Additional Critique of Evidence

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Additional Critique of Evidence

Unit 5 Assignment – Additional Critique of Evidence 4/7/22 1000w

This is part 3 of your evidence-based practice project.

In this assignment, you will refer back to assignment you completed in week 4/ the previous week, as this assignment will build upon it.

For this assignment, you will re-review your three articles selected from your week 2 and 4 assignment. Then, you’ll write a paper on the following (be sure to include the content from your previous papers in weeks 2 and 4.

For each of the three articles, please discuss the following in your paper: Additional Critique of Evidence

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  1. Research design of the study
  2. Threats to external/internal validity
  3. Potential legal/ethical issues within the article
  4. Data analysis (be sure to elaborate on this more from your paper in week 4, providing specifics about the results)
  5. Implications for evidence-based practice and how this article could be used to make an evidence-based change
  6. Conclusion/summary of the evidence

Remember to support your ideas with the articles you found. These articles should be less than five (5) years old. They should not be from the Web, but from the library databases, and be sure to use a narrative format.

In addition, you must follow APA guidelines, providing a title page, reference page, appendix, and in-text citations, as well as use level headings to match the assignment criteria listed above. Additional Critique of Evidence

Please use, at minimum three scholarly references, and your paper should be 800-1000 words, excluding title and reference pages.

 

 

 

 

 

 

Topic and PICOT Question

“The effects of proning treatment in COVID-19 patients” is the evidence-based practice topic chosen. Respiratory distress is the outstanding and pervasive COVID-19 symptom, thus, the prone position is a typical treatment for such problems. It necessitates practitioners to keep an eye on patients lying on their stomachs for effective proning. The prone posture entails lying on the frontal abdomen to relieve respiratory discomfort. The prone posture contrasts with the supine position, in which people lie horizontally on their backs. In a respiratory crisis, however, the prone position is preferable to the supine position because the supine posture compresses the lungs and inhibits air exchange, resulting in low oxygen levels.

Acute respiratory distress syndrome (ARDS) caused by deteriorating symptoms is of primary importance to the evidence-based issue. Although additional problems such as multi-organ failure andpulmonary edema might occur, ARDS is the most common in severely ill patients, involving around 17% of COVID-19 patients. The chosen evidence-based subject aims to investigate the efficacy of prone treatment in treating COVID-19 individuals experiencing deteriorating symptoms. In addition, it also assesses whether it reduces mortality for COVID-19 patients without access to mechanical ventilators (White & Lo, 2020).

A PICOT question is also created to address the evidence-based topic.Because of its specificity, the PICOT question is a foreground question since the important information required is for making therapeutic judgments. Because it examines whether proning treatment leads to better results for COVID-19 patients, the PICOT question can be categorized as targeting an intervention. The complete PICOT question is; “For COVID-19 positive patients, has the use of proning therapy been effective in reducing mortality and intubation rates?”The separate elements of the PICOT question include:

P: Covid- 19 positive patients in the ICU.

I:Proning therapy

C: supine position

O: Reduced intubation and mortality of COVID-19 patients

T: during hospital admittance.

First Article

The first article is by Ghelichkhani & Esmaeili, 2020 which is a commentary on using the prone position in managing COVID-19. The article’s concept is that prone positioning is the most effective intervention when dealing with acute respiratory distress syndrome (ARDS). Since ARDS is prevalent among COVID-19 patients by about 17%, prone positioning can be used to improve ventilation. However, the article’s authors assert that the efficiency of the prone position is influenced by commencement of therapy, duration of intervention, and patient selection

As a result, it’s critical to pick particular patients for the therapy and keep track of their time in the posture. The authors conclude thatproning be done for a minimum of 12 hours each day to be successful and started early in ARDS patients to reduce mortality.

The study is qualitative and does not collect numerical data. Instead, the authors depend on the available information in already published research articles to arrive at conclusions. The authors depend on historical studies and select primary sources that contain relevant information about COVID-19 and proning. For instance, the article references a meta-analysis that identified mortality rates dropping by about 17% after implementing the prone position for 12 hours a day.

The primary subjects of the article are COVID-19 patients suffering from ARDS. The article does not specify the specific tools that were deployed to select and identify relevant articles, the selection criteria, or database sources. The article is reliable because it is located in a health-related database, PubMed Central, and is created by authors with expertise on the subject. The weakness of the article is its commentary nature. The authors do not specify how they selected their sources of information.

Second Article

The second article is by Rahmani et al.(2020) and is qualitative in design. The article focuses on the outcome of using the prone position in the treatment of COVID-19. The prone position is commonly used to improve oxygenation in patients with ARDS who cannot breath without assistance. According to Rahmani et al. (2020), the prone posture promotes uniform ventilation and lowers patient mortality. Proning as a medical intervention is non-invasive ventilation; however, it is not entirely perfect and contains weaknesses. Of key interest is that it is usuallyeffective and successful when controlled by a healthcare team. COVID-19 patients under respiratory distress need supervision and constant monitoring when applying proning to improve oxygenation.

The method used in the study is a literary analysis of previous works to establish facts. It is qualitative, and thus the authors attempt to assess the effects of proning on COVID-19 patients based on available research. The authors reference multiple studies adapting statistics and other factual information. In addition, the authors also reference present theories on the prone position that illustrate proning results in homogenous ventilation. The article’s primary focus is COVID-19 patients admitted to the Intensive Care Unit (ICU) suffering from respiratory distress.

The article’s authors do not specify the tools used to select the studies referenced in the literature. However, one can infer that the studies selected to align with the main topic and are relevant in helping the authors identify relevant information. The information in the article is credible first because it is located in a recognized medical journal. Second, the article’s authors have competency in the relevant topic and expertise in presenting similar information. The last rationale for the article’s credibility is because it has been cited by other authors and used as a reference point in creating other published peer-reviewed articles.

 

Third Article

The third article is a study by Hallifax et al. (2020) to determine if successful awake proning of COVID-19 patients in need of respiratory assistance is linked to better medical outcomes. The study’s problem of focus is that awake proning promotes oxygenation in COVID-19, despite the lack of data on clinical effects. Its goal is to investigate how effective awake proning is in COVID-19 patients who need breathing assistance. A total of 565 COVID-19 patients were studied in a High Dependency Unit (HDU). According to the authors, awake proning may be beneficial for COVID-19 patients.

The researchers’ methods used for data analysis included logistic regression analysis and multivariate logistic regression. The authors specified criteria for patient admission to the HDU. Patients for the study were transferred to the HDU when their oxygen requirement increased. However, patients with increasingly deteriorating conditions were not enrolled in the study. Respiratory specialists monitored the patients in the HDU and encouraged them to line in the prone position for at least 2 hours daily.

Regarding the study’s validity,it expands on previously unsolved issues; for example, it provides evidence that awake proning improves medical outcomes in patients with respiratory distress. The study’s outcomes are consistent with earlier research, and they add that awake proning is a viable intervention in COVID-19 that needs more research. The study’s findings are consistent with past studies on the issue, and the authors remain cautious in their assertions, instead urging more evaluation and investigation. Nurses may utilize awake proning in COVID-19 patients in the HDU to enhance outcomes, and the findings are immediately applicable in nursing practice.

Conclusion

In conclusion, the prone position has been historically used to address respiratory distress problems, specifically ARDS. Since ARDS is the most common condition in COVID-19 patients with worsening symptoms, it is vital to assess the effectiveness of applying proning to alleviate their respiratory distress. There are specific aspects that should be addressed before using the prone position. For instance, the efficiency of the prone position is influenced by patient selection, commencement, and length of placement in the prone position. Practitioners need to select specific patients capable of benefiting from the intervention. It is also essential for health care practitioners applying the intervention to monitor the patients and ensures they receive a minimum of two hours of proning daily.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678

Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580

White, D. B., & Lo, B. (2020). A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. https://doi.org/10.1001/jama.2020.5046

 

 

 

 

 

 

 

 

Appendix

Matrix Table

Article/Reference (in APA format) Purpose of the Article/Study Question Variables (i.e.; Independent vs. Dependent) Study Design Sampling Methods Instrument Findings/Results
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/

 

 Assessing the management of COVID-19 patients through prone position There are no variables Narrative inquiry Purposeful sampling of COVID-19 patients Selecting previous relevant  articles Document or article analysis The prevalence of ARDS in COVID-19 is 17% and prone position can be used to improve ventilation in this population.
Rahmani, F., Salmasi, S., &Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580

 

 The effects of prone position in COVID-19 patients There are no variables Narrative inquiry Purposeful sampling of COVID-19 patients Selecting previous relevant  articles Literature analysis the prone position leads to homogenous ventilation and reduces patients’ mortality rate
Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678

 

 Determine if successful awake proning of COVID-19 patients who require respiratory support is linked to better outcomes. Respiratory support.

Ventilation

 Retrospective study. COVID-19 patients requiring respiratory assistance in the HDU Selecting patients who require oxygen support for the HDU and performing awake proning at least twice a day for 2 hours. Logistic regression analysis, Multivariate logistic regression, and Firth bias-reduced logistic regression High mortality rate for COVID-19 patients who require respiratory support although awake proning can address this issue.
               

 

 

Nursing homework help

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Nursing homework help

Number 1 post: PA

 

Q1. Which classes of diabetes medications are either weight neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class.

Type 2 diabetes (T2D) has been recognized as a bi hormonal disorder, with insulin and glucagon exerting opposite effects on glucose metabolism. Lang, et al., (2015). GLP-1-based diabetes therapies affect glucose control through several mechanisms, including slowed gastric emptying, regulation of postprandial glucagon, reduction of food intake, and enhancement of glucose-dependent insulin secretion without the risk of hypoglycemia. Chia-Hung, et al., (2015). One of the medications in the GLP-1 class is Exenatide with a generic name Byetta. In clinical trials, Sub Q injection of Exenatide (Byetta) 5 or 10ug was taken twice daily before the two largest meals of the day produced a modest decrease in fasting blood glucose and a large decrease in postprandial blood glucose. However, patients did not gain any weight and much lost weight. Rosenthal, & Burchum (2021). Nursing homework help

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Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with frequency, and route.

It is appropriate to treat this patient with monotherapy. Metformin is a first-line treatment for T2DM that has been used for over 60 years. Upon ingestion, approximately 50% of metformin is absorbed primarily from the duodenum and jejunum, and systemically available metformin is renally excreted unchanged. Henry. (2018).

I would recommend Metformin since it is the first-line therapy for Type 2 diabetes, it is  a medication in the drug class of Biguanide with a generic name Metformin (Glucophage). Patient will take 500 mg/tablet, once a day, taken orally with food. Nursing homework help

Q3. What are the contraindications of your selected diabetic therapy?

Liver and renal dysfunction and heart failure and severe metabolic acidosis for the patient with significant renal impairment. Rosenthal, & Burchum. (2021).

The patient returns to your office six months later complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism.

Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism?

The lab work-up I will obtain during this patient visit will be her thyroid hormone test. Which include: TSH (thyroid-stimulating hormone), T4 (Thyroxine). Free T4 is preferred and Free T3 (Triiodothyronine).  TSH, T3, and T4 can be used to diagnose, monitor, and treat thyroid disorders. Low T3, T4, and high TSH levels are seen with hypothyroidism, whereas high freeT3, T4, and Low TSH levels may indicate hyperthyroidism.

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

I will prescribe medication with the brand name Synthroid and a generic (Levothyroxine)50mcg PO daily with a max dose of 300mcg/day. Levothyroxine is the most used medicine. Hypothyroidism (2018). Levothyroxine increases metabolic rate, decreases thyroid-stimulating hormone (TSH) production from the anterior lobe of the pituitary gland, and, in peripheral tissues, is converted to T3. Thyroxine is released from its precursor protein thyroglobulin through proteolysis and secreted into the blood where is it then peripherally deiodinated to form triiodothyronine (T3) which exerts a broad spectrum of stimulatory effects on cell metabolism. (Physiology, Thyroid Stimulating Hormone Pirahanchi).

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

Side effects include fever, hot flashes, sensitivity to heat, sweating, headache, nervousness, irritability, nausea, sleep problems (insomnia).

Patient will be informed that she will be prescribed the lowest dose possible that relieves her symptoms and brings her blood hormone levels back to normal. When starting on this medicine, the doctor may check the hormone levels every 2 to 3 months. After that, her thyroid hormone levels should be monitored at least once every year. Patients will be told not to stop taking the medicine even when she feels better, she needs to continue taking it exactly as the doctor prescribed. Thyroid medicine works best on an empty stomach and is taken 1 hour before any other medicines. I will also inform the patient that it may take one to three weeks after initiating therapy with levothyroxine or changing the dose before the effects are seen.

 

 

Number 2 post: BP

DM
Q1. Classes of DM medications that increase weight loss are identified as GLP-1-RA and SGL2. An example of a GLP1-RA is Semaglutide with the brand name Ozempic (Higbea et al., 2017). An example of an SGL2 drug would be Empagliflozin sold as the brand name Jardiance (Higbea et al., 2017). Weight neutral DM medications include drugs such as Biguanides and DDP4i medications (Higbea et al., 2017). Biguanides include medications such as Glucophage which goes by the generic name Metformin. DDP4i medications include drugs such as sitagliptin, the brand name Januvia (Higbea et al., 2017).

Q2. The American Diabetes Association defines a hgbA1C above 6.5% as Diabetic (American Diabetes Association, 2022). The patient’s hgbA1C is 8.4% which requires treatment (American Diabetes Association, 2022). The American Diabetes Association would suggest Metformin and lifestyle changes for this patient. Glucophage that goes by the generic name Metformin. Starting dose for this patient would be 500mg PO once daily (Lexicomp, 2021).

Q3. Precautions for this drug include decreased absorption post-bariatric surgery, renal impairment, hepatic impairment, heart failure, and increased stress levels (Lexicomp, 2021). Metformin products should be temporarily held for surgical procedures and studies using Iodine contrast, and the black box warning includes Lactic Acidosis (Lexicomp, 2021).

Thyroid
Q1. The preferred test to run is a TSH (thyroid-stimulating hormone) level. The anterior pituitary is sensitive to changes in serum t3 and serum t4 levels, which can cause a rise in TSH levels (Rosenthal & Burcham, 2021). Other tests include the “serum thyroxine test” which measures T4 levels, both free and total (Rosenthal & Burcham, 2021). In addition, the “Serum Triiodothyronine Test” measures T3 levels free and total (Rosenthal & Burcham, 2021). Normal TSH levels range from 0.3-6, over 6 is reflective of hypothyroidism, and under 0.3 is indicative of hyperthyroidism (Rosenthal & Burcham, 2021). Hypothyroidism would include total T4 under 4.5, free T4 under 0.9, total T3 under 80, and free T3 under 230 (Rosenthal & Burcham, 2021). Hyperthyroidism would include ranges such as total T4 over 12.5, free T4 over 2, total T3 over 220, and free T3 over 620 (Rosenthal & Burcham, 2021).

Q2. The treatment of choice for Hypothyroidism is Levothyroxine also known as Synthroid (brand name). Hypothyroidism results in insufficient secretion of thyroid hormones including T4 (Correa &Eghtedari, 2021). Levothyroxine is the synthetic version of thyroid hormone T4. In a normally functioning thyroid, the anterior pituitary secretes TRH (thyroid- releasing hormone). TRH stimulates TSH (thyroid-stimulating hormone) which in turn stimulates the release of T4 (Correa &Eghtedari, 2021). T4 is then converted to T3 which is responsible for metabolism, cardiac function, and development (Rosenthal & Burcham, 2021). The starting dose of Levothyroxine is 1.6 mg/kg per day PO in the morning. Follow up with labs and titrate does up as necessary based on TSH levels.

Q3. Although side effects are rare, severe adverse reactions such as toxicity can occur which can include tachycardia, angina, tremor, nervousness, and insomnia (Rosenthal & Burcham, 2021). Patient teaching should include notifying the provider of any of these signs and symptoms. Toxicity is treatable with Cholestyramine, glucocorticoids, or PTU (Rosenthal & Burcham, 2021). Certain drugs accelerate the metabolism of Levothyroxine such as certain seizure medications and Zoloft (Rosenthal & Burcham, 2021). Levothyroxine increases the breakdown of Vitamin K (Rosenthal & Burcham, 2021). Therefore it should be used with caution for patients on Warfarin. It also increases the effects of catecholamines, increasing the risk for arrhythmia (Rosenthal & Burcham, 2021). It can also increase insulin and digoxin needs(Rosenthal & Burcham, 2021). Patients must understand that this medication cannot be skipped or discontinued without instructions and monitoring from a healthcare provider (Lexicomp, 2021). Education regarding medication administration includes taking medication on an empty stomach 30-60m before food in the morning, and 4hrs between calcium or iron-containing products (Lexicomp, 2021). It must be taken at the same time every day.

 

 

Qualitative Research Critique and Ethical Considerations

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Qualitative Research Critique and Ethical Considerations

Rough Draft Qualitative Research Critique and Ethical Considerations

Assessment Description

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

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Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.  Qualitative Research Critique and Ethical Considerations

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

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance. Qualitative Research Critique and Ethical Considerations

Research Critique Guidelines – Part I

Qualitative Studies

Background of Study

  1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

How do these two articles support the nurse practice issue you chose?

  1. Discuss how these two articles willbe used to answer your PICOT question.
  2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Study:

  1. State the methods of the two articles you are comparing and describe how they are different.
  2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

Results of Study

  1. Summarize the key findings of each study in one or two comprehensive paragraphs.
  2. What are the implications of the two studies in nursing practice?

Ethical Considerations

  1. Discuss two ethical consideration in conducting research.
  2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

 

 

Nursing homework help

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Nursing homework help

Episodic/Focused SOAP Note Template

 

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

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Location: head Nursing homework help

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better Nursing homework help

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.

O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

A.

Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 

Literature Evaluation Table

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Literature Evaluation Table


Topic 4: Development Of Evidence-Based Practice Change Proposal II

 

Max Points:85

In this topic, students will continue to examine the research literature and utilize library resources to locate quality, peer-reviewed sources that support their chosen topic and solution. Students will begin to synthesize the research data from multiple sources to identify strategies for implementation of a nursing intervention. Students must identify a change or nursing theory to support their proposed capstone project intervention. Literature Evaluation Table

Objectives:

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  1. Synthesize evidence-based research data to support the development of the capstone project change proposal.
  2. Identify a change or nursing theory to support the nursing intervention for the capstone project change proposal.
  3. Write measurable outcomes for the evidence-based nursing practice intervention used in the capstone project change proposal.
  4. Integrate reflective practice into the practicum reflective journal.
  5. Demonstrate interprofessional collaboration during the creation of the capstone project change proposal.

 

 

 

DQ1

 

Why is understanding the health care system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course preceptor that you will take into consideration for your own change project.

 

 

DQ2

 

Compare and contrast two change theories, and determine which theory makes the most sense for implementing your specific EBP intervention. Why? Has your preceptor used either theory, and to what result? Literature Evaluation Table

Literature Evaluation Table

 

Points

50

 

In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

Qualitative Research

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Qualitative Research

Conduct a literature search to select a qualitative research study on the topic identified in Module 1. Conduct an initial critical appraisal of the study.

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Respond to the overview questions for the critical appraisal of qualitative studies, including:

  • What type of qualitative research design was utilized to conduct the study?
  • Are the results valid/trustworthy and credible?
  • How were the participants chosen?
  • How were accuracy and completeness of data assured?
  • How plausible/believable are the results?
  • Are implications of the research stated?
  • May new insights increase sensitivity to others’ needs?
  • May understandings enhance situational competence?
  • What is the effect on the reader?
  • Are the results plausible and believable?
  • Is the reader imaginatively drawn to the experience?
  • What are the results of the study?
  • Does the research approach fit the purpose of the study?
  • How does the researcher identify the study approach?
  • Are the data collection and analysis techniques appropriate?
  • Is the significance/importance of the study explicit?
  • Does the literature support a need for the study? Qualitative Research
  • What is the study’s potential contribution?
  • Is the sampling clear and guided by study needs?
  • Does the researcher control selection of the sample?
  • Do sample size and composition reflect the study needs?
  • Is the phenomenon (human experience) clearly identified?
  • Are data collection procedures clear?
  • Are sources and means of verifying data explicit?
  • Are researcher roles and activities explained?
  • Are data analysis procedures described?
  • Does analysis guide directions of sampling when it ends? Qualitative Research
  • Are data management processes described?
  • What are the reported results (descriptive or interpretation)?
  • How are specific findings presented?
  • Are the data meanings derived from data described in context?
  • Does the writing effectively promote understanding?
  • Will the results help me care for my patients?
  • Are the results relevant to persons in similar situations?
  • Are the results relevant to patient values and/or circumstances?
  • How may the results be applied to clinical practice?

Please be sure to answer the questions thoroughly using complete sentences and APA format. Explain responses to yes/no questions in detail by presenting information found in the study to support your response.

Provide a reference for the article according to APA format and a copy of the article.

Nursing Care Plan

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Nursing Care Plan

This is a nursing care plan assignment, based on your assessment of Brian Foster. You should identify a nutritional problem for your care plan based on your assessment.  You will see I speak of “Cues” you should find cues in your transcripts of your interview with Brian Foster. For example, if we had a diagnosis of risk for unstable glucose level…what evidence does Brian provide to you that this is a problem? For example during your interview you would identify I just have a lot going on in my life, and I only have space in my mind for so much, you know? It’s a lot easier to stay away from sweets than it is to remember to test my sugar and be pricking my finger all the time and all of that. Anyway, the num Nursing Care Plan

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Identify client’s health goal

1.      Choose a problem-based diagnosis based on the client’s nutritional status assessment with supportive evidence from your interview (20pts).

 

2.      Provide a rationale for your choice (10pts).

 

 

 

 Nursing Diagnosis: Iron deficiency anemia

 

 

 

 

Rationale: The client displays the following symptoms: extreme fatigue; pale skin; headache, lightheadedness, and dizziness; brittle nails; shortness of breath; damaged or dry skin; brittle nails; and inflammation of the tongue. All these symptoms are associated with iron deficiency anemia.
3.      Identify two nursing interventions (10pts) based on the client’s identified nursing diagnoses with rationale (10pts) for each intervention (Total = 20pts).

4.      Identify two nursing goals (10pts) based on your client’s identified nursing interventions (10pts) for each intervention (Total = 20pts).

 

 

 

 

 

 

5.      Interventions must be supported by ONE evidence-based practice article within 5 years. The article must be uploaded your assignment in Bb; a full and proper APA format is required in the right column under reference (10pts)

 

 

 

 Intervention 1:Iron supplements

 

Rationale: As a nurse, I will advise the patient to take iron supplements (including drops, capsules, pills, etc.) to treat the symptoms of the disease and increase the levels of iron in the body (Cleveland Clinic, 2018)

 

Goal Intervention 1: To replenish iron stores.

 

Reference: Cleveland Clinic. (2018). Oral Iron Supplementation. Retrieved from:  https://my.clevelandclinic.org/health/articles/14568-oral-iron-supplementation

Intervention 2: Treating underlying causes of iron deficiency

 

Goal Intervention 2: To treat the underlying condition or disease

 

Rationale: If iron supplements do not increase the levels of iron in the body, it is more likely that the iron deficiency is a result of bleeding or malabsorption of iron (Mayo Clinic, 2022). Depending on the cause, treatment may include medications (including oral contraceptives) to stop heavy periods; surgery to get rid of a bleeding fibroid, a tumor, or polyp; or antibiotics to treat peptic ulcers.

 

Reference: Mayo Clinic. (2022). Iron Deficiency Anemia. Retrieved from: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/diagnosis-treatment/drc-20355040

 

 
6.      Identify how you will evaluate each intervention/goal (with a rationale) that the client will achieve the health goal (20pts)

 

 

 

 

 Evaluation of Intervention 1: Assess the symptoms of the disease

 

Rationale: By evaluating the symptoms of the illness, I will determine if iron supplements were effective. The effectiveness of the intervention lies in its ability to reduce the symptoms.

 

Evaluation of Intervention 2: Evaluate the iron levels in the body

 

Rationale: By evaluating the iron levels in the body, I will determine if the medications and antibiotics were effective in treating the underlying condition.

 

 

Assessing the Abdomen

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Assessing the Abdomen

Assignment 1: Lab Assignment: Assessing the Abdomen

A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with AAA; however, as a precaution, the doctor ordered a CTA scan.

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical assessments and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Assessing the Abdomen

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To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment.

  • About      the Episodic note case study provided:
    • Review       this week’s Learning Resources and consider the insights they provide       about the case study.
    • Consider       what history would be necessary to collect from the patient in the case       study.
    • Consider       what physical assessment and diagnostic tests would be appropriate to       gather more information about the patient’s condition. How would the       results be used to make a diagnosis?
    • Identify at       least five possible conditions that may be considered in a       differential diagnosis for the patient.

Case study

ABDOMINAL ASSESSMENT

Subjective:

CC: “My stomach has been hurting for the past two days.”

HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain.  Assessing the Abdomen

PMH: HTN

Medications: Metoprolol 50mg

Allergies: NKDA

FH: HTN, Gerd,  Hyperlipidemia

Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female

Objective:

  • VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Skin: Intact without lesions, no urticaria
  • Abd: abdomen is tender in the epigastric area with      guarding but without mass or rebound.
  • Diagnostics: US and CTA

Assessment:

  1. Abdominal Aortic Aneurysm (AAA)
  2. Perforated Ulcer
  3. Pancreatitis

PLAN: 

The Assignment

  1. Analyze      the subjective portion of the note. List additional information that      should be included in the documentation.
  2. Analyze      the objective portion of the note. List additional information that should      be included in the documentation.
  3. Is      the assessment supported by the subjective and objective information? Why      or why not?
  4. What      diagnostic tests would be appropriate for this case, and how would the      results be used to make a diagnosis?
  5. Would      you reject/accept the current diagnosis? Why or why not? Identify three      possible conditions that may be considered as a differential diagnosis for      this patient. Explain your reasoning using at least three different      references from current evidence-based literature.Episodic/Focused SOAP Note Template

     

    Patient Information:

    Initials, Age, Sex, Race

    S.

    CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

    HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

    Location: head

    Onset: 3 days ago

    Character: pounding, pressure around the eyes and temples

    Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

    Timing: after being on the computer all day at work

    Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

    Severity: 7/10 pain scale

    Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

    Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

    PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

    Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

    Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

    ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

    HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat.

    SKIN:  Denies rash or itching.

    CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

    RESPIRATORY:  Denies shortness of breath, cough or sputum.

    GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

    GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

    NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

    HEMATOLOGIC:  Denies anemia, bleeding or bruising.

    LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

    PSYCHIATRIC:  Denies history of depression or anxiety.

    ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

    ALLERGIES:  Denies history of asthma, hives, eczema or rhinitis.

    O.

    Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

    Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

    A.

    Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

    This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

    References

    You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

     

The Crisis of Addiction

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The Crisis of Addiction

Research Paper Instructions #1

 

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Chemical Dependency: The Crisis of Addiction

 

The research paper must have a minimum of 2000 words – main body (does not include the title page, abstract, or reference pages). Times New Roman, Size 12, and 5 references about that topic (4 of them most be research articles). The criteria exposed in your paperwork must be exclusively based on peer reviewed article, and I will be very fussy in confirming the reliability of your statements. A formal paper using APA format according to Publication Manual American Psychological Association (APA) (6th ed.).2009 ISBN: 978-1-4338-0561-5 will be submitted via Exercise Submission. This paperwork must be submitted on week # 6 (Sunday, 2/13 at 11:59 PM EST), The Crisis of Addiction

Question Guide:

The paper should include the following:

  • What is Chemical dependency?
  • Statistics / Most common abused substance
  • Sociocultural determinants of substance abuse
  • Models of addiction
  • Dynamics of addiction
  • Interventions / Treatments approaches (pharmacological and non-pharmacological)
  • Other considerations in the management of Chemical dependency (including but not limited to management of behaviors, family considerations, challenges in the care of patients with addiction.

Examine evidence-based practice guidelines / research, nursing theories that support the identification of clinical problems, implementation of nursing skills in the care of adults with addiction.

Grading Criteria:

  • What is Chemical dependency? – 2%
  • Statistics / Most common abused substance – 2%
  • Sociocultural determinants of substance abuse – 2%
  • Models of addiction – 2%
  • Dynamics of addiction – 2%
  • Interventions / Treatment approaches (pharmacological and non-pharmacological) – 2%
  • Other considerations in the management of Chemical dependency (including but not limited to management of behaviors, family considerations, challenges in the care of patients with chemical dependency – 2%
  • References: At least 5 reference sources – 4 of them most be research articles – 3%
  • APA style – 3 %

MAXIMUN POINTS – 20%

It accounts for 20% of your final grade

 

ABDOMINAL ASSESSMENT

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ABDOMINAL ASSESSMENT

ABDOMINAL ASSESSMENT

Subjective:

  • CC: “My stomach hurts, I have diarrhea, and nothing seems to help.”
  • HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterward.
  • PMH: HTN, Diabetes, hx of GI bleed 4 years ago
  • Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
  • Allergies: NKDA
  • FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
  • Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

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Objective:

  • VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall symmetrical
  • Skin: Intact without lesions, no urticaria
  • Abd: soft, hyperactive bowel sounds, pos pain in the LLQ
  • Diagnostics: None

Assessment:

  • Left lower quadrant pain ABDOMINAL ASSESSMENT
  • Gastroenteritis

Plan: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not?
  6. Identify three possible conditions that may be considered as a differential diagnosis for this patient ( consider diverticulitis, colitis, appendicitis). Explain your reasoning using at least five different references from current evidence-based literature. The paper has to be write in APA format. ABDOMINAL ASSESSMENT