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Professional Capstone and Practicum Reflective Journal

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Paper 1

Work with your preceptor to assess the organization for required resources needed for the strategic plan if the change proposal were to be implemented. Review your strategic plan and determine what resources would be needed if the change proposal were to be implemented. Write a list of at least four resources you will need in order to implement your change proposal.

The assignment will be used to develop a written implementation plan.

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.

Paper 2

 

Professional Capstone and Practicum Reflective Journal

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

  1. New practice approaches
  2. Interprofessional collaboration
  3. Health care delivery and clinical systems
  4. Ethical considerations in health care
  5. Practices of culturally sensitive care
  6. Ensuring the integrity of human dignity in the care of      all patients
  7. Population health concerns
  8. The role of technology in improving health care      outcomes
  9. Health policy
  10. Leadership and economic models
  11. Health disparities

While APA style is not re

Centers for Disease Control and Prevention

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Reply Cathy

Asking the patient about any breast changes including size change, dimpling, or nipple discharge would be helpful (Centers for Disease Control and Prevention, 2018). In addition, asking the patient about any family history of breast cancer and her menstrual cycle timing could be helpful. A  breast exam would be appropriate during this patient’s physical exam. The patient reported feeling a lump in the shower. By the provider doing their own exam, the patient’s technique and lump placement could be verified (Centers for Disease Control and Prevention, 2018).

Some possible differential diagnosis for this patient include breast cancer, a cyst, fibroadenoma, lipoma, mastitis, and breast injury (Mayo Clinic, 2018). Getting a full health history and ordering tests would be needed to know for sure. Some tests that may be ordered include imaging to see what the potential lump looks like and placement.  A mammogram is commonly used along with a biopsy to test the breast tissue cells to determine if they could be cancerous (Mayo Clinic, 2018).

Based on the results for this patient, it is possible that a referral could be necessary. This patient may need to see an oncologist or even a surgeon. If this patient has cancer, radiation or chemotherapy may be an necessary intervention (Mayo Clinic, 2018). Making sure this patient has access to information and support is also important when considering management of care.

Reference
Centers for Disease Control and Prevention. (2018). “What Are the Symptoms of Breast Cancer”. Retrieved from:  (Links to an external site.)Links to an external site.https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm
Mayo Clinic. (2018). Breast lumps. Retrieved from https://www.mayoclinic.org/symptoms/breast-lumps/basics/causes/sym-20050619 (Links to an external site.)Links to an external site.

Reply Quiana

A 35-y.o. woman is seen in the office with a chief complaint of a breast mass. She states she found the lump when she was in the shower, and she is quite visibly distressed. Her medical history is unremarkable, although she reports that she has not had a mammogram. She takes no prescription medications.

What additional questions should you ask the patient and why?

  • Additional questions to ask this patient would be if the lump is painful, pain in fibrocystic disease is bilateral and increases before the monthly menstruation.
  • Has the lump changed in size or remained the same, has she ever noticed a lump before, is she menstruating. Cyst gets smaller and pain decreases when the menstrual cycle starts. If the patient is menstruating it is important to have her come back at the end of her menstrual period. This is because the breast cysts can fluctuate during the menstrual cycle (So you found a lump, now what? 2015).
  • Does she have a nipple discharge? A nipple discharge that is unilateral, pink or bloody, non-milky or associated with a mass is an indicator of breast cancer.
  • Ask at what age did she begin menstruating because early menarche increases the risk of breast cancer.
  • Does she have a family history of breast cancer? If a mother or sister had breast cancer there is twice the risk and if both have it there is three times the risk of developing breast cancer.
  • Does she have any children? Null parity increases your risk of breast cancer (Seller, & Symons, 2018).

What should be included in the physical examination at this visit?

A complete breast exam should be included in this visit. The breast lump should be assessed to determine if it is firm, with indistinct borders and if it is attached to the skin. Assessment should include if there is any dimpling or nipple retraction, and unilateral nipple discharge, all of which are a signs of breast cancer. Benign lumps usually have well-defined borders and are mobile (Sellers, & Symons, 2018).

Possible differential diagnoses at this time are as follows:

  • Breast cancer–Patients that develop breast cancer with no family history are normally older than 40 years.
  • Fibrocystic breast disease-Patients have cyclic bilateral breast pain, especially near and during menstruation. The pain and tenderness worsen before menstruation.
  • Fibroadenoma- Usually presents in patients 20-40 years. Usually, a solitary lump that is firm, mobile, smooth, and rubbery (Seller, & Symons, 2018).

What tests should you order and why?

A mammogram is the first test to order. If the mammogram is inconclusive or the breast has dense tissue then a breast ultrasound should be ordered to differentiate between a cystic mass and a solid mass. If needed a needle aspiration breast biopsy should be ordered. In some cases an MRI can be ordered, especially in high-risk patients (Sellers, & Symons, 2018).

How should this patient be managed?

If it is fibrocystic breast disease the patient should be advised to wear a firm bra even at night. Dietary restrictions will include coffee, chocolate, and tea. The patient should also take 400 IU of vitamin E daily. If the patient is experiencing pain or moderate to severe fibrocystic breast disease, the therapeutics to prescribe are oral contraceptives, NSAIDs and/or progestin. The patient should also be educated on the importance of conducting breast self-exams monthly even though the breasts may be lumpy (Dunphy, Winland-Brown, Porter, & Thomas, 2015).

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. A. (2015). Primary

care. The art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.

Seller, R. H., & Symons, A. B. (2018). Differential diagnosis of common complaints. (7th Ed.). Philadelphia, PA. Elsevier, Inc.

clinical issue

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Prepare:

  • Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
  • Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest.
  • Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
  • Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

Part 1: An Introduction to Clinical Inquiry

Create a 4- to 5-slide PowerPoint presentation in which you do the following:

  • Identify and briefly describe your chosen clinical issue of interest.
  • Describe how you used keywords to search on your chosen clinical issue of interest.
  • Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
  • Provide APA citations of the four peer-reviewed articles you selected.

Part 2: Identifying Research Methodologies

After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

  • The full citation of each peer-reviewed article in APA format.
  • A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
  • A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
  • A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
  • A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

Theories of Development

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Assignment 3.2: Theories of Development
Theories of Development
OBJECTIVE
Discuss the various theories related to each developmental phase

ASSIGNMENT OVERVIEW
This reaction and response assignment explores the theories of Piaget, Vygotsky, and Erikson.

DELIVERABLES
A one-page (12-point font) report

Step 1 Review the material in this lesson on major developmental theorists.

Be sure to review the theories of Piaget, Vygotsky, and Erikson.

Step 2 Research and read.

Research and read an article about one or more of the “major developmental theories

Step 3 Read this case study.

Vlad is 12 years old and has just changed schools because his parents moved again. He did not do well in his previous five schools. Now he is living next door to his uncle, who likes him a lot and is teaching him about car engines and computers. In his new school, he is becoming a good student. His teachers are surprised but pleased. He is even helping his younger brother with his studies.

Step 4 Explain Vlad’s changes using ideas from two theorists.

Using the information you have gathered, write about how two of the major theorists would explain Vlad’s changes in a one-page report. After using the theorists’ ideas, briefly add any ideas you might have about Vlad’s changes. Why do you think he has improved in school?

Step 5 Save and submit your assignment.

After you complete the assignment, save a copy for yourself in an easily accessible place, submit a copy to your instructor using the dropbox.

Submission status
Submission statusNo attemptGrading statusNot gradedDue dateSaturday, 1 June 2019, 11:00 PMTime remaining12 days 7 hoursLast modified-Make changes to your submissionSkip Main menu

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Evidence-Based Project

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Assignment: Evidence-Based Project, Part 4: Critical Appraisal of Research

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 an appraisal tool 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 Tool Worksheet Template 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 Evaluation Table within the Critical Appraisal Tool Worksheet Template.

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.

cause and effect relationship in response to disease.

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No Plegarism please, assignemnt will be checked with Turnitin. 

Will need 4 full pages double spaced for the case study, APA Style, Times New Roman, font 12, Title Page and a Reference page. 

In your discussion be sure to include evidence of your knowledge of tissue and organ structure and function to physiologic alterations in systems and analyze the cause and effect relationship in response to disease.

Make sure all of the questions in the case study have been addressed and answered.

Cite at least 3 References; journal articles, textbooks, or evidenced-based websites to support the content. 3.

All sources must be within five years (2012-2017).

Case Study 7 Disorders of Hemostasis

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a two-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take. Unfortunately, just three days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona’s DVT?

Why was Leona already at risk for thrombus development?How does Leona’s atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?

How do atherosclerosis and immobility promote changes in blood coagulation?

When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

legal issues

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Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources.  Some answers may require you to do additional research on the Internet or in other reference sources.  Choose your sources carefully.

3. Consider the discussion and any insights you gained from it.

4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.

Assignment:

1. Locate an article that discusses a bioethics issue. First, provide a summary of the article and the bioethics issue being presented. Next, discuss what ethical actions the nurse should take in relation to the issue being presented. Also, discuss possible legal issues that the nurse should be aware of. This section should include at least 1 outside reference and your textbook and should be at least 1 ½ pages long.

2. Analyze the following case study and then answer the following questions:

You are working on the Operating Room and the trauma alert goes off. You respond to the ER to provide support. Once in the ER, you receive report that an 89 year old male is coming in with a self-inflicted GSW (Gun Shot Wound) to the head.  You listen to the radio traffic between the ER and ambulance to get an idea what kind of surgery you need to set up for and what will be needed as far as lines and fluid.  Here is the report:

HR: 121

B/P: 60/45

Saturation: 93%

Patient is intubated and non-responsive. Right pupil is fixed and dilated. Paramedic also states there is a large extended family headed to the ER. The patient lost his wife of 60 years 1 week ago and left a note stating that he is too heartbroken to go on. The patient and family arrive. The neurosurgeon discusses that their father’s potential outcome, even with surgery, is not good. The family still insists that the neurosurgeon complete the surgery.

1. What are the ethical and legal issues in this case study. Be specific and support your response with references

Once you have the patient in the room and you are prepped and ready for surgery, the phone rings. You receive word that the patient signed DNR orders two days ago.

1. As the OR nurse what are your legal and ethical issues now? Was the patient of sound mind when he signed this order? Do you honor the DNR or the family’s wishes? Explain and support your response.

Your response to this case study should be at least 2 pages and include 2 outside references and your textbook.

Please submit one paper which includes both assignments.

Reaching out a Solution

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Reaching out a Solution  This assignment is designed to assist you in developing a thoughtful process for advocating about an issue as a nurse, from identifying a problem that needs to be solved through articulating a process for doing so.

This assignment consists of answering each of the questions listed below from the “Political Analysis and Strategies” chapter of your course textbook. Write each question as a new topic area; then follow with a paragraph or two to answer the question. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources, if any used. This project should be no longer than 4 pages.

Let us assume that you are a school nurse in a high school. At a recent school athletic event, a spectator suffered a cardiac arrest in the stands. A coach of the home team went into the high school to fetch the automatic emergency defibrillator (AED) only to find out that it was not readily available. In the meantime, an emergency squad arrived and resuscitated the spectator. On Monday morning, you learn of the absence of the AED only to find out that it had been locked in the custodian’s closet. Reflect on the following questions outlined in the “Political Analysis and Strategies” chapter:

•What is the issue?

•Is it my issue, and can I solve it?

•Is this the real issue or merely a symptom of a larger one?

•Does it need an immediate solution, or can it wait?

•Is it likely to go away by itself?

•Can I risk ignoring it?

•What are the possible solutions? Are there risks to these solutions?

•What steps would you need to take in order to solve the issue?

•Does anyone else at the school need to be involved in the solution?

•Where is the power leverage in the school to reach the preferred solution?  Reaching a solution requires the use of power vested in the nurse.

Review Box 9-1 (Sources of Power) and determine which type(s) of power the school nurse has in this situation. State your reasons for your answer.

Managing Health Care Quality 

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Assignment 2: Managing Health Care Quality 

Due Week 8

Imagine that you are a hospital administrator at the Sunlight Hospital in California. The main complaint among the patients is the quality of care. Your job is to understand the state of the hospital, create value, increase efficiency, and turn the facility into a local hospital of choice. Whenever you are making visits in various wards to meet the employees and the patients, you hear how the patients love the hospital, but they would like to see certain improvements in care. The employees seem to be very busy executing their duties and not interacting much with the patients. The hospital board has asked you to compile a report of your findings and suggested strategy for achieving the hospital’s current goals.

Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.

Write a four to six (4-6) page paper in which you:

  1. Classify five (5) measurements      of quality of care in a hospital, and justify the major reasons why you believe      these measurements matter to patients in their process of choosing a      hospital for emergency or inpatient care.
  2. Specify four (4)      main features in health care organizations that can be used to design a      successful quality improvement plan. Articulate the significant manner in      which the specified features can lead to failure or success of quality of      care in Sunlight Hospital.
  3. Suggest the      salient reasons why quality of care would add value to and create a      competitive advantage for the Sunlight Hospital. Justify your response.
  4. Use four (4)      recent (within the last five [5] years) quality academic resources in this      assignment. Note: Wikipedia and      other websites do not qualify as quality academic resources.

Your assignment must follow these formatting requirements:

  • Be typed, double      spaced, using Times New Roman font (size 12), with one-inch margins on all      sides; citations and references must follow APA or school-specific format.      Check with your professor for any additional instructions.
  • Include a cover      page containing the title of the assignment, the student’s name, the      professor’s name, the course title, and the date. The cover page and the      reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

  • Propose      methodologies that have been proven to increase value in health care      delivery systems
  • Examine leadership      and management frameworks that are most applicable to a certain      organization type within the health care industry.
  • Craft a strategic      plan that leads to a competitive advantage within a certain market.

· Use technology and information resources to research issues in health care management.

  • Write clearly and      concisely about health care management using proper writing mechanics.

Risk Factors

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6-1 Case Study: Risk Factors

Previous Next 

Instructions

Mr. R is a 48-year-old Hispanic man who has worked the past 10 years as a warehouse worker. He is 5’6″, weighs 175 pounds, and has a waist circumference of 38″. At his last visit at your office, his blood pressure was 140/60 mm Hg. Prior to the visit, he had fasting blood work done, and his primary care provider plans to review the results with him today. The pertinent diagnostic results are as follows: a fasting plasma glucose level of 137 mg/dL, an HDL level of 27 mg/dL, LDL level of 247 mg/dL, a serum triglyceride level of 210 mg/dL. Use the following prompts as guidelines while performing and writing your case study:

  1. Identify what this individual is most at risk for based on the information presented in this case above.
  2. Explain the significance of this individual’s weight and waist diameter. Explain how this individual is at increased risk for insulin resistance.
  3. Explain briefly the differences between hypoinsulinemia, hyperinsulinemia, hyperglycemia, and hypoglycemia as each relate to an individual with type 1 diabetes mellitus and type 2 diabetes mellitus.

 

Pathology: Introduction and Identification

Begin each case study by introducing the scenario/specific themes so that any reader would know what this case study is about. From there, start answering prompts above.

Pathology: Explanation and Plan of Care

Follow the rubric. You need to develop a plan of care for the patient. What education or care would you provide? Provide more than 1 example

Make a table for plan for Pt care

Plan for the Patient Care

 

Assessment

Nursing Diagnosis

Patients Outcome

Interventions

Rationale

Evaluation of the outcome

Response to Questions

Explore issues ideas and concerns as it relates to this patient. Integrate your own thought processes into your responses.

(Adequately address prompts above in the case study, and explore issues, ideas, or concerns)

Patient-Care Technologies

Follow the rubric. Explain the role of patient care technologies in caring for this patient. What might assist this patient? Provide different Examples(i.e might be a patient portal,  tele-medicine, etc.)

Incorporation of Resources

Multiple resources best to support claims

Articulation of Response (APA/Mechanics)

For additional details, please refer to the Case Study Guidelines & Rubric