Tag Archive for: nursing

genitourinary problem

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Apply information from the Aquifer Case Study to answer the following discussion questions:

· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?

· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them.  What was your final diagnosis and how did you make the determination?

· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.

You and Dr. Lee take a few minutes to review Mr. Payne’s chart:

Vital signs:

· Temperature: 98.6° Fahrenheit

· Heart rate: 80 beats/minute

· Respiratory rate: 12 breaths/minute

· Blood pressure: 130/82 mmHg

· Weight: 170 pounds

· Body Mass Index: 24 kg/m2

Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.

Past Surgical History: None

Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,

Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.

Medication:

· metformin 500mg 2 twice daily

· glyburide 5mg 2 twice daily

· amlodipine 2.5 mg daily

· lisinopril 40 mg daily

· simavastin 40 mg daily

Allergies: No known drug allergies.

Can you tell me about your back pain?”

“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.

“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”

“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”

“It’s probably a 7.”

“Have you found anything that improves the pain?”

“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”

“What about positions that make things better or worse?”

“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”

“Have you had back pain before?”

“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”

Review of Systems

Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.

Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.

Back Exam – Standing:

Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.

Back Exam – Seated:

Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.

Pulmonary Exam: His lungs are clear.

Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.

Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:

Pertinent History

Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.

Pertinent Exam Findings

Vital signs: stable

Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.

Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.

You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.

FOLLOW-UP TREATMENT

MANAGEMENT

One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.

MRI report:

1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.

2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.

You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.

You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.

  • Posted: 2 Years Ago
  • Due: 18/08/2018
  • Budget: $20

Visual Teaching Tool

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Select an Option to Complete this Assignment

There are 3 options for creating your Visual Teaching Tool. Be sure to choose a format that makes sense for your selected topic, population, and setting. For example, if will be teaching adults at a health fair, then an educational brochure would be an appropriate choice. You must use the Patient Teaching Plan you have developed in this course to create your Visual Teaching Tool.

Option #1 – Power Point

Directions: 

  1. Create a 6-8 slide Power Point presentation for your selected population setting.
  2. The goal of this Power Point Presentation is to address the three learning outcomes you developed in the Patient Teaching Plan. Once the learner has viewed your Power Point, all three of the learning objectives should have been met.For Example:
    If a learning objective in the teaching plan is: “At the end of this education, the learner will be able to demonstrate the proper way to wear a bike helmet,” then there should be content in your Power Point related to how to properly wear a bike helmet.
  3. Tips for a great Power Point presentation:

    • Be creative! Choose a design (from the design tab of the PowerPoint presentation) to enhance visual appeal.
    • Incorporate graphics, clip art, or photographs to increase interest.
    • Use words and phrases suitable for your selected population.
    • Avoid writing paragraphs. Use simple sentences and bullet points.
    • Cite all sources used to create the educational content with (author, year).
    • Proofread for spelling and grammar errors prior to final submission.

Option #2 – Educational Brochure (Using Microsoft Word)

Directions:

  1. Open Microsoft Word, and select create a New document.Under the Education option, select Education Brochure. This will provide you with a blank tri-fold brochure template. You can change the design, insert graphics, and create text as you wish.
  2. The goal of this Educational Brochure is to address the three learning outcomes you developed in the Patient Teaching Plan. Once the learner has viewed your Educational Brochure, all three of the learning objectives should have been met.
    For Example:
    If a learning objective in the Patient Teaching Plan is: “At the end of this education, the learner will be able to demonstrate the proper way to wear a bike helmet,” then there should be content in your Educational Brochure related to how to properly wear a bike helmet.
  3. Tips for a great educational brochure:
    For Example:

    • Be creative! Choose a design (from the design tab of the PowerPoint presentation) to enhance visual appeal.
    • Incorporate graphics, clip art, or photographs to increase interest.
    • Use words and phrases suitable for your selected population.
    • Avoid writing paragraphs. Use simple sentences and bullet points.
    • Cite all sources used to create the educational content with (author, year).
    • Proofread for spelling and grammar errors prior to final submission.

possible costochondritis.

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Need 2 responses done. Answer as if it were me.

– Min 150 words EACH,

– Min 1 scholar source (no later than 5 years) EACH,

– APA format.

The post: Karen is still not convinced that Theory has any place in APN practice. Provide a specific example of how theory is relevant to APN practice in one of the four specialties (CNM, CNP, CRNA or CNS). Provide evidence to support your arguments.

                                                                 ANSWERS TO POST:                                                                          

POST 1:

As an emergency room nurse, working alongside several nurse practitioners, it is very apparent that nursing theory is relevant to everyday practice. Woten and Karakashian (2017) describe the role of an emergency room nurse practitioner as, an advanced practice nurse with specialized training that can provide holistic care to patients. The idea of providing holistic care branches from several nursing theorists that discuss the importance of treating every individual as a whole. For example, an individual may arrive to the emergency department with chest pain, which will immediately warrant an electrocardiogram.  The patient will then be triaged and have vital signs taken. Most patients with chest pain will have blood work and a chest x-ray. Sometimes patients may present with chest pain and all the results are negative, this does not mean that the patients pains are not legitimate or a concern.  As a holistic provider, we are to rule out every life-threatening emergency but also provide continuation of care. Sometimes patients may not have a primary care provider, a support system, or means of seeking further help.  This is where the provider is to seek help from a social worker and assist the patient in having follow-up care. In some cases, the patient may be admitted to the hospital for further testing that cannot be completed in the emergency room.  This plan of care shows a holistic approach to treating a patient. Patients “pain” level should never be ignored, even though results are negative. On several occasions, patients are treated with antacids to rule out gastritis or GERD that can cause chest pain, and anti-inflammatory medication to treat possible costochondritis. The importance of a holistic approach is to avoid missing any possible findings that are not initially seen and so that if there is something that may occur the patient is not treated as if nothing is wrong with them.  Holistic nursing care is one of the most important theories all nurses should follow, it leads to the best possible patient outcomes.

POST 2:

Theory helps to generate knowledge in which nursing should develop in the future. Nursing theory can be used to improve and evaluate the quality of clinical practice by distinguishing the practice that can help patients with better care and enhance professional status for nurses. Nursing theory helps to define a relationship that creates a domain of interest in the healthcare profession. A valuable theory creates expectations about a conduct, health problems, and environment that are reasonable and reliable with daily remarks. For instance, in nursing theory class, we discussed Watson theory of caring which focuses on the caring aspect of nursing practice. I think that it is a very important theory because it reflects on the ability to create a relationship of trust and respect with patients. The theory of Watson implies the ability for a nurse to care for patients holistically to accommodate a better relationship between patients and healthcare providers. A recent study was done that applies Watson’s theory of practice in an assessment for patients with chronic heart failure with acceptance of collaboration between nurses and patient for transpersonal teaching-learning was showed to be efficient on improving CHF self-management. The strategy of nursing management of care for CHF patients activates the main element of Watson’s model for an enhancement for a better result of self-management care for CHF patients (Leong, Lao, & Chio, 2013).  A CNP can use the Watson model to interact with patients. For instance, as a future NP, it is vital that we connect with patients, so we can create a good relationship with patients in order to help them. Based on King’s theory, nursing is outlined as a practice of interactions between nurse and patients to perceive and set goals to reach the goals (Leon-Demare et al., 2015). The function of king’s theory of goal accomplishment to NP clinical encounters supports the nursing foundations motivating advanced practice nursing. King’s theory accentuates on a constructive bond between the presence of connection and patients ‘point of view of belief and gratification as outcomes of the NP patient connection.

Learning Objectives

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AssiAssignment 1: Practicum – Week 8 Journal Entry

Learning Objectives

Students will:
  • Develop effective documentation skills for group therapy sessions *
  • Develop diagnoses for clients receiving group psychotherapy *
  • Evaluate the efficacy of cognitive behavioral therapy for groups *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.
  • Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.gnment 1: Practicum – Week 8 Journal Entry

Learning Objectives

Students will:
  • Develop effective documentation skills for group therapy sessions *
  • Develop diagnoses for clients receiving group psychotherapy *
  • Evaluate the efficacy of cognitive behavioral therapy for groups *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.
  • Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.

implementation plan

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While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

  1. Title page
  2. Introduction section
  3. A comparison of research questions
  4. A comparison of sample populations
  5. A comparison of the limitations of the study
  6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.

This assignment uses a rubric.

You are required to submit this assignment to LopesWrite.

RUBRIC

An introduction is present, and it relates to the body of the paper. Information presented in the introduction is intriguing and encourages the reader to continue reading. 10%

A reflective and insightful comparison of research questions is presented. 20%

A reflective and insightful comparison of sample populations is presented. 20%

A reflective and insightful comparison of the limitations of the study is presented. 20%

A conclusion and recommendations for further research are reflective and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 5%

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 5%

Writer is clearly in command of standard, written, academic English. 5%

All format elements are correct. 2%

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 3%

plan to maintain wellness

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The purpose of developing this Plan is to set a framework and a plan to maintain wellness and to stay motivated and engaged throughout your Program. Doing this will help you achieve success during your coursework and as a professional nurse.

The goal of the Project is to help you become self-aware and reflective as a means of identifying personal self-care strategies that will increase your energy and help you manage your stress. The Project will give you a chance to learn how this is accomplished as you will be doing similar work with clients during the Program and as a professional nurse to assist them in the same way.

Share in a 2 – 3 page paper, the following:

Re-look at your Quality of Life Self-Care Wheel scores. Have they changed? If so, in what ways.
Think about your current levels of tension and stress. On a scale of 1-10 with 10 being the highest level, what is your score? Now think about the strategies you identified. Describe how well you have put them into action. If you have not been able to implement them, identify why and what you can do to overcome this.
Identify any new strategies that you think will “fit” better and describe why.
Minimum length 2-3 pages not including cover or referencing. APA formatting

health care setting

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Select a health care setting you want to focus on for your sustainability initiative (e.g., local hospital, veterans hospital, ambulance service, urgent care, nursing home, etc.).

Analyze the setting you have selected and break it down to the main departments, employee roles, operating activities, etc. While doing so, brainstorm opportunities to reduce costs or eliminate waste while improving patient care or outcomes.

Review the list of sustainable initiatives from the list below, and select one that you want to promote for your course project:

  • Energy efficiency
  • Lighting
  • IR scanning
  • Cogeneration
  • Kanban Inventory
  • Device exchange
  • CR pack reformation
  • Device reprocessing
  • Red bag waste reduction
  • Blue wrap recycling

Note: Ensure that the opportunity you select correlates with the setting you select. Additionally, if you want to complete a sustainable initiative that is not on the list, obtain approval from your instructor before completing the assignment.

Identify data sources you might need to collect and analyze for your initiative. Consider contacting people in the industry and at your organization who may be able to help.

Write a 525- to 700-word proposal of the sustainability initiative you want to promote at the health care setting you selected. Your proposal should:

  • Create a clear vision or mission statement that defines the scope of the initiative and would generate buy-in.
  • Define what outcomes you expect to achieve over time.
  • Be specific with what you can realistically deliver.

Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

Format your assignment according to APA guidelines.

Submit your assignment. For additional help, check out the ULTRA: Access your assignments page.

ANA Fast Facts

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Access the following information. You may read the PDF online or download it.

American Nurses Association. (2014). Fast facts: The nursing workforce 2014: Growth, salaries, education, demographics & trends. ANA. Retrieved from https://www.nursingworld.org/globalassets/practiceandpolicy/workforce/fastfacts_nsgjobgrowth-salaries_updated8-25-15.pdf

(Links to an external site.)

Review the data presented in the ANA Fast Facts and describe some of the key attributes/characteristics of this sample of the nursing workforce.

Discuss some of the data that you found interesting; include what you believe the purpose (intent) of ANA sharing these results.

The instruments and tools that we use to collect data need to be reliable and valid. Define these terms and explain the importance of each. Share one way that can be used to collect data that you were not aware of or familiar with.

 Nursing Informatics

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Are there areas in your practice that you believe should be more fully explored? The central aims of nursing informatics are to manage and communicate data, information, knowledge, and wisdom. This continuum represents the overarching structure of nursing informatics. In this Assignment, you develop a research question relevant to your practice area and relate how you would work through the progression from data to information, knowledge, and wisdom.

To prepare:

  • Review the information in Figure 6–1 in Nursing Informatics and the Foundation of Knowledge.
  • Develop a clinical question related to your area of practice that you would like to explore.
  • Consider what you currently know about this topic. What additional information would you need to answer the question?
  • Using the continuum of data, information, knowledge, and wisdom, determine how you would go about researching your question.
    • Explore the available databases in the Walden Library. Identify which of these databases you would use to find the information or data you need.
    • Once you have identified useful databases, how would you go about finding the most relevant articles and information?
    • Consider how you would extract the relevant information from the articles.
    • How would you take the information and organize it in a way that was useful? How could you take the step from simply having useful knowledge to gaining wisdom?

Write a 3- to 4-page paper that addresses the following:

  • Summarize the question you developed, and then relate how you would work through the four steps of the data, information, knowledge, wisdom continuum. Be specific.
    • Identify the databases and search words you would use.
    • Relate how you would take the information gleaned and turn it into useable knowledge.
  • Can informatics be used to gain wisdom? Describe how you would progress from simply having useful knowledge to the wisdom to make decisions about the information you have found during your database search.

Your paper must also include a title page, an introduction, a summary, and a reference page.

health history

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In this assignment, you will be completing a health assessment on an older adult. To complete this assignment, do the following:

Perform a health history on an older adult. Students who do not work in an acute setting may “practice” these skills with a patient, community member, neighbor, friend, colleague, or loved one. (If an older individual is not available, you may choose a younger individual).
Complete a physical examination of the client using the “Health History and Examination” assignment resource. Use the “Functional Health Pattern Assessment” resource as a guideline to assist you in completing the template.
Document findings of complete physical examination in Situation-Background-Assessment-Recommendation (SBAR) format. Refer to the sample SBAR Template located on the National Nurse Leadership Council website at https://www.ihs.gov/nnlc/includes/themes/newihstheme/display_objects/documents/resources/SBARTEMPLATE.pdf as a guide.
Document the findings of the physical examination in the assessment worksheet.
Using the “Health History and Examination” assignment resource, provide the physical examination findings summary with planned interventions for the client. Include any community services in the interventions.
APA format is not required, but solid academic writing is expected.

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 not required to submit this assignment to LopesWrite.

NRS-434VN-R-Functional-Health-Pattern-Assessment-Student.docx NRS-434VN-R-IndividualHealthHistoryandExaminationAssignment-Student.docx