The Reversible changes occur to tissue cells when they are hypoxic

No Plegarism please, assignemnt will be checked with Turnitin. 

Will need 4 full pages for the case study, APA Style, double spaced, times new romans, font 12, and a title page and a reference page. 

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

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

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

Case Study 2

Maria is a sedentary, 68-year-old woman who is overweight. She complains that her hands and feet are always cold, and she tires quickly when cleaning the house. At her most recent visit to her doctor, her blood pressure was 184/98 mm Hg. She has edema around her ankles and legs, and her physician is concerned about an echocardiogram that indicates Maria has an enlarged heart. 

1.Identify two reasons why Maria will have tissue ischemia. How might this lead to hypoxia? 

2.What two early and reversible changes occur to tissue cells when they are hypoxic? 

3. What specific type of cellular adaptation has taken place in Maria’s enlarged heart? What made you come to this conclusion? 

4.Predict why Maria’s heart has become enlarged. Why doesn’t this enlargement give her the same cardiac strength and endurance as a well-trained athlete?

The quality improvement (QI) approaches and models that health care administrators can effectively apply.

Module 4 – Case

HEALTH CARE OPERATIONS AND QUALITY

Assignment Overview

According to the Agency for Healthcare Research and Quality (2002), “a central goal of healthcare quality improvement is to maintain what is good about the existing healthcare system while focusing on the areas that need improvement” (para. 2). This assignment will familiarize you with the quality improvement (QI) approaches and models that health care administrators can effectively apply.

Case Assignment

Use the library to access the following book: The healthcare quality book: vision, strategy, and tools.  Review Chapter 4, Quality Improvement: Foundation, Processes, Tools, And Knowledge Transfer Techniques. There are six approaches/models of quality improvement discussed in Chapter 4.

Create an 8- to 10-slide PowerPoint (PPT) to discuss three of the six approaches/models of quality improvement discussed. Your presentation should address the following explicitly:

1. Explanation and/or reasoning for the importance of using quality improvement as a health care administrator. 

2. The steps, stages, or processes of each selected approach/model.

3. Example of health care administrator’s applicable use of each selected approach/model.

Assignment Expectations

1. Speaker notes, citations, and a reference slide are required.

2. Conduct additional research to gather sufficient information to support the information presented in PPT.

3. Support your case with peer-reviewed articles, with at least 2 references (you can use the book as one reference). Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.

4. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/

Critical Thinking: The Case of the Missing Record

Critical Thinking Exercise 3

The Case of the Missing Record

Mary Dunn was a 65-year old woman who lived alone. Her husband had been dead for many years and her only daughter, Betty Dunn, was actively serving in the military overseas in Germany. Mary was the epitome of health. She ate right, never smoked, and exercised every day by walking three miles. Monday morning when she awoke she did not feel well. She was slightly nauseated and had severe heartburn. A couple of hours later, the pain was no better.She began to feel dizzy so she called her primary care physician, Dr. Nancy Morgan. Dr. Morgan told her to call 911, and that she would meet her at the hospital ER.

Mary was transported to Quinbery General Hospital. During her initial interview she informed the RN, Sarah Thompson, that she had a Living Will and a DNR order on file in her record.Dr. Morgan arrived at the ER and requested Mary s previous records.

Rachel Rivers, a 1st shift HIM clerk, received the call from the ER for Mrs. Dunns medical records. Rachel looked everywhere for the records, but was unable to locate them. While she was looking for the charts, John Roberts, another 1st shift HIM clerk, received another call from the ER requesting Mary s medical records. So, John joined the hunt for the missing records. They were nowhere to be found. Rachel went to Jonathan Smith, the HIM Director and informed him of the missing records. Dr. Morgan came to the HIM department, abruptly stating the urgency of the situation. She had called her office to see if there might be a DNR or living will in their physician records. Again, no paperwork was found.

Meanwhile, Dr. Morgan had the nursing staff contact the daughter to inform her of her mother s condition. It was suggested that she might take leave and come home as soon as possible since her mother was in critical condition and on life support measures. When Betty arrived home she searched her mother s house for a copy of the two missing documents. She too was unsuccessful. Betty had no idea who her mother s attorney was or whether she had even gone through an attorney to complete the documents. Betty was upset with the hospital s inability to locate her mother s medical records that contained the do not resuscitate order and the living will. The following day a feeding tube was inserted and Mary was no longer able to function at all on her own. Betty was faced with a difficult decision and had no idea what her mother s wishes were in her living will.

Critical Thinking Questions:

1. Communications: Define the problem in your own words.

2. Analysis: Compare and contrast the available solutions within this case study.

3. Problem Solving: Select one of the available solutions and defend it as you chosen solution.

4. Evaluation: Identify the weaknesses of your chosen solution.

5. Synthesis: Suggest ways to improve/strengthen your chosen solution.

6. Reflection: Reflect on your own thought process after completing the assignment.

Types of immunity related to vaccination, immunization effects on the individual, and community as well as worldwide

Purpose: Assignment of Class 5 Unit 8 (M)

Things to remember: SEE RUBRIC

Assignment Details

Immunization Presentation

Directions

For this Assignment, you are creating a PowerPoint® presentation. Your presentation audience is the community. The topic is immunization/ vaccination. Information should include herd immunity, types of immunity related to vaccination, immunization effects on the individual, and community as well as worldwide effects of immunization. Additionally, content should include vaccination trends, myths, disease statistics for those conditions prevented with vaccination, and pediatric vaccination schedule/s. Legal, ethical, and cultural considerations should be addressed.  The presentation must have speaker notes per slide; 1–3 paragraphs. The PowerPoint should be developed in a professional design and style; succinct, not overly wordy, with a tasteful amount of elegant text and visual appeal, as well as accurate and complete content.

Number of content slides are 12, not to exceed 14. Title slide and reference slide required and not included in the total. This presentation should adhere to appropriate 6th edition APA format.

This link provides Microsoft tutorials in PPTX:

PowerPoint 2013 videos and tutorials. (n.d.). Retrieved from https://support.office.com/en-us/article/PowerPoint-2013-videos-and-tutorials-bd93efc0-3582-49d1-b952-3871cde07d8a

Analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement

Overview

Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a 3-4 page report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

In the era of health care reform, many of the laws and policies set by government at the local, state, and federal levels have specific performance benchmarks related to care delivery outcomes that organizations must achieve. It is critical for organizational success that the interprofessional care team is able to understand reports and dashboards that display the metrics related to performance and compliance benchmarks. This assessment offers an opportunity for you to demonstrate and sharpen your ability to analyze, interpret, and evaluate performance dashboard metrics.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 1: Analyze the effects of health care policies, laws, and regulations on organizations, interprofessional teams, and personal practice.

Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team.

Competency 3: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.

Advocate for ethical action in addressing a benchmark underperformance, directed toward an appropriate group of stakeholders.

Competency 4: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, for health care policies and law for patients, organizations, and populations.

Evaluate dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws.

Evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance.

Competency 6: Apply various methods of communicating with policy makers, stakeholders, colleagues, and patients to ensure that communication in a given situation is professional, clear, efficient, and effective.

Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.

Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Context

Maintaining standards and promoting quality in modern health care are crucial, not only for the care of patients, but also for the continuing success and financial viability of health care organizations. In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set by relevant federal, state, and local laws and policies. An understanding of relevant benchmarks that result from these laws and policies, and how they relate to quality care and regulatory standards, is also vitally important.

Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards. You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers. Adding partisan politics and social media to the mix can further complicate understanding of the process and buy-in from stakeholders.

How many health care laws can you name that affect your practice in your current or future workplace? How do they impact your daily work? How many regulatory agencies oversee the types of services your health care organization provides? Which regulatory agencies apply to your workplace setting? Are you familiar with the process of complying with those agencies in order to maintain certification? You might be overwhelmed as you consider these broad questions.

Questions to Consider

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend or family member, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

What local, state, or federal health care policies or laws set benchmarks and standards reflected in performance dashboards common in your professional area of practice?

What are the potential challenges or opportunities for health care organizations or interprofessional teams in meeting prescribed performance benchmarks and standards? Factors you might consider include the organization’s mission, its size and resources, operational policies and procedures, and the population the organization serves. 

Suggested Resources

Library Resources

These resources examine performance measurement tools used for health care delivery:

Behrouzi, F., Shaharoun, A. M., & Ma’aram, A. (2014). Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian Health Review, 38(2), 208–17.

Ghazisaeidi, M., Safdari, R., Torabi, M., Mirzaee, M., Farzi, J. & Goodini, A. (2015). Development of performance dashboards in healthcare sector: Key practical issues. Acta Informatica Medica, 23(5), 317–321.

This resource explores hospital rankings in the United States:

Huerta T. R., Hefner J. L., Ford E. W., McAlearney A. S., & Menachemi N. (2014). Hospital website rankings in the United States: Expanding benchmarks and standards for effective consumer engagement. Journal of Medical Internet Research. 16(2), e64.

Martin, E. (2015). Healthcare policy legislation and administration: Patient Protection and Affordable Care Act of 2010. Journal of Health and Human Services Administration, 37(4), 407–411.

This resource explains current health care policy in the United States

Oliver, T. R. (Ed.). (2014). Guide to U.S. Health and Health Care Policy. Washington DC: CQ Press.

Internet Resources

These resources provide performance measurement data that will help you complete your assessment:

Johns Hopkins Medicine. (n.d.). Patient safety and quality dashboard: Core measures at JHM. Retrieved from http://www.hopkinsmedicine.org/patient_safety_quality_dashboard/understanding_performance_metrics/core_measures.html

National Committee for Quality Assurance. (2016). Retrieved from http://www.ncqa.org/

National Committee for Quality Assurance. (2016). HEDIS & performance measurement. Retrieved from www.ncqa.org/tabid/59/default.aspx

Assessment Instructions

Preparation

For this assessment, you may choose one of the following three options for a performance dashboard to use as the basis for your benchmark evaluation.

Option 1: Dashboard and Health Care Benchmark Evaluation Simulation

If you decide to use one of the simulation dashboards for your evaluation, review both dashboards, as well as the relevant local, state, and federal laws and policies linked in each dashboard. Choose one of the dashboards and consider the metrics within it  that are falling short of the prescribed benchmarks.

Option 2: Actual Dashboard From a Professional Practice Setting

If you choose an actual dashboard from a professional practice setting for your evaluation, be sure to add a brief description of the organization and setting that includes:

The size of the facility that the dashboard is reporting on.

The specific type of care delivery.

The population diversity and ethnicity demographics.

The socioeconomic level of the population served by the organization.

Note: Ensure that your data is Health Insurance Portability and Accountability Act (HIPAA) compliant. Do not use any easily identifiable organization or patient information.

Option 3: Hypothetical Dashboard Based on a Professional Practice Setting

If you have a sophisticated understanding of dashboards that are relevant to your own practice, you may also construct a hypothetical dashboard for your evaluation, based on that setting. Your hypothetical dashboard must present at least four different metrics, at least two of which must be under-performing the relevant benchmark set forth by a federal, state, or local laws or policies. In addition, be sure to add a brief description of the organization and setting that includes:

The size of the facility that the dashboard is reporting on.

The specific type of care delivery.

The population diversity and ethnicity demographics.

The socioeconomic level of the population served by the organization.

Note: Ensure that your data is HIPAA compliant. Do not use any easily identifiable organization or patient information.

Report Requirements

Structure your report in such a way that it would be easy for a colleague or supervisor to locate the information they need. Be sure to cite relevant local, state, or federal health care laws or policies when evaluating metric performance against prescribed benchmarks. Cite an additional 2–4 credible sources to support your analysis and evaluation of the challenges in meeting the benchmarks, the potential for performance improvement, and your advocacy for ethical action.

Note: The tasks outlined below correspond to grading criteria in the scoring guide.

In your report, be sure to:

Evaluate dashboard metrics against the benchmarks set by local, state, or federal health care laws or policies.

Which metrics are below the mandated benchmarks in the organization? Evaluate weaknesses within the entire set of benchmarks.

What are the local, state, or federal health care laws or policies that set these benchmarks?

Analyze challenges that meeting prescribed benchmarks can pose for the organization or for an interprofessional team.

What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider:

The strategic direction of the organization.

The organization’s mission.

Available resources:

Staffing.

Operational and capital funding.

Physical space.

Support services (any ancillary department that supports a specific care unit in the organization, such as a pharmacy, cleaning services, and dietary services).

Cultural diversity in the organization.

Cultural diversity in the community.

Organizational processes and procedures.

How might these challenges be contributing to benchmark underperformance?

Evaluate a benchmark underperformance in the organization or interprofessional team that has the potential for greatly improving overall quality or performance.

Which metric is underperforming its benchmark by the greatest degree?

Which benchmark underperformance is the most widespread throughout the organization or interprofessional team?

Which benchmark affects the greatest number of patients?

Which benchmark affects the greatest number of staff?

How does this underperformance affect the community the organization serves?

Where is the greatest opportunity for improvement in the overall quality or performance of the organization or interpersonal team—and ultimately in patient outcomes?

Advocate for ethical action in addressing the benchmark underperformance that has the potential for greatly improving overall quality or performance.

At which group of stakeholders should your advocacy be directed? Which group could be expected to take the appropriate action to improve the benchmark metric?

What are some ethical actions that the stakeholder group could take that support improved benchmark performance?

Why should the stakeholder group take action?

Communicate your findings and recommendations in a professional and effective manner.

Ensure that your report is well organized and easy to read.

Write clearly and logically, using correct grammar, punctuation, and mechanics.

Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.

Did you cite relevant local, state, or federal health care laws or policies when discussing the mandated benchmarks?

Did you cite an additional 2–4 credible sources to support your analysis, evaluation, and advocacy?

To determine differences between the intervention and control groups for the lumbar and femur neck BMDs

NameCourseHLT362v
DateSection

EXERCISE 10 Description of a Study Sample

1. What demographic variables were measured at the nominal level of measurement in the Oh et al. (2014) study? Provide a rationale for your answer.

2. What statistics were calculated to describe body mass index (BMI) in this study? Were these appropriate? Provide a rationale for your answer.

3. Were the distributions of scores for BMI similar for the intervention and control groups? Provide a rationale for your answer.

4. Was there a significant difference in BMI between the intervention and control groups? Provide a rationale for your answer.

5. Based on the sample size of = 41, what frequency and percentage of the sample smoked? What frequency and percentage of the sample were nondrinkers (alcohol)? Show your calculations and round to the nearest whole percent.

6. What measurement method was used to measure the bone mineral density (BMD) for the study participants? Discuss the quality of this measurement method and document your response.

7. What statistic was calculated to determine differences between the intervention and control groups for the lumbar and femur neck BMDs? Were the groups significantly different for BMDs?

8. The researchers stated that there were no significant differences in the baseline character​istics of the intervention and control groups (see Table 2). Are these groups heterogeneous or homogeneous at the beginning of the study? Why is this important in testing the effec​tiveness of the therapeutic lifestyle modification (TLM) program?

9. Oh et al. (2014, p. 296) stated that “the adherence rate to the TLM program was 99.6%.” Discuss the importance of intervention adherence, and document your response.

10. Was the sample for this study adequately described? Provide a rationale for your answer.

Advanced Practice Nursing Decisions that Cause Moral Distress

Purpose: Discussion Unit 2 (MN506) (L)

Things to remember:

Discussion post is at least 200 words.

Answers all questions with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

3 References, try to find resources that are 5 years or less

No errors with APA format 6thEdition

To Discuss:

· Unit 2 Discussion Topic 1

Topic 1: Advanced Practice Nursing Decisions that Cause Moral Distress Choose an ethical-legal dilemma that would cause the advanced practice nurse moral distress. The dilemma could be one you have faced in your practice. Write at least the introductory paragraphs for the Unit 4 Assignment. Be specific about the dilemma — something you may have experienced in your practice. Outline the topics that will be discussed in the Unit 4 Assignment using level one APA headings.Use the APA template provided in the class for this paper. It is set up for all papers in APA format. Place the beginning of your paper in the Discussion Board for all to read and critique.After receiving feedback from your peers and instructor, work on refining the paper to submit in Unit 4. Choose someone to peer review that does not have feedback.Cite and reference at least three nursing peer reviewed articles to support the content in the paragraph. In the final Assignment, you will have a minimum of seven references relating to legal and ethical issues.Chapter 16, titled Effective Peer Reviews, in the Kaplan Guide to Successful Writing handbook explains the importance of conducting peer reviews (critiques), how to conduct the peer review, and how to help your classmates and the reviewer achieve an improved learning experience.Review pages 213–219 of Guide to Successful Writing.

· Unit 2 Discussion Topic 2  

Topic 2: Evaluation of Ethical Models and the Ethics Committee You identified an ethical dilemma in Discussion topic 1 of this unit. Present your dilemma to the ethics committee of your institution. Outline an ethical theory or model you wish the committee to consider when reviewing this case. What arguments do you have to support the use of this model? Discuss the role of the ethics committee in this particular ethical dilemma.

Overview and Outcomes Ethical Self-Awareness in the Role of an Advanced Practice Nurse

10/23/17, 9*12 AMSample Content Topic

Page 1 of 1file:///Users/OrlandoHayaCuan/Downloads/Unit%202%20Overview%20and%20Outcomes.html

Unit 2 Overview and Outcomes Ethical Self-Awareness in the Role of an Advanced Practice Nurse

In this unit, you will have the opportunity to explore beliefs and question the ethics of those foundations. The National Council of State Boards of Nursing (2009) has set boundaries that must be maintained among patients, families, and practitioners. You will evaluate ethical theories and models that can be used to decide an ethical dilemma. You will choose an ethical dilemma to develop into a paper that is due in Unit 4. The dilemma you choose may deal with death and dying, transplant issues, HIV, informed consent, confidentiality, dealing with minors, education, teaching, or leadership dilemmas to name a few. The dilemma you choose maybe something you have encountered in your practice and wish to explore. Ethical models and theories provide a way to evaluate ethics, morality, and your own personal philosophy about what is right and what is wrong. Ethics are a part of the art of being a nursing leader.

Reflect on the following:

Do you have a moral compass grounded in emotional intelligence that guides your practice or do you react without reflection, causing conflict and chaos using a model of incivility? Does pride prevent you from doing the right thing? Decide what is right for the subject(s) of the dilemma? What is the right thing and how can law, ethics, and morals help you?

References

The National Council of State Boards of Nursing. (Producer). (2014). Professional boundaries in nursing . Available from https://www.ncsbn.org/464.htm

After completing this unit, you should be able to:

Explain how ethics, morality, and philosophies affect ethical and legal decision-making. Evaluate ethical models and theories and how they apply to ethical dilemmas. Present an ethical dilemma to your institution’s ethics committee.

Class 6 Unit 2

Health Promotion Program Plan to Address Health Issue

Course Project—Health Promotion Program Plan to Address Health Issue

In Week 1, you selected and analyzed a health issue and described the population most affected by it, using the PRECEDE-PROCEED health promotion program planning model. In Week 2, you learned how to conduct a needs assessment and how the results of the needs assessments are used in health promotion program planning and design. In Week 3, you analyzed the predisposing, reinforcing, and enabling behavioral risk factors for your selected health issue, using the PRECEDE-PROCEED health promotion program planning model. In Week 4, you selected and evaluated the strategies of two social marketing campaigns.

This week you will address your selected health issue based on the individual project components you have completed throughout this course. Compile the relevant ideas from the papers developed from Week 1 through Week 4 to create a complete health promotion program plan. Write a 15 to 20 page, double-spaced, research paper. Use the eight (8) phases of PRECEDE-PROCEED health promotion planning model, to create a health promotion plan for your selected health issue.

Please include the following in your paper:

  • Write a 1 to 2-page executive summary about the health promotion program plan. The executive summary should be written keeping a lay audience in mind.
  • Create one or more graphic organizers for the planning model, following the framework of the PRECEDE-PROCEED model.
  • Please remember to also:
    • Identify a working group for implementation of your selected strategies (Phase 4)
    • Explain how strategies would be adopted, implemented, and maintained in the community (Phase 5)
  • Write an introduction, a summary, and include a separate title page and a page for references.
  • Be sure to use a minimum of five scholarly references and support your statements with appropriate examples.

Evaluating the efficacy of cognitive behavioral therapy for groups

3 PAGES

Assignment 1: Practicum 8 Journal Entry

Part A

· Develop effective documentation skills for group therapy sessions *

· Develop diagnoses for clients receiving group psychotherapy *

· Evaluate the efficacy of cognitive behavioral therapy for groups *

· Analyze legal and ethical implications of counseling clients with psychiatric disorders *

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

· Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.

· Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for each client.

· Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.

· Explain any legal and/or ethical implications related to counseling each client.

· Support your approach with evidence-based literature.

Part B Post a description of a group therapy session with older adults, including the stage of the group, any resistances or issues that were present, and therapeutic techniques used by the facilitator. Explain any challenges that may occur when working with this group. Support your recommendations with evidence-based literature.

FORMAT

Assignment 1: Practicum 8 Journal Entry

Effective Documentation skills for group therapy sessions

All nursing providing services to clients with psychiatric disorders must adhere to standards and principles of Mental Health and Substance Use Services (MHSUS).

Diagnoses for clients receiving group psychotherapy

Evaluation of cognitive behavioral therapy

Legal and ethical implications of counseling clients

Selected clients (Two)

Practicum 8 Journal Entry

Group session Documentation

Description First client

Justification of first client diagnosis

Description 2nd client

Justification of 2nd client diagnosis

Cognitive behavioral therapy effectiveness

Legal and/or ethical implications related to counseling Supported with Literature

Part B