Assignment 1 PICOT Statement and Literature

The first step of the EBP process is to develop a question from the nursing practice problem of interest. Select a practice problem of interest to use as the focus of your research. Start with the patient and identify the clinical problems or issues that arise from clinical care. Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project. The PICOT statement will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem. Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts. Suggestions for locating qualitative and quantitative research articles from credible sources:

1. Use a library database such as CINAHL Complete for your search.
2. Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
3. When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative. To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. https://www.guideline.gov/(week 1)

Question 

Question 1. Xi, a fifty-four-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Which of the following actions would you take for appropriate decision making?

Prescribe Maxalt, but to monitor the use, only give her four tablets with no refills.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 2. Chronic pain is a complex problem. Some specific strategies to deal with it include ________.

telling the patient to “let pain be your guide” to using treatment therapies

prescribing pain medication on a pro re nata (PRN) basis to keep down the amount used

scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment

All the given options

Question 3. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes which one of the following instructions?

Gout may worsen with therapy.

Febuxostat may cause severe diarrhea.

The patients should consume a high-calcium diet.

The patients will need frequent CBC monitoring.

Question 4. The Pain Management Contract is most appropriate for:

Patients with a history of chemical dependency or possible inappropriate use of pain medications

All patients with chronic pain who will require long-term use of opiates

Patients who have a complex drug regimen

Patients who see multiple providers for pain control

Question 5. Patients whose total dose of prednisone exceed 1 gram will most likely need a second prescription for _________.

metformin, a biguanide to prevent diabetes

omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

naproxen, an NSAID to treat joint pain

furosemide, a diuretic to treat fluid retention

Question 6. Sallie has been taking 10 mg of prednisone per day for the past six months. She should be assessed for ________.

gout

iron deficiency anemia

osteoporosis

renal dysfunction

Question 7. All NSAIDs have an FDA black box warning regarding __________.

potential for causing life-threatening GI bleeds

increased risk of developing systemic arthritis with prolonged use

risk of life-threatening rashes, including Stevens-Johnson

potential for transient changes in serum glucose

Question 8. Which of the following statements is true about age and pain?

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 9. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be __________.

ibuprofen (Advil)

acetaminophen with hydrocodone (Vicodin)

oxycodone (OxyContin)

oral morphine (Roxanol)

Question 10. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of __________.

serum glucose

stool culture

folate levels

vitamin B12

Question 11. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes which one of the following instructions?

It is OK to double the dose of Vicodin if the pain is severe.

Vicodin is not habit forming.

He should not take any other acetaminophen-containing medications.

Vicodin may cause diarrhea; therefore, he should increase his fluid intake.

Question 12. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is _____.

black, tarry stools

vomiting

tremors

tinnitus

Question 13. Henry is eighty-two years old and takes two aspirin every morning to treat the arthritis pain in his back. He states that the aspirin helps him to “get going” each day. Lately, he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Add an H2 blocker such as ranitidine to his therapy.

Discontinue the aspirin and switch him to Vicodin for the pain.

Decrease the aspirin dose to one tablet daily.

Have Henry take an antacid fifteen minutes before taking the aspirin each day.

Question 14. Patients with RA who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?

A bisphosphonate

Calcium supplementation

Vitamin D

All of the above

Question 15. One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not affected by these drugs.

Question 16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

Use of more than one drug to treat the pain

Multiple times when prescriptions are lost with requests to refill

Preferences for treatments that include alternative medicines

Presence of a family member who has abused drugs

Question 17. Jayla is a nine-year-old who has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

Prescribe amitriptyline (Elavil) daily, start at a low dose and increase the dose slowly every two weeks until effective in eliminating migraines.

Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.

Prescribe propranolol (Inderal) to be taken daily for at least three months.

Explain that it is rare for a nine-year-old to get migraines and that she needs an MRI to rule out a brain tumor.

Question 18. Narcotics are exogenous opiates. They act by ______.

inhibiting pain transmission in the spinal cord

attaching to receptors in the afferent neuron to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the pituitary

Question 19. Pathological similarities and differences between acute pain and chronic pain include which of the following options?

Both have decreased levels of endorphins.

Chronic pain has a predominance of C-neuron stimulation.

Acute pain is most commonly associated with irritation of peripheral nerves.

Acute pain is diffuse and hard to localize.

Question 20. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence ______.

the sensory aspects of pain

the discriminative aspects of pain

the motivational aspects of pain

the cognitive aspects of pain

Logistic regression is used to analyze a wide variety of variables that may surround a singular outcome. For example, logistic regression could be used to identify the likelihood of a patient having a heart attack or stroke based on a variety of factors including age, sex, genetic characteristics, weight, and any preexisting health conditions. The biological systems and issues with which the health care field is concerned represent the kinds of applications for which logistic regression is especially useful.

Logistic regression is used in the health care field for many purposes, including diagnoses, predictions, and forecasting. The three articles in this week’s Learning Resources illustrate the many uses of logistic regression in the health care field. This Discussion allows you to explore the different uses of logistic regression and cultivate a deeper understanding of the application of logistic regression in evidence-based practice.

To prepare:

• Review      the three articles in this week’s Learning Resources and evaluate their      use of logistic regression. Select one article that interests you to      examine more closely in this Discussion
• Critically      analyze the article you selected considering the following questions:

1. What       are the goals and purposes of the research study the article describes?
2. How       is logistic regression used in the study? What are the results of its       use?
3. What       other quantitative and statistical methods could be used to address the       research issue discussed in the article?
4. What       are the strengths and weaknesses of the study?
5. How       could the weaknesses of the study be remedied?
6. How       could findings from this study contribute to evidence-based practice, the       nursing profession, or society?

By Thursday 10/12/17, 5 pm, write a minimum of 550 words essay in APA format. Use at least 3 references from the list of required reading below.  Include the level one headings as numbered below.

Post a cohesive response that addresses the following:

1) In the first line of your posting, identify the article you examined, providing its correct APA citation. (See attached PDF file for the article).

2) Post your critical analysis of the article as outlined above (make sure to answer all the points asked above in the “To Prepare” area, bullets [1, 2, 3]).

3) Propose potential remedies to address the weaknesses of each study (bullets 4 and 5 in the “To Prepared” area).

4) Analyze the importance of this study to evidence-based practice, the nursing profession, or society (bullet 6 in the “To Prepared” area).

Learning Resources

.

Required Media

“Multiple Regression”

Used by permission from SPSS VideoTutor.com A division of Consumer Raters LLC., 1121 S Military Trail, 314, Deerfield Beach, FL 33442, USA

Note: The approximate length of this media piece is 5 minutes.

“Logistic Regression”

Used by permission from SPSSVideoTutor.com A division of Consumer Raters LLC., 1121 S Military Trail, 314, Deerfield Beach, FL 33442, USA 

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

Required Readings

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

Chapter 24, “Using Statistics to Predict”

This chapter asserts that predictive analyses are based on probability theory instead of decision theory. It also analyzes how variation plays a critical role in simple linear regression and multiple regression.

Statistics and Data Analysis for Nursing Research

Chapter 9, “Correlation and Simple Regression” (pp. 208–222)

This section of Chapter 9 discusses the simple regression equation and outlines major components of regression, including errors of prediction, residuals, OLS regression, and ordinary least-square regression.

Chapter 10, “Multiple Regression”

Chapter 10 focuses on multiple regression as a statistical procedure and explains multivariate statistics and their relationship to multiple regression concepts, equations, and tests.

Chapter 12, “Logistic Regression”

This chapter provides an overview of logistic regression, which is a form of statistical analysis frequently used in nursing research.

Hoerster, K. D., Mayer, J. A., Gabbard, S., Kronick, R. G., Roesch, S. C., Malcarne, V. L., & Zuniga, M. L. (2011). Impact of individual-, environmental-, and policy-level factors on health care utilization among US farmworkers. American Journal of Public Health, 101(4), 685–692. doi:10.2105/AJPH.2009.190892

This article discusses the results of a study of how many U.S. farmworkers accessed U.S. health care. The study considered this question on several levels—individual, environmental, and policy—and used logistic regression to analyze the multivariate data gathered.

Tritica-Majnaric, L., Zekic-Susac, M., Sarlija, N., & Vitale, B. (2010). Prediction of influenza vaccination outcome by neural networks and logistic regression. Journal of Biomedical Informatics, 43(5), 774–781. doi:10.1016/j.jbi.2010.04.011.

This article describes the methods and results of a neural network study on the effectiveness of the influenza vaccine using historical data in three neural network algorithms. The article also provides a discussion of logistic regression in comparison to the neural network algorithms used.

Xiao, Y., Griffin, M. P., Lake, D. E., & Moorman, J. R. (2010). Nearest-neighbor and logistic regression analyses of clinical and heart rate characteristics in the early diagnosis of neonatal sepsis. Medical Decision Making, 30(2), 258–266. doi:10.1177/0272989X09337791

This article outlines the procedures and findings of a study on the use of two methods of neonatal sepsis diagnosis: nearest-neighbor analysis and logistic regression analysis. The results indicated that each method generates unique information useful to diagnosis, and therefore both methods should be used simultaneously for improved accuracy of diagnoses.

Optional Resources

Walden University. (n.d.). Linear regression. Retrieved August 1, 2011, from http://streaming.waldenu.edu/hdp/researchtutorials/educ8106_player/educ8106_linear_regression.html

Due Date: Oct 15, 2017 23:59:59       Max Points: 150

Details:

In a written paper of 1,200-1,500 words, apply the concepts of epidemiology and nursing research to a communicable disease.

Communicable Disease Selection

Choose one communicable disease from the following list:

Chickenpox

Tuberculosis

Influenza

Mononucleosis

Hepatitis B

HIV

Epidemiology Paper Requirements

Include the following in your assignment:

Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence).

Describe the determinants of health and explain how those factors contribute to the development of this disease.

Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).

Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).

Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.

A minimum of three references is required.

Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.

Due Tomorrow Monday 5:00 PM CST

Discussion Board #8

HCA 340 500

Discussion Board Assignment #8

Chapter10–Mental Health Services

Answer the following questions on Mental Health Services:

1. The recipients of mental health services in the U.S. represent only a small percentage of those in need of services. State two (2) factors that impede access to mental illness treatment.
2. Name two (2) ways WWI and WWII affected the awareness of mental health disorders among the federal government and the American public? Name one (1) result of that awareness?
3. From colonial times through the 1960s, the primary mode of mental illness treatment was institutional. In the 1960s, mental health treatment shifted to a community-based orientation. Name two (2) factors responsible for this shift? What were the effects on patients and on the community?
4. As mental illness treatment shifted from the institutional to the community setting, public dollars were allocated on the basis of units of service delivered, not on results of care. Discuss the implications of this policy on the deinstitutionalized severely mentally ill.
5. The author states, “In contrast to widely held assumptions, mental disorders can now be diagnosed and treated as effectively as physical disorders.” Identify and discuss two (2) factors that have contributed to the persistence of erroneous assumptions about mental illness treatment.  Identify one (1) factor that “allow mental disorders to be diagnosed and treated as effectively as physical disorders.”