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objective information

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The Assignment

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by the subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not? Identify five possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

In this Assessment 1 Assignment:

You will analyze an Episodic Note case study that describes abnormal findings in patients seen in a clinical setting.

You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted.

You will also formulate a differential diagnosis with several possible conditions.

Review the following Episodic note case study for this Assignment: See Below

Assessment of the Abdomen and

Gastrointestinal System

ABDOMINAL ASSESSMENT:

Subjective:

• CC: “My stomach hurts, I have diarrhea and nothing seems to help.”

• HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started

3 days ago. He has not taken any medications because he did not know what to

take. He states the pain is a 5/10 today but has been as much as 9/10 when it

first started. He has been able to eat, with some nausea afterwards.

• PMH: HTN, Diabetes, hx of GI bleed 4 years ago

• Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10

units qhs

• Allergies: NKDA

• FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN,

Hyperlipidemia, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Skin: Intact without lesions, no urticaria

• Abd: soft, hyperactive bowel sounds, pos pain in the LLQ

• Diagnostics: None

Assessment:

• Left lower quadrant pain

• Gastroenteritis

PLAN: 

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diabetic on chronic hemodialysis

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1……..A patient is admitted to the unit. He is a diabetic on chronic hemodialysis. He has an Arteriovenous (A-V) graft, which is annulated each time he undergoes dialysis treatments. You notice an area on his graft arm that is red and warm to the touch. He states that he has had this on his arm for several weeks. He asked the dialysis staff about the area, but they told him to apply warm compresses to the site. The staff at the dialysis center continues to use the graft, but they are careful to avoid the area when they cannulate for his treatments. Now the patient presents with extreme low back pain, fever, nausea, and swelling of his lower extremities. On checking his fasting serum glucose, you notice that the reading is 159 (Normal fasting blood glucose range 64 to 110 mg/dl), and his white blood cell count is 36,000 (normal range is 4,500-10,000 white blood cells/mcl). He states that his sugars were normally well controlled, but in the past ten days he seems to be requiring more insulin.

  • How would you proceed with this patient?
  • What could be the underlying problem?

2……..This patient presents with an AV graft that is red and warm to touch.  He probably has cellulitis.  Cellulitis is a bacterial infection that can be staphylococcal or streptococcal in nature (Eden, 2014).  It is often marked by a reddened skin area that is warm-hot to touch.  For this patient, his WBC is already elevated at 36,000,  and he now presents with nausea and vomiting, fever, back pain, and lower extremity swelling. What started out as a local infection has now probably spread and become more systemic.  I would get a set of vital signs first. It is known that he is febrile; an accurate temperature would be important to know how high it is. It may require an antipyretic, like Tylenol or Ibuprofen. An elevated heart rate would be a normal finding for one with a fever. A low blood pressure would be an indicator of how aggressive the medical staff should respond. This patient could be on the verge of becoming septic; this would need to be ruled out. Additional labs would need to be drawn: Lactic acid ( used as an indicator for sepsis), blood cultures x 2 sets, chemistry panel, with magnesium and phosphorus. This is a renal patient; a baseline evaluation of his renal function and electrolytes would need to be established. A CBC has already been done.  This patient would definitely need antibiotics; once the blood cultures are drawn he could be started on a broad spectrum antibiotic.  Along with the vital signs, I would get a weight on the patient.  This is a renal patient who is presenting with edema to his legs. This could be due to his poor renal function, or it could be due to some other underlying cause. I probably would start the patient on a “gentle” rehydration bolus of IV fluids. Again, this is a renal patient. If this patient has not been feeling well, his oral intake may have been poor and he could have become dehydrated. This patient also complains of pain. A pain assessment would be performed. This patient would also be given analgesic for his pain as well as an anti-emetic for his nausea. Another consideration would be to place a vascular catheter to use until the AV graft could be further assessed for infection. A nephrologist or vascular surgeon would need to be consulted for that. Lastly, this patient’s blood sugars would need to be monitored and treated. It is normal response for a diabetic’s blood sugar to rise during an illness; consequently, his insulin requirements may increase as well.

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Ethical issues in nursing practice

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Choose one of the articles below, and address the essay prompt associated with it. You will need to log in to the WCU library to access the full article.

Park, M. (2009). Ethical issues in nursing practice. Journal of Nursing Law, 13(3), 68-77. doi:10.1891/1073-7472.13.3.68

Link:  Ethical issues in nursing practice 

Essay Prompt: Identify primary areas for legal and ethical issues faced by oncology nurses in this study (Park, 2009), and strategies they may have developed to work with those ethical issues.

Or,
Croke, E. (2006). Nursing malpractice: determining liability elements for negligent acts. Journal of Legal Nurse Consulting, 17(3), 3.

Link: Nursing malpractice: determining liability elements for negligent acts

Essay Prompt: Identify primary problems that led to the malpractice suits (Croke, 2006), and identify the role the nurse played and what the nurse did wrong.

 

Rubrics:

The writer clearly and effectively responds to the assignment.

There is one clear, well-focused topic. Main ideas are clear and are well supported by detailed and accurate information.

The introduction is inviting, states the main topic, and provides an overview of the paper. Information is relevant and presented in a logical order. The conclusion is strong.

 

The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.

 

 

 

2 Pages each assignemnt. I need three assignments

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The Role of the Nurse in Promoting and Preserving Health

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Week 6: The Role of the Nurse in Promoting and Preserving Health

It is common knowledge that a healthy lifestyle will lead to a longer life. Healthy individuals have strong immunity and are at limited risk for contracting some of the prominent diseases facing individuals in the United States, such as obesity, diabetes, cardiovascular disease, hypertension, orthopedic disorders, and cancer. The problems faced by Americans are not the same as those faced by individuals in other parts of the world. In fact, many people in the world struggle with problems on the opposite end of the spectrum, such as malnutrition, and iron, iodine, and folic acid deficiencies, which have a negative impact on reproductive, infant, and child health. The risk factors that increase in individuals who are not living healthy lives can challenge a nurse’s ability to build a healthier community and a healthier world.

In this, your final week of the course, you will identify health promotion strategies for addressing obesity and the chronic health issues that may result from obesity. You will explore how these issues affect health costs.

Learning Objectives

Students will:
  • Create health promotion and prevention strategies for addressing obesity
  • Analyze strategies nurses might implement to modify messages for obesity prevention that integrate cultural sensitivity
  • Analyze challenges nurses might face when modifying messages for obesity prevention and health promotion

Photo Credit: [Alex Treadway]/[National Geographic]/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Holtz, C. (2013). Global health care: Issues and policies (2nd ed.). Burlington, MA: Jones & Bartlett.

  • Chapter 10, “Global Perspectives on Selected Chronic Cardiovascular Diseases” (pp. 239–262)
  • Chapter 11, “Global Perspectives on Diabetes and Respiratory and Orthopedic Chronic Diseases” (pp. 263–282)
  • Review Chapter 14, “Global Perspectives on Nutrition” (pp. 364–366)

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.).St. Louis, MO: Elsevier.

  • Chapter 20, “Promoting Health Through Healthy Communities and Cities” (pp. 441–454)

Public Health Nursing: Population-Centered Health Care in the Community, 9th Ed. by Stanhope, M., & Lancaster, J. Copyright 2015 by Elsevier Health Science Books. Reprinted by permission of Elsevier Health Science Books via the Copyright Clearance Center.

Laws, R., Campbell, K. J., van der Pligt, P., Ball, K., Lynch, J., Russell, G., … Denny-Wilson, E. (2015). Obesity prevention in early life: An opportunity to better support the role of maternal and child health nurses in Australia. BioMedCentral Nursing, 14(26), 1–14.

Retrieved from the Walden Library databases.

Required Media

Laureate Education. (Producer). (2010e). Public and global health: The role of the nurse in promoting and preserving health [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 7 minutes.

 

TED. (2013). How an obese town lost a million pounds. Retrieved from https://www.ted.com/talks/mick_cornett_how_an_obese_town_lost_a_million_pounds

 

Note: The approximate length of this media piece is 15 minutes.

 

Mayor Mick Cornett talks about how the people of Oklahoma City lost 1 million pounds after being labeled one of the fattest towns in America in a men’s health magazine.

Writing Resources and Program Success Tools

Document: AWE Checklist (4000) (Word document)

 

This checklist will help you self-assess your writing to see if it meets academic writing standards for this course.

Discussion: Obesity: A Global Health Concern

Obesity is a continuing challenge for citizens and health care providers in the United States, as you likely know. Obesity can lead to numerous chronic health problems, including heart disease and type 2 diabetes. Childhood diabetes is also increasing at a disconcerting rate, which will lead to an increased health care burden within a few short years. Current estimates set the cost of obesity on the U.S. health care system at $147–$210 billion per year (The State of Obesity, 2016). Think about this week’s media as you take a moment to consider obesity as a burgeoning global challenge.

To prepare for this Discussion:

  • Compare rates of obesity in the United States to other developed and also developing countries. Think about how health issues resulting from obesity compare as well.
  • Reflect on health promotion and prevention strategies that nurses can implement.
  • Contemplate the ethical, cultural, economic, political, and environmental issues a nurse should consider when developing a primary obesity health prevention strategy.
By Day 3

Post an obesity health promotion and prevention strategy a nurse could implement for a specific cultural group in the United States. Then, modify your message for use in one other country, being sensitive to the cultural nuances of the country you select. Describe why you chose to take the approach you did in your strategies and explain any challenges you anticipate a nurse may encounter when trying to implement these strategies.

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 250–350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

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CLINICAL CASE DECISION

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CLINICAL CASE DECISION INSTRUCTIONS

Grading Criteria for Clinical Case Decisions:

The highest potential points for each Clinical Case Decision Question are 15-points.  Students are required to upload their response as a word document attachment to the assignment drop box.

Each uploaded response is worth a possible 15 points.

  1. Your comments should be substantiated and substantive. Postings require two citations from 1 scholarly journal and/or 1 outside textbook. Textbooks assigned to this course may be used for an additional citation only.
  2. Each of the two references must be from a different reference source.
  3. To gain full credit for the assignment, the response must be a full page, but no more than three (3) pages in length, which includes the reference list.
  4. Students are required to use APA format, proper citations, and references.  Students using direct quotes from referenced sources in the body of the paper must include quotations.
  5. Students will be assigned to a question.

Clinical Decision Cases

Begin with a Head-Toe assessment, you decide if it should be treated as episodic with rationale.

You have been assigned two (2) cases to provide analysis. All cases should include the following

a. Pathophysiology and pharmacology of the disease

b. Expected signs and symptoms of the disease.

c. Nursing Diagnosis with a plan of care.

C3. Mrs. Muller is a 78-year-old homemaker who arrives in the emergency department with a history of chest discomfort and indigestion two days ago that lasted about 12 hours. She was severely fatigued after this and within the past 2 hours has become increasingly short of breath. Her initial ECG shows that she recently experienced an anterior AMI. Her skin is cold, and she is very diaphoretic and cyanotic. She is diagnosed with acute heart failure and cardiogenic shock.

a. What will be the intent of her management, and what will be included in her management plan?

C4. John lacerates his radial artery while cutting a bagel. He loses approximately one-fourth of his blood volume before arriving at the hospital.

a. What physiological responses do you expect in response to this blood loss?

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city urban hospitals

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Groups 1 and 3 will present Case 1 on 09/20/2018. All groups will be required to turn in a position brief. For the position brief, please answer the nine questions listed below. Please include the questions with the brief. When answering the questions, please ensure to use all information given to the class as a reference. For the questions requiring external research, please ensure to cite the information.  The group presentation should be between 20-25 minutes. The presenting group will be required to provide at least four PowerPoint slides. One set of slides are to be given to the professor and the other three are to be distributed among the other groups. When presenting, business casual attire will be required. Non-business casual attire will result in a reduction of points. Please have the group leader submit an electronic copy of the brief [as a word document (.doc/.docx)] and (when applicable) the PowerPoint slides under the Tests and Quizzes section on blackboard by 11:59 PM Monday (09/24/2018).

1: Please provide a detailed summary of the case. Please ensure to include and discuss all relevant material .

2: Please discuss at least four challenges facing inner city urban hospitals today (external research from respectable sources is required to answer this question) .

3: Please discuss the policy associated with the formation of 501C3 hospitals and the rationale associated with their existence. In addition, please discuss the community benefit obligations under the PPACA and how it may relate to Summit Regional Hospital (external research from respectable sources are required to answer this question) .

4: Please discuss the concept of population health management and what is needed to succeed in this environment (external research from respectable sources are required to answer this question) .

5: Please perform a SWOT (strengths, weaknesses, opportunities and threats) analysis on Summit Regional. Identify and explain at least four points for each category (please ensure to use information provided in the case to support your answer) .

6:  Please illustrate and discuss all of the steps in the Evidence Based Management (EBM) model to analyze three overall problems and arrive at three specific evidence based solutions.  Please analyze the solutions separately and use a table/chart to organize/explain the points in the mode and also ensure to use information provided in the case to support your answer .

7: Please rank and explain the three evidence based solutions from most likely to implement to least likely to implement .

8: Please specifically identify how your group will implement the chosen solution and then identify how you will evaluate the effectiveness (impact) of the solution .

9: Please identify at least three examples of courses (taken during the HCA program), which were most applicable in helping to apply the material in the case. Please ensure to explain why these courses were chosen .

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clinical guiding question

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The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

Use the “Literature Evaluation Table” to complete this assignment.

  1. Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
  2. Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
  3. The PICOT question will provide a framework for your capstone project.
  4. Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles.  Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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psychosocial factors

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Write a short (50-100-word) paragraph response for each question. This assignment is to be submitted as a Microsoft Word document.

  1. Give examples of psychosocial factors that affect the health care professional and the effect those factors could have on patient education.
  2. Give examples of psychosocial factors that affect the patient and the effect those factors could have on patient education.
  3. Explain what is meant by personality styles and give examples of approaches that could be used to help the patient. Include self-perception as a factor.
  4. List the steps in adjustment to illness and how the patient copes with each step.
  5. Explain the health professional’s role in teaching the patient at different life stages.
  6. Define the role of the family in patient education.
  7. How might the family influence the compliance of the patient and what measures can the health care professional use in communication with the family?

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professional nursing practice.

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Purpose

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

  • CO 1: Examine the sources of evidence that contribute to professional nursing practice. (PO 7)
  • CO 2:Apply research principles to the interpretation of the content of published research studies.  (PO 4 & 8)
  • CO 5: Recognize the role of research findings in evidence-based practice. (PO 7 & 8)

Discussion

Professional nurses rely on research findings to inform practice decisions; they use critical thinking to apply research directly to specific patient care situations.

Think about an independent nursing practice problem you care passionately about and would be interested in searching for evidence. The below problems should not be used:

*medical/doctor/physician problems such as medications, or medications administration or effects, diagnostics such as EKGs, labs, cardiac catherizations.

*staffing, nurse-to-patient ratios, workforce issues are organizational/system /political/administrative/multi-stakeholder problems which nursing cannot solve independently.

  • Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
  • Write your clinical question in the PICO(T) format for your nursing practice problem. *To write your clinical question in the PICO(T) format, use the NR439_Guide for writing PICOT Questions and Examples found in your required reading or access the following link:

NR439_Guide for writing PICOT Questions and Examples (Links to an external site.)

  • List each of your PICOT elements.

Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.

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interprofessional audience

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Review the feedback on the change proposal professional presentation and make required adjustments to the presentation. Present your evidence-based intervention and change proposal to an interprofessional audience of leaders and stakeholders. Be prepared to answer questions and accept feedback.After presenting your capstone project change proposal, write a 250-350 word summary of the presentation. Include a description of the changes that were suggested by your preceptor before your presentation and how you incorporated that feedback. Describe how this interprofessional collaboration improved the effectiveness of your presentation. Include a description of the feedback and questions from your audience after your presentation, and how this experience will affect your professional practice in the future.While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.You are not required to submit this assignment to LopesWrite.

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