NURSING INTERVENTIONS

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Assignment Objectives: Identify and select appropriate interventions including diagnostic tests and nursing interventions. Analyze physiological and psychological responses to illness and treatment modalities

Purpose: Examine case studies related to renal and urologic systems and fluid and electrolytes. Answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.

Assignment Description: Answer the questions in the grading criteria related to each of the patients provided. Your answer must follow APA 6th edition format. Submit the answer in the assignment area of your course. This assignment is worth 50 points.

Patient 1 – A 52 year old female patient with a long-standing history of COPD and heart failure is being seen for recent onset of headache, muscle cramps, bilateral lower extremity edema, and nervousness. She also reports a 5-day history of watery diarrhea.

Her medications include diuretics and long-acting and short-acting beta-2 agonists. The results of a Basic Metabolic Profile (BMP) reveal abnormally low serum sodium, potassium, and chloride levels. Her anion gap is normal.

a. Describe the relationship of sodium and potassium in the ICF and ECF.

b. Identify the acid-base imbalances for which this patient is at risk and why she is at risk for them.

b. Define “anion gap” and the significance of the anion gap being normal in this patient.

Patient 2-You are asked to see a 20 year old woman who has white blood cells present in her urinalysis results. How would you determine whether she has cystitis or pyelonephritis?

a. Differentiate between cystitis and pyelonephritis. Consider history, possible presenting symptoms, and urinalysis results,.

b. Provide specific patient education for this patient regarding possible treatments and behaviors to prevent this condition in the future.

Parameters: Mini Case Study Assignment Grading Criteria

RequirementMaximum PointsEarned Points
   
Patient 1 – Described relationship of sodium and potassium in the ICF, ECF. Correctly identified possible acid-base imbalances. Defined anion gap and its signicance.
 		20 
Patient 2 – Differentiated cystitis and pyelonephritis. Provided patient education information re: treatment and prevention future occurrences.20 
Submitted the assignment on time and in the correct location2
 
Used APA 6th edition style guidelines consistently and accurately.5
 
Used correct spelling and grammar3
 
 Total50 
 

Upon Completion of this assignment:

  • Upload your completed assignment, and
  • Upload your originality report from turnitin.

FINANCE REPORT

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NUR 4030 Scholarly Finance paper-30 points (Individual Assignment)

Using a minimum of 3 peer reviewed journal articles, discuss financial factors that influence health care today. Include funding sources, reimbursement methods, economic factors, business influences, and cost containment. Paper should be 3-5 pages in length (not counting cover sheet or reference page) and be in APA format.   This paper is a comprehensive view of the business of healthcare. 

§  Some questions to consider:

§  Is there a relationship between socioeconomic status and health/health outcomes? 

§  Is health care a right or a privilege?

§  Is the Affordable Care Act the answer for Americans?

§  What is the fiscal responsibility in the role of the nurse today?

§  In an ideal world, what would your health care vision for America look like?

Grading Rubric for Scholarly Paper

CATEGORY6542
  Amount of InformationAll topics are addressed and all questions fully answered.All topics are addressed and most questions fully answered.All topics are addressed, and most questions partially answered.One or more topics were not addressed or completely answered.
Quality of InformationInformation clearly relates to the main topic. It includes several supporting details and/or examples.Information clearly relates to the main topic. It provides supporting details/examples.Information clearly relates to the main topic. A few details and/or examples are given.Information has little or nothing to do with the main topic.
If you need help in these sections, (Organizations, Sources, and Mechanics), please consult the writing lab. OrganizationInformation is very organized with well-constructed paragraphs.Information is organized with well-constructed paragraphs.There is an attempt at organization but errors exist.The information or overall structure appears to be disorganized.
SourcesAll sources (information and graphics) are accurately documented in the desired APA format.Many sources (information and graphics) are documented in the desired APA format.A few sources (information and graphics) are accurately documented in the desired APA format.Some sources are not accurately documented.  Major APA deficiencies.
MechanicsNo grammatical, spelling or punctuation errors.Almost no grammatical, spelling or punctuation errors.A few grammatical spelling or punctuation errors.Many grammatical, spelling, or punctuation errors.
Total30 Possible Points

CLINICAL SUPPORT SYSTEMS

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Decision support systems were first designed and implemented in the corporate world to support business management. The integration of support systems into health care organizations brings a sharpened analysis capacity to data warehousing and data mining. This refined data analysis capability can lead to improved patient care and diagnoses through evaluation of various symptoms, prediction of certain drug interaction outcomes, and much more.

In this Discussion, you explore the use of clinical decision support systems and consider their value in assisting advanced practice nurses in making informed decisions and providing quality health care.

To prepare:

  • Review the information in the Learning Resources focusing on the use of clinical decision support systems.
  • Consider where you seek support for clinical decisions. Do you seek advice from other health care professionals in your organization? Do you use computerized clinical decision support systems? Do you perform your own research? Assess the advantages and disadvantages of each approach.
  • Reflect on how decision support technologies, including databases, might assist nurses in clinical practice.
  • Consider how you can validate the integrity of the data you are using in a clinical decision support system.
  • Peruse the information presented at the Open Clinical website presented in this week’s Learning Resources. Locate an article that focuses on how clinical decision support systems can be used to support or improve patient care.
  • How does the information in the article align with or differ from your own experiences?Post by tomorrow 8/2/16 550 words in APA format and 3 references from the list below. Include the level one heading below:1)  a description of how you currently seek support for clinical decision making and how you determine the integrity of the information you gather. 2) Analyze the advantages and disadvantages of using computerized clinical decision support systems in clinical practice. Justify your response. 3) Finally, summarize the article you selected from the Open Clinical website and include an evaluation of how computerized clinical decision support systems can be used to improve care.

EVIDENCE BASED PRACTICE

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On occasion, some processes have crept into nursing and medical practice without appropriate evidence to back up their use. For example, consider tetanus shots. In the past, tetanus shots were given to patients who stepped on a rusty nail. It was assumed—at the time—that if the nail was rusty, it must have had some contact with the barnyard soil outside, which meant that it would be contaminated with bacteria.

For a while this thinking made sense. As time went on, however, tetanus shots continued to be given to patients who cut themselves on rusty objects, regardless of where the rusty object had come from. And, of course, fewer and fewer people lived within close proximity to barnyards and associated contamination.

As this week’s examples highlight, not all practices that nurses engage in are tied to evidence. For this reason, clinical decision support (CDS) systems have been created. CDS systems support the decision-making tasks of nursing professionals. As the nurse inputs patient information into the CDS system, evidence-based content is provided back to the nurse.

The nurse can then combine this content with their own nursing knowledge to diagnose and treat the patient. One of the most useful characteristics of CDS systems is that they are available during the point of care. No longer do nursing professionals have to consult thick research books; a great deal of information can be accessed with a few strategic clicks!.

In this Discussion, you continue to explore CDS systems. In addition, you investigate whether or not a health care practice with which you are familiar is grounded in evidence-based practice.

To prepare:

  • Review this week’s Learning Resources and consider how nurses can determine if they are using evidence-based practices in patient care.
  • Select one health care practice (e.g., using alcohol swabs before giving an injection) with which you are familiar. Conduct research to determine if this practice is grounded in research.
  • Consider how a clinical decision support system provides evidence-based content to its users.
  • What are the benefits and challenges of using CDS systems? How can this assist nurses in providing evidence-based care to their patients?

Post by tomorrow 8/2/16 55 words in APA format with 3 references  from the list below. Include the level one headings as followed:

1)  A description of the health care practice you selected. 

2)  Explain whether the evidence you found supports or opposes the practice and whether you believe this process is grounded in evidence-based practice.

3) Next, explain how informatics technologies, such as CDS systems, can facilitate nurses moving toward evidence-based practices. Justify your response.

Required Resources

Readings

  • Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
    • Chapter 39, “Translation of Evidence Into Nursing Practice”

      Evidence-based practice (EBP) synthesizes nursing research with decisions and processes in the practice setting. The chapter introduces current issues and topics related to EBP, including meaningful use, the expansion of practice networks, the use of comparative effectiveness research (CER), and the emergence of electronic EBP tools.
    • Chapter 40, “Improving Healthcare Quality and Patient Outcomes Through the Integration of Evidence-Based Practice and Informatics”

      This chapter details the importance of evidence-based practice (EBP) in health care. The chapter discusses steps in EBP, barriers and facilitators to EBP, and the roles that technology and decision support play in EBP.
    • Chapter 41, “Incorporating Evidence: Use of Computer-Based Clinical Decision Support Systems for Health Professionals”

      In this chapter, the authors explore the use of clinical decision support systems (CDSS) in health care. The authors outline the definition and history of CDSS as well as the future of CDSS in health care.
  • Starmer, J. M., Pinson, C. W., & Lorenzi, N. M. (2010). Informatics and evidence-based medicine: Prescription for success. Studies in Health Technology & Informatics, 160, 656–660.
    Retrieved from the Walden Library databases.

    This article explains a case study of how one organization developed and implemented an informatics system to improve health care quality. The ways this organization used informatics to incorporate evidence-based practice across many aspects of care is discussed.Media
  • Laureate Education, Inc. (Executive Producer). (2012c). Evidence-based content. Baltimore: Author. 

    Note: The approximate length of this media piece is 7 minutes.

    Gail Latimer, Dr. Patricia Button, and Dr. Roy Simpson discuss how and why informatics systems can communicate evidence-based practices to increase the quality of care given to patients. The presenters highlight nurse informaticists’ role in this endeavor, as well as key quality metrics that informaticists should be aware of.

Optional Resources

  • Reisner, R. (2011, June 4). Medical myths that can kill you. Retrieved from http://www.lifescript.com/health/centers/womens/articles/medical_myths_that_can_kill_you.aspx

HEALTH ASSESSMENT

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NR 305 Week 2 TD 1:

 Pain Assessment
John, a 46-year-old African-American male presents for admission to your hospital for hemi-colectomy for colon polyps. He is complaining of chronic back pain. Patient is on disability from work related injury. History of two (2) previous back surgeries with relief of numbness in RLE but pain has not been relieved.

His current medications include Methadone, Neurontin and Norco. John states he takes Benadryl PM every night in addition to his prescribed medications. John is a smoker and smokes 1 PPD. John confides in you that he is considering a spinal cord stimulator for the chronic pain.
What risk factors does John have for risk of opioid withdrawal during this hospitalization?
Is there a stigma connected to being disabled and or methadone?
Does the nurse need to be concerned about acetaminophen use?
What are the differences in acute and chronic pain?

NR 305 Week 2 TD 2:

 Nutritional Assessment
Yulang Lei, an 82-year-old Vietnamese man, was admitted to your floor with dehydration and a urinary tract infection following a fall at home. He is alert and oriented, but weak. He appears frail. His admission history includes the following.
•           He lives alone; his wife died 6 months ago.
•           He states he ran a traditional Vietnamese family, unlike his children, who are married and have now moved away.
•           His wife did all the cooking and he hasn’t had much of an appetite since she died. He eats rice and some vegetables, but rarely “bothers to cook meat for just one person.”
•           Usual daily activity is reading the Vietnamese community newspaper with his morning tea for breakfast. He says he usually eats lunch, but can’t remember what he usually eats. He has rice and a few vegetables for dinner.
•           You notice that his clothes fit very loosely. He states he weighed 140 pounds at his doctor’s office 5 months ago. When you weigh him, he weighs 123 pounds and is 5’8″ tall.
Look at the list of nursing diagnoses in Appendix A of your text. What nursing diagnoses would you choose for Mr. Lei?
•           What additional questions would you ask to confirm your diagnosis?
•           What physical examination and laboratory findings would you expect Mr. Lei to have?
•           What psychosocial and cultural factors should you consider when assessing Mr. Lei?

Week 2 Assignment:

Journal Article Review

You will read an assigned nursing article and write a critique related to a selected topic.

This assignment enables to meet the following course outcomes:

CO #3: Utilize effective communication when performing a health assessment. (PO #3)

CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO #6)

The body of the paper should have four sections with these headings:

  1. Introduction
  2. Summary of the Article
  3. Evaluation of the Article
  4. Conclusion
  5. Use scholarly writing including correct English grammar, syntax and sentence structure

ASSESSMENT OF THE ABDOMEN

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  • Describe a patient with an abdominal symptom or group of symptoms, such as bloating, flatus, and eructation; constipation; nausea and vomiting; diarrhea; or abdominal pain. Do not limit yourself to these examples. Remember that there are different types and locations of abdominal pain.
  • What questions would you ask as part of your focused assessment?
  • What history might be associated with the symptom, if any?
  • What are the known risk factors for this condition?
  • What physical examination techniques would you use?
  • What patient education would you give the patient?
  • Find a nursing journal article about these symptoms.

NR 305 Week 5 TD 2:

Assessment of the Genitourinary System

Describe a patient with a genitourinary symptom or group of symptoms; such as incontinence, burning on urination, irregular menses, pain in the scrotum, erectile dysfunction, and so on. Do not limit yourself to these; for example, there are different types of incontinence.

  • What questions would you ask as part of your focused assessment?
  • What history might be associated with the symptom, if any?
  • What are the known risk factors for this condition?
  • What physical examination techniques would you use?
  • What patient education would you give to the patient?
  • Find a nursing journal article about these symptoms

Assessing the Musculoskeletal System

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•           Describe a patient with a musculoskeletal symptom or group of symptoms, such as joint pain, back pain, neck pain, and so on. Do not limit yourself to these examples. Remember: There are different types and locations of joint pain.
What questions would you ask as part of your focused assessment?
What history might be associated with the symptom, if any?
What are the known risk factors for this condition?
What physical examination techniques would you use?
What patient education would you give the patient?
Find a nursing journal article about these symptoms.

NR 305 Week 7 TD 2:

 Assessing the Nervous System 
Choose one common complaint such as (symptom or group of symptoms) related to the neurological system. For example, you may select syncope, hand tremors, seizures, right/left-sided weakness or paralysis, abnormalities of gait or posture, changes in mental status, and so on. Do not limit yourself to these examples.
What questions would you ask as part of your focused assessment?
What history would be associated with the symptom?
What are the risk factors for this condition?
What physical examination techniques would you use?
What patient education would you give to the patient?
Find a nursing journal article about this symptom or condition.

DISRUPTIVE TECHNOLOGIES

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Consider the following excerpt from an article in Managed Care:

A disruptive technology, or technological enabler, is a new technology that unexpectedly displaces an established technology, but only if it is accompanied by an innovative business model. The enabler is generally cheaper, simpler, smaller, and frequently more convenient to use. It is initially embraced by the least profitable and usually the poorest customers in a market… A disruptive innovation is one that brings to market products and services that are much more affordable, and, in the end, much higher in quality. It improves a product or service in ways that the market does not expect, typically by being lower priced or being designed for a different set of consumers.
(Glabman, 2009)

In health care, there are many new technologies and innovations that can be considered “disruptive” by the definitions outlined above. In this final Discussion, you explore how disruptive technologies and innovations have the potential to transform health care practices worldwide.

To prepare:

  • Review Chapter 34, “Public Health Practice Applications,” and Chapter 35, “Informatics Solutions for Emergency Planning and Response,” in the course text. SEE ATTACHED FILES
  • Consider how organizations such as the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) are taking strides to address public health issues worldwide, including emergency planning and response.
  • How might disruptive technologies and innovations assist health care organizations in these efforts? Conduct additional research as necessary.

Post by tomorrow Wednesday 08/10/16 550 words in APA format and 3 references from the list below

1)An explanation of how disruptive technologies and innovations might contribute to public health efforts worldwide, specifically in areas with disadvantaged populations.

2) Explain how these technologies might also assist emergency planning and response efforts. Support your response with specific examples from the research literature.  

P.S. THIS ASSIGNMENT IS FROM THE FIELD OF NURSING INFORMATIC AND AS SUCH SHOULD REFLECT IT.

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

·   Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.

o   Chapter 32, “Public Health Practice Applications”

This chapter focuses on the application of informatics to public health. It also provides information on public health information systems and how these two areas can improve health in the United States.

o   Chapter 33, “Informatics Solutions for Emergency Planning and Response”

Attention to emergency planning and response has steadily increased over the past few years. This chapter focuses on the role that information technologies increasingly play in disaster management scenarios and emergency preparedness.

·   Armour, Q., & Thizy, D. (2010). 11 disruptive technologies that will change the face of EHRs—and how your competition is using them. Retrieved from http://s3.amazonaws.com/rdcms-himss/files/production/public/HIMSSorg/Content/files/Code%20151-Disruptive%20Technologies%20That%20Will%20Change%20the%20Face%20of%20EHRs%E2%80%94and%20How%20Your%20Competition%20is%20Using%20Them_Macadamian.pdf
This article explores a variety of disruptive technologies and how they are used in health care.

Media

·   Laureate Education, Inc. (Executive Producer). (2012d). The future of informatics. Baltimore: Author. 

Note: The approximate length of this media piece is 6 minutes.

Gail Latimer discusses her personal history with technology and the informatics field. She illustrates how professionals from diverse backgrounds can come together to create new informatics technologies and also highlights key challenges that the informatics profession will experience in the future. Dr. Roy Simpson conveys his vision for future informaticists and offers an important closing message.

Optional Resources

·   Centers for Disease Control and Prevention. (n.d.). Public health genomics. Retrieved August 9, 2012, from http://www.cdc.gov/genomics/

·   Atkinson, H. G., Montgomery, B., Igrejas, A., & Hill, S. (2011). Improving health and avoiding alarming trends. In T. Miller (Ed.),Dream of a Nation: Inspiring Ideas for a Better America (pp. 216–245). Retrieved from http://dreamofanation.org/docs/chapters/healthchapter.pdf

·   Romano, A. M., Gerber, H., & Andrews, D. (2010). Social media, power, and the future of VBAC. Journal of Perinatal Education, 19(3), 43–52.
Retrieved from the Walden Library databases

MASTERED PREPARED ROLE

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Purpose: I am doing the FNP track.
The purpose of this assignment is to: a) demonstrate how the skills outlined in the AACN Essentials are applicable to the role of a master’s–prepared nurse (CO #5, #6) and b) present ideas in a clear, succinct, and scholarly manner (CO #1).
Course Outcomes
Through this assignment, the student will demonstrate the ability to:
(CO#1) Demonstrate effective verbal, written, and technological communication using legal and ethical standards for transferring knowledge. (PO 3)
(CO#5) Analyze the American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing [AACN Essentials]. (PO 1)
(CO#6) Assess the roles of the master’s-prepared nurse. (PO 1)
REQUIREMENTS:
1. Discuss the MSN specialty track (educator, executive, informatics, health policy, FNP) that you have selected.
2. Demonstrate how the skills outlined in the nine (9) AACN Essentials are applicable to your selected master’s-prepared specialization. 
3. Identify three ways that a master’s-prepared nurse in your specialty would use the AACN Essentials skills in nursing practice.
4. Provide empirical evidence to support the three (3) ways a master’s-prepared nurse would use the AACN Essentials in practice. A minimum of two (2) current scholarly articles are required in this section of the presentation.
5. Concluding statements summarize content.
6. 15-slide presentation with speaker notes in APA format, not counting title and reference slides.

PREPARING THE PAPER
1. This is a PowerPoint presentation. 
2. Review the Creating a Professional Presentation located in Doc Sharing.
3. This presentation is to focus on the specific role you have chosen in the MSN program (e.g., educator, executive, informatics, health policy, FNP) and identify the AACN Essentials that are applicable to your specific role.

CHRONIC DISEASES

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Prior to completing this discussion, read the Bronfenbrenner Ecological theory in Chapter 1 of our textbook, the Schneiderman (2004) article, “Psychosocial, Behavioral, and Biological Aspects of Chronic Diseases,” the Kondrat (2013) article “Person In Environment” and review the Instructor Guidance.  Watch the videos below to get an understanding of the Bronfenbrenner’s Ecological Model and Erik Erikson’s Biopsychosocial Model.

  1. Choose one of the following chronic conditions: 
    1. Cancer
    2. Post-traumatic stress disorder (PTSD)
    3. Hypertension (High blood pressure)
    4. Diabetes
    5. Arthritis 
  2. Describe how the chronic condition leads to changes in behaviors, disability, and morbidity.
  3. Review the three theories (Bronfenbrenner’s Ecological theory, Biopsychosocial, Person-In-Environment) in the Instructor Guidance and/or the videos in the resources list, and discuss the following in your initial post.
    1. Consider one system in Bronfenbrenner’s theory, what system would have the greatest positive impact in managing the disease?  Explain your answer.
    2. Consider Biopsychosocial Model, which aspects of biological, psychological, and social domains are most important to understanding and promoting the patient’s health?  Explain your answer.
    3. Consider the Person-In-Environment system, how should the environment change to improve the person’s ability to live with the disease and vice versa?

Your initial contribution should be a minimum 250 words in length.  Support your claims with research from the Library or course text.  Use proper APA formatting for in-text citations and references as outlined in the Ashford Writing Center.Guided Response:Choose two of your classmate’s posts.  Reviewing the choices your peers made for each of the listed items, respectfully argue their explanation including the choices you would have made.  Use one of the theories to justify your choices.