Overview of Genetics and Genomics in Nursing

1. A patient who is 38 years of age is diagnosed with autosomal dominant polycystic kidney disease, a hereditary disease that results in fluid-filled cysts occupying space in the kidneys. The cysts can interfere with the function of the kidney and may burst and cause bleeding inside the kidney. The patient with polycystic kidney disease may or may not have a berry aneurysm of a blood vessel in the brain that could lead to bleeding and death, cysts on the ovaries, and a mitral valve prolapse (in females) that can lead to dysrhythmias (irregular heart rhythms), or diverticula (outpouching of the bowel) that are susceptible to infection and inflammation and may lead to gastrointestinal bleeding. The patient is susceptible to retaining fluid in the abdomen so the abdomen is large to constipation, and to hypertension. There is no cure for the disease. The patient receives supportive care for the various symptoms or complications the patient may have. (Learning Objectives 1 to 3) Overview of Genetics and Genomics in Nursing

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1. When explaining to the patient and family about polycystic kidney disease, the nurse should explain what characteristics about an autosomal dominant genetic disease?
2. How does variable expression of genetic characteristics play a role in the course of polycystic kidney disease and how can the nurse further predict the level of the disease?
3. Identify the roles of the nurse in integrating genetics in the nursing care provided for the patient.

2. Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

1. Describe the pattern of autosomal dominant inheritance.
2. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?
3. Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

Overview of Genetics and Genomics in Nursing

Practicum Step 4: You will work on this assignment over weeks 9-10.  It is submitted at the end of week 10.  In this assignment, you will

1. Present the findings from your practicum experience in a 10-15-minute presentation for a group of nurses.  Imagine that you presenting this to your coworkers or at a nursing conference.  Make it interesting and visually appealing.
2. Create a seven- to ten-slide, professional quality presentation with approximately six bullet points per slide.  Slides should contain relevant pictures, tables, and charts when indicated.  In your presentation, address the following information: Nursing homework help
   1. Title page
   2. Introduction to the at-risk group. Include descriptive and demographic data.
   3. Description of the community (city or county).
   4. Summary of the needs assessment (step 1).
   5. Summary of the health disparity and recommendation (step 2)
   6. Summary of the community strengths, assets, and programs available for this group (step 3).
   7. Description of the agency and summary of the interview (step 3).
   8. How your plan supports social justice advocacy to improve the health of at-risk populations (new information).
   9. References

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3. Narrate your presentation.  Once you have created your slides, write a script to narrate the presentation in the notes section of your presentation. Your narration text should support and explain the information on the slides. You are also welcome to use a voice over narration.
4. Save and submit your assignment to the Week 10 drop box.

Keep these quality considerations in mind as you create your presentation::

• It should be organized and aesthetically pleasing (attractive design, layout, and neatness)
• Elements on the slide should be aligned and balanced
• Background, color choices, and font should enhance readability
• Images support and enhance the topic. Nursing homework help

Assessment Description

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

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

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

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

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

 

 

Literature Evaluation Table (Sample)

Student Name:

Summary of Clinical Issue (200-250 words):

The importance of feeding human milk to infants is well documented and supported from a variety of national as well as international committees. The American Academy of Pediatrics (AAP) confirmed that given the short-term and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health initiative (AAP, 2012). An increasing number of studies reported an association between breastfeeding and long-term protection against chronic disease in both the infant and mother (Binns, 2016, AAP, 2012).  Despite the overwhelming evidence in support of exclusive breastfeeding, the United States current six month breastfeeding rate of 49.4% is well below the goal of 60.6% of infants receiving any breast milk at 6 months set by Healthy People 2020 (CDC, 2015).  The current rate of infants being exclusively breastfed at 6 months is 18.8%, with a goal rate of 25.5% as reported in the 2016 Breastfeeding Report Card published through the Center for Disease Control (CDC, 2015). The challenge with the reported data was that the information comes predominately from maternal recall of their feeding practices of full-term healthy infants leaving to question the accuracy of this information (CDC, 2015). Very little information was available regarding the breastfeeding rates of hospitalized infants during the first seven days of life.  These infants and mothers were often placed into a healthcare system that was not prepared to address the mother infant dyad, but rather a system focused primarily on the needs of the infant.  Pediatric health care systems were not prepared for the breastfeeding mother and infant during the first week of life and were challenged to provide effective support that would allow for the mother to continue to breastfeed while the infant was hospitalized.  When an interruption in breastfeeding occurred during the first week, this caused significant changes to a mother’s milk supply, the amount of milk the infant demanded, and other barriers created a significant challenge for mothers to reach their breastfeeding goals (Binns, 2016).

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PICOT Question:

Does providing a breastfeeding educational program for pediatric nurses within Cook Children’s Medical Center increase their knowledge of breastfeeding support to hospitalized infants as compared to nurses having no breastfeeding education? Nursing homework help

P = Pediatric nurses within a specific medical center

 

I = Implementation of a breastfeeding education program

 

C = Nurses that received no breastfeeding education

 

O = Increase breastfeeding support to hospitalized infants

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Radzyminski, S., & Callister, L.C. (2015). Health professionals’ attitudes and beliefs about breastfeeding. The Journal of Perinatal Education, 24(2), 102-109.   Permalink:	Garner, C.D., Ratcliff, S.L., Thornburg, L.L., Wethington, E., Howard, C.R., & Rasmussen, K.M. (2016). Discontinuity of breastfeeding care: “There’s no captain of the ship”. Breastfeeding Medicine, 11(1), 32-39.   Permalink:	Cross-Barnet, C., Augustyn, M., Goss, S., Resnik, A., & Paige, D. (2012).  Long-term breastfeeding support: Failing mothers in need.   Permalink:
How Does the Article Relate to the PICOT Question?	Looking at how health care professional’s perceptions impacts breastfeeding support.	By learning what health care professionals understand about breastfeeding and support.	By identifying how healthcare has failed breastfeeding mothers allows for a better understanding.
Quantitative, Qualitative (How do you know?)	Qualitative design – descriptive study using a convenience sampling of staff using interview sessions.	Qualitative design – Semi structured in-depth interview	Qualitative study using semi-structured interviews.
Purpose Statement	The purpose of this study was to determine the perceptions of health care providers regarding breastfeeding and support of breastfeeding.	To understand health professionals perspectives on their experiences providing breastfeeding care across the continuum.	Sought to explore the comprehensive infant feeding education and support experiences of mothers enrolled in the Maryland WIC program.
Research Question	Does the perception of breastfeeding and support impact how healthcare professionals support breastfeeding mothers and infants?	Does a health professionals personal perspective impact the support that they provide to breastfeeding mothers.	Does a comprehensive breastfeeding educational program at different levels of health care, improve the rate of breastfeeding.
Outcome	Four themes identified: Understanding the benefits of breastfeeding Lacking consistency Not knowing how to help Understanding the barriers to breastfeeding	Six themes identified: Gaps within healthcare system structure Reliance on other health professionals Time: limited or not the right time. Lack of skills or not their role. Inconsistent message Potential strategies to improve continuity	This study looked at mothers breastfeeding at three different stages: Prenatal care – the intent of the mothers to breast feed.  Almost half of mothers received some education. Hospitals – of the mothers identified as wanting to breastfeed, there were approximately 20% of mothers that received no breastfeeding education. Pediatricians – many mothers identified their pediatrician as their primary source of breastfeeding information.
Setting (Where did the study take place?)	Within one health care setting including pediatricians, OB’s , nurse midwife	Two central New York counties.	Three different Maryland WIC office
Sample	53 health care professional providing care to breastfeeding mothers and infants.	Purposive sampling used from different health professional settings. 34 health professionals interviewed.	Convenience sample of 75 mothers
Method	Qualitative descriptive study	Qualitative semi structured in depth interviews	In depth semi-structured interview
Key Findings of the Study	Identification of themes that relate to breastfeeding.  Clinical implications: improve education, assess maternal knowledge	Identified theses associated with the limitation of the health professionals knowledge associated with breastfeeding.	This study identified different opportunities to offer breastfeeding education.
Recommendations of the Researcher	Provide additional education to health care providers that support breastfeeding mothers and infants.	Identification that more breastfeeding education is needed across all areas of health care.	Breastfeeding education is critical at all levels of healthcare to support the breastfeeding mother.

 

T = Within a 6 month time frame

 

                                                                                                           

 

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Cobb, M.S. (2014). Nurses’ current breastfeeding knowledge: An evidence-based change project. Clinical Scholars Review 7(1), 42-47.   Permalink:	Bozzette, M., & Posner, T. (2013). Increasing student nurses’ knowledge of breastfeeding in baccalaureate education. Nurse Education in Practice, 13, 228-233.   Permalink:	Rosen-Carole, C., Waltermaurer, E., Goudreault, M., Larimer, A., Pokharel-Wood, M., Rajupet, S., & Kouba, N. (2016). Assessing the efficacy of a breastfeeding-friendly quality improvement project in a large federally qualified health center network.  Journal of Human Lactation, 32 (3), 489-497.   Permalink:
How Does the Article Relate to the PICOT Question?	By assessing the current knowledge that nurses have to identify what is needed.	Identifying the amount of education that is provided in the baccalaureate program.	By reviewing the effectiveness of a quality improvement project.
Quantitative, Qualitative (How do you know?)	Quantitative design using a pre – post survey design.	Quantitative design using a convenience sample using a pre and post survey.	Quantitative design using a pre-post design.
Purpose Statement	Discuss the application of an evidence-based practice project to postpartum nurses to support, protect and promote breastfeeding in the hospital setting.	To examine the changes in student knowledge after receiving content on breastfeeding and lactation in their obstetrical course.	Evaluate the effect of a Breastfeeding-Friendly Initiative in the complex environment of a Federally Qualified Health Center.
Research Question	What is the nurses current knowledge associated with the support of breastfeeding information.	Does education increase the knowledge that students provide to mothers during their baccalaureate education.	Does a breastfeeding friendly initiative influence the breastfeeding rates of a large federally funded health center
Outcome	Using a paired t test analysis of the pretest and posttest scores.  Statistical significance established and demonstrated that education improved the participants breastfeeding knowledge.	Improvement was noted within each course objective from pre- and post- test.	Of those that completed both the pre survey, the education and then the post survey, there was a statistical difference in the knowledge that the providers had regarding breastfeeding.
Setting (Where did the study take place?)	Nurses within a single postpartum unit.	A single baccalaureate nursing program.	31 health centers stratified by size and location in order to randomly assign half of the 709 direct contact employees to either of 2 interventions
Sample	41 nurses agreed to participate.  All staff members that are in contact with the breastfeeding mother were solicited.	28 nurses were in attendance and the final sample was 24 students	31 health centers recruited. 709 direct care providers participated. 220 attended the face-to-face education 150 staff members accessed the web-based education
Method	Postpartum nurses were solicited to participate in a pretest prior to the initiation of an individual breastfeeding education session and completion of the same questionnaire after the session.	Two phase study with a pre and post design.  Pre-test was used to evaluate the beginning knowledge and a post test was used to evaluate the knowledge after an educational program.	Two interventions evaluated, one was a face-to-face education session and the other was a web-based module process.  Two questionnaires were administered to participants.
Key Findings of the Study	Postpartum nurses play a key role in the support of breastfeeding mothers.  It is critical that they have a solid breastfeeding knowledge.	Benefits of breastfeeding have been clearly established and nurses have been identified as having a significant impact.	This study showed that face to face education was a better mechanism to provide comprehensive breastfeeding as compared to the web-based education.
Recommendations of the Researcher	Increase the amount and type of breastfeeding education that is provided. Nursing homework help	Develop and provide breastfeeding education in all nursing and physician programs.	Breastfeeding education should be included in all health care settings that work with mothers and infants.

Reference

 

AAP. (2012). Breastfeeding and the Use of Human Milk. Pediatrics, 129(3), e827-e841.

Binns, C. L. (2016). The long-term public health benefits of breastfeeding. Asia-Pacific Journal of Public Health, 28(1), 7-14.

CDC. (2015). Breastfeeding Report Card. Retrieved 11 18, 2016, from Center for Disease Control and Prevention: cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf

 

Psychopathology And Diagnostic Reasoning

In many realms of medicine, objective diagnoses can be made: A clavicula is broken.  An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015). Psychopathology And Diagnostic Reasoning

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Thanks to myriad advances during recent decades, we know that psychopathology is caused by many interacting factors. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

To Prepare:

• Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.
• Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

By Day 3 of Week 1

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.

Read a selection of your colleagues’ responses

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology. Psychopathology And Diagnostic Reasoning