Holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case

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DUE TUESDAY 01/10/2017 —> ADVANCE NURSING PRACTICE 1

Assignment 2: Case Study Analysis and Care Plan Creation

Click here (I COPIED AND PAST IT ON BELOW)  to download and analyze the case study for this week. Create a holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

CASE STUDY

Week 2: Respiratory Clinical Case

Patient Setting:

65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily.  She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.

HPI

Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.

PMH

History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.

Past Surgical History

None

Family/Social History

Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF

Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.

Medication History

Theophylline SR Capsules 300 mg PO BID

Albuterol inhaler, PRN

Phenytoin SR capsules 300 mg PO QHS

HTCZ 50 mg PO BID

Enalapril 5 mg PO BID

Allergies

NKDA

ROS

Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.

Physical exam

BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”

VS after Albuterol breathing treatment – BP 134/79, HR 80, RR 18

Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.

Laboratory and Diagnostic Testing

Na – 134

K – 4.9

Cl – 100

BUN – 21

Cr – 1.2

Glu – 110

ALT – 24

AST – 27

Total Chol – 190

CBC – WNL

Theophylline – 6.2

Phenytoin – 17

Chest Xray – Blunting of the right and left costophrenic angles

Peak Flow – 75/min; after albuterol – 102/min

FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%

Visit the South University Online Library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, and Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.

Click here to access the codes.

https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?generalError=Thank+you+for+your+interest+in+the+Medicare+Coverage+Database.+You+may+only+view+the+page+you+attempted+to+access+via+normal+usage+of+the+Medicare+Coverage+Database.

I PUT IT AT THE END OF THIS POST

Click here to download the care plan template to help you design a holistic patient care plan. The care plan example provided here is meant only as a frame of reference for you to build your care plan. You are expected to develop a comprehensive care plan based on your assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.

Format

Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be 2 pages excluding the title page and references and in 12pt font.

Name your document: SU_NSG6001_W2_A2_LastName_FirstInitial.doc.

Submit your document to the W2 Assignment 2 Dropbox by Tuesday, January 10, 2017.

Assignment 2 Grading CriteriaMaximum Points
Subjective DataThe submission included the patient’s interpretation of current medical problem. It included chief complaint, history of present illness, current medications and reason prescribed, past medical history, family history, and review of systems.15
Objective DataThe submission included measurements and observations obtained by the nurse practitioner. It included head to toe physical examination as well as laboratory and diagnostic testing results and interpretation (especially those that pertain to the diagnosis).15
AssessmentThe submission included at least three priority diagnoses. Each diagnosis was supported by documentation in subjective and objective notes and free of essential omissions. All diagnoses were documented using acceptable terminologies and current ICD-10 codes.15
Plan of CarePlan included diagnostic and therapeutic (pharmacologic and non-pharmacologic) management as well as education and counseling provided. The plan was supported by evidence/guidelines, and the follow-up plans were noted.20
APAUsed APA standards consistently and accurately when citing in the SOAP note and reference page. Utilized proper format with coversheet and header.10
Total75

SAMPLE (OR TEMPLETE) FOR THE WORK

Title of Plan of Care

Name

South University Online

Faculty Name

NSG 6001

Date

**Please delete this statement and anything in italics prior to submission to shorten the length of your paper.

Patient Initials ______

Subjective Data: (Information the patient tells you regarding themselves: Biased Information):

Chief Compliant: (In patient’s exact words)

History of Present Illness: (Analysis of current problems in chronologic order using symptom analysis [onset, location, frequency, quality, quantity, aggravating/alleviating factors, associated symptoms and treatments tried]).

PMH/Medical/Surgical History: (Includes medications and why taking, allergies, other major medical problems, immunizations, injuries, hospitalizations, surgeries, psychiatric history, obstetric and history sexual history).

Significant Family History: (Includes family members and specific inheritable diseases).

Social History: (Includes home living situation, marital history, cultural background, health habits, lifestyle/recreation, religious practices, educational background, occupational history, financial security and family history of violence).

Review of Symptoms: (Review each body system –This section you should place POSITIVE for… information in the beginning then state Denies…). – General:; Integumentary:; Head:; Eyes:  ; ENT:; Cardiovascular:; Respiratory: ; Gastrointestinal:; Genitourinary:; Musculoskeletal:; Neurological:; Endocrine:; Hematologic:; Psychologic: .

Objective Data:

Vital Signs:  BP – ; P ; R ; T ; Wt. ; Ht. ; BMI .

Physical Assessment Findings: (Includes full head to toe review)  

HEENT:

Lymph Nodes:

Carotids:

Lungs:

Heart:

Abdomen:

Genital/Pelvic:

Rectum:

Extremities/Pulses:

Neurologic:

Laboratory and Diagnostic Test Results: (Include result and interpretation.)

Assessment: (Include at least 3 priority diagnosis with ICD-10 codes.  Please place in order of priority.)

Plan of Care: (Addressing each dx with diagnostic and therapeutic management as well as education and counseling provided).

References

The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners

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Question

1. Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

testosterone therapy.

estrogen-only therapy.

nonhormonal drugs for osteoporosis.

estrogen-progesterone therapy for 1 to 2 years.

Question 2. A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should:

contact the insurance provider to explain why this particular formulation is necessary.

change the patient’s medication to a different drug class that doesn’t have these bioavailability variations.

accept the situation and monitor the patient closely for drug effects with each prescription refill.

ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

Question 3. A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it. The NP notes that the information is from an internet site called “Prism.com.” The NP should tell this patient that:

this information is probably from a drug advertisement website.

this is factual, evidence-based material with accurate information.

the information is from a nonprofit group that will not profit from drug sales.

internet information is unreliable because anyone can post information there.

Question 4. A primary care NP is reviewing written information about a newly prescribed medication with a patient. To evaluate this patient’s understanding of the information, the NP should ask the patient to:

read the information aloud.

describe how the medication will be taken.

write down questions about the medication.

tell the NP if the information is unclear.

Question 5. A patient is diagnosed with lupus and reports occasional use of herbal supplements. The primary care NP should caution this patient to avoid:

ginseng.

echinacea.

ginkgo biloba.

St. John’s wort.

Question 6. A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication. The primary care NP notes that the medication refill is not due for 2 weeks. The patient tells the NP that the refill is needed because he is going out of town. The NP should:

fill the prescription and document the patient’s explanation of the reason.

review the patient’s chart to see if this is a one-time or repeat occurrence.

call the patient’s pharmacist and report suspicion of drug-seeking behaviors.

confront the patient about misuse of narcotics and refuse to fill the prescription.

Question 7. The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners.Which statement by the patient indicates she understands the  regimen?

“I have to take a pill only every 3 months.”

“I should expect to have only four periods each year.”

“I will need to use condoms for only 7 more days.”

“This type of pill has fewer side effects than other types.”

Question 8. The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary.” The NP should:

inform the patient that an out-of-pocket expense will be necessary.

write the prescription for a generic drug if it meets the patient’s needs.

call the patient’s insurance provider to advocate for this particular drug.

contact the pharmaceutical company to see if medication samples are available.

Question 9. A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms. She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT). The NP should:

tell her that starting HT now may reduce her risk of breast cancer.

advise a short course of HT now that may decrease her risk for CHD.

tell her that HT will not help control her symptoms during postmenopause.

recommend herbal supplements for her symptoms to avoid HT side effects.

Question 10. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:

to take the dose recommended by the manufacturer.

not to worry about taking this drug with any other medications.

to avoid taking other drugs that cause sedation while taking this drug.

that over-the-counter acid reflux medications are generally safe to take with other medications.

Question 11. A patient will begin taking two drugs that are both protein-bound. The primary care NP should:

prescribe increased doses of both drugs.

monitor drug levels, actions, and side effects.

teach the patient to increase intake of protein.

stagger the doses of drugs to be given 1 hour apart.

Question 12. The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should:

compromise with the parents and order a nasogastric tube for feedings.

initiate a discussion with the parents about the potential outcomes of each possible action.

refer the family to a case manager who can help guide the parents to the best decision.

understand that the child’s parents have a right to make choices that override those of the medical team.

Question 13. A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

use an existing guideline from a leading research hospital.

follow the guideline provided by a third-party payer to help ensure reimbursement.

review expert opinion and experimental, anecdotal, correlational study data.

write the guideline to adhere to long-standing practice protocols already in use.

Question 14. The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system. The pharmacist will fill this prescription when:

the electronic prescription is received.

the patient brings a written copy of the prescription.

a copy of the written prescription is faxed to the pharmacy.

the pharmacist accesses the patient’s electronic record to verify.

Question 15. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:

monitor frequently for desired and adverse effects.

administer a much higher initial dose as a loading dose.

monitor creatinine clearance at baseline and periodically.

administer the drug via a route that avoids the first-pass effect.

Question 16. An important difference between physician assistants (PAs) and NPs is PAs:

always work under physician supervision.

are not required to follow drug treatment protocols.

may write for all drug categories with physician co-signatures.

have both inpatient and outpatient independent prescriptive authority.

Question 17. A primary care NP writes a prescription for an off-label use for a drug. To help ensure compliance, the NP should:

include information about the off-label use on the E-script.

provide the patient with written instructions about how to use the medication.

tell the patient to let the pharmacist know that the drug is being used for an off-label use.

follow up by phone in several days to see if the patient is using the drug appropriately.

Question 18. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:

review healthy dietary practices with this patient.

make sure that the supplements contain large doses of vitamin A.

tell the patient that antioxidants are especially important for patients who smoke.

tell the patient that evidence shows antioxidants to be effective in preventing cancer.

Question 19. A woman comes to the clinic to talk about weight reduction. The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28. The woman’s waist measures 34 inches. The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months. The NP should:

suggest she try over-the-counter (OTC) orlistat.

consider prescribing phentermine short-term.

discuss her short-term and long-term weight loss goals.

give her information about physical activity and diet modification.

Question 20. A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should:

tell the patient that when postmarketing data is available, it will be considered.

review the pharmaceutical company promotional materials about the new medication.

prescribe the medication if it is less expensive than the current drug formulation.

prescribe the medication if the new drug is available in an extended-release form.

Question 21. An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she:

should consider another form of contraception after 1 year.

may have irregular bleeding, especially in the first month or so.

will need to take calcium and vitamin D every day while using this method.

will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics.

Question 22. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form:

is absorbed less quickly.

has reduced bioavailability.

has fewer systemic side effects.

provides dosing that is easier to regulate.

Question 23. A patient who has breast cancer has been taking toremifene for 2 weeks. She tells her primary care NP that she thinks her tumor has grown larger. The NP should:

schedule her for a breast ultrasound.

reassure her that this is common and will subside.

tell her she may need an increased dose of this medication.

contact her oncologist to discuss adding another medication.

Question 24. The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should:

write “off-label use” on the prescription and provide a rationale.

call the pharmacist to explain why the instructions deviate from common use.

write the alternative drug regimen on the prescription and send it to the pharmacy.

tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.

Question 25. The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years. The NP decreases the dosage, and several weeks later, the woman calls to report having several hot flashes each day. The NP should:

increase the HT dose.

discontinue HT.

recommend black cohosh to alleviate symptoms.

reassure her that these symptoms will diminish over time.

Tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste

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Assignment: Creating a Flowchart

PLEASE SEE ATTACHED FILE FOR SAMPLE DOCUMENT

Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining.

In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

To prepare:

  • Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.
  • Consider how you would design a flowchart to represent the current workflow.
  • Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.

To complete:

Write a 3- to 5-page paper which includes the following:

  • Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)
  • Next, in your paper:
    • Explain the process you have diagrammed.
    • For each step or decision point in the process, identify the following:
      • Who does this step? (It can be several people.)
      • What technology is used?
      • What policies and rules are involved in determining how, when, why, or where the step is executed?
      • What information is needed for the execution of this step?
    • Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?
    • Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.
    • Summarize why it is important to be aware of the flow of an activity.
    • McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
      • Chapter 14, “Nursing Informatics: Improving Workflow and Meaningful Use”

        This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.
      Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.Retrieved from the Walden Library databases.In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.Retrieved from the Walden Library databases.This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.
  • Remember to include a cover page, introduction, and summary for your paper.

Effective Public Health Program Implementation

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Evaluate the hypothetical program that you created (see attached paper) using the following types of evaluation: formative, process, outcome, and impact. Identify each type of evaluation that you are using and the part of the program to which it applies, program goals, and program accomplishments. Describe successful areas of the program and areas that need improvement. For the areas requiring improvement, present the changes that will be made, the anticipated outcomes, and how those changes would be evaluated.

Write a 15–20-page, double-spaced paper in Word format. Apply APA standards to citation of sources.

Utilize at least 7–10 scholarly sources in your research and be sure to include a references page. Write in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation and attribution of sources; and display accurate spelling, grammar, and punctuation.

Support your statements with scholarly references and appropriate examples. Cite all sources using the APA format.

Reference

Centers for Disease Control and Prevention. (n.d.). Types of evaluation.
           Retrieved from http://www.cdc.gov/std/Program/
           pupestd/Types%20of%20Evaluation.pdf

Assignment 2 Grading Criteria Maximum Points
Evaluated program using formative, process, outcome, and impact processes.150
Described areas of success and areas that need improvement.95
Provided recommendations, outcomes, and future evaluation methods.95
Presented a structured document free of spelling and grammatical errors.20
Properly cited sources using APA format.20
Used at least seven current and relevant references.20
Total:400

Case Study: Selective Abortion and IVF

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Case Study: Selective Abortion and IVF

Case Study Assignments (45 points each, see rubric) 

Greg and Abigail Grossman, an older couple who were patients of Mrs. Clemmons (a nurse in a clinic specializing in assisted reproduction), were finally successful in their third attempt at IVF. Mrs. Grossman’s pregnancy test was positive 2 weeks after the procedure, and her hormone levels were very high, indicating that more than one embryo was viable. Indeed, by the fourth month of pregnancy, five fetuses could be seen on ultrasound, and all seemed to be developing normally. The clinic had followed the usual procedure of implanting more than one embryo in order to increase the chance that at least some would survive. Although implanting as many as five is uncommon, some people wanting to increase the probability of at least one successful pregnancy do transfer that many, especially if the woman is older and previous attempts have failed Case Study: Selective Abortion and IVF.

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At this point, the clinic physician recommended that the Grossmans reduce the pregnancy to two fetuses to ensure their survival, to prevent the birth of premature infants needing costly neonatal nursery services for weeks after the birth, and to avoid potential harm (cardiac overload) to Mrs. Grossman. The procedure would be a selective abortion of three of the fetuses.

The Grossmans were horrified by this information and did not know what to do. They asked Mrs. Clemmons to help them make their decision. To be honest, she found it very hard to see couples faced with this type of choice. She shared their grief when they failed to become pregnant through sometimes several IVF procedures. Each IVF attempt was hard on the woman’s health, hard on the marriage relationship, and expensive. Many couples used their retirement savings or took huge loans to pay for the treatment and then had no idea how they would pay for the child’s college education. Once a woman became pregnant, it seemed a cruel twist to then recommend killing some of the fetuses so that others would have a better chance at healthy births—especially when it took such a great effort to have any fetuses in the first place! She found the potential for selective abortion one of the most undesirable aspects of IVF. Even though this possibility was explained to couples before beginning IVF, she had not observed one case in which a couple who made the decision to selectively abort did not experience serious emotional trauma and did not later question their decision. Two of the clinic’s couples had, in fact, lost their remaining fetuses a few weeks after elective abortion procedures. How could Mrs. Clemmons best help the Grossmans through this difficult decision?

1. If a couple could make a selective abortion choice based on sexual preference, what would prohibit some other couple from making a selective abortion choice based on genetic endowments such as blue eyes and blond hair, or mental intelligence? 

2. What role should nurses have in discussing the limits of technological advances and the morality of their uses? Case Study: Selective Abortion and IVF

 

Integrated Prescriptive Pain Theories

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Integrated Prescriptive Pain Theories

Several theoretical frameworks have been proposed to explain the physiological basis of pain, although none yet completely accounts for all aspects of pain perception. Here, we provide a historical overview of the major contributions, ideas, and competing theories of pain from ancient civilizations to Melzack and Wall’s Gate Control Theory of Pain.

The current definition of pain, established by the International Association for the Study of Pain (IASP) in 1986, defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of tissue damage, or both.” This definition is the culmination of centuries of ideas and work that have explored the concept of pain.

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A number of theories have been postulated to describe mechanisms underlying pain perception. These theories date back several centuries and even millennia (Kenins 1988; Perl 2007; Rey 1995). This review will mainly focus on theories postulated since the 17th century and then provide an overview of current thinking. The four most influential theories of pain perception include the Specificity (or Labeled Line), Intensity, Pattern, and Gate Control Theories of Pain (Fig. 1)Integrated Prescriptive Pain Theories.

 

Fig. 1.Schematic diagrams of pain theories. A: based on the Specificity Theory of Pain; each modality (touch and pain) is encoded in separate pathways. Touch and pain stimuli are encoded by specialized sense organs. Impulses for each modality are transmitted along distinct pathways, which project to touch and pain centers in the brain, respectively. DRG, dorsal root ganglion. B: based on the Intensity Theory of Pain; there are no distinct pathways for low- and high-threshold stimuli. Rather, the number of impulses in neurons determines the intensity of a stimulus. The primary afferent neurons synpase onto wide-dynamic range (WDR) 2nd-order neurons in the dorsal horn of the spinal cord, where low levels of activity encode innocuous stimuli, and higher levels of activity encode noxious stimuli. C: the Pattern Theory of Pain posits that somatic sense organs respond to a dynamic range of stimulus intensities. Different sense organs have different levels of responsivity to stimuli. A population code or the pattern of activity of different neurons encodes the modality and location of the stimulus. D: the Gate Control Theory of Pain proposes that both large (A-fibers) and small (C-fibers) synpase onto cells in the substantia gelatinosa (SG) and the 1st central transmission (T) cells. The inhibitory effect exerted by SG cells onto the primary afferent fiber terminals at the T cells is increased by activity in A-fibers and decreased by activity in C-fibers. The central control trigger is represented by a line running from the A-fiber systerm to the central control mechanisms; these mechanisms, in turn, project back to the Gate Control system. The T cells project to the entry cells of the action system. +, excitation; −, inhibition. Figure is Integrated Prescriptive Pain Theories

SPECIFICITY THEORY OF PAIN

The Specificity Theory refers to the presence of dedicated pathways for each somatosensory modality. The fundamental tenet of the Specificity Theory is that each modality has a specific receptor and associated sensory fiber (primary afferent) that is sensitive to one specific stimulus (Dubner et al. 1978). For instance, the model proposes that non-noxious mechanical stimuli are encoded by low-threshold mechanorecepetors, which are associated with dedicated primary afferents that project to “mechanoreceptive” second-order neurons in the spinal cord or brainstem (depending on the source of the input). These second-order neurons project to “higher” mechanoreceptive areas in the brain. Similarly, noxious stimuli would activate a nociceptor, which would project to higher “pain” centers through a pain fiber. These ideas have been emerging over several millennia but were experimentally tested and formally postulated as a theory in the 19th century by physiologists in Western Europe.

Descartes’ description of the pain system.

René Descartes was one of the first Western philosophers to describe a detailed somatosensory pathway in humans. Descartes’ manuscript, Treatise of Man (originally written in French), was illustrated, edited, and published posthumously, first in Latin in 1662 (Descartes 1662) and then in French in 1664 (Descartes et al. 1664). In Treatise of Man, based on the French edition by Louis La Forge (who was also one of the illustrators), Descartes describes pain as a perception that exists in the brain and makes the distinction between the neural phenomenon of sensory transduction (today, known as nociception) and the perceptual experience of pain. What is essential to the development of Descartes’ theory is his description of nerves, which he perceived as hollow tubules that convey both sensory and motor information. This understanding of neural function was by no means novel. In the third century BCE, Herophilus demonstrated the existence of sensory and motor nerves, and Erasistratus demonstrated that the brain influenced motor activity (Rey 1995). One-half of a millennium later, Galen demonstrated that sectioning the spinal cord caused sensory and motor deficits (Ochs 2004). Within the spirit of scientific enquiry that resurfaced in the renaissance, anatomical studies by Vesalius published in 1543 reiterated and confirmed Galen’s findings (Ochs 2004)Integrated Prescriptive Pain Theories. In relation to this, Galen had postulated that three conditions be met for perception: 1) an organ must be able to receive the stimulus, 2) there must be a connection from the organ to the brain, and 3) a processing center that converts the sensation to a conscious perception must exist (Rey 1995). Descartes contributed to Galen’s model by postulating that a gate existed between the brain and the tubular structures (the connections), which was opened by a sensory cue (Descartes et al. 1664). A sensory cue would “tug” on the tube, which would then open a gate between the tube and the brain. The opening of this gate would then allow “animal spirits” (an extension of the Greek pneuma1) to flow through these tubes and within the muscles to move them. Although this sensory system was not specific to pain, La Forge’s drawing (based on Descartes’ concept and La Forge’s understanding of contemporaneous anatomy) of a foot near a flame is one of the most famous figures in neuroscience (Fig. 2). This example describes the pathway for promptly moving one’s foot away from a hot flame. In the figure (and its description in the text), the heat of the flame near the foot activates a fibril (or fiber) within the nerve tubule that traverses up the leg, to the spinal cord, and finally, to the brain. Descartes compared this fiber with a cord attached to a bell—by pulling on the other end of cord, the bell will ring. The proverbial bells, in this case, are the pores that line the ventricles in the brain. Once these pores open in response to the sensory input, the animal spirits were thought to flow through the tubule and elicit a motor response. This motor response included turning the head and the eyes to see the flame and raising the hands and folding the body away from the flame for protection. Descartes conceived that there are many of these fibrils and that their movements elicit the sensations. For example, the perception of pain would be felt in the brain when there is a significant tug on the fiber, which caused it to sever. In contrast, a tug of the same magnitude that does not cause the fiber to break would evoke a tickling (or tingling; Descartes uses the French word chatouillement) perception. Although La Forge’s figure of the boy and the flame suggests that there is a dedicated pain pathway, a closer read of the text indicates that Descartes believed that the pattern and rate of firing (intensity of tugging) of a fiber provided the adequate information to the brain about the stimulus intensity and quality. In fact, it is likely that the misconception of a dedicated pathway in the somatosensory system by Descartes is an extension of his proposal that the visual system requires a labeled line (where the image is carried and projected in the brain)Integrated Prescriptive Pain Theories.

The integration of community health, leadership, and an EBP

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In collaboration with your approved course mentor, you will choose a specific evidence-based practice proposal topic for the Capstone Project. Consider the clinical environment in which you are currently working or have recently worked. The Capstone Project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. A combination of 100 “supervised clinical hours” in community health and leadership areas will be obtained through the application of the objectives listed in the “Guidelines for Undergraduate Field Experiences” manual and as captured in the ISP.

Practicum immersion experiences are required in a community health setting. Community health and leadership practice immersion can occur in the same site and in conjunction with the evidence-based project in the NRS-490V course. Definitions of community-based settings should encourage community integration and involvement; expand accessibility of services and supports; promote personal preference, strengths, dignity; and empower people to participate in the economic mainstream. Examples of the integration of community health, leadership, and an EBP can be found at Healthy People 2020.

The goals of the practice immersion experience is to apply the learning from your research, community health, and leadership courses:

After studying this course, you should be able to:

  1. Demonstrate and apply knowledge of factors to consider when planning to work with a chosen community.
  2. Demonstrate and apply knowledge of approaches that will facilitate engagement of the community.
  3. Demonstrate and apply knowledge and skills required to work constructively with communities.
  4. Demonstrate and apply knowledge related to engagement of organizational leadership and change agents.
  5. Demonstrate and apply knowledge related to disseminating project findings/data with organizational leadership and change agents.
  6. Demonstrate and apply knowledge related to completing an evidence-based project to impact population health outcomes.
  7. Demonstrate and apply Healthy People 2010/2020 principles related to completing an evidence-based project to impact population health outcomes.

According to Healthy People.gov, educational and community-based programs and strategies are designed to reach people outside of traditional health care settings. These settings may include:

  • Schools
  • Worksites
  • Health care facilities
  • Communities

Each setting provides opportunities to reach people using existing social structures. This maximizes impact and reduces the time and resources necessary for program development.

In a composition of no more than 750 words, describe the nature of your proposed project topic. Include the following in your discussion:

  1. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
  2. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
  3. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
  4. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.

Preview and utilize the “Project Topic Checklist” resource located in the topic materials to assist in developing your proposed Capstone Project topic. This resource will assist you in organizing your work and will provide additional information regarding the assignment. Note: You are required to retrieve and assess a minimum of 15 peer-reviewed articles. Plan your time to complete this assignment accordingly.

Attach the completed “Project Topic Checklist” to your assignment submission.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are not required to submit this assignment to Turnitin.

The Connection Between Academic and Professional Integrity

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The Connection Between Academic and Professional Integrity

Using the Academic and Professional Success Development Template you began in Week 1 and continued working on in Week 2, write a 2- 3-paragraph analysis that includes the following:

  • Clearly and accurately explains in detail the relationship between academic integrity and writing.
  • Clearly and accurately explains in detail the relationship between professional practices and scholarly ethics.
  • Accurately cite at least 2 resources that fully support your arguments, being sure to use proper APA formatting. The Connection Between Academic and Professional Integrity
  • Use Grammarly and Safe Assign to improve the product.

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Clearly and accurately describe in detail how Grammarly, SafeAssign, and paraphrasing contributes to academic integrity. Include sufficient evidence that Grammarly and SafeAssign were utilized to improve responses.

Part 3, Section 2: Strategies for Maintaining Integrity of Work

Expand on your thoughts from Section 1 by:

  • Clearly identifying and accurately describing strategies you intend to pursue to maintain integrity and ethics of your 1) academic work while a student of the MSN program and 2) professional work as a nurse throughout your career.
  • Include a clearly developed review of resources and approaches you propose to use as a student and a professional.
  • Note: Add your work for this Assignment to the original document you began in the Week 1 Assignment, which was built off the Academic Success and Professional Development Plan Template.

Remember to include an introductory paragraph that contains a clear and comprehensive purpose statement that delineates all required criteria, and end the assignment Part with a conclusion paragraph. Also, cite at least 5 references The Connection Between Academic and Professional Integrity

Health Services Organizations Assignment

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Health Services Organizations Assignment

Your third assignment will be an analysis of the place and price decisions of a health services organization. You might have to seek out some information on the organization by visiting its website, or if it is an employer interviewing someone who has knowledge of the pricing and distribution decisions.  After you have completed your research, answer each of the following questions in turn following all the general guidelines or written assignments posted in the syllabus. Health Services Organizations Assignment

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  1. Brief overview of the organizations service/products and a description of their target market.  This is important to ensure that your analysis considers the needs of the target market in evaluating their pricing and channel decisions.
  2. How do you think the organization arrives at its price?  Refer to the Week 6 Overview for a framework of some of the pricing considerations and discuss those that appear relevant to your organization. Health Services Organizations Assignment
  3. Do you think the pricing strategy is appropriate?  Can it be improved to better meet its customer’s needs?
  4. Is the organization hindered or helped in their pricing decisions by government or payer restrictions.  If so, how do these restrictions impact their pricing strategy?
  5. What kind of value delivery network does the organization employ, e.g. horizontal or vertical, and what is their distribution strategy, e.g. exclusive, intensive or intensive? What factors influence the distribution strategies of this organization?  Are they customer-focused?   If possible, outline all of the channel members and what function they perform to serve the customer?
  6. Can you recommend any changes to the value delivery network that would serve customer needs better?

Health Services Organizations Assignment

 

 

The need for change in health care policy is now an intricate part of your role as a social change agent

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During NP clinical practicum experiences, we identify, as nurses, many health care issues that need to be addressed at the local, state, or national level. Addressing the need for change in health care policy is now an intricate part of your role as a social change agent.

For this Discussion, you will identify a change needed in your community (state of Mississippi) and what your nursing legacy for positive social change will be.

To prepare:

  • Consider the health care issues and deficits you have recognized in your professional practice.
  • Identify a change needed in your community (state of Mississippi) in health care policy and discuss how you could impart change during your career as an NP.
  • Consider your future as a NP and what your nursing legacy will be. How will you impart Social Change?

To complete:

Post 1-2 pages on:

A change needed in your community (state of Mississippi) and an explanation for how you will begin to implement that change.

Then, share with your colleagues a brief explanation of what your nursing legacy will be and how will you impart Social Change.

References

Buppert, C. (2015). Buppert, C. (2015). Lawmaking and Health Policy. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.). (423-436). Burlington, MA: Jones & Bartlett.

Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102-112, 199.

National Conference of State Legislatures. (n.d.). Glossary of Legislative Terms. Retrieved from http://www.ncsl.org/research/about-state-legislatures/glossary-of-legislative-terms.aspx

You may use other scholarly resources and websites as you see fit.