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Drooping of Face

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

With regard to the case study you were assigned:

  • Review this week’s Learning Resources, and consider the insights they provide about the case study.
  • Consider what history would be necessary to collect from the patient in the case study you were assigned.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

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Patient Preferences and Decision Making

Discussion: Patient Preferences and Decision Making

Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions?

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

· Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.

· Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.

o Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.

NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

By Day 3 of Week 8

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

· Reflect on the four peer-reviewed articles you critically appraised in Module 4.

· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)

· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.

· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.

· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.

· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

· Add a lessons learned section that includes the following:

o A summary of the critical appraisal of the peer-reviewed articles you previously submitted

o An explanation about what you learned from completing the evaluation table (1 slide)

o An explanation about what you learned from completing the levels of evidence table (1 slide)

o An explanation about what you learned from completing the outcomes synthesis table (1 slide)

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

  • Chapter 7, “Patient Concerns, Choices and      Clinical Judgement in Evidence-Based Practice” (pp. 219–232)

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/1910118

Note: You will access this article from the Walden Library databases.

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788386/

Note: You will access this article from the Walden Library databases.

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. doi:10.1097/NND.0000000000000483

Note: You will access this article from the Walden Library databases.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x

Note: You will access this article from the Walden Library databases.

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historical application of statistics

Discuss the historical application of statistics in the field of health care. Describe an example, other than Florence Nightingale’s contributions, where statistical application has greatly influenced or changed health care operations or practice.

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 False Alarms and Overmonitoring

Qualitative Research Critique!

Please use article – False Alarms and Overmonitoring : Major Factors in Alarm Fatigue Among Labor Nurses  – ATTACHED BELOW!!

 

Prompt: Use the article provided. Start by filling out the provided worksheet. Then, using the worksheet as your guide, write a critique to dig deeper into each section and identify the specific examples of each element (e.g., what is the research question? Does the author justify the importance of the research? In the case of a literature review, has the author examined the relevant literature?). Elaborate on each section and evaluate it for its strengths and limitations. Be sure to identify your chosen article and address the following critical elements:

 Critique
Purpose and Research Question: What is the research question? Does the author justify the importance of the research?
DesignandMethods:Whatdesignandmethodswereused?Aretheyrigorousandsystematic?
Validity and Reliability: Is the study valid and reliable? (For qualitative research, this section of your critique should consider the study’s

trustworthiness and rigor.)
Findings and Conclusions: Are the conclusions reasonable given the findings?

 Evaluation: What are the strengths and weaknesses of the research article? Do you agree with the author’s conclusions? Why or why not? Did the author succeed or fail in the purpose of the study? Recommend areas for improvement or suggest direction for future research.

Guidelines for Submission: Your paper must be submitted as a 1–2 page Microsoft Word document with double spacing, 12-point Times New Roman font, one- inch margins, and in APA format.

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Big Data Risks and Rewards

Discussion: Big Data Risks and Rewards

When you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.

From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.

As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.

To Prepare:

· Review the Resources and reflect on the web article Big Data Means Big Potential, Challenges for Nurse Execs.

· Reflect on your own experience with complex health information access and management and consider potential challenges and risks you may have experienced or observed.

Post a description of at least one potential benefit of using big data as part of a clinical system and explain why. Then, describe at least one potential challenge or risk of using big data as part of a clinical system and explain why. Propose at least one strategy you have experienced, observed, or researched that may effectively mitigate the challenges or risks of using big data you described. Be specific and provide examples.

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 Knee Injury

Knee Injury

Case Studies

A 15-year-old gymnast has noted knee pain that has become progressively worse during the past several months of intensive training for a statewide meet. Her physical examination indicated swelling in and around the left knee. She had some decreased range of motion and a clicking sound on flexion of the knee. The knee was otherwise stable. Studies Results Routine laboratory values Within normal limits (WNL) Long bone (femur, fibula, and tibia) X-ray No fracture Arthrocentesis with synovial fluid analysis Appearance Bloody (normal: clear and straw-colored) Mucin clot Good (normal: good) Fibrin clot Small (normal: none) White blood cells (WBCs) <200 WBC/mm3 (normal: <200 WBC/mm3 ) Neutrophils <25% (WNL) Glucose 100 mg/dL (normal: within 10 mg/dL of serum glucose level) Magnetic resonance imaging (MRI) of the knee Blood in the joint space. Tear in the posterior aspect of the medial meniscus. No cruciate or other ligament tears Arthroscopy Tear in posterior aspect of medial meniscus Diagnostic Analysis The radiographic studies of the long bones eliminated any possibility of fracture. Arthrocentesis indicated a bloody effusion, which was probably a result of trauma. The fibrin clot was further evidence of bleeding within the joint. Arthrography indicated a tear of the medial meniscus of the knee, a common injury for gymnasts. Arthroscopy corroborated that finding. Transarthroscopic medial meniscectomy was performed. Her postoperative course was uneventful.

Critical Thinking Questions

1. One of the potential complications of arthroscopy is infection. What signs and symptoms of joint infection would you emphasize in your patient teaching?

2. Why is glucose evaluated in the synovial fluid analysis?

3. What are special tests used to differentiate type of Tendon tears in the knee ?

Explain how they are performed (Always on boards)

Testicular Cancer

Case Studies

A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. Studies Results Routine laboratory studies Within normal limits (WNL) Ultrasound the testicle Solid mass, right testicle associated with calcifications HCG (human chorionic gonadotropin) 550mIU/mL (normal: <5) CT scan of the abdomen Enlarged retroperitoneal lymph nodes CT scan of the chest Multiple pulmonary nodules Diagnostic Analysis At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes.

Critical Thinking Questions

1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer?

2. What might be the side effects of cytotoxic chemotherapy?

3. What was the purpose of preserving his sperm before chemotherapy?

4. Is this young man’s age typical for the development of testicular carcinoma?

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teaching strategies

Topic 1

Seasoned nurse educators possess wisdom about teaching (a kind of “with-it-ness”), which they have developed through practical experience over the years. As a person new to nursing education, you have a great deal to learn from a seasoned mentor. In order to gain access to that knowledge, you will conduct an interview with an experienced nurse educator either in a hospital or college setting. Your interview may be conducted face-to-face, online, or by telephone.

For this assignment, you are to:

  • Generate a list of questions you will ask during the interview such as teaching strategies, theories, technology, and evaluation techniques.
  • Conduct the interview.
  • Your discussion post should include:
    • The setting.
    • How the interview was conducted.
    • The questions asked and the responses given.
    • Anything else you think to be important.

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Structure and Function of the Male Genitourinary System

Case Study: Topic

Case Study Posting Requirements

  1. Make sure all of the topics in the case study have been addressed.
  2. Cite at least three sources—journal articles, textbooks or evidenced-based websites to support the content.
  3. All sources must be within five years.
  4. Do not use .com, Wikipedia, or up-to-date, etc., for your sources.

Case Study 1

Structure and Function of the Male Genitourinary System

Mario is a 68-year-old male whose wife died of cancer five years ago. Since her death, he began to eat more fast food and stay at home and watch television. Recently, however, Mario’s friend introduced him to a woman whom he became to like very much. After seeing her a few times, Mario became concerned about his health and went to see his doctor. He noticed a change in his sexual performance when he turned 60 and, after seeing so much on television about erectile dysfunction, was concerned he would experience this with his girlfriend.

  1. What factors are present in Mario’s history that predispose him to erectile dysfunction?
  2. What condition would you suspect if Mario had a blood test indicating elevated LH and decreased testosterone levels? What effect do low testosterone levels have on the reproductive organs of the male?
  3. How do the parasympathetic and sympathetic nervous systems generate erection, emission, and ejaculation?

Case Study 2

Disorders of the Male Genitourinary System

Darius is 63 years old and began to wake up at night to urinate. When he went to the bathroom, he had to strain to initiate the flow, and the stream of urine was weak. Over time, the pattern became more apparent during the day; he often had a sense of urgency and felt he was going to the bathroom frequently. When he did, however, he did not always feel he had emptied his bladder, and he tended to dribble throughout the day. Much to his reluctance, his wife urged him to see a physician. At the doctor’s office, his case history was carefully taken, a digital rectal exam was performed, and lab work was ordered. His blood results were unremarkable, but his urinalysis showed an elevated white blood cell count and bacteria. His physician diagnosed Darius with benign prostatic hyperplasia and urinary tract infection.

  1. How does BPH contribute to the signs and symptoms of bladder dysfunction, and how was Darius prone to developing a urinary tract infection?
  2. What are the static and dynamic components of BPH? Why are α1-adrenergic receptor blockers sometimes used to treat prostatic hyperplasia?
  3. How does the prostate feel during a digital rectal exam with benign prostatic hyperplasia, acute bacterial prostatitis, and prostate cancer?
  4. Why does the patient with prostate cancer present with symptoms later in the disease?

Case Study 3

Structure and Function of the Female Reproductive System

Janice is 49 years old, is married, and has two teenage children. Over the last year, her periods tended to be irregular and heavier than usual. She also noticed intercourse was becoming more painful for her, and her interest in sex declined. She knew her mother was 51 when she reached menopause, and Janice was concerned about having the mood swings and hot flashes her mother had experienced. She phoned some of her friends to seek their advice. Some said she should try hormone therapy, while others said it was not a good idea at all. Other friends said she should use remedies like red clover tea and soy isoflavone supplements. Janice decided her best bet was to go to the local women’s health care clinic to discuss her options with a nurse.

  1. Using the data collected by the Women’s Health Initiative and the Nurses’ Health Study, why are some women at an increased risk for CHD and others are at a decreased risk when hormone therapy is prescribed?
  2. Why are alternative methods like red clover and some plant oils being promoted for the menopausal woman? What are the changes that occur in a woman’s reproductive organs when estrogen levels decline?
  3. How does estrogen affect bone growth during puberty? Why are postmenopausal women at risk for osteoporosis?

Case Study 4

Disorders of the Female Reproductive System

Tracie is 39 years old and is in a casual relationship with a man. She had her first sexual relationship when she was 13 and prefers to have short-term sexual relationships with men instead of a monogamous, committed partnership. It had been several years since Tracie had a complete physical, so before going on a vacation, she decided to have one done. Tracie’s Pap smear indicated CIN 3 (HSIL) dysplasia. Her physician immediately ordered a colposcopy and LEEP excision, and then asked to see Tracie for a follow-up appointment 6 months later.

  1. Why is cervical cancer considered a sexually transmitted disease?
  2. Explain what the Pap smear entails and why it is an effective tool in the detection of cervical cancer. What does Tracie’s result mean?
  3. What is the transformation zone, and why is it vulnerable to the development of cervical cancer?
  4. What is the LEEP procedure, and why is it useful for the diagnosis and treatment of cervical dysplasia?

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home.

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“College of Nursing and Health Care

Health care organizations continually face challenges from various regulatory and government agencies, and are also bound by Managed Care Organization (MCO) standards. View the video “College of Nursing and Health Care Professions: Do we know what our future is?” for insight into the challenges of health care reform. http://lc.gcumedia.com/zwebassets/courseMaterialPages/nur508_healthcare-reform-video-series-v1.1.php. Based on the video, describe, with rationale, two key factors that you feel will need to be addressed by future health care workers and health care leaders. (Note: you can download slides from this video within the media piece itself for ease of review in developing your forum response).

Additionally, what role does adherence to MCO standards play in your future health care vision?

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diagnosis

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

· Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).

· Review the Work Environment Assessment Template.

· Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.

· Select and review one or more of the following articles found in the Resources:

o Clark, Olender, Cardoni, and Kenski (2011)

o Clark (2018)

o Clark (2015)

o Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

· Review the Work Environment Assessment Template you completed for this Module’s Discussion.

· Describe the results of the Work Environment Assessment you completed on your workplace.

· Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.

· Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

· Briefly describe the theory or concept presented in the article(s) you selected.

· Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.

· Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

· Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.

· Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.

Required Readings

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.

· Chapter 5, “Collaborative Leadership Contexts: Networks, Communication, Decision Making, and Motivation” (pp. 121–144)

· Chapter 9, “Creating and Shaping the Organizational Environment and Culture to Support Practice Excellence” (pp. 247–278)

· Chapter 10, “Building Cohesive and Effective Teams” (pp. 279–298)

Select at least ONE of the following:

Clark, C. M., Olender, L., Cardoni, C., & Kenski, D. (2011). Fostering civility in nursing education and practice: Nurse leader perspectives. Journal of Nursing Administration, 41(7/8), 324–330. doi:10.1097/NNA.0b013e31822509c4

Note: You will access this article from the Walden Library databases.

Clark, C. M. (2018). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator. doi:10.1097/NNE.0000000000000563

Note: You will access this article from the Walden Library databases.

Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf 

Griffin, M., & Clark, C. M. (2014). Revisiting cognitive rehearsal as an intervention against incivility and lateral violence in nursing: 10 years later. Journal of Continuing Education in Nursing, 45(12), 535–542. doi:10.3928/00220124-20141122-02

Note: You will access this article from the Walden Library databases.

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