Tag Archive for: nursing

Hypercholesterolemia

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Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Example:

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory:Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal:Denies abdominal pain or discomfort.Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular:S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory:No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no reboundno distention or organomegaly noted on palpation

Musculoskeletal:No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary:intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis(ICD10 I70.1)

Ø Chronic kidney disease(ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

 

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

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Pro-Position Proposal Template

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Apply the following writing resources to your assignment:

Instructions
The goal of the proposal is to create a working thesis statement and basic research plan that considers context, audience, purpose, and presents potential sources. A proposal is not an outline, as it does not structure the paper. Rather, a proposal offers direction for research needs and gives your professor an opportunity to provide feedback before the drafting process.

Access the Pro-Position Proposal Template and complete the six required sections:

  • Subject
  • Research Question
  • Claim
  • Research Plan
  • Synthesis Matrix (Add the 3 pro sources.)
  • Reference Page

For an example proposal, refer to pages 269-270 of our textbook.

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implementing a new computer system

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 Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Be sure to include a title slide, objective slide, content slides, reference slide in APA format. Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly citations to support your claims

 

You are a project manager assigned to implementing a new computer system in an organization:

  • 1) Why is it important to understand usability, configurability, and interoperability? Should these concepts outweigh the underlining cost of the new system? Which system do you recommend and why?
  • 2) During phase one, you are selecting a team. What characteristics are important to consider when selecting a team?
  • 3) During phase two the following principle was discussed, “lead with culture, determining where the resistance is,” and then, engage all levels of employees (Sipes, 2019, p. 161). What does this principle mean to you and how can you implement this principle?
  • 4) How will you handle physician and other key professionals’ resistance to change and using the new system?
  • 5) Discuss possible pitfalls during the implementation phase and how you can avoid them?
  • 6) Describe your personal experience with automation and new information systems.

Structure: Include a title slide, objective slide, content slides, reference slide in APA format.

  • Posted: 8 Months Ago
  • Due: 30/09/2019
  • Budget: $20

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Collaborative Learning Community

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This is a Collaborative Learning Community (CLC) assignment.

The purpose of this assignment is to assess leadership styles, traits, and practices as a nursing professional, establish the importance of effective interprofessional communication as a leader in nursing, and to explore the role of servant leadership in nursing practice.

Share with your group about specific leadership styles, traits and qualities, so you can become familiar with how you are similar and different from your peers when it comes to being a leader.

Review the servant leadership. Using what you have learned about the tenets of servant leadership and traits and practices of successful leaders, create four slide PowerPoint presentation (excluding slide showing name, course study and references). Add speaker notes to each slide

Include the following in your presentation:

1. Create a slide that summarizes your leadership style, traits, and practices.

2. Compare the personal leadership styles of your group members, including commonalities between group members’ strengths and weaknesses.

3. Discuss what leadership traits and styles are necessary to be an effective communicator. Explain the importance of leaders adapting communication approaches when working interprofessionally (across ancillary departments, vendors, community members).

You are required to cite three sources to complete this assignment and the sources must be published within the last 5 years. 

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Asthma and Stepwise Management

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Assignment: Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

· Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.

· Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.

· Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

· Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.

· Explain the stepwise approach to asthma treatment and management for your patient.

· Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

Resources for reference. Need 3 reference

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

· Chapter 60, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 673–693)

· Chapter 61, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 695–702)

· National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

·

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Health Assessment 

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Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Main Post

Week 1 Advanced Health Assessment

Initial Post

My patient: 38-year-old Native American pregnant female living on a reservation 

Each patient you meet you will have different techniques and ways of going about communication with them depending on their culture and beliefs. It is important to understand what is important to them. Ask yourself what do they value most? You want to be able to connect with them to get an accurate history to provide care.  The nursing assessment includes gathering information concerning the patient’s individual physiological, psychological, sociological, and spiritual needs. It is the first step in the successful evaluation of a patient. (Jamieson H,2019)In my situation with my patient being of the Native American decent livening on a reservation whom is pregnant I can already assume she does not have much interaction with the outside world such as those outside the reservation. She mainly probably stays with those who live around her and live off the land with little unhealthy habits since nature is very important in this culture.

My interview techniques to obtain a health history would need to be based on her lifestyle. I need to make sure I am wording them correctly so that she can understand what I am needing from her. Certain health information that is important to us may not be pertinent to the patient. I need to target my questions towards her lifestyle. The function of the initial nursing assessment is to identify the assessment parameters and responsibilities needed to plan and deliver appropriate, individualized care to the patient. (Gray LC,2018) I also need to base a lot of my question on the fact she is pregnant. I need to ensure she Is healthy not only for herself but for the baby. I may have to redirect and reword my question multiple times to obtain accurate information. With this patient living on a reservation I need to ask about her diet and environmental factors since my way of life Is different than hers I need to first understand how she lives. The cultural competency assessment will identify factors that may impede the implementation of nursing diagnosis and care. (Dunham M,2018)I then need to focus on potential health risk based on first this patient age. This patient is 38 years old and is pregnant. This is automatically a high-risk pregnancy due to her age. 35 is considered geriatric pregnancy. This increase the risk for many health concerns for her and the baby. Also, her living situation can at time be difficult for her and baby depending on what type of reservation she lives on. I need to ensure she has quick access to medical care and is receiving the proper supplements. Many native American cultures believe in herbal and home remedies which can sometimes be harmful or interact with other medications. Some questions that need to be asked I order to obtain an accurate health history are the following: Do you have any allergies to medication?Is this your first child? If not, how many children do you have, and did you have a C-section?
What medication including herbal supplements are you taking?Have you ever had any major surgeries?Have you ever been hospitalized for any reason including mental health reasons? What is your family history?Have you been having any complications that you have noticed or concerns?

References

Jamieson H, Abey-Nesbit R, Bergler U, Keeling S, Schluter PJ, Scrase R, Lacey C. Evaluating the Influence of Social Factors on Aged Residential Care Admission in a National Home Care Assessment Database of Older Adults. J Am Med Dir Assoc. 2019 Mar 26;Gray LC, Beattie E, Boscart VM, Henderson A, Hornby-Turner YC, Hubbard RE, Wood S, Peel NM. Development and Testing of the interRAI Acute Care: A Standardized Assessment Administered by Nurses for Patients Admitted to Acute Care. Health Serv Insights. 2018 Dunham M, MacInnes J. Relationship of Multiple Attempts on an Admissions Examination to Early Program Performance. J Nurs Educ. 2018 Oct 01;57(10):578-583.

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Nursing

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profileScarlett12

Field: Nursing

Posted: A Day AgoDue: 19/09/2017Budget:  $8Report Issue

Week 4: Transformational Nursing Leaders

3 3 unread replies. 3 3 replies.

Review Appendix A, Sections I–V in Finkelman (2016).

Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies.  Your comments should be about the “highest nursing leader” in your organization. Typically this is the leader who represents nurses and nursing to the governing board.

In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive?

Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences.

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Collapse SubdiscussionDesirae Freeze

Desirae Freeze

Friday Sep 15 at 8:18pm

Manage Discussion Entry

You may begin posting to this discussion on: Sunday, September 17, 2017

Class,

There are several sections in this appendix from which you can choose. Concentrate on one section and discuss competencies you see your Nurse Executive displaying. Keep in mind that they Nurse Executive the individual ultimately responsible for nursing and is at the top of your organization. This is not your director or nursing manager, but your Chief Nurse Executive.

Thanks,

Desirae

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Communicable Disease Chain,

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Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance completing this assignment.

Communicable Disease Selection

Choose one communicable disease from the following list:

  1. Chickenpox
  2. Tuberculosis
  3. Influenza
  4. Mononucleosis
  5. Hepatitis B
  6. HIV
  7. Ebola
  8. Measles
  9. Polio
  10. Influenza

Epidemiology Paper Requirements

Address the following:

  1. Describe the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
  2. Describe the determinants of health and explain how those factors contribute to the development of this disease.
  3. Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle). Are there any special considerations or notifications for the community, schools, or general population?
  4. Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).
  5. Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.
  6. Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

A minimum of three peer-reviewed or professional references is required.

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.

Please refer to the directions in the Student Success Center.

NRS427V-RS-CommunicableDiseaseChain.doc

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Dosage Calculation 

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1) Dosage Calculation 

Complete the dosage calculation practice test. To best prepare yourself for the dosage calculation test, only allow yourself to use a pencil and calculator. You will have 30 minutes to complete 10 questions for the actual dosage calculation test. You do not need to turn in the dosage calculation test. This is for you to practice. I will open the answers next week so that you can review your work.

Family Nursing Dosage Calculation Practice

1. A physician ordered Magnesium Sulfate bolus 4 grams in 100 MLS of LR to be given over 20 minutes. What rate should the nurse set the infusion pump at?

2. Your patient Zachary weighs 6 kg. He has prescribed rifampin 75 mg per nasogastric tube. You have rifampin 20 mg/mL suspension. How many mL will you give via the nasogastric tube? Round to the nearest 10th.

3. A Physician ordered Magnesium Sulfate 40 grams in 1,000mL of LR at a rate of 2g/hour for a woman in preterm labor. What rate should the infusion pump be set at? It should be a whole number.

4. Betony is a 2 ½-year-old who is newly diagnosed with HIV infection. She is to be started on Retroviral 120 mg by mouth every 12 hours. She weighs 13 kg and is 90 cm long.

A. Using the formula for BSA calculate her body surface area:

BSA (m2) = Ht (cm) X Wt. (kg) / 3600

B. Retroviral is prescribed on an individual basis ranging from 180 to 240 mg/m2 per dose every 12 hours. It comes in a concentration of 10 mg/mL.

Is her dose of 120 mg within the acceptable range?

How many mL with you administer?

5. Your patient Nicole is admitted with sepsis and you have an order for meperidine 29 mg intramuscular. A vial comes up Meperidine 100mg/ml. How many mL will you give? Round to the nearest 100th.

6. Your post-op patient has fentanyl 42 mcg intramuscular ordered. The vial you have is 250 mcg/mL. How much will you give? Round to the nearest 100th.

7. Your patient weighs 21 lbs. She has captopril 3 mg PO QD ordered. The safe range is 0.3 to 0.5 mg /kg/day. You have a Captopril solution 1mg/mL on hand. Is this dose within the safe dose range and if so how many MLS would you administer? Round to a whole number.

8. Your 5-year-old post-op patient is having pain. The doctor wants to order fentanyl and ask for the safe dose range. Your patient weighs 53 lbs. The safe range for fentanyl is 1-2 mcg/kg. What would be a safe dose for this patient? The doctor wants to order 42 mcg, is this within the safe dose? You have an ampule that contains 50mcg/mL. How many MLS would you administer IV? Round to the 100th place.

9. Your patient has metoclopramide 0.68 mg PO. You have metoclopramide syrup in a concentration of 5 mg/ 5 mL. How many MLS will you administer? Round to the nearest 100th.

10. You have oral Lasix 10 mg/ mL. The prescribed dose is 25 mg PO once daily. The patient weighs 9.5 kg. The safe range for this medication is 1 to 6 mg/kg/day. How many MLS will you administer? Round to the nearest 10th.

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Healing and Autonomy”

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This assignment will incorporate a common practical tool in helping clinicians begin to ethically analyze a case. Organizing the data in this way will help you apply the four principles of principlism.

Based on the “Case Study: Healing and Autonomy” and other required topic study materials, you will complete the “Applying the Four Principles: Case Study” document that includes the following:

Part 1: Chart

This chart will formalize principlism and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.

Part 2: Evaluation

This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.

Remember to support your responses with the topic study materials.

APA style is not required, but solid academic writing is expected.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

PHI-413V-RS-T3ApplyingFourPrinciplesCaseStudy.docx

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