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medication for dyslipidemia

 Case Study #5 NURS 6541: Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia.

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

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Evidence for Nursing 

Evidence for Nursing 

Assessment Item 3: Using evidence to inform clinical decision-making

Weight: 50% of total mark

Word limit: 1500

Intent

In this assessment, you demonstrate that you can provide an evidence-based conclusion to an uncertain clinical situation. It requires you to search for relevant research, understand levels of evidence, consider the quality of evidence, present the summary of each article, interpret their findings, and reach a conclusion based on your reviewed evidence.

Task: You have been provided with three clinical scenarios. Each scenario indicates an area of clinical uncertainty. Select a scenario that interests you and using your evidenced based practice skills answer the question that follows.

Scenario 1:

In the course of your clinical placement in a surgical ward, you noted inconsistency in wound care. While some nurses use a sterile technique, others employ a clean dressing change technique.

Is clean wound dressing a safe option for dressing of surgical wounds?

Scenario 2:

You are working on a hospital ward where you encounter stroke patients. You notice that some doctors order compression stockings for prevention of deep venous thrombosis while others not.

Should antithrombotic stockings be routinely used for patients with stroke or not?

Scenario 3:

You are working as an RN in an emergency department. A 10-year-old child has been admitted to the department with a diagnosis of exacerbation of asthma secondary to bronchitis. The patient has been prescribed salbutamol.

What is the more effective method of delivery- a nebuliser or a spacer?

Format

Written paper with well-structured paragraphs. Headings can be used if they help structure your work.

Introduction (500 words)

Briefly describe the process you used to answer the question. i.e. how you formulated a searchable question and developed a search strategy. Justify the approach you took in accessing the evidence. Describe the rationale behind the selection of each paper (hint: level of the evidence, quality of the evidence, relevance). Both quantitative and/or qualitative articles can be used, as appropriate to the clinical scenario and question you have developed. It is not necessary to present all the evidence you found (and you have limited word count to do this). The key thing is quality not quantity – so four or five research-based articles are better than a large number of low-level papers. Provide the print screens of the abstracts of the papers you have chosen.

Main body of the paper (800 words)

Briefly present each paper and their main findings. What does the research show?

Conclusion (200 words)

This is where you clearly state what you think the answer to your question is and why.

The marking rubric 

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Rheumatoid arthritis (RA)

reply candace

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s own immune system attacks the joints on both sides of the body including the hands, wrist and knees. Early stages of RA include:

  • Joint pain, tenderness, swelling or stiffness for 6 weeks or longer
  • Morning stiffness for 30 minutes or longer
  • More than one joint is affected
  • Small joints ( wrists, certain joints of the hands and feet) are affected
  • The same joints on both side of the body are affected

The history would include complaints of the above systems along with deformities of the affected areas depending on the severity. Rheumatoid nodules are commonly observed over the olecranon process or other extensor surfaces of the limbs and may be tender (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The patient may present with a low grade fever. A thorough history of other systems is elicited because of the involvement of other extra-articular organ systems. Physical exam would include inspection and palpation of the joints on both sides of the body. Passive and active range of motion may be limited due to the swelling and tenderness to the affected area. The initial diagnostic test is the presence of Rheumatoid factor (RF) in the blood. This test alone is not diagnostic and specific test such as circulating anti-CCP autoantibodies. Other test include a ESR, CRP, CBC, platelet count and joint fluid analysis. Studies for a more progressive diagnosis include ANA and comprehensive autoantibody panel. Management of RA progresses from conservative interventions to aggressive symptom management. Initial management would include heat/cold applications, exercise, rest, OT/PT, assistive devices, splints, and weight loss. Subsequent management for a more progressive version of the disease include drug therapies such as NSAIDs, analgesics, corticosteroids and DMARDs.Patient education focuses on medication therapy and control of pain and inflammation. Both primary and secondary medication nonadherence may be affected by low levels of health literacy and patient education (Joplin, Zwan, Joshua, & Wong, 2015). Emotional, spiritual and social education is advised due to disability and pain.

References

Joplin, S., Zwan, R., Joshua, F., & Wong, P. (2015). Medication adherence in patients with rheumatoid

arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BioMed

Research International, 2015, 10.

Dunphy, L., Brown, J., Porter, B., & Thomas, D. (2015). Primary Care: The Art and Science of

Advanced Practice Nursing. Philadelphia: F.A. Davis Company.

reply vivian

Rheumatoid arthritis is a condition that is chronic and consists of inflammation to different joints. RA in the hands is very common. This condition is related to an autoimmune response where the patient’s immune system ends up attacking its own body tissues. This condition can be very painful and requires certain testing for diagnoses and treatment (Mayo Clinic, 2018).

I would get a health history on this patient to determine if she has RA and what she has done for treatment of it. If this patient has a “flare up” then this patient most likely is educated and familiar with her condition. Risk factors for this condition include being female, age 40-60, having a family history of RA, smoking or other environment exposures like asbestos, and being obese (Mayo Clinic, 2018).

Some testing for this patient would include a blood test looking for elevated erythrocyte sedimentation rate or C-reactive protein. Imaging could be helpful to see how this condition is progressing for the patient. Medication to help include NSAIDs, steroids, antirheumatic drugs, and biological agents. The goal is to decrease inflammation and slow the progression of the disease. Physical therapy is also an option to help the patient maintain joint flexibility (Mayo Clinic, 2018).

For patient education, it could be helpful to make sure the patient has signs to be aware of a flare up starting. It can be easier to prevent flare ups than treat them. Some signs of a flare up include an increased stiffness to the joints, entire body pain, swelling that may cause shoes not to fit, a change in fatigue that is intense, and even flu-like symptoms. Some foods or medications could be the cause of a flare up and this is something for the patient to be aware of (Healthline, 2019).

Reference

Healthline. (2019). Signs of rheumatoid arthritis exacerbations and how to prevent them. Retrieved from https://www.healthline.com/health/rheumatoid-arthritis-exacerbations

Mayo Clinic. (2018). Rheumatoid arthritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648 (Links to an external site.)Links to an external site.

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The Lewis and Clark Expedition

pick two (2) of the following historical events:

  • The Lewis and Clark Expedition
  • The Missouri Compromise
  • Independence of Texas
  • Mexican War of 1846-1848
  • The California Gold Rush

Then, address the following for your selections:

  • Which of your two selections do you consider most impactful on Westward Expansion during 1800-1848? Explain why.
  • Analyze the effects of the ideology of Manifest Destiny on the two historical events that you chose from the list.

2 reference with I text citation

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Changes in culture and technology

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/.
    • 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.

1- 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. 

2- Be specific and provide examples. 

3- Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan.

4- 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. 

Supported by at least three current, credible sources.

Learning Resources

 

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
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
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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Nursing Process: Approach to Care 

Benchmark – Nursing Process: Approach to Care

The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.

Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:

  1. Describe the diagnosis and staging of cancer.
  2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
  3. Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
  4. Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?
  5. Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.
  6. Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.

You are required to cite to a minimum of four sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

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.

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

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN-BSN

2.1: Incorporate liberal arts and science studies into nursing knowledge.

3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.

Benchmark – Nursing Process: Approach to Care

No of Criteria: 11 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content80.0     Diagnosis and Staging of Cancer15.0A description of the diagnosis and staging of cancer is omitted.A partial description summarizes the diagnosis and staging of cancer. There are significant omissions.A general description summarizes the diagnosis and staging of cancer. There are inaccuracies. Some information is needed.A description of the diagnosis and staging of cancer is presented. There are very minor inaccuracies. Some detail is needed for clarity.A detailed description of the diagnosis and staging of cancer presented. The description is informative and well-developed.Complications of Cancer, Side Effects of Treatment, and Methods to Lessen Physical and Psychological Effects15.0Three complications of cancer, side effects of treatment, and methods to lessen the physical and psychological effects are omitted.Fewer than two complications of cancer are described. The side effects of treatment and methods to lessen the physical and psychological effects are partially presented. There are major inaccuracies.At least three complications of cancer are generally described. The side effects of treatment and methods to lessen the physical and psychological effects are summarized. There are some inaccuracies.Three or more complications of cancer are described. The side effects of treatment and methods to lessen the physical and psychological effects are generally described. Some detail is needed for clarity or accuracy.Three or more complications of cancer are detailed. The side effects of treatment and methods to lessen the physical and psychological effects are thoroughly described.Factors Contributing to Incident and Mortality Rates of Various Cancers in Americans15.0Factors contributing to the yearly incidence and mortality rates of various cancers in Americans are omitted.The factors contributing to the yearly incidence and mortality rates of various cancers in Americans are partially outlined. Key factors are missing. There are major inaccuracies.Some key factors contributing to the yearly incidence and mortality rates of various cancers in Americans are generally discussed. There are some inaccuracies. The discussion lacks rationale or evidence to support the key factors presented.The major factors contributing to the yearly incidence and mortality rates of various cancers in Americans are discussed. The discussion provides general rationale or evidence to support the factors presented.The discussion is accurate, detailed, and presents all significant factors contributing to the yearly incidence and mortality rates of various cancers in Americans. Strong rationale and evidence support the discussion.American Cancer Society (ACS)15.0Explanation for how the ACS might provide education and support is omitted.A partial explanation for how the ACS might provide education and support is presented. Overall, the role and function of the ACS are unclear. There are inaccuracies.A summary for how the ACS might provide education and support is presented. Some additional information is required to fully represent the role and function of the ACS. There are some inaccuracies. General ACS services to be recommended are referenced.An explanation for how the ACS might provide education and support is presented. The role and function of the ACS are apparent. Some ACS services to be recommended are referenced. Detail is needed for clarity.A detailed explanation for how the ACS might provide education and support is presented. The role and function of the ACS are clear and informative. ACS services to be recommended are discussed and rationale is provided for the recommendation.Utilization of Nursing Process Across the Life Span (C3.1)15.0Explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is omitted; or, the explanation fails to accurately represent the nursing process.A partial explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. Major aspects of the nursing process are omitted from the explanation. It is unclear the process provides safe and effective care for patients across the life span.A general explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. A summary outlines how the process provides safe and effective care for patients across the life span. There are some inaccuracies. Rationale or evidence is needed for support.An explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. The explanation generally describes how the process provides safe and effective care for patients across the life span. Some rationale or evidence is needed for support.A well-developed explanation of how the nursing process is utilized to provide safe and effective care for cancer patients across the life span is presented. The explanation clearly describes how the process provides safe and effective care for patients across the life span. Strong rationale or evidence is provided for support. Insight into the nursing process and its utilization to provide safe and effective care for patients across the life span is demonstrated.Contribution of Liberal Arts and Science Studies to Nursing Knowledge (C2.1)5.0Discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is omitted.An incomplete summary on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. There are significant omissions. It is unclear how undergraduate education contributed.A general discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. A general correlation for how undergraduate education contributed to nursing knowledge is established.A discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. A correlation for how undergraduate education contributed to nursing knowledge and prepares nurses to work with patients utilizing the nursing process is established. Some information or detail is needed for clarity or support.A thorough discussion on how undergraduate education in the liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process is presented. A strong correlation for how undergraduate education contributed to nursing knowledge and prepares nurses to work with patients utilizing the nursing process is clearly established. Insight into the contribution of liberal arts and science studies to nursing practice is demonstrated.Organization, Effectiveness, and Format20.0     Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)2.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100

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 HC affiliated stakeholders

Your Supervising Manager called a meeting early Monday morning to discuss the tasks you will need to accomplish in this week. He/she was very complimentary about the efficiency of your performance and quality of the submitted Memos. However, further investigation is necessary to make sure all areas of the response were covered accordingly.

You are asked to conduct research and to compile the information about the HC affiliated stakeholders in this situation in a table (attached).  Make sure to choose the stakeholders that will be involved in your area of expertise (as per your job description).

For example in an ebola outbreak situation, the Clinical coordinator may choose the CDC (Center for the Disease Control) as a stakeholder due to the mandatory reporting and follow up on the guidelines.  CDC affiliated stakeholder would be a local health department that reacts to the situation based on CDC provided preparatory guidance. At the same time, the local health department would be a direct stakeholder for the Clinical Coordinator because its representatives will be directly involved in guiding potential public health issues at the site.

All information should be presented in a table format. You can use bullet points, subcategories, and other white space organizational components. Each stakeholder should have their own PAGE in the workbook to give you enough space to put information for each stakeholder (4 – HEALTHCARE STAKEHOLDERS). In this instance the stakeholder is not the patient, doctor, hospital or the oil company – you are specifically looking for regulatory or other external stakeholders in the health care industry. 

The template is attached. Make sure to provide

– minimum 2 credible sources from the UMUC library per stakeholder (their website does not count)

– the stakeholder home website

– the information pertaining to 4 discussed stakeholders (2 chosen direct and 1 affiliated to each direct stakeholder) – as above the direct is the state department and the affiliated / national is CDC

– APA format is required for the citation and references which can be placed at the bottom of the workbook

Post the table in the Group Forum and in the assignment folder for grading.

The briefing statement from week 2 and the stakeholder analysis from week 4 are the base for your week 5 group assignment- the linkage map.

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communication tool

Topic 3 DQ 1

You have an idea to improve patient care that you would like upper management to support and fund. What type of communication tool would you use to present your idea and why?

 

Topic 3 DQ 2

What differentiates someone that is intrinsically motivated from someone that is extrinsically motivated? Give an example of how you would go about motivating an individual who is intrinsically motivated and one who is extrinsically motivated. What are the characteristics of a performance-driven team?

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 Environmental Health.

Environmental Health.

This week’s graded topics relate to the following Course Outcome (CO).

  • CO6: Utilize a systems-based and collaborative approach to address factors that influence the health of a community and population health problems. (PO2)

Textbook:

Nies, M. A., & McEwen, M. (2019). Community/Public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Saunders/Elsevier.

  • Chapter 14: Environmental Health, pp. 252-265, 266-271

Visit the U.S. Environmental Protection Agency’s MyEnvironment site at http://www.epa.gov/myenvironment (Links to an external site.)Links to an external site., and enter Staten Island, NY 10305 .

Choose one of the topic areas.

  • My Health
  • My Climate
  • My Air
  • My Water

Then, click on the boxes under the Map Contents menu to add data into the map on specific topics. Explore the site to learn more about your environment and things that might be impacting the health of its citizens.

  • Identify something new you learned about your environment and how it could be affecting health by completing this statement, “I didn’t know _____.”
  • How could you, in the role of a community health nurse, address these concerns?

Optional: For more environmental health information, you can also visit the following resources.

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THE DIAGNOSIS OF PEDIATRIC BIPOLAR

Write: “AGAINST” THE DIAGNOSIS OF PEDIATRIC BIPOLAR: see file.

 

Some debate in the literature exists specific to whether or not bipolar disorder can be diagnosed in childhood. While some have anecdotally argued that it is not possible for children to develop bipolar disorder (as normal features of childhood confound the diagnosis), other sources argue that pediatric bipolar disorder is a fact.

In this Discussion, you engage in a debate as to whether pediatric bipolar disorder is possible to diagnose.

Learning Objectives

Students will:

· Evaluate diagnosis of pediatric bipolar depression disorder

· Analyze consequences to diagnosing/failing to diagnose pediatric bipolar depression disorder

To Prepare for the Discussion:

· The instructor will assign you a position for or against the issue of diagnosing pediatric bipolar depression disorder.

· Review the Learning Resources concerning the controversy over the diagnosis of pediatric bipolar depression disorder.

Write: “AGAINST” THE DIAGNOSIS OF PEDIATRIC BIPOLAR:

· Write “for” or “against” in the subject line of your Discussion post.

· Based on the position you were assigned, justify whether or not pediatric bipolar depression disorder should be diagnosed.

Support your position with evidence and examples.

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