Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies. 
In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

• Is there any additional subjective or objective information you need for this client? Explain.

In addition to what we have been told there are several things that may be identified. On first glance it would be important to assess the patients skin color, assess if they were sweating or were cold. It would be necessary to ask about allergies and see if he has been exposed to any possible allergens or irritants. It would need to be determined if this was the first time this has happened or has been a common occurrence. Assessing any recent traumatic injuries, headaches, or nose bleeds may help the clinician determine the root cause of the problem. Family history, patients past medical history, social history, and any current medications is a definite must. His vitals are stable besides the climb in temperature, so you could ask how he was sleeping and if he was getting enough fluid intake.

• Would you treat Mr. JDs cold? Why or why not?

I would definitely treat JD’s symptoms. He has been down and out for two weeks and his condition is not getting any better. His temperature is increasing, and he is symptomatic with tender mucous membranes, post nasal drip, and erythema. These are signs of an infection that should be treated. Not only is he at risk for getting worse but he could potentially expose others to his current illness.  Clinical diagnosis of acute bacterial sinusitis requires prolonged, nonspecific upper respiratory signs such as rhinosinusitis and cough without improvement for more than 10 days, and symptoms such as fever, facial swelling, or facial pain (Woo & Robinson, 2016).

What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

Many times, antibiotics are prescribed too quickly and often times will not be effective if it is a viral infection. Based on the assessment findings and the little we know about the patient; the patient could have possible sinusitis. The first-line treatment for sinusitis in adults is amoxicillin/clavulanate (875 mg amoxicillin/125 mg clavulanate) for 5 to 7 days (Woo & Robinson, 2016). This medication has a half-life of 1-1.3 hours, is metabolized by the liver and eliminated in the urine. It usually takes 30 minutes to be effective and peaks in 1-2 hours. This medication is an oral antibacterial combination that consist of the semisynthetic antibiotic amoxicillin and the β-lactamase inhibitor (FDA, n.d.). This bactericidal hinders bacterial growth by inhibiting the biosynthesis of bacterial cell wall mucopeptide (Woo & Robinson, 2016). For JD, it would be necessary to check a comprehensive metabolic panel to assess liver and kidney function. There is not a black box warning and usually does not have any side effects other than a possible rash. It is usually safe during pregnancy however before prescribing it would be necessary to assess allergies and inform the patient about potential side effects like a rash.

Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings

Amoxicillin is first-line therapy for sinusitis in children (Woo & Robinson, 2016). If the child has not recently been on antibiotics, they should be on a dose of 25-50mg/kg/d in divided doses. This bactericidal medication is an aminopenicillin that is taken orally, has a half-life of 1.3hrs, is metabolized in the liver and excreted in the urine, and works by inhibiting the bacterial cell wall mucopeptide (Woo & Robinson, 2016). As stated before, it does not have any black box warnings and patients kidney and liver functioning is a concern before use.

What health maintenance or preventive education is important for this client based on your choice medication/treatment?

I would instruct this patient to take the medication until it is gone; not stop it early. In addition, if they failure to respond within 3 to 5 days he should prompt notify his PCP and a change in therapy should be considered (Woo & Robinson, 2016). I would instruct the patient to get plenty of sleep, increase fluid intake, and take a probiotic once they are done with their regimen. Antibiotics have been known to kill of not only the bad bacteria in the gut but the good as well. Preventing side effects like diarrhea should be taken prophylactically.  They should be taken on an empty stomach, 1 hour before a meal or 2 hours after meals (Woo & Robinson, 2016). For additional resources, I would tell the patient the pharmacist is a great tool for resource if they had questions when they picked up the medication but to always call the PCP for further questioning.

References:

Research Critiques and PICOT Statement Final Draft

 

Prepare  this assignment as a 1,500-1,750 word paper using the instructor  feedback from the previous course assignments and the guidelines below.

PICOT Question  

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The  final PICOT question will provide a framework for your capstone project  (the project students must complete during their final course in the  RN-BSN program of study).

Research Critiques

In  the Topic 2 and Topic 3 assignments, you completed a qualitative and  quantitative research critique on two articles for each type of study (4  articles total). Use the feedback you received from your instructor on  these assignments to finalize the critical analysis of each study by  making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer  to “Research Critiques and PICOT Guidelines – Final Draft.” Questions  under each heading should be addressed as a narrative in the structure  of a formal paper.

Proposed Evidence-Based Practice Change

Discuss  the link between the PICOT question, the research articles, and the  nursing practice problem you identified. Include relevant details and  supporting explanation and use that information to propose  evidence-based practice changes.

General Requirements

Prepare  this assignment according to the APA 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.

Many of us can think of leaders we have come to admire, be they historical figures, pillars of the industry we work in, or leaders we know personally. The leadership of individuals such as Abraham Lincoln and Margaret Thatcher has been studied and discussed repeatedly. However, you may have interacted with leaders you feel demonstrated equally competent leadership without ever having a book written about their approaches.

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

• Chapter 1, “Expert Clinician to Transformational Leader in a Complex Health Care Organization: Foundations” (pp. 7–20 ONLY)
• Chapter 6, “Frameworks for Becoming a Transformational Leader” (pp. 145–170)
• Chapter 7, “Becoming a Leader: It’s All About You” (pp. 171–194)

What makes great leaders great? Every leader is different, of course, but one area of commonality is the leadership philosophy that great leaders develop and practice. A leadership philosophy is basically an attitude held by leaders that acts as a guiding principle for their behavior. While formal theories on leadership continue to evolve over time, great leaders seem to adhere to an overarching philosophy that steers their actions.

What is your leadership philosophy? In this Assignment, you will explore what guides your own leadership.

To Prepare:

• Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
• Reflect on the leadership behaviors presented in the three resources that you selected for review.
• Reflect on your results of the CliftonStrengths Assessment, and consider how the results relate to your leadership traits.

The Assignment (2-3 pages):

Personal Leadership Philosophies

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

• A description of your core values
• A personal mission/vision statement
• An analysis of your CliftonStrengths Assessment summarizing the results of your profile
• A description of two key behaviors that you wish to strengthen
• A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples.
• Be sure to incorporate your colleagues’ feedback on your CliftonStrengths Assessment from this Module’s Discussion 2

Rubric:

Develop and submit a personal leadership philosophy that reflects what you think are characteristics of a good leader. Use the scholarly resources on leadership you selected to support your philosophy statement. Your personal leadership philosophy should include the following:

·   A description of your core values.
·   A personal mission/vision statement. 

Analysis of your CliftonStrengths Assessment summarizing the results of your profile.
·   A description of two key behaviors you wish to strengthen.

 

A development plan that explains how you plan to improve upon the two key behaviors you selected and an explanation of how you plan to achieve your personal vision. Be specific and provide examples. 

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. 

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation 

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 

Draft Prospective

Instructions

Tutor MUST have a good command of the English language

Tutor MUST have a good command of the English language

Sources need to be journal/scholarly articles. 

Use only articles that are published between 2015-2018 (except for your theory articles which will be older as you must cite primary sources).

No textbook or direct quotes

I have attached the Rubric

My project is CLABSI prevention

Instructions

Development of the prospectus is an iterative process that lays the foundation for your DPI Project. The prospectus will also assist your project chair in providing valuable feedback to guide you in your project development.

General Requirements:

Use the following information to ensure successful completion of the assignment:

• Locate      and download the most recent version of the prospectus template in the DC      Network (http://dc.gcu.edu).      This document has help and criteria information embedded to assist you in      the completion of the prospectus.
• Locate      “The 10 Strategic Points for the Prospectus, Proposal, and Direct      Practice Improvement Project” document (completed in previous      courses). You will use information from this document to write the      prospectus and attach this document as an appendix in the prospectus.
• Review “Academic Quality Review Checklist      (AQR)” (Chapters 1-3 only) for use in writing the prospectus.
• Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is 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.
• You      are required to submit this assignment to LopesWrite. Please refer to the      directions in the Student Success Center.

Directions:

Complete a draft of your DPI Project prospectus according to the instructions and criteria provided in each section of the prospectus template. The draft should include information taken from “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” document (from previous courses). Use the “Academic Quality Review Checklist (AQR)” (Chapters 1-3 only) to assist you in writing this prospectus. Include the following sections in the prospectus:

1. Introduction:      Provide an overview of your project.
2. Background      of the Problem: Provide an overview of the history and present state of      the problem.
3. Theoretical      Foundations: Identify and describe one or two theories or models to be      used to inform the project. Identifies the seminal      source for each theory or model (a seminal      source may be quite old and may be      published in a textbook). Illustrate how the theory or model will      inform your project.
4. Review      of the Literature/Themes: Describe the main and subthemes of your project.      You should begin with at least three main themes with three subthemes      each. Your literature review will eventually be 30+ pages with over 50      references (85% of these references must be from primary sources that is less than 5 years.
5. Problem      Statement: Specify the problem proposed for the project by presenting a      clear declarative statement that begins with “It is not known . . .      .” Identify the need for the project. Identify the broad population      (not the sample) for the project. Describe how this project may contribute      to solving the problem.
6. Purpose      of the Project: Describe the purpose      of this project. Use a declarative statement “The purpose of this      project is to . . . .” Describe the methodology and design. Describe      the specific population that this project will affect and how this project      will contribute to the field.
7. Clinical      Questions and Variables: Provide a brief introduction to the question      portion. State your clinical questions or PICOT questions. Describe and      operationally define each variable of interest.
8. Significance of the Project: Provide an      overview of how this project fits with other research in the field. Be      specific and relate to other studies. How will this project contribute to      the research overall? What is the expected value?
9. Rationale for Methodology: Clearly justify the methods chosen for      this project. Ensure the methods      align with the project questions or PICOT questions. Describe why this      method is the best fit.
10. Nature      of the Project Design: Describe the design you have chosen for this      project. Discuss why this design is appropriate based on the method chosen and the project questions.
11. Instrumentation      or Sources of Data: Describe the sources of data you will use. One source must be a valid and reliable tool,      survey, or questionnaire. You may use your discussion question from Topic      3 to assist with this section. Describe in detail all data collection      instruments. Describe the validity and reliability of each as appropriate      (one must be valid and reliable).
12. Data      Collection Procedures: Describe step by step how you will collect data.      All major steps need to be described. Include a discussion of      project sample recruitment, sample selection, and assignment to groups (as      applicable). Describe the process of obtaining informed consent, if      applicable.
13. Data      Analysis Procedures: Begin by describing your demographic data from your      participants. How will you analyze this data using descriptive statistics?      Restate each project question or PICOT question. For each question, describe in detail what      inferential statistics you will use to analyze your data. Include steps to      ensure your data meet the assumptions for each inferential statistic used.      Describe the a priori alpha level you plan to use.
14. Ethical      Considerations: Provide a description of      ethical issues related to your project and how you plan to deal with them.      Consider your methodology, design, and data collection. Compare to a      randomized controlled trial. Address anonymity, confidentiality, privacy,      lack of coercion, informed consent, and potential conflicts of interest.      Discuss how you plan to adhere to the Belmont Report key principles (respect, justice,      beneficence).