Low Birth-Weight Babies

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Describe the effect of extremely low birth weight babies on the family and community. Consider short-term and long-term impacts, socioeconomic implications, the need for ongoing care, and comorbidities associated with prematurity.

Explain how disparities relative to ethnic and cultural groups may contribute to low birth weight babies.

Identify one support service within your community to assist with preterm infants and their families and explain how the service adequately addresses the needs of the community, or a population in your community. Provide the link to the resource in your post.

Consider the following patient scenario:

A mother comes in with 9-month-old girl. The infant is 68.5cm in length (25th percentile per CDC growth chart), weighs 6.75kg (5th percentile per CDC growth chart), and has a head circumference of 43cm (25th percentile per CDC growth chart).

Describe the developmental markers a nurse should assess for a 9-month-old female infant. Discuss the recommendations you would give the mother. Explain why these recommendations are based on evidence-based practice.

Power Point Of A Discharge Teaching Plan

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Power Point Of A Discharge Teaching Plan

Term Project

 

Assignment: Select a disease process that we have covered in class. Create a discharge teaching plan for a patient recently diagnosed with the selected disease.

Project should include:

  • Patient profile with patient demographics and storyline (appropriate risk factors).
  • Complaints and presenting symptoms
  • Nursing assessment
  • Expected procedures and lab tests to be ordered to confirm the diagnosis. Include an explanation of how the procedures, medications, or tests will confirm/support the patient’s diagnosis.
  • Pathophysiology: Explanation of what the confirmed diagnosis is how the patient ended up with this diagnosis (risk factors, health history, etc.) Power Point Of A Discharge Teaching Plan
  • Treatment of disease: Medications,5 interventions, diet, procedures, follow up visits, interdisciplinary team, etc. Include rationale for each treatment that you list.
  • References: At least two references for the project in APA format

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Rubric

  • Presentation: completed in a professional and organized manner (15 pts)
  • Creativity: Demonstrates creativity in the design of presentation. The presentation is engaging and visually appealing. (10 pts)
  • Patient objectives: learning points for the patient and what the patient needs to monitor for in relation to the diagnosis. (25 pts)
  • Teaching Focus: Includes topic: disease process, risk factors and medications (25 pts)
  • Resources: Did student list who should be involved in the patient care, how interdisciplinary teamwork and collaboration promoted patient care and affect the outcome of care? (20 pts)
  • References: Utilizes APA format (5 pts) Power Point Of A Discharge Teaching Plan

 

 

Politics, Stress, and Sleep

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In your reading assignments for this module, you read about a classic example of politics and health promotion in the episode of Rick Perry and the HPV vaccine. For your original post, cite another example of politics and a health promotion topic. An example could be smoking cessation and politics (whether on the local, state, or national level). Thoroughly explain how politics and the selected health promotion topic are related. Your post should clearly demonstrate a thorough understanding of the example being provided. Remember to include an APA formatted in-text citation and corresponding reference from a recent (within last 5 years) professional journal or website (NIH, CDC, etc.).

Provide your initial post, then engage at least two of your online colleagues in a discussion about his/her initial posts. Therefore, you should have at least one initial post and one response to each of two colleagues. Please note that your postings and responses must be “substantive”, which means that they are to be made AFTER you have read the assigned course material and additional self-chosen material. Please note that your Discussion Board assignments are worth a significant part of your course grade, therefore, you are expected to put thought and effort into these entries.

Original post is due by Wednesday at 2359, and the two responses to peers are due by Saturday of Module 2 at 2359.

An APA formatted in-text citation and corresponding reference from a recent (within last 5 years) professional journal or website (NIH, CDC, etc.) are required in your initial discussion post. Blogs, magazines, and newspapers are NOT considered scholarly, professional sources.

Proffesional Nurse Educating

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The purpose of this assignment is to demonstrate the skills of the professional nurse as an educator. You are to prepare a guide that will serve as a handout to assist a specific patient that you identify. Your guide or handout should help this patient find and evaluate a reliable mobile health, or mHealth application (app) that is already developed. This may be related to the patient’s disease process or diagnosis, or may be an app that can help a patient maintain or improve good health, and prevent illness.

You will develop the guide using Microsoft PowerPoint. PowerPoint is a versatile application that lets you design slideshows and handouts. For this assignment, you will be using PowerPoint to create a guide or handout that you may print and give to patients and families. You will be submitting this PowerPoint file for grading.

Course Outcomes

This assignment enables the student to meet the following Course Outcomes.

CO 1: Describe patient-care technologies as appropriate to address the needs of a diverse patient population. (PO 1)

CO 5: Identify patient care technologies, information systems, and communication devices that support safe nursing practice. (PO 5)

Points

This assignment is worth a total of 175 points.

Due Date

The Patient Education Technology Guide to a Mobile Health Application PowerPoint assignment is due in Week 2. Submit your completed assignment. You may consult the Policies section in the Introduction & Resources module for details regarding late assignments. Late assignments will result in loss of points. Post questions about this assignment in the Course Q & A Forum.

Directions

Use Microsoft PowerPoint to create slides, which will be the basis of the guide or handout. You are required to cite your source(s) as it relates to your application slide. Other citations are permitted, but this is not a requirement for the assignment.

Title slide (first slide): Include a title slide with your name and the title of the presentation.

Scenario Slide (one slide): This slide should include a brief scenario, then identify a patient who is experiencing a specific disease process or diagnosis who would benefit from an already developed and reliable mHealth app. Or it could identify a person who is currently healthy and would like to maintain or improve health and prevent illness. Be sure to include the nurse’s assessment of the patient’s learning needs and readiness to learn. Be specific.

Example:

Scenario for Ms. Ellis

Jane Doe (your name here)

Jennifer Ellis, a 62-year-old African American woman, has been recently diagnosed with chronic kidney disease (CKD). She has been prescribed several medications she must take every day.

The nephrologist has stressed the importance of leading a healthy lifestyle to slow or stop the progression of CKD.

She is interested in ways in which she can better track her health and make healthier choices.

She is a high school graduate and iPhone user, mostly to send text messages to family and friends.

She is eager to learn how to use an app that can help her manage her CKD.

Prepare the following slides as if you are presenting them to the patient.

mHealth application slide (one to three slides): Identify a developed and reliable mHealth app that could benefit the patient. Describe the app, including the following.

Name

Purpose

Intended audience

Mobile device(s) upon which it will operate

Where to download or obtain it (include a working link if it is to be downloaded from a website)

Any other information you believe would be pertinent to this situation

Be sure to cite all sources you use.

Teaching slides (one to three slides): Prepare slides that contain important points about the app that you want to teach to the patient, such as how to use the app safely and effectively (including how to interpret and act on the information that is provided).

Evaluation slide (one to three slides): Describe how you would determine the success of the patient’s use of this app. For example, include ways to evaluate the effectiveness of the teaching plan that are a good fit for the type of app or focus on specific ways that this app benefits the patient’s health and wellness.

References (last slide): List any references for sources that were used or cited in the presentation.

Writing and design: There should be no spelling or grammatical errors. Writing is concise and clear. Avoid words that the patient may not understand. Slides are visually appealing, incorporating graphics, photographs, colors, and themes.

Review the section on Academic Integrity Policy found in the RNBSN Policies. All work must be original (in your own words) unless properly cited.

Best Practices in Preparing PowerPoint Slideshows

Be creative but realistic.

Incorporate graphics, color, themes, or photographs to increase interest.

Make it easy to read with short bullet points and large font.

Review directions thoroughly.

Cite all sources within the slides with (author, year), as well as on the reference slide.

Proofread prior to final submission.

Check for spelling and grammar errors prior to final submission.

Abide by the Chamberlain academic integrity policy.

Tutorial: For those not familiar with the development of a PowerPoint slideshow, the following link to the Microsoft website may be helpful. http://office.microsoft.com/en-us/support/training-FX101782702.aspx (Links to an external site.)Links to an external site. The Chamberlain Student Success Strategies (CCSSS) offers a module on Computer Literacy that contains a section on PowerPoint. The link to SSPRNBSN may be found in your student portal.

Academic Integrity Reminder

Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments.

By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment. Please see the grading criteria and rubrics on this page.

NOTE: Please use your browser’s File setting to save or print this page.

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Rubric

NR361 Patient Guide

NR361 Patient Guide

Criteria​Ratings​Pts

This criterion is linked to a Learning OutcomeScenario Slide

view longer description

40.0 pts

Scenario is a clear and concise description of patient with a specific disease or diagnosis, or someone who is healthy and wants to prevent illness and maintain good health. Makes clear that the person is seeking information, including a detailed assessment of learning needs and readiness to learn.

35.0 pts

Scenario is clear but not concise as it exceeds more than one slide. It includes a description of the patient with specific disease or diagnosis, or desire to maintain good health. Scenario generally describes the nurse’s assessment of learning needs and readiness to learn.

32.0 pts

Scenario includes a description of the patient with specific disease or diagnosis, or desire to maintain good health. Scenario lacks the nurse’s assessment of learning needs OR readiness to learn.

15.0 pts

Scenario is missing the description of disease process OR diagnosis OR desire to maintain good health Scenario lacks both the nurse’s assessment of learning needs AND readiness to learn.

0.0 pts

Scenario fails to describe the patient’s situation The nurse’s assessment of learning needs and readiness to learn are lacking.

40.0 pts

This criterion is linked to a Learning OutcomemHealth Application Slide

view longer description

50.0 pts

Describes the mHealth application in detail including its: Name, Purpose, Intended Audience, Mobile device upon which it operates, Download or where to obtain, Other pertinent information, and Sources that are used are cited.

44.0 pts

Describes the mHealth application but is lacking one of the elements in the first column.

40.0 pts

Describes the mHealth application but is lacking two of the elements in column.

19.0 pts

Describes the mHealth application but is lacking three of the elements in the first column.

0.0 pts

Provides a poor or confusing description of the mHealth application that lacks most of the elements in the first column.

50.0 pts

This criterion is linked to a Learning OutcomeTeaching Slide

view longer description

40.0 pts

Prepares slides that teach all pertinent details about how to use the app safely and effectively including how to interpret and act on the information that is provided.

35.0 pts

Prepares slides that teach most information about how to use the app safely and effectively including how to interpret the information that is provided.

32.0 pts

Prepares minimal information that the patient needs to know to use the device, for example, lacking safety guidelines that may need to be followed.

15.0 pts

Prepares slides that are confusing and does not convey useful information that the patient needs to know.

0.0 pts

Teaching slides are not included in the presentation

40.0 pts

This criterion is linked to a Learning OutcomeEvaluation Slide

view longer description

20.0 pts

Describes in detail ways to evaluate the effectiveness of the teaching plan that are a good fit for the type of app or focus on specific ways that this app benefits the patient’s health and wellness.

18.0 pts

Describes general or universal ways to evaluate the effectiveness of the teaching plan that considers the nature of the app.

16.0 pts

Describes limited ways to evaluate the effectiveness of the teaching plan, which does not reflect the nature of the app.

8.0 pts

Describes an evaluation plan but it is unlikely to determine if the patient has learned what is necessary.

0.0 pts

Does not include an evaluation plan.

20.0 pts

This criterion is linked to a Learning OutcomeWriting and Design

view longer description

25.0 pts

Slides have the following elements: Name of student appears on the Title Slide; Themes of slides are clearly identified; Bullets are used instead of long sentences or paragraphs; Reading level appropriate for patient; Slides are visually appealing incorporating graphics, photographs, colors and themes; Grammar, punctuation, and spelling are correct; Citation present for application.

22.0 pts

Good mechanics considering the elements listed in the first column.

20.0 pts

Fair mechanics considering the elements listed in the first column.

10.0 pts

Poor mechanics considering the elements listed in the first column.

0.0 pts

Very poor mechanics such that assignment is difficult to read.

25.0 pts

Total Points: 175.0

Week 4 Discussion: Utilitarianism

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Week 4 Discussion: Utilitarianism

Week 4 Discussion: Utilitarianism

Required Resources
Read/review the following resources for this activity:

  • Textbook: Chapters 7, 8
  • Lesson
  • Minimum of 1 scholarly source (in addition to the textbook)

Initial Post Instructions
The principle of utility involves maximizing happiness as a desirable outcome of decisions. Although it does not get directly said, there is an inverse intention to minimize the undesirable outcome of disaster. Utilitarian decisions are directed toward outcomes—that is, the consequences of decisions. Week 4 Discussion: Utilitarianism

We need to look at results. We first look at the actual results of an action. We judge if it was the best possible result. We can judge the actual results in comparison to other results that reasonably could be said to have been possible.

If we do not yet have the actual results of an action, we do not know if it is moral or not. We can talk hypothetically about what might happen, and then what that would show about the morality of an action. However, if we do not know what the action had as its consequences, we cannot yet say if it is moral or not.

Initial Post Instructions
For the initial post of this week’s discussion respond to one of the following options, and label the beginning of your post indicating either Option 1, Option 2, or Option 3:

Option 1: You are a nurse on a floor with only elderly patients. Every day, each patient tells you about how much pain they are in and asks you to help them. They want you to inject them with something to end their lives. If the patients die, the beds on that floor would be freed up for other patients. The hospital is at 100 percent capacity. There is no other hospital for 30 miles. Other patients may be not receiving care due to a lack of free beds. What is the moral thing to do here? Why is that the moral thing to do? What would an utilitarian say is the moral thing to do? Why would they say that? Compare and contrast the utilitarian approach with that of an ethical egoist or social contact theorist

Option 2: A new social media app is offering itself to you for free. If you upload a picture to it, the app will show how you will look at 10 years. John Doe, a friend of yours, says not to use the app as it will then possess your biometric facial data. Jane Doe, another friend of yours, says that she heard the app shares the facial data with a security firm that helps the government detect terrorists at airports. Should you use this app? Why or why not? If John Doe is right, would an utilitarian say it is right to use the app? Why or why not?  If Jane Doe is right, would a social contract theorists say it is right to use the app? Consider the role the Fourth Amendment at play here.

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Option 3: You are a nursing student at the XYZ College. It has a 50 percent acceptance rate (half the applicants do not get in). XYZ is a public college. XYZ has decided to implement an affirmative action policy. The college has few students over the age of 50. To encourage more students of that age, every student 50 or older will receive a bonus point. A student’s admission is dependent on having 11 points. One earns points for a GPA above a certain score, ACT/SAT score above a certain number, having a letter of recommendation, etc. XYZ also lacks LGBT students, Muslim, and African-American students and is considering offering a bonus point for any student fitting those categories. What is the key moral conflict for XYZ? What social values should XYZ promote here? What diverse populations are involved here, and what are their interests? Do you think XYZ’s social action is the correct solution to lack of diversity? Why or why not? Factor the ethics of egoism and utilitarianism into your answer. Week 4 Discussion: Utilitarianism

Follow-Up Post Instructions
Respond to at least one peer. If possible, respond to one peer who chose an option different than the one you chose. Further the dialogue by providing more information and clarification. Make sure that you add additional information and not repeat the same information already posted on the discussion board as you further the dialogue.

Writing Requirements

  • Minimum of 2 posts (1 initial & 1 follow-up)
  • Minimum of 2 sources cited (assigned readings/online lessons and an outside scholarly source)
  • APA format for in-text citations and list of references. Week 4 Discussion: Utilitarianism

 

 

 

Understanding The Bio-Psychosocial Concept

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Understanding The Bio-Psychosocial Concept

Introduction

Bio-psychosocial is a concept that combines the biological, social, and psychological aspects of a disease. Unlike other aspects, addressing the Bio-psychosocial aspects of a disease is important in extensively addressing the concepts of health and wellness in modern-day society. This is because it combines all the aspects, including the biomedical aspects of a disease thus explaining the best methods to remedy a certain disease in people (Merriam Webster, n.d.). According to Sarafino, Smith, King, and DeLongis (2015), health and wellness are common concepts in society. These two concepts overlap each other along a continuum. In addition to that, people in modern society have increasingly become aware of the best methods of maintaining good health. On the other hand, different sources have established that facts the patterns of illness affecting people have been changing in society since the 1900s Understanding The Bio-Psychosocial Concept.

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Bio-Psychosocial Concepts

The causes of illness and health problems in modern society are well documented. Different studies have outlined that chronic illness in modern society has caused healthcare specialists to focus on methods of improving as well as maintaining the quality of life. On the other hand, it is well established that the linkage between psychology and illness was stronger in the olden times when people believed that some illnesses were caused by some evil spirits. The conceptualization of illness and psychology concepts has been changing across the years. The Greek Philosophers as well as scholars from the nineteenth and twentieth centuries have tried to explain the concepts of illness and the mental operations of human beings. However, biomedical innovations and explanations have helped increase the health statuses of people Understanding The Bio-Psychosocial Concept.

In modern society, different scholars have supported the fact that the general lifestyles of people play a vital role in their general health. Common aspects such as lifestyles, life history, relationships, biological processes, mental processes, and personalities of people play a vital role in ensuring that they stay in good health. These are some of the common facets that make Bio-Psychosocial interactions. These interactions refer to the main methods in which these facets interact with each other to influence the general health of human beings. The conceptualization of great mental and psychological conditions to attain better health in people is a common concept that has been approved by different medical and healthcare scholars in modern-day society. The development of the bio-psychosocial concepts has assisted in better developing the health and wellness concepts in modern society. In conjunction with the biomedical concepts, the concepts of bio-psychosocial have greatly assisted in ensuring better health of human beings (Sarafino, Smith, King and DeLongis, 2015) Understanding The Bio-Psychosocial Concept.

Health psychology is a common concept that has received much attention in modern society. This is a knowledge facet that is enriched by knowledge from many other fields in society. On the other hand, the concepts of health and psychology are often interpreted differently across cultures. On the other hand, the processes of health care are often intertwined with other basic concepts that assist in offering better healthcare services. With the development of the bio-psychosocial interaction concepts, it is well established that providing healthcare services for a patient involves combining efforts from different specialists. This is a concept that arose from the emphasis on the bio-psychosocial concepts in society. Some of these specialists include physicians, nurses, midwives, physical therapists, dietitians, occupational therapists, and social workers. This shows that healthcare provision is a complicated endeavor that requires a combination of different concepts in society Understanding The Bio-Psychosocial Concept.

Conclusion

Therefore, it is well established that combining different concepts presented by different specialists in the society can go a long way in ensuring that the healthcare services provided by the medical specialists are up to standards in terms of ensuring that the overall goals of good health are achieved. Therefore, the bio-psychosocial concepts in society combine different aspects seen in society to explain the best methods that can assist in ensuring that the goal of better health among people is achieved. Therefore, combining knowledge from different disciplines can go a long way in ensuring that the goal of better health is achieved Understanding The Bio-Psychosocial Concept.

References

Merriam Webster (n.d.). Medical Definition of biopsychosocial. Retrieved from https://www.merriam-webster.com/medical/biopsychosocial

Sarafino, E. P., Smith, T. W., King, D. B., & DeLongis, A. (2015). Health Psychology: Biopsychosocial Interactions. (Canadian Ed.). John Wiley & Sons Canada, Ltd. Chapter 1. Pp. 1 – 27 Understanding The Bio-Psychosocial Concept

Week 4 Assignment: Greater Good Analysis

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Week 4 Assignment: Greater Good Analysis

Required Resources

Read/review the following resources for this activity:

  • Textbook: Chapters 7, 8
  • Lesson
  • Minimum of 2 scholarly source (in addition to the textbook)
  • Narrated PowerPoint Tutorial(Links to an external site.) (Make sure to review this tutorial before you begin recording.)

Instructions

For this week’s assignment respond to one of the following options, and include Option 1, 2, or 3 as part of your heading.

Option 1: The first option is to name and describe in detail a key specific and recent healthcare technology. What are at least two key moral problems this technology creates? What are the proper moral guidelines for dealing with it in your view? Compare your approach to what a utilitarian and ethical egoist would say (each independently). Consider whether differing ethical beliefs globally might or not agree with what you say.

Option 2: In the second option, name and describe in detail a key specific and recent social technology. What are at least two key moral problems this technology creates? What are the proper moral guidelines for dealing with it in your view? Compare your moral approach to what a utilitarian and social contract ethicist would say (each independently). Consider whether differing ethical beliefs globally might or not agree with what you say. Week 4 Assignment: Greater Good Analysis

Option 3: John Doe, Patient One, is in late stage of kidney disease. If he does not receive a new kidney, then he is predicted to die within a week. Doe is 45, single, and has no children. Doctors theorize that Doe damaged his kidney by not following a low-salt diet. Doe inherited one million dollars and is known for giving money to charity. Without a transplant, he will probably be forced to spend all his money searching for a kidney outside of the usual legal channels. Patient Two is Jane Doe (no relation to John). Patient Two is a mother of two children (ages 21 and 24). She is divorced and 55 years old. She developed kidney problems due to eating a high-fat and high-sugar diet. If she does not receive a kidney within one month, doctors believe she will die. Patient Three is an orphan. This orphan lives in a state facility. She was born with a genetic condition that constantly damages her kidney. The only known approach to her condition is to provide her with a kidney transplant every so often. She is 11 and has already undergone two kidney transplants. She will perish in two months if she does not receive another transplant.

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All three patients are at the same hospital. The hospital only has one kidney to give out. The orphan’s birth parents were known to be of a religion that is opposed to organ donation. The other patients come from religions that do not oppose organ donation. Who should get the kidney? Why should that candidate receive it over the others? Devise a course of social action and a solution for this case by using the ethics of egoism and then utilitarianism to a key moral conflict involving health care in this case. Appraise the interests of diverse populations (in terms of ethnicity, race, religion, sexual orientation, etc.) and how they relate to the case. Consider whether differing ethical beliefs globally might or not agree with what you say.

For all the options:

Cite the textbook and incorporate outside sources, including citations.

You should not be using any text you used in a discussion board or assignment for this class or any previous class.

Consider whether differing ethical beliefs globally might or not agree with what you say. Week 4 Assignment: Greater Good Analysis

You will submit the following:

  • An audiovisual presentation that presents one of the options above. Be sure to give equal time to each element. Doing a PowerPoint presentation with audio recorded on the slides is preferred. Please refer to the Narrated PowerPoint Tutorial located in the Required Resources in this assignment.
  • Please provide a transcript of anything said in the recording aloud that does not appear as text on a slide. This transcript can be provided as a Word document or placed in the Notes section on the PowerPoint slides.
  • The link or a scan of the article mentioning any health technology, social technology, or case you are reporting on. If you made up the case, please indicate that in your report. If you choose to do option #3 (the case about a shortage of transplant kidneys), your article would likely be an article about the shortage of transplant organs, or a shortage of people signing up to be transplant donors, or the status of educating people about being donors, etc.

Presentation Requirements

  • Length: 4-6 minutes narrated presentation
  • Slide length: 4-6 slides (not including title slide, conclusion slide, or references slide)
  • Title slide
  • Conclusion slide
  • References slide (minimum of 2 scholarly sources cited in APA format; not narrated)

Grading

This activity will be graded based on the Assignment Grading Rubric. Week 4 Assignment: Greater Good Analysis

Nursing homework help

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Module part

Module 1b: Introduction

Researchers at Harvard have developed over a dozen tests for measuring implicit bias related to race, sexuality, disability, religion, and other forms of prejudice as part of Project Implicit. Visit the projects Take a Test site (link below) and take TWO of the IATs (one must be the Race IAT) (you may also choose to take other tests). After you view your results, reflect on the test itself, your experience taking the test, and your interpretation of the results.

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https://implicit.harvard.edu/implicit/selectatest.html

Answer the following 6 questions in the submission text box

  1. Summarize the module readings in one paragraph (don’t be vague)
  2. Define implicit bias in your own words
  3. What additional test did you take? What were your results for both tests?
  4. Have you ever thought about what biases you have and how they shape how you interact with others? why or why not?
  5. What are your thoughts about this activity? (feelings, responses, etc)
  6. Was this activity eye-opening? why or why not? Nursing homework help

Advanced Practice Nursing – Case Study – Hypertension

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Hypertension Case Study

C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure.

PMH

Allergic Rhinitis

Depression

Hypothyroidism

Family History

Father died at age 49 from AMI: had HTN

Mother has DM and HTN

Brother died at age 20 from complications of CF

Two younger sisters are A&W

Social History

The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted or exercised.

Medications

Zyrtec 10 mg daily

Allergies

Penicillin

ROS

States that his overall health has been fair to good during the past year.

Weight has increased by approximately 30 pounds in the last 12 months.

States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis.

Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse.

Denies any nausea, vomiting, diarrhea, or blood in stool.

Self treats for occasional right knee pain with OTC Ibuprofen.

Denies any genitourinary symptoms.

Vital Signs

B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 6’1”, Wt 240 lbs.

HEENT

TMs intact and clear throughout

No nasal drainage

No exudates or erythema in oropharynx

PERRLA

Funduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema

Neck

Supple without masses or bruits

Thyroid normal

No lymphadenopathy

Lungs

Mild basilar crackles bilaterally

No wheezes

Heart

RRR

No murmurs or rubs

Abdomen

Soft and non-distended

No masses, bruits, or organomegaly

Normal bowel sounds

Ext

Moves all extremities well

Neuro

No sensory or motor abnormalities

CN’s II-XII intact

DTR’s = 2+

Muscle tone=5/5 throughout

What you should do:

Develop an evidence-based management plan.

Include any pertinent diagnostics. (Screening Chest Xray/EKG, LABS, referrals to cardiologist to eval cardiovascular disease, smoking cessation education, nutritional consult)

Describe the patient education plan. (lifestyle changes, weight management, AHA/DASH diet)

Include cultural and lifespan considerations. ( Common in African American )

Provide information on health promotion or health care maintenance needs.

Describe the follow-up and referral for this patient.

Prepare a 3 page paper (not including the title page or reference page).

Psychiatric Nursing

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sychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antipsychotic therapy for clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

SAMPLE ONLY

NURS 6630

WEEK SEVEN

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Introduction

Briefly, this is a scenario of a 42 year- old woman with a complex psychiatric history extending from depression, posttraumatic stress disorder, insomnia, visual hallucinations (little man)and impaired behavior with aggression. In the course of more than 36 months, the client was treated with Paroxetine (SSRI), Bupropion ( NDRI), Tiagabine, Ramelteon and , but finally a combination of Lexapro, Bupropion and quetiapine was able to decrease her symptoms . The client’s medical history includes diabetes, hypertension, CAD, hyperlipidemia, COPD, OSA, GERD, Glaucoma, overweight and a remote history of substance abuse.

Related Professional Questions

Certain medications or supplements can cause symptoms of mental illness and also due to her extensive medical history and usage of multiple medications I would ask the following questions:

  1. Do you take any over -the – counter, herbal supplements or remedies and I would check for interactions with current medication regimen?
  2. When and how often do you use your albuterol inhaler ? Some of the side effects of albuterol include anxiety, nervousness, and insomnia ( Cunha, 2016)

Sleep Hygiene: Do you keep regular sleep schedule ? Do you drink caffeine beverages close to bedtime?

Patient History

The patient may not be a reliable source of information, particularly that she has a significant mental illness that affects her functioning, hence verifying her responses with her direct family members, and mental social workers to get clues to the underlying or precipitating causes of mental crisis. Also checking facility records from previous encounters, or any psychiatric hospitalizations would be useful.

Diagnostics Testing

  1. Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017)
  2. Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of cardio complications. In the setting of taking antidepressants and antipsychotics, baseline ECG and possibly every three to six months would be appropriate. Several atypical antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)

Differential Diagnoses

  1. Posttraumatic Stress Disorder ( PTSD)_
  2. Major Depressive Disorder (MDD)
  3. Insomnia Disorder. Pharmacotherapy Options for Sleep/ Wake cycle
  4. Zolpidem (Ambien) 5mg oral at bedtime for Seven days.

Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA (Stahl, 2017). With its side effects of sedation, low dose prescribed as the client has respiratory problems (sleep apnea OSA)). Studies have shown that Zolpidem did not significantly worsen OSA as measured by the numbers and duration of pauses in breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels during the night when compared with placebo ( Mason & Smith, 2015).

  1. Trazadone 25 mg oral at bedtime for Thirty days.

Trazadone is a serotonin 2 antagonist/reuptake inhibitor, used in management of depression and insomnia. It is absorbed well, metabolized by CYP 450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem (Stahl, 2017)

The best choice for the client would be Trazadone as there is no reliable evidence of dependence or withdraws and it can also work for the client’s depression.

Conclusion

The case was a perfect example how it is sometimes difficult to find effective pharmacological treatments of psychiatric illnesses. In the course of four years, the client was prescribed 5-6 medications targeting different neurotransmitters to improve the symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her medical comorbidities increased risks of adverse reactions. Lesson learned from this study was that treatment should be optimally initiated after diagnosis, and augment or switching to a new agent must be carefully done in consideration of possible side effects and better outcomes.

References

Bhagwat, N., Tayde, P., Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism and depression: Are cytokines the link? Indian Journal of Endocrinology and Metabolism, 21(6), 886. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-40a4-bd10-f956796bc9e8%40sessionmgr101

Cunha, J. (2016). Common Side Effects of Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htm

Mason, M., & Smith, I. (2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea (OSA) in adults with known OSA | Cochrane. Retrieved from http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-medications-obstructive-sleep-apnoea-osa-adults-known-osa

Zhai, D., Lang, Y., Dong, G., Liu, Y., Wang, X., Zhou, D., … Zhang, R. (2017). QTc interval lengthening in first-episode schizophrenia (FES) patients in the earliest stages of antipsychotic treatment. Schizophrenia Research, 179, 70-74. Retrieved from https://resolver-ebscohost-com.ezp.waldenulibrary.org/openurl?ID=pmid%3a27727006&genre=article&atitle=QTc+interval+lengthening+in+first-episode+schizophrenia+(FES)+patien