possible (usually found in scholarly journals/libraries). Essentially, if you do not possess a physical copy of the source, a URL or DOI is required. 

A father of a 17-year-old wants to know whether his child is sexually active.

• What will you tell him?
• What if the child is 14 years old?
• What if the child is 11 years old?
• What is your state law regarding parental notification? It is Florida!

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

Discussion 5 

Describe a situation of ethical dilemma that you have experienced as a psych nurse  and how it was resolved. (Saunders, 2014)

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

  The learning resources in the unit provided an overview of the impact of nurses’ practice environment on patient outcomes, as well as, professional autonomy and role satisfaction.

https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-01772-9

The resource articles provide illustrations of how a practice environment analysis has been applied in tertiary and ambulatory care settings.

Using the 7 domains of analysis noted in Figure 2 of the Pursio et al. (2024) article and the TOP10 items (Extracted of PES-NWI) from the right-hand side of Table 5 of the Martinez-Riera et al. (2020) article develop a professional presentation that aligns with the requirements noted below.

Include the following in your presentation:

1. A title slide
2. A minimum of four slides for each of the 7 domains of analysis from the Pursio et al. (2024) article (total of 28 slides for this element of the presentation)
   • first slide for each domain of analysis – Title of the Domain (from the Pursio et al. article)
   • second slide – correlate that domain with what you perceive to be the appropriate PES-NWI item(s) noted in the right-hand side of Table 5 of the Martinez-Riera et al. (2020) article
   • third slide for each domain of analysis – provide a discussion of your observations and thoughts about the strengths and opportunities in your current practice environment with the PES-NWI items you have correlated with this domain; this discussion may require more than a single slide
   • fourth slide for each domain of analysis – identify one nursing leadership strategy you would deploy to either bolster the strength OR address the opportunity you identified on the preceding slide; be sure to include a resource/reference to support your selected strategy
3. Summary slide – discuss how the practice environment analysis framework aligns with contemporary leadership theories in nursing
4. References slidehttps://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-01772-9
5. https://www.mdpi.com/1660-4601/17/20/7520

Now that you are moving deeper into the literature surrounding your proposed project, it is imperative for you to stay engaged with review, appraisal, and synthesis activities.

In this unit you have the Scholarship of Application – Part 2 assignment to create a presentation about the range of strategies/interventions you located in the literature to address the identified problem, the overview of the strategy/intervention you selected to implement and the rationale why this strategy/intervention is the best one to implement in your practice setting.

Using the Synthesis Matrix Table, you submitted in week 4, update the table with a minimum of an additional 5 resources of evidence.

For this unit table assignment, the next 5 entries in your table will demonstrate support for the intervention you have selected to address the identified problem.

After completing the table entries for this week, your updated table will now minimally include 10 resources.

Direct access to the article is essential for grading. Either upload all evidence along with your table or be sure an activated link is provided to ensure it leads directly to the article you are presenting.

Synthesis Matrix Table part 1 and Scholarship application part 2 attached