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ethical issues

Purpose

This week’s graded topics relate to the following Course Outcomes (COs).

  • CO 3: Identify ethical issues common to research involving human subjects. (PO 6)
  • CO 5: Recognize the role of research findings in evidence-based practice. (PO 7 & 8)

Discussion

We begin our journey into discovering the new world of research and evidence-based practice (EBP) by exploring our past. After completing the required readings and lesson, answer the following:

  • Explain how research has evolved since the Florence Nightingale era.
  • Discuss how research and EBP are different; include how you believe research supports EBP for nursing.
  • Describe one past/historical unethical breach of research conduct; then, share how you would ensure care of a study participant using one ethical or legal research consideration (guideline/principle)

Hello Class,
Why should nurses incorporate research? How could it (or does it?) impact your nursing practice?  Think about these questions as you complete the assigned readings this week.  Our profession was founded by Florence Nightingale, who was not just our nursing pioneer, but a researcher, too. In the last few years, we have seen many trends pushing nurses to have a professional practice based on evidence.  With that as our beginning, consider our week’s discussion:

1. How has research evolved since Florence Nightingale?

2. How are research and EBP different and how does research support EBP?

3.  Unfortunately, despite the positive impact research and EBP has, there have been major cases of research misconduct.  Please choose one historical case and how you would engage in ethical treatment of a research participant.

Professor’s comment: This week, we will meet the following course outcomes:

  • Identify ethical issues common to research involving human subjects.
  • Recognize the role of research findings in evidence-based practice.

You may begin posting in this thread no sooner than the first Sunday of week one. Posts prior to this time will not receive credit. I look forward to your thoughts!   Dr. Smailes

references: Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning.

This textbook is available as an e-book and can be accessed from the module view.

Legal and Ethical Conduct

Legal and Ethical Conduct

Legal and Ethical Conduct

As emphasized in this week’s media presentation, all nurses need to be familiar with the laws and regulations that govern their practice: their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of Practice, specialty group standards of practice, etc. In addition, basic ethical principles guide nurses’ decision-making process every day. ANA’s Code of Ethics and ANA’s Social Policy Statement are two important documents that outline nurses’ ethical responsibilities to their patients, themselves, and their profession. This said, there is a dilemma: The laws are not always compatible with the ethical positions nurses sometimes take. This week’s Discussion focuses on such a dilemma.

To prepare:

  • Review this week’s Learning Resources, focusing on the information in the media presentation about the relationship between the law and ethics.
  • Consider the ethical responsibility of nurses in ensuring patient autonomy, beneficence, non-malfeasance, and justice.
  • Read the following scenario:

    Lena is a community health care nurse who works exclusively with HIV-positive and AIDS patients. As a part of her job, she evaluates new cases and reviews confidential information about these patients. In the course of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV positive. Lena would like to protect her sister from harm and begins to consider how her sister can find out about her boyfriend’s health status.

  • Consult at least two resources to help you establish Lena’s legal and ethical position. These resources might include your state’s Nurse Practice Act (I LIVE IN CALIFORNIA), the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of Practice, and internal or external standards of care.
  • Consider what action you would take if you were Lena and why.
  • Determine whether the law and the ANA’s standards support or conflict with that action.

Post by Day 3 a description of the actions you would take in this situation, and why. Justify these actions by referencing appropriate laws, ethical standards, and professional guidelines.

 

 

Required 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.
Readings
  • Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers.
    • Chapter 4, “Government Regulation: Parallel and Powerful” (pp. 73–109)

      This chapter explains the major concepts of the regulation of health professionals, with emphasis on advanced practice nurses (APN) and the process of licensure and credentialing.

  • ANA’s Foundation of Nursing Package– (Access this resource from the Walden Library databases through your NURS 6050 Course Readings List)
    • Guide to the Code of Ethics: Interpretation and Application

      This guide details the history, purpose and theory, application, and case studies of this must-have Code of Ethics.

    • Nursing Social Policy Statement

      The Nursing Social Policy Statement provides an understanding of the social framework and obligations of the nursing profession.

    • Nursing: Scope & Standards of Practice

      This book contains several national standards of practice that can be used to inform the decision-making process, development, implementation, and evaluation of several functions and aspects of advanced practice nursing.

  • Gallagher, T. H. (2009). A 62-year-old woman with skin cancer who experienced wrong-site surgery: Review of medical error. JAMA: Journal of the American Medical Association, 302(6), 669–677.

    Retrieved from the Walden Library databases.

    The article showcases the different sides of medical error, from a 62-year-old patient who suffered and the components of the medical error’s impact and aftermath.

  • Reinhardt, U. E. (2010, Jan 30). Repercussions of simplicity. New York Times, p. A14.

    Retrieved from the Walden Library databases.

    This article determines that the government should take low-income families into account when determining mandatory health insurance because many Americans choose to go without insurance despite preexisting conditions presumably no longer being an issue.

  • Board on Health Care Services. (2007). Preventing medication errors: Quality Chasm Series. Washington, DC: The National Academies Press. Retrieved from http://www.nap.edu/openbook.php?record_id=11623&page=43
    • Part 1, “Understanding the Causes and Costs of Medication Errors” (pp. 43–49)
  • This article discusses the multilayered nature of medication error as a system of failures due to individual behaviors and conditions.

 

NOTE: 1 1/2 TO 2 PAGES; Consult at least two resources to help you establish Lena’s legal and ethical position.

   Policy Analysis Summary

 Policy Analysis Summary

Health care policy can facilitate or impede the delivery of services. For the past several weeks, you have been engaging in an authentic activity by critically analyzing a specific health care policy and various aspects of the impact associated with its implementation. A critical step in the policy process is communicating your findings with others. This week, you will share information from your policy analysis and its implications.

To prepare:

  • Briefly      summarize your policy analysis, focusing on the implications for clinical      practice that may be most relevant or interesting for your colleagues.      Include how evidence-based practice influenced the policy, policy options,      or solutions.

By tomorrow 05/08/2018 10 pm, write a minimum of 250 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below”

Post a 2-paragraph succinct summary of your policy analysis paper. Include at least two of the options or solutions for addressing the policy and the resulting implications for nursing practice and health care consumers.

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.

  • Chapter      17, “Conclusion: Tensions and Challenges”

    This chapter concludes with final thoughts on the challenge of providing      quality health care and controlling health care costs. The solution is      likely to be resolved only by a collaborative approach, involving all      health care stakeholders, and by health professionals taking the lead.

Howard, J., Levy, F., Mareiniss, D. P., Craven, C. K., McCarthy, M., Epstein-Peterson, Z. D., & et al. (2010). New legal protections for reporting patient errors under the Patient Safety and Quality Improvement Act: A review of the medical literature and analysis. Journal of Patient Safety, 6(3), 147-152.

The authors studied the dissemination of information on the Patient Safety and Quality Improvement Act (PSQIA), a federal act that affords protection to those reporting medical errors. They found medical literature to be inadequate in this regard, and as a result, medical personnel were uninformed on their legal protections. This lack of information has become a barrier to policy implementation.

Jacobson, N., Butterill, D., & Goering, P. (2003). Development of a framework for knowledge translation: Understanding user context. Journal of Health Services Research & Policy, 8(2), 94–99.

Lau, B., San Miguel, S., & Chow, J. (2010). Policy and clinical practice: Audit tools to measure adherence. Renal Society of Australasia Journal, 6(1), 36–40.

The authors study the compliance to renal-care policies by health care professionals. They conclude with the necessity for nurses to support evidence-based protocols as well as to obtain continuing education on new protocols.

McCracken, A. (2010). Advocacy: It is time to be the change. Journal of Gerontological Nursing, 36(3), 15-17.

The author proposes that nurses, as patient advocates, need to be more involved in the making of health care policy instead of reacting to policies that are constantly changing. The article provides a guide to help organize initial policy efforts.

Nannini, A., & Houde, S. C. (2010). Translating evidence from systematic reviews for policy makers. Journal of Gerontological Nursing, 36(6), 22–26.

The article cites geronotological nurses as examples of those who are able to translate research into policy briefs that can be clearly understood by policy makers. Geronotological nurses are in this unique position because of their clinical experience and educational background.

Paterson, B. L., Duffet-Leger, L., & Cuttenden, K. (2009). Contextual factors influencing the evolution of nurses’ roles in a primary health care clinic. Public Health Nursing, 26(5), 421-429.

This article provides details on a study conducted in a nurse-managed clinic related to the changing roles of nurses. The authors found that nurses, in response to social, political, and economic forces, became involved in advocacy for the clinic through political action, government funding issues, and media relations roles.

Sistrom, M. (2010). Oregon’s Senate bill 560: Practical policy lessons for nurse advocates. Policy, Politics, & Nursing Practice, 11(1), 29-35. doi: 10.1177/1527154410370786

The author uses the efforts by a nurse advocate in lobbying for an Oregon bill related to healthy food in public schools to illustrate nurse advocacy and policy making. The bill, developed in response to childhood obesity, did not immediately become law. The author concludes with the importance of considering the political environment when creating successful policy.

Spenceley, S. M., Reutter, L., & Allen, M. N. (2006). The road less traveled: Nursing advocacy at the policy level. Policy, Politics, & Nursing Practice, 7(3), 180-194. doi: 10.1177/1527154410370786

Nurses have always been advocates at the patient-level of care, but the authors of this article promote the need for all nurses to become advocates at the policy level as well. They discuss factors that have kept nurses from getting involved with policy making and they provide strategies to resolve these challenges.

Wyatt, E. (2009). Health policy advocacy: Oncology nurses make a difference. ONS Connect, 24(10), 12-15.

The author presents information on two nurses who have become health care policy advocates—one as a policy maker and one as an elected legislator. Both have been able to use their perspectives from their nursing careers to affect health policy.

Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing: Clarifying the ‘thin line.’ Journal of Advanced Nursing, 65(8), 1746-1752.

The authors attempt to distinguish the concepts of advocating for a patient and paternalism, or overriding a patient’s wishes. They provide clinical examples to illustrate the differences between these concepts, and they conclude with strategies to use in practice.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Advocating through policy. Baltimore: Author. 

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

In this media presentation, Dr. Joan Stanley and Dr. Kathleen White discuss how nurses can influence practice and engage in advocacy through the policy process.

Optional Resources

Birnbaum, D. (2009). North American perspectives: POA, HAC and never events. Clinical Governance: An International Journal, 14(3), 242–244.

g Trauma/Bariatric/General surgeries

Hello Professor and Classmates,

My name is Sandra Robles. I’m from Puerto Rico. I like to watch movies and go ride with my family. I work in operating room for 22 years, I’m work in Jackson Medical Center, currently Circulating Nurse in the Operating Room doing Trauma/Bariatric/General surgeries and I would like to continue in this area assisting the Surgeon during procedures. I would like to learn about policies, research, analysis, how you have priorities, to grow professionally as a FNP. In 5 years I visualize me studying my PhD.

My greatest weakness is always to be more than I give. I overprotect my work a lot and take too much care of my patients. Mostly I work directly with overweight patients, who feel a lot of confusion and fear, I give moral support and I serve as an example, that bariatric surgery is the best decision they can have for both their physical and emotional health. Patient safety is first.

In my 22 years as a nurse I have never had a conflict with any co-worker, let alone a patient. I feel very capable and professional to be able to do things responsibly without having to make mistakes or have to mourn anything. For me my patients come first, I provide them with a clean and safe environment. With my co-workers they have all the help and confidence they need. I like to work as a team. But conflicts often happen in every area of work, if they always happened to notify the supervisor so that the problem does not get any further.

Nurse/Patient Empowerment in Practice

A female health professional explains health options to an elderly woman patient.Currently Reading

Week 4: Nurse/Patient Empowerment in Practice

Introduction

As a registered nurse, you have the power to influence change in patient outcomes. An important aspect of influencing change is identifying areas that need improvement. This is done primarily through measurement of data. There are several different measures to gather data within organizations as well as on a national scale. Some of these measurements include core measures, standards, best practices, evidence-based practices, and the National Database of Nursing Quality Indicators (NDNQI). These support mechanisms have also been discussed as a means for helping nurses to deliver quality care and improve patient safety. Each measurement essentially focuses on providing care that is safe, effective, patient-centered, timely, efficient, and equitable.

Although there are several different measurements, NDNQI data is used in the process of attaining Magnet Recognition. Magnet Recognition is the highest honor a health care organization can receive for nursing excellence and high-quality patient care. The nurse-specific measures presented in the NDNQI help inform nursing staffs and their organizations of areas where nursing practices can be improved and where nursing practice efforts are producing positive clinical outcomes. Nurses must be directly involved in developing and implementing action plans based on the data presented by the NDNQI.

This week, you will explore the importance of nurse empowerment in effecting change and how action plans are created based on the results of the NDNQI as presented on a dashboard. You will also consider how nurses advocate for patients’ rights, even when that means supporting a patient whose personal choices may have negative health outcomes.

Learning Objectives

Students will:
  • Evaluate strategies to empower both the nurse and the patient to improve quality of care
  • Analyze the use of National Database of Nursing Quality Indictors for nurse empowerment in practice
  • Analyze nurse empowerment in relation to use of quality improvement data for practice
  • Analyze practice experiences for patient or nurse empowerment
  • Analyze quality improvement dashboards for nursing plans

Note: The Assignment related to these Learning Objectives is introduced this week and submitted in Week 5.

Photo Credit: [Eva Katalin Kondoros]/[iStock / Getty Images Plus]/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

Brown, D. S., Aydin, C. E., & Donaldson, N. (2008). Quartile dashboards: Translating large data sets into performance improvement priorities. Journal of Healthcare Quality, 30(6), 18–30. doi: 10.1111/j.1945-1474.2008.tb01166.x

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

 

Typically, references should be within five to seven years of publication. However, this publication is considered a classical research reference pertaining to quality improvement and the use of data sets.

Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576–582. doi: 10.1177/0969733013511362

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

Garrard, L., Boyle, D. K., Simon, M., Dunton, N., & Gajewski, B. (2016). Reliability and validity of the NDNQI® injury falls measure. Western Journal of Nursing Research, 38(1), 111–128. doi: 10.1177/019394591454281

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

Giancarlo, C., Comparcini, D., & Simonetti, V. (2014). Workplace empowerment and nurses’ job satisfaction: A systematic literature review. Journal of Nursing Management, 22(7), 855–871. doi: 10.1111/jonm.12028

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

Guglielmi, C. L., Stratton, M., Healy, G. B., Shapiro, D., Duffy, W. J., Dean, B. L., & Groah, L. K. (2014). The growing role of patient engagement: Relationship-based care in a changing health care system. AORN, 99(4), 517–528. doi: 10.1016/j.aorn.2014.02.007

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

Rock, M. J., & Hoebeke, R. (2014). Informed consent: Whose duty to inform? MEDSURG Nursing, 23(3), 189–194. Retrieved from http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=9&sid=273f009b-d8f5-4cd8-8f01-0973c944bcf7%40sessionmgr104&hid=107

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

American Hospital Association. (2003). The patient care partnership: Understanding expectations, rights and responsibilities. Retrieved from http://www.aha.org/content/00-10/pcp_english_030730.pdf

 

Read through this document created by the American Hospital Association. This document was created for inpatient hospital stays. However, it is applicable to other practice settings as well.

Montalvo, I. (2007). The national database of nursing quality indicators. The Online Journal of Issues in Nursing, 12(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.html

Institute for Healthcare Improvement. (2016). Retrieved from http://www.ihi.org/Pages/default.aspx

 

The IHI offers numerous resources for improving nursing practice and patient care. Explore a variety of topics and examine some of the resources available.

National Quality Forum. (2016b). Retrieved from http://www.qualityforum.org/Home.aspx

 

The National Quality Forum (NQF) strives to improve patient safety and reduce medical errors. Explore the NQF’s endorsed standards and consider how they apply to nursing practice.

Document: Dashboard Directions (Word document)

Document: Sample Dashboard (Excel spreadsheet)

Required Media

Laureate Education. (Producer). (2009a). Topics in clinical nursing: Accountability and nursing practice [Video file]. Baltimore, MD: Author.

 

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

 

Discussion: Nurse/Patient Empowerment

As a nurse, you are the individual who has the ability to empower patients in the decision-making process pertaining to their health care. In addition, you are in a unique position to empower your nursing colleagues to improve job satisfaction and use performance indicator data from dashboards to effect social change.

In this week’s Learning Resources, you examined both the National Database of Nursing Quality Indicators (NDNQI) and the key role nurses play as advocates for patient rights. To assist nurses in being better prepared for this role, programs such as Patient Care Partnership provide guidance.

For this Discussion, you will analyze the use of quality improvement data and discuss how this data can help empower both patients and nurses. Review the Patient Care Partnership information presented in this week’s Learning Resources. In addition, reflect on the media presentation and the information shared by Ms. Manna on patients’ rights.

By Day 3

Respond to the following:

  • What are the best strategies the nurse can employ to empower patients and support patients’ rights to improve quality of care? (Some considerations to keep in mind may include: providing information on effectiveness, risks, and benefits of alternative treatments.)
  • In what ways can NDNQI data from dashboards or quality improvement data be used to support nurse empowerment in practice?
  • How has your institution empowered the nursing staff through the use of quality improvement data?
  • Provide an example of how you have personally empowered either a patient or a fellow nurse.

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).

historical evolution

The “Pulse” Check.  Where are you in your journey and how are you doing?

DQ2 of Week 5 is an opportunity for you to self-assess and reflect on your journey. You can write about it or you can share a created video (you-tube) expressing your navigation through the Role course. Model from the scripts in this week, but be specific to your experience.

Evaluate how you have achieved course competencies and your plans to develop further in these areas. The course competencies for this course are as follows:

  1. Explore the historical evolution of the advance practice nurse.
  2. Differentiate the roles and scope of practice for nurses working in advanced clinical, education, administration, informatics, research, and health policy arenas.
  3. Analyze attributes of the practice arena such as access and availability, degree of consumer choice, competition, and financing that impact advanced practice nurses and their ability to effectively collaborate with other health professionals.
  4. Integrate evidence from research and theory into discussions of practice competencies, health promotion and disease prevention strategies, quality improvement, and safety standards.
  5. Identify collaborative, organizational, communication, and leadership skills in working with other professionals in healthcare facilities and/or academic institutions.
  6. Synthesize knowledge from values theory, ethics, and legal/regulatory statutes in the development of a personal philosophy for a career as an advanced practice nurse.

Commission National Patient Safety Goals

Purpose

The purpose of this PowerPoint presentation is to present the best plan of action, as a leader, assigned to make a change to a problem or issue in your place of work. If you are not presently working, use information from your prelicensure experience or previous healthcare experience. You will be using the Joint Commission National Patient Safety Goals to align with the problem or issue that you see in your workplace or most recent place of employment. You will prepare a PowerPoint presentation and share how you will meet one of the goals in your place of work that will solve the problem or issue you have selected.

Course Outcomes

Completion of this assignment enables the student to meet the following course outcomes.

CO1: Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)

CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)

CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)

CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and system-wide practice improvements that will improve the quality of healthcare delivery. (POs 2 and 3)

CO8: Apply concepts of quality and safety using structure, process and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)

Directions

1. Develop a PowerPoint slideshow consisting of 8-15 slides. Include the following. Title slide, written speaker notes, and Reference slide. Do not use Voice Over recordings. All information needs to be written in slides and notes.

3. As the leader, you have identified a problem or issue related to one of the National Patient Safety Goals 2018 created by the Joint Commission that will lead to quality improvement. You will find the National Patient Safety Goals using this link: NPSG (Links to an external site.)Links to an external site.

4. Assess the problem or issue. State the problem/issue and identify three rationales (reasons) that the problem exists.

5. Determine the people who are involved in the issue and explain three reasons as to how their role will contribute to the problem or issue solution.

6. Identify three solutions and discuss the purpose, cost and desired outcome.

7. Pick one solution to share with the director and discuss why this solution was chosen over the others.

8. Make an action plan to share the solution with the director and staff.

9. Summarize issue, plan and desired outcome and purpose for quality improvement on slide.

10. Summarize your learning and value of doing the assignment.

11. Include written speaker notes for all slides except title slide and reference slide.

https://www.jointcommission.org/assets/1/6/2018_HAP_NPSG_goals_final.pdf

property appraisals

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use appraisal tools to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

  • Review the Resources and consider the importance of critically appraising research evidence.
  • Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
  • Review and download the Critical Appraisal Tools document provided in the Resources.

The Assignment (Evidence-Based Project)

Part 4A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:

  • An evaluation table
  • A levels of evidence table
  • An outcomes synthesis table

Part 4B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

Heart;Blood Vessels

Please include the question on the paper

Chapters: 14 and 15

Heart;Blood Vessels

Anterior cross section showing the valves and chambers of the heart

What blood-tight partition divides the left heart from the right heart?

Which portion of the ECG represents a small deflection sometimes seen just after the T wave, representing the final phase of ventricular repolarization?

Does heart size increase or decrease with age? why?

Make a chart describing the characteristics of the following types of chest pain:

  1. Angina
  2. Esophageal
  3. Pain from a peptic ulcer
  4. Biliary
  5. Arthritis or bursitis
  6. Cervical
  7. Musculoskeletal (chest)
  8. Psychoneurotic

A patient is complaining of prolonged fever, signs of neurologic dysfunctions, and the sudden onset of congestive heart failure. What should be expected?

Name the five traditionally designated auscultatory areas

Is the absence of S3 and S4 an unusual finding?

Splitting of S2 is greatest during which part of respiration?

Describe a pericardial friction rub.

Not all murmurs are the result of valvular defects. Name four other causes of murmurs

Which four cardiac defects make up the tetralogy of Fallot?

TY is a 67-year-old female patient who presents for follow-up for her hypertension and hyperlipidemia. Her PMH includes a diagnosis of aortic stenosis diagnosed 2 years ago, IBS, and a seizure disorder. Her family history includes her father, who died at age 55 years of a myocardial infarction and her mother, who is deceased, who had hypertension, diabetes, and coronary artery disease. Her social history is positive for smoking 1 PPD for 30 years; she quit 9 years ago. She is negative for alcohol and drug use. She lives in a two-bedroom condominium on one floor.

a)On examination, describe the murmur that you would hear for aortic stenosis.

b)Describe the cause of aortic stenosis. What is the cause for TY?

If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, what other causes are there for a heart murmur?

c)If TY’s past medical history did not include a diagnosis of aortic stenosis as well as cardiac risk factors, describe a subaortic stenosis.

   Palpation of arterial pulses: Carotid, Brachial,  Radial, Femoral, Popliteal, Dorsalis pedis,  Posterior tibial.Define arterial blood pressure

Define arterial blood pressure

Which variables contribute to the characteristics of the pulses?

A pregnant patient (32 weeks’ gestation) is having difficulty with dependent edema and painful varicosities. What can you suggest to help this patient’s problem?

What should you do if you have trouble finding the patient’s pulse?

Heart;Blood Vessels

If a patient experiences pain in the calf muscles, which artery is probably obstructed?

What two values are recorded for the blood pressure?

What is the mechanism behind cardiac tamponade?

Where are the most common places for venous ulcers to appear?

TB is a 56-year-old female patient with Raynaud phenomenon. Her past medical history includes spinal stenosis, systemic lupus erythematosus, bipolar disorder, and overactive bladder.

A-Differentiate the primary and secondary types of Raynaud phenomenon.

B-In the patient’s initial presentation what would be the chief complaint if the patient had primary Raynaud phenomenon? Secondary Raynaud phenomenon?

C-Based on TB’s presentation, what assessment results would you expect to find?

What if is she had primary Raynaud phenomenon?

health care professionals

To prepare:

Review Chapters 7 and 8 in the course text. Focus on the strategies for planning and implementing change in an organization, as well as the roles of nurses, managers, and other health care professionals throughout this process.
Reflect on a specific change that has recently occurred in your organization or one in which you have worked previously. What was the catalyst or purpose of the change?
How did the change affect your job and responsibilities?
Consider the results of the change and whether or not the intended outcomes have been achieved.
Was the change managed skillfully? Why or why not? How might the process have been improved?
Post a summary of a specific change within an organization and describe the impact of this change on your role and responsibilities. Explain the rationale for the change, and whether or not the intended outcomes have been met. Assess the management of the change, and propose suggestions for how the process could have been improved.