The pathophysiology of osteoarthritis and rheumatoid arthritis

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While arthritis impacts nearly 50 million adults in the United States, it is not a disease that is limited to adulthood. Consider the case of Ashley Russell. At the age of 14 months, Ashley was diagnosed with juvenile rheumatoid arthritis. As a baby, her parents noticed that her knee was always swollen and that she often wanted to be carried instead of walking on her own (Cyr, 2012). After seeking medical care, Ashley’s underlying disorder was discovered. Arthritis in children is not uncommon. According to the CDC (2011), an estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition. Due to the prevalence of the disorder in both children and adults, you must understand the pathophysiology and symptoms of arthritis in order to properly diagnose and prescribe treatment.

To Prepare

· Review Chapter 37 in the Huether and McCance text and Chapter 24 in the McPhee and Hammer text. Identify the pathophysiology of osteoarthritis and rheumatoid arthritis. Consider the similarities and differences of the disorders.

· Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of and treatment for the disorders.

Post a description of the pathophysiology of osteoarthritis and rheumatoid arthritis, including the similarities and differences between the disorders. Then explain how the factors you selected might impact the pathophysiology of the disorders, as well as the diagnosis of treatment for the disorders. 

Pick any 2

How the problem from a closed-system perspective could be addressed by viewing it from an open-system perspective

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For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.

Note: You may find it helpful to view the Assignment instructions and use the same problem for this Discussion.

To prepare:

· Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems.

· Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved.

· Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes?

Post a description of the problem that you identified in your selected organization. Explain the problem from a closed-system perspective. Then, describe how the problem could be addressed by viewing it from an open-system perspective, and explain how this modification would help you and others improve health care outcomes.

Week 6: Discussion: Healthcare Financing

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Week 6: Discussion: Healthcare Financing

Purpose

The purpose of this discussion is to explore the DNP-prepared nurse’s role in meeting the organization’s mission through effective planning, budgeting, and determining the allocation of resources.

Instructions

This week, you will have an opportunity to estimate the budget for your practice change project   *( my practice budget project is Obesity in my patients in the primary care setting) . The practice change project includes the estimated resources with associated expenses and the estimated revenues. The practice change project budget must balance to a positive number or to zero. (A negative balance reveals there is insufficient planning and revenues needed for the project to be successful.)

Reflect upon your readings and professional experience and complete the budget for your practice change project.

  1. Start by listing all of the Resources needed for your budget. Some resources that may be needed in your budget are listed here and some items may not apply to your project: the number of staff and their roles,  education time for staff (how many and how long), office and/or medical supplies, marketing materials, statistician consult, meeting rooms, overhead (if renting the room), and any other resources not covered in this list. Week 6: Discussion: Healthcare Financing
  2. Next, estimate the Expense for each of the resources. For example, when estimating the salary and benefits for staff, first calculate the number of hours X the hourly salary (adding in the estimated cost of employee benefits) X the number of individuals. An example is 20 nurses for 3 hours at an average salary and benefit of $50 hour:  20  x  3 x  50 =  $3000. The expenses in your budget can be estimated.
  3. Next, discuss the Revenue sources which will pay for the expenses. All expenses in the budget must have a revenue source. Examples of revenue sources are:

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    • Institutional Budget Support (if the hospital or facility is paying the costs of salary, supplies, and/or services).
    • In-Kind Donation (If you, or a department, or both are paying the statistician consult or out-of-pocket payment for the refreshments for meetings, etc.)
    • There are limited projects in which billing for a new procedure or new treatment type is applicable. If the organization is currently billing for the visit or treatment or procedure then do not include this in your budget.(Check the state laws for rules regarding billing and reimbursement for services such as telehealth(Links to an external site.))
  • https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicaid-and-medicare-billing-for-asynchronous-telehealth/
  1. . Encounter Charge  X   # patients per day   X   # days per week   X   # weeks
  • Grant money: If grant money is used, state the name of the grant and the specific elements within the budget that the grant is paying for. Add the revenues for the exact elements of the budget. Please ensure that the grant funding states it will pay for that specific expense(s) in your budget.
  1. Balance the Budget. Add the expenses and the revenues then subtract the expenses from the revenues. The result should be a zero-dollar balance or a positive dollar balance.
    (Revenues – Expenses = 0 or positive $$)
  2. Examine your role in monitoring and controlling your practice change project expenses and resources.

Please review the following link for complete discussion requirements:

  • Link (webpage): Graduate Discussion Grading Guidelines and Rubric

 

( need to use minimum 3 scholarly sources , no older than 5 years old , with in-text citations _) Week 6: Discussion: Healthcare Financing

 

Nursing homework help

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take some time to reflect upon your new knowledge gained to answer the following questions:

Describe how your definition of aging, disability, and chronic illness changed during this course.
Describe your approach to care of the aged, disabled, and chronically ill upon completion of your assignments.
Identify and describe your professional growth by providing 2 strengths (identify pre-existing or newly developed) and 2 areas for improvement (identify pre-existing or newly developed) in relation to providing care to the aged, disabled, and chronically ill population. (A minimum of 2 strengths AND 2 weaknesses discussed. )
Describe at least 2 methods you will incorporate to strengthen your weakness identified above.
*Complete and thorough; obvious that the assignment was taken seriously and completed with thoughtfulness. Nursing homework help

APA format. 3 pages. 1 reference

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take some time to reflect upon your new knowledge gained to answer the following questions:

Describe how your definition of aging, disability, and chronic illness changed during this course.
Describe your approach to care of the aged, disabled, and chronically ill upon completion of your assignments.
Identify and describe your professional growth by providing 2 strengths (identify pre-existing or newly developed) and 2 areas for improvement (identify pre-existing or newly developed) in relation to providing care to the aged, disabled, and chronically ill population. (A minimum of 2 strengths AND 2 weaknesses discussed. )
Describe at least 2 methods you will incorporate to strengthen your weakness identified above.
*Complete and thorough; obvious that the assignment was taken seriously and completed with thoughtfulness. Nursing homework help

APA format. 3 pages. 1 reference

Application of systems theory to the examination of a problem in a department or a unit within a health care organization

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For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)

To prepare:

· Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).

· Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.

· Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.

· Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.

· Research professional standards that are pertinent to your identified problem.

· Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

To complete:

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

· Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.

· Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).

· Based on this information, explain how you would address the problem as follows:

o Formulate a desired outcome.

o Identify goals and objectives that would facilitate that outcome.

o Translate those goals and objectives into policies and procedures for the department or unit.

o Describe relevant professional standards.

· Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

Hematopoietic And Cardiovascular

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Hematopoietic And Cardiovascular

Hematopoietic:


J.D. is a 37 year old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries. Hematopoietic And Cardiovascular

Case Study Questions

  1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

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Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills. Hematopoietic And Cardiovascular

Case Study Questions

  1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
  2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
  3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
  4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
  5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

 

Submission Instructions:

  • You must complete both case studies.
  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
  • Each question must be answered individually. Not in an essay format.
    • Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; etc.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) Your response should be at least 150 words.
  • All replies must be constructive and use literature where possible.
  • Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
  • You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.  Hematopoietic And Cardiovascular

 

Nursing homework help

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Question 1:

You are admitting a 19-year old female college student to the hospital for fevers.  Using the patient information provided, choose a culture unfamiliar to you and describe what would be important to remember while you interview this patient. Discuss the health care support systems available in the community (Virginia) for someone of this culture. If no support systems are available in the community, identify a national resource. Minimum of   250 words (Please cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.) Nursing homework help

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Question 2:

For the middle-aged adult, exercise can reduce the risk of various health problems. Choose two at-risk health issues that regular physical exercise and activity can help prevent and manage. Discuss the prevalence of each of these health problems in society today. Describe measures that you would take as a nurse to assist clients with health promotion measures to incorporate exercise and physical activity into their lives. Include the kind of activities you would recommend, the amount of exercise, and the approach you would use to gain cooperation from the client. Support your response with evidence-based literature. Minimum of   250 words (Please cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria and public health content.) Nursing homework help

 

The ethical or legal requirements and responsibilities that a health care organization has in ensuring its staff members are licensed and certified

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Apply business principles to the management of the healthcare organization

Apply ethical and legal principles to the management of a healthcare organization

You must include a minimum of 3 scholarly references. 3–4 pages not including a title page and a reference page

Building on your Weeks 1 through 3, you must now identify and discuss some of the legal and ethical considerations that must be taken into account in constructing your proposed healthcare facility. You are required to include the following:

Define and discuss the differences between licensure, certification, and accreditation as they relate to health care facilities.

Discuss the ethical or legal requirements and responsibilities that a health care organization has in ensuring its facility is licensed, certified, and accredited. When discussing licensure requirements, ensure that you research requirements based on the state in which you reside.

Define and discuss the differences between the licensure and certification as they relate to healthcare providers or professionals.

Discuss the ethical or legal requirements and responsibilities that a health care organization has in ensuring its staff members are licensed and certified.

Research and discuss an accrediting body that will provide accreditation to the facility you are proposing. Ensure that you provide a history of the organization, what types of facilities they accredit, and how the organization has impacted the quality of health care in the United States.

Nursing homework help

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Answer the 2 questions below and give a rationale why its the right answer.

A. The AG-ACNP is developing a QI project for decreasing falls in patients 65 years of age or older admitted to the Med-Surg floors of a large suburban hospital. When preparing the project, the AG-ACNP knows the highest quality of evidence will be obtained from:

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  1. RCT
  2. Expert Opinion
  3. Cohort Study
  4. Case Series

B. A 55-year-old woman with advanced metastatic breast cancer. Her pain is managed on long-acting opioids and she is able to participate in very limited ADL’s. Her husband is her primary caregiver and would like to discuss the code status of his wife. With respect to ethical principles that guide nursing practice, what is the best response?

  1. The attending physician would need to be consulted.
  2. The patient must be involved in the discussion.
  3. This topic should be discussed during the palliative care consult
  4. The patient can’t consent to DNR while on hydromorphone . Nursing homework help

REPLY

  • RQ

Adult Patients on a Medical-surgical Unit

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Adult Patients on a Medical-surgical Unit

PEER RESPONSE; BORN

“For adult patients on a medical-surgical unit, does implementation of the Enhanced Recovery After Surgery (ERAS) protocol, as compared to current practice, impact surgical site infection (SSI) rates in 8-10 weeks?”

The evidence-based intervention I chose for this DNP project was the implementation of the Enhanced Recovery After Surgery (ERAS) protocol to help decrease the incidence of surgical site infections in colorectal surgical patients. I chose this intervention based upon discussion with stakeholders within the organization I work. I found that we currently do not implement ERAS protocol on surgical patients.

In the United States, surgical site infections affect as many as 300,000 patients annually (Loyola University Health System, 2017) contributing to the costliest hospital-acquired infections with an estimated cost of $3.3 to $10 billion dollars annually and account for nearly 1 million additional inpatient days (Loyola University Health System, 2017; Centers for Disease Control and Prevention, 2021). The risk of surgical site infection after colorectal surgery is one of the highest when compared to any other surgical specialty. Colorectal surgery places a considerable burden on health care systems related to high complications risks, notably surgical site infections, and contributes to poor outcomes and increased readmission rates (Leaper et al., 2020; Turner & Migaly, 2019).  Adult Patients on a Medical-surgical Unit

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The purpose of this proposed DNP project is to reduce the surgical stress response, optimize physical function, and facilitate recovery for adult patients undergoing colorectal surgery. This will be done through the implementation of the Enhanced Recovery After Surgery (ERAS) protocol. This protocol is a multi-modal pathway intended to reduce stress, maintain homeostasis, for quick postoperative recovery for the patient undergoing surgery (Gados & Nador, 2019). The main aspects of the ERAS protocol are to optimize perioperative management using procedures established on scientific evidence. The ERAS protocol has been nationally recognized as contributing to positive patient outcomes, reducing postoperative complications, and early discharge without increasing costs (AANA, 2017; Pagano et al., 2021; Arrick et al., 2019; Johnson & Fogel, 2017; Kim et al., 2016).

Initially, the plan was to implement my proposed practice change within the organization in which I work, however, due to the current pandemic policies for allowing practicum hours to be completed within the hospital had to be postponed and I opted for the case study. I am hoping that once my project is complete, to present this to the major stakeholders in an attempt to influence a policy change with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol to assist in better patient outcomes, decreased length of stays, decreased monies spent related to complications, increase patient satisfaction, and decrease mortality and morbidity.

References:

American Association of Nurse Anesthesiology. (2017). Enhanced recovery after surgery:

Considerations for pathway development and implementation. AANA American Association of Nurse Anesthesiology. https://aana.com/practice/clinical-practice-resources/enhanced-recovery-after-surgery

Arrick, L., Mayson, K., Hong, T., & Warnock, G. (2019). Enhanced recovery after surgery in

colorectal surgery: Impact of protocol adherence on patient outcomes. Journal of Clinical Anesthesia, 55, 7-12. doi:10.1016/jcliniane.20.18.12.034

Centers for Disease Control and Prevention. (2021, January 1). Surveillance for surgical site

infection (SSI) events. https://www.cdc.gov.nhsn/pdfs/pscmanual/9pscssicurrent.pdf (Links to an external site.)

Gajdos, C., & Nader, N. D. (2019). Enhanced recovery after surgery in colorectal surgery:        Impact of protocol adherence on patient outcomes. Journal of Clinical Anesthesia, 56, 50–51. https://doi.org/10.1016/j.jclinane.2019.01.038 (Links to an external site.) Adult Patients on a Medical-surgical Unit

Johnson, N., & Fogel, S. (2017). An expanded preoperative component within an enhanced recovery protocol improves outcomes in colorectal surgery. The American Surgeon. 83(8), 928-934.

Kim, B., Park, S., Park, K., & Ryoo, S. (2017). Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme. Journal of clinical nursing, 26(21-22), 3336-3344. https://doi.org/10.111/jocn.13862 (Links to an external site.)

Loyola University Health System. (2017, January 19). Surgical site infections are the most costly of hospital infections: Guidelines for preventing surgical site infections are updated. Science Daily. Retrieved November 18, 2021 from www.sciencedaily.com/releases/2017/01/170119161551.htm (Links to an external site.)

Leaper, D., Holy, C., Spencer, M., Chitnis, A., Hogan, A., Wright, G., Po-Han Chen, B., & Edmiston Jr., C. (2020). Assessment of the risk and economic burden of surgical site infections following colorectal surgery using a US longitudinal database: Is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection? Dis Colon Rectum, 63, 1628-1638. https://doi.10.1097/DCR.0000000000001799Links to an external site.

Pagano, E., Pellegrino, L., Rinaldi, F., Palazzo, V., Donati, D., Meineri, M., Palmisano, S., Rolfo, M., Bachini, I., Bertetto, O., Borghi, F., & Ciccone, G. (2021). Implementation of the ERAS (Enhanced Recovery After Surgery) protocol for colorectal cancer surgery in the Piemonte Region with an Audit and Feedback approach: study protocol for a stepped wedge cluster randomized trial: a study of the EASY-NET project. BMJ Open, 11(6), e047491. https://doi.org/10.1136/bmjopen-2020-047491 Adult Patients on a Medical-surgical Unit