Evidenced Base Practice

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Details:
In 500-750 words (not including the title page and reference page), apply a change model to the implementation plan. Include the following:

Rogers’ diffusion of innovation theory is a particularly good theoretical framework to apply to an EBP project. However, students may also choose to use change models, such as Duck’s change curve model or the transtheoretical model of behavioral change. Other conceptual models presented such as a utilization model (Stetler’s model) and EBP models (the Iowa model and ARCC model) can also be used as a framework for applying your evidence-based intervention in clinical practice.
Apply one of the above models and carry your implementation through each of the stages, phases, or steps identified in the chosen model.
In addition, create a conceptual model of the project. Although you will not be submitting the conceptual model you design in Topic 5 with the narrative, the conceptual model should be placed in the appendices for the final paper.
Prepare this assignment according to the APA 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.

Upon receiving feedback from the instructor, refine “Section E: Change Model” for your final submission. This will be a continuous process throughout the course for each section.

NR534A-NEED RESPONSES

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NR534A-NEED RESPONSES

 

NR534A-NEED RESPONSES

Anna Tam

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Using technology to engage patients at the point of care enables them to learn more about their illnesses or conditions, set care goals, provide real-time feedback on their experiences, and stay connected to health care providers across the care continuum. For certain patient populations, utilization of interactive patient care technology is positively correlated with improved clinical quality and patient experience outcomes (Clavelle, 2018). NR534A-NEED RESPONSES

Asan et al. (2018) using a mixed method study regarding screen sharing and found that providing patient access to the EHRs with screen sharing was linked with several benefits including improved patient engagement, education, transparency, comprehension, and trust. These factors are vital in engaging patient centered care. NR534A-NEED RESPONSES

How might you utilize health IT systems to support your patients, as well as their families and caregivers?

In order to support patients, Balhara and Millstein (2020) advocate for clinicians partnering with patients to create meaningful, personalized narratives. The idea of Open notes, which allows for patients to review their physician’s progress notes. The authors also discuss the idea of a personal “snapshot,”. This could be an easily accessible tab in the EHR where patients could create and store their profile of personally important things they would like their doctors to know—family photo, preferred way to receive information, names of loved ones, and upcoming milestones. Such “snapshots” could immediately humanize episodic acute care encounters; an emergency physician, for instance, would have instant access to details that would facilitate a more personalized care encounter. Similarly, such “snapshots,” evolving over the course of a patient’s relationship with their primary care provider, would lend increased depth and intimacy to long-term care relationships. This would help restore inclusivity and patient agency to the EHR.

References

Asan, O., Tyszka, J., & Crotty, B. (2018). The electronic health record as a patient engagement tool: mirroring clinicians’ screen to create a shared mental model. JAMIA open, 1(1), 42-48. https://doi.org/10.1093/jamiaopen/ooy006

Balhara, K. S., & Millstein, J. H. (2020). Partners in Narrative: Empowering Patient–Physician Partnerships in the Electronic Health Record. Journal of Patient Experience, 833–835. https://doi.org/10.1177/2374373520962608 NR534A-NEED RESPONSES

Clavelle, J. (2018). Leveraging Technology to Increase Patient and Family Engagement and Improve Outcomes. Nursing Administration Quarterly, 42 (3), 246-253. doi: 10.1097/NAQ.0000000000000301.

 

 

 

CyronDalida 

 

How can health IT systems be leveraged for patient engagement and empowerment?

The promotion of patient portals as an extension of care delivery can empower patients by giving them access to their digital health information. Having the power to check diagnostic results, access physician’s notes, and make appointments through a handheld device supports patient-centered care, especially for older patients with chronic health conditions. Promotion of this technology starts with providers at a clinic or by nurses in the ED during discharge teaching.

Why is it important for families and caregivers of patients to be included in these processes?

Being included in this process through the patient portal system supports patient-centered care and keeps them connected with their providers or specialists, knowing that the technology supports their health and answers questions they may have.

How might you utilize health IT systems to support your patients, as well as their families and caregivers?

By paying attention to the needs of diverse patient populations, doing one-on-one training for patients with limited digital literacy, and involving clinicians and staff in promoting patient portal use is key to achieving higher patient engagement rates with the patient portal system (Lyles et al., 2020).

References:

Lyles, C.R., Nelson, E.C., Frampton, S. (2020). Using electronic health record portals to improve patient engagement: Research priorities and best practices. Annals of Internal Medicine. https://doi.org/10.7326/M19-0876

 

 

Maria Houston 

Personal Health Records (PHRs) are becoming more important in healthcare today due to a stronger emphasis on patient engagement, which can result in improved disease management and patient outcomes (George &Hopla, 2015). According to Health IT.gov, Personal Health Records (PHRs) contain similar types of information as Electronic Health Records (EHRs), such as diagnoses, medications, immunizations, family medical histories, and provider contact information, but are designed to be set up, accessed, and managed by patients. Patients can use PHRs to manage their health information in a private, secure, and confidential environment with information that is clinically informative for a health systems team.

Similarly, self-tracking and self-management tools are valuable for health care consumers and encourage people to be active participants in their care. Health applications today have billions of users in America with an increasing range of digital health systems (Statistica, 2022). The ability for people to track and monitor their own health status is a feature that can be invaluable to patients and is expanding.

 

In a study exploring colorectal cancer survivors, a Personal Health Record eJournal was utilized that contained a “Reflection and Communication” element. Here, patients viewed the journal as a tool for reflection where they could record their personal thoughts, emotions, symptoms, and “vent” about frustrations. If shared with their health professionals, the information recorded in the journal as a way to open a dialogue with treatment professionals that would potentially reduce a sense of isolation that co-occurs with a cancer diagnosis. These are just several examples of ways to leverage Health IT to improve patient engagement and empowerment.

George, T., and Hopla, D., (2015). Advantages of personal health records, Nursing Critical Care: V10 – I 6 – p 10-12  https://journals.lww.com/nursingcriticalcare/Fulltext/2015/11000/Advantages_of_personal_health_records.3.aspx#:~:text=%20Advantages%20of%20personal%20health%20records%20%201,the%20security%20of%20their%20health%20information.%20More%20?msclkid=38ecbd38b48c11ecbf1e516f79b65583

Health IT.gov (nd). What are the differences between electronic medical records, electronic health records, and personal health records? https://www.healthit.gov/faq/what-are-differences-between-electronic-medical-records-electronic-health-records-and-personal?msclkid=92f22b8a

Haggstrom, D. A., & Carr, T. (2022). Uses of personal health records for communication among colorectal cancer survivors, caregivers, and providers: interview and observational study in a human-computer interaction laboratory. Jmir Human Factors, 9(1), 16447. https://doi.org/10.2196/16447

 

NR514: EPIDEMIOLOGY & POPULATION HEALTH

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NR514: EPIDEMIOLOGY & POPULATION HEALTH

 

NR514-NEED RESPONSES

Lauren Brown 

 

When considering the risks associated with pediatric obesity, one of the biggest concerns is the development of diabetes mellitus (DM).

In 2016, the prevalence in thousands of individuals diagnosed with DM was 383,453.  The incidence in thousands of those diagnosed with DM was 20,828.  The YDL in thousands was 28,584.  This created a 23.6% change between 2006-2016, a ten year span.  Further, it created a -1.2 YLDs (years lived with disability) change in age-standarized rates between the same ten year time frame, 2006-2016 (Vos et al., 2017). NR514: EPIDEMIOLOGY & POPULATION HEALTH

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When considering these numbers related to DM, it is important to remember that this study was a survey of global health.  With that, mortality rates are declining, life expectancy is increasing, and populations are aging differently than the used to.  This is due to a number of factors, most of which have to do with the access and advancement of treating chronic health issues for a longer amount of time.  Diabetes is one of the chronic health issues that has continued to increase across the globe, in both incidence and YLD rates (Vos et al., 2017).

The ability to understand and read these trends is valuable in determining how healthcare systems can make changes to help prevent diabetes.  Pediatric obesity is so closely linked to the prevention of diabetes, particularly early onset.  However, treating pediatric obesity is a process of lifestyle changes that can be all encompassing for a family (Chobot et al., 2018).

As providers, which lifestyles changes do you think are most important for a pediatric patient to make in order to prevent chronic issues such as diabetes from developing?  What recommendations would you make for a family that struggles with weight control or eating healthy?  This applies to all of our communities.

Resources

Chobot, A., Górowska-Kowolik Katarzyna, Sokołowska, M., & Jarosz-Chobot, P. (2018). Obesity and diabetes—not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews, 34(7). https://doi.org/10.1002/dmrr.3042

Vos, T., Amanuel, A. A., Kalkidan, H. A., et al. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 390(10100), 1211-1259. http://dx.doi.org/10.1016/S0140-6736(17)32154-2 NR514: EPIDEMIOLOGY & POPULATION HEALTH

 

 

Maria Houston

 

Opioid use disorders affect over 16 million people worldwide, over 2.1 million in the United States, and there are over 120,000 deaths worldwide annually attributed to opioids. Examples of opioids include heroin, morphine, codeine, and synthetic opioids such as fentanyl and oxycodone. Opioid use disorder includes dependence and addiction with addiction representing the most severe form of the disorder (Dydyk, et al., 2022). The CDC reports that over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recently obtained data (2021). Of those, incidences involved 42,687 overdose deaths involving fentanyl in the 12 months leading up to May 2020.  NR514: EPIDEMIOLOGY & POPULATION HEALTH

Fentanyl is a synthetic opioid made in a laboratory and overdose rates are rising 2.5 times faster than heroin overdoses. Fentanyl overdoses outpace prescription opioid overdoses by 550.94% (over 500%). Fentanyl OD rates increased by 1,105% from 2012 to 2018 according to the National Center for Drug Abuse (2022). Naltrexone may be useful to prevent relapse and is used to treat opioid overdose, although repeated and higher doses may be needed than are practically available in a Fentanyl OD.

Patients with opioid problems may have extended periods of abstinence and can function in society, however, there is a chronic risk of accidental overdose, trauma, suicide, and infectious diseases (Dydyk, et al., 2022). I am saddened and surprised by the fentanyl statistics. I am aware of how extremely severe this problem is and why it needs a rapid and robust crisis response. It is difficult to determine the life span of someone with an opioid addiction due to the variable of overdose death.

Two relevant implications for prevention or intervention are harm reduction tactics such as mental health treatment and medication-assisted therapy (MAT). According to the Substance Abuse and Mental Health Services Administration (SAMSHA), the following approaches can be utilized to reduce the health consequences of addiction:

  • Connect individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders.
  • Distribute opioid overdose reversal medications (e.g., naloxone) to individuals at risk of overdose, or to those who might respond to an overdose.
  • Lessen harms associated with drug use and related behaviors that increase the risk of infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.
  • Reduce infectious disease transmission among people who use drugs, including those who inject drugs by equipping them with accurate information and facilitating referral to resources.
  • Reduce overdose deaths, promote linkages to care, and facilitate co-location of services as part of a comprehensive, integrated approach.
  • Reduce stigma associated with substance use and co-occurring disorders
  • Promote a philosophy of hope and healing by utilizing those with lived experience of recovery in the management of harm reduction services, and connecting those who have expressed interest to treatment, peer support workers and other recovery support services (SAMSHA, 2022).

Centers for Disease Control (2020). Press release, newsroom. Overdose deaths accelerating during COVID-19, expanded prevention efforts needed, https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

Dydyk, A. M., Jain, N. K., & Gupta, M. (2022). Opioid Use Disorder. In StatPearls. StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/31985959/

National Center for Drug Abuse Statistics (2022). https://drugabusestatistics.org/fentanyl-abuse-statistics/?msclkid=41a23aa9b3b511ecae9caf63e6694703

Substance Abuse and Mental Health Services Administration, (2022). Harm reduction. From https://www.samhsa.gov/find-help/harm-reduction?msclkid=a745230ab3bb11ec92e56617a288bd13

CyronDalida 

As a significant risk factor for burden of mortality and morbidity, alcohol use has been linked to alcoholic liver disease (ALD) and alcohol use disorders (AUD) (Rehm et al., 2019).  The burden of disease differs between ALD and AUD.  The burden of disease for ALD is due to premature death, while for AUD, it is mainly due to disability resulting from alcohol use (Rehm et al., 2019).  According to the 2018 World Health Organization’s (WHO) Global Status Report, the harmful use of alcohol caused 3 million deaths worldwide, more than diabetes and hypertension combined (WHO).  According to the WHO, the mean lifetime prevalence of alcohol use globally was 80% combined, ranging from 3.8% to 97%, with AUD prevalence much higher for men than women.  It is essential to point out that mental health disorders (MHD) preceded the onset of AUD for most comorbidity combinations, and high-income households, married and educated, were associated with a lower risk for lifetime AUD (Glantz et al., 2020).

References:

Glantz, M.D., Bharat, C., Degenhardt, L., Sampson, N.A., Scott, K.M., Lim, C., Al-Hamzawi, A., Jordi, A., Andrade, L.H., Cardoso, G., De Girolamo, G., Gureje, O., He, Y.,  Hinkov, H., Karam, E.G.,  Kovess-Masfety, V., Lasebikan, V., Lee, S., Levinson, D., McGrath, J., Medina-Mora, M.,  Mihaescu-Pintia, C., Mneimneh, Z., Moskalewicz, J., Navarro-Mateu, F., Posada-Villa, J., Rapsey, C., Stagnaro, J.C., Tachimori, H., Ten Have, M., Tintle, N., Torres, Y., Williams, D.R., Ziv, Y.,  Kessler, R.C.  (2020). The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys,AddictiveBehaviors,Volume 107,2020,106128,ISSN 0306-4603. https://doi.org/10.1016/j.addbeh.2019.106128.

Rehm, J., Shield., K.D. (2019). Global burden of alcohol use disorders and alcohol liver disease. Biomedicines 2019, 7(4), 99. https://doi.org/10.3390/biomedicines7040099

 

Louann Robinson  

The Global Burden of Diseases, Injuries and Risk Factors Study (GBD) (2016) is a global effort to quantify non-fatal outcomes using a standardized evaluation and collection methodology. The report allows comparisons between fatal and non-fatal outcomes of a comprehensive list of diseases and injuries and is the only global report of this nature. The GBD (2016) offers a comprehensive comparison of the prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016 (pp.1212 – 1213).

Diabetes

The GBD (2016) reported slower progress in addressing non-fatal compared with fatal health outcomes and ageing of populations. Non-fatal diseases such as diabetes make years lived with a disability (YLDs) an ongoing fundamental aspect of global disability-adjusted life-years (DALYs) (p. 1229).

Prevalence, Incidence and Trends

Factors that have contributed to the increase in the prevalence of diabetes are the ageing of populations and lifestyle-related risk factors such as high BMI and obesity. Together they have increased the incidence of diabetes in almost all countries except Taiwan and China.  Improvements in treatment options of diabetes have increased the life expectancy which increases the prevalence rate. An increase in prevalence increases the economic burden on health-care systems. In the United States, diabetes was responsible for the largest health-care spending and the greatest increase over the past two decades among 155 health conditions (GBD, 2016 pp. 1243-1245; AHRQ 2021; OMH, 2021).

In the leading 30 Level 4 causes of global prevalence of disease, diabetes was ranked 9th in 2006, and 8th in 2016 (see Appendix) (GBD, p.1231).

The GBD (2016) established criteria for diabetes prevalence was the proportion of a population with fasting plasma glucose greater than 7 mmol/L or on diabetes treatment. Overall, the trend for diabetes is the prevalence and incidence rates are approximately the same. However, the YLDs slightly improved in wealthier countries due to new medications and treatments available.

References

Agency for Healthcare Research and Quality. (2021). NHQDR Web Site – National Diabetes Benchmark Details. Nhqrnet.Ahrq.Gov. Retrieved April 04, 2022, from https://nhqrnet.ahrq.gov/inhqrdr/National/benchmark/table/Diseases_and_Conditions/Diabetes#far

Office of Minority Health. (2021, March 1). Diabetes and Native Hawaiians/Pacific Islanders – The Office of Minority Health. Minorityhealth.Hhs.Org. Retrieved April 4, 2022, from https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=78

 Vos, T., Abajobir, A., Abate, K., … et. al. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. [Library Link]

 

Introduction And Problem Statement

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Introduction And Problem Statement

Week 3: Assignment – Part 1: Introduction and Problem Statement Introduction And Problem Statement

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Assignment Prompt

The assignment will be broken up into three steps: STEP 1 – Introduction and Overview of the Problem; STEP 2 – Project Purpose Statement, Background & Significance and PICOT Formatted Clinical Project Question; and STEP 3 – Literature Review and Critical Appraisal of the Literature. The three steps, when completed, will be combined in the final Signature Assignment formal paper in Week 8.

This week’s assignment is STEP 1 – Introduction and Problem Statement.

First, the student will select a clinical question from the Approved List of PICOt/Clinical Questions  Provide a title that conveys or describes the assignment.

 

  1. Provide a title that conveys or describes the assignment
  2. Introduction – Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding of what the project will cover and what can be gained from the implementation of this project.
  3. Overview of the Problem – Provide a synopsis of the problem and some indication of why the problem is worth exploring or what contribution the proposed project is apt to make to practice. Introduction And Problem Statement

 

Expectations

Initial Post:

APA format with intext citations

References: at least 2 high-level scholarly references within the last 5 years in APA format.

Plagiarism free.

Turnitin receipt.

Approved Clinical Questions For PICOT Development List

 

Implementing a clinical practice protocol/guideline for the management of [hypertension or disease] in [the homeless or population/clinic type] Introduction And Problem Statement

 

Developing a clinical protocol to prevent [community acquired pneumonia or disease] in [vulnerable populations] in primary care

 

Identifying barriers to [diabetic treatment or disease or health promotion] adherence in a community primary care clinic

 

An educational program to improve [influenza and/or pneumococcal or type] vaccination rates among [population]

 

Evaluation of an intervention protocol to improve adult vaccination rates among [older adults or population]

 

Primary care providers’ adherence to treatment guidelines for the management of [Type II diabetes or disease] in a [rural or type] clinic

 

The implementation of a clinical protocol to identify and manage [COPD or disease] in [the working poor or vulnerable population or setting]

 

Evaluation on implementing [smoking cessation or disease prevention/health promotion] primary clinic in long-term care

 

Improvement of screening rates for [sexually transmitted diseases or disease prevention targets] in a primary care clinic

 

Implementing a peer review process in a primary care clinic or setting

 

The effectiveness of implementing the [Geriatric Depression Scale or standardized assessment instrument] for the treatment and management of [depression or disease] in primary care

 

Evaluating the use of computer reminder systems for providers to improve treatment guideline adherence in [community care or setting]

 

Screening for mild cognitive impairment in a primary care setting

 

 

Primary care provider practice patterns for the treatment and management of [pain or disease] in [older adults or population]

 

Effectiveness of obesity management strategies in [working adults or population] with [cardiac risk factors or disease] in primary care

 

The impact of the Adult-Gerontology Primary Care Nurse Practitioner’s role in a healthcare home model

 

Identification of perceived barriers to care of [women or population] seeking treatment for [depression or disease] in primary care

 

Culturally sensitive care for [Asian Americans or population] seeking treatment for chronic [hypertension or disease] management in primary care

 

Barriers and facilitators to implementing a culturally sensitive clinical protocol in [Hispanic men or population] with [prostate cancer or disease]

 

Evaluation of [cost or type] outcomes of a primary care model that includes a psychiatric-mental health care nurse practitioner overlay service

 

Development of a [cardiac or disease/type] risk profile to identify high risk [women or population] in primary care

 

Effective [ADHD/Other] Screening of Children in the Primary Care Setting

 

Reducing BMI of Overweight and Obese [Children or population]: Evidence-Based Approach

 

Expedited Partner Therapy: An Option in the Treatment of [Genital Chlamydial Infection or other STI]

 

Effectiveness of the Use of Insulin [pens/pump]: An Analysis of the [Hispanic adult or population] Patient’s Satisfaction and Outcomes

 

An Effective Plan to Reduce Polypharmacy in a [State Prison or Long-term Care Facility]

 

The Role of Reminder Cards and Telephone Follow-Up on Office Visits on Adherence of Patients with [T2DM or other chronic diseases]

 

Effects on A1C among Insulin Managed Diabetic Patients following an Electronic, Patient-Centered, Feedback System: An Evidence-Based Practice

 

The Effect of Language in the Delivery of Care in [Home Health or other community settings]

 

The Effect of Culture and Eating Habits on [Childhood or population] Obesity in [the United States or state]

 

The Effectiveness of [Basic Daily Monitoring or other intervention] for [Elderly or population] with Heart Failure to Reduce Hospital Readmission

 

Adherence to Diet and Exercise to Reduce Hyperlipidemia in [Adults or population]

 

Evidence-Based Practice in Management of Acute Otitis Media: Topical versus Systemic Treatments

 

[Walking 3x/week or Other exercise activity] for 45-minutes Reduce Blood Sugar levels in [African- Americans or population] with Type II Diabetes

 

Implement a [Brisk Physical Activity or other activity} to Improve BS Levels in [Women with GDM or population]?

 

Asthma Treatment in Pediatric Patients: Spacer versus Conventional Inhaler

 

Concurrent use of Probiotics during Antibiotic Therapy Reduce the Incidence of Developing Antibiotic-associated Diarrhea

 

The Role of Nurse Practitioner in the [Breast Cancer Risk Assessment or other Assessment] on [Hispanic Women or populations]

 

Brain Exercise Reduce the Cognitive Decline in Patients with [Cognitive Decline or population]

 

Measuring the Effectiveness of 5-2-1-0 every day to Reduce Obesity in [Children or population]

 

Spiritual Care: The Missing Link in Health Care Among Patients with [Advanced Cancer in Palliative Care or population]

 

Effectiveness of Nurse Practitioner’s Home Visits in Improving Patient Adherence in the Management of [Hypertension or population]

Nurse Practitioner’s Focus Patient Education to Prevent Complications of [Pre-eclampsia or population]

 

Providing Education to [Reduce Hb1Ac or Other measures] in Adherence with Current [Diabetes or other chronic diseases] Guidelines

 

Utilization of Nurse Practitioners in the [Emergency Department or other Community Settings] on Patient Satisfaction, Provider to Patient time, and Length of Stay

 

Use of NP-led Triage Orders in Emergency Department for Early Patient Discharge

 

Screening of Patients with Drug-Seeking Behaviors in [Emergency Department or other Community Setting]

 

Developing an Education-based Approach to Increase Awareness on [Prostate Cancer or other] Screening

 

Reducing [HPV or another preventable disease] Incidences with Vaccination among the [Latino Population ages 11-­26 in the United States or population]

 

Evaluate the Effectiveness Of Post-Discharge Follow-Up Among [Congestive Heart Failure or high-risk population] Patients on Reduction of Hospital Readmission, Improve Quality Of Life, Medication Reconciliation, Self-Care Skills and Coordination of Care During Transition to Home [Other]

 

Primary Care Provider Practice Patterns for the Identification, Treatment, and Management of [early onset sepsis disease or other diseases] in [pediatric or populations]

 

Evaluation on Implementing and Follow-up with Health Screening Guidelines [Colonoscopy or other Screening] in a Primary Clinic or other Community Setting

 

Primary Care Provider Practice Patterns for the Treatment and Management Follow-up after UC or ED visit in [older adults or population]

 

Barriers and facilitators to implementing a culturally sensitive clinical protocol in [refugee men or population] with [depression or other chronic diseases]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mental Health & Crisis Management

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Mental Health & Crisis Management

1. A pregnant patient receives the news that she has low iron according to the complete blood count (CBC) lab results. The patient panics and worries that there is something wrong. Your response to the patient is:

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2. A newborn is delivered by Cesarean Section and weighs 4000 gms. As the nurse caring for the newborn you will complete the following action: Question 40 options: Avoid skin to skin with mother Heel stick for blood glucose Recommend formula feeding as a supplement Refrain from covering the newborn’s head with a hat to avoid overheating Mental Health & Crisis Management

3. Fertility Awareness Methods are best utilized by:

4. The purpose of applying pressure to the anus and perineal area with a sterile towel during the delivery of the fetal head is:

5. A patient in labour and delivery is hemorrhaging after the vaginal delivery of a 2800 gm newborn. You know that the most likely cause of hemorrhage is: Question 31 options:  Uterine atony Lacerations to the perineum and birth canal Placental abruption Retained palcental tissue

6. A pregnant patient reports having upper epigastric pain, a headache and pitting edema. You know that these are all symptoms of: Question 27 options: Preeclampsia Fatty liver disease Seizure disorder of pregnancy Eclampsia

7. When palpating a contraction, what criteria is the nurse assessing regarding the contraction?

8. you are assessing a non-hispanic black, 35 years old multipara at 24 weeks gestation. Mental Health & Crisis Management

9. You are coming onto shift and have been assigned Room #3. You receive report that the newborn in Room #3 is 39 weeks gestation, Large for gestational age, pink and feeding well. When you observe the newborn you see that the newborn weighs 3000 gms, is covered in lanugo and is feeding well. This observation concludes that: Question 14 options: The newborn is actually large for gestation age The newborn is actually intrauterine growth restricted The social worker needs to be contacted. The newborn is less than 39 weeks gestation

10. An newborn is delivered vaginally at 36 weeks gestation. You are aware that this newborn may :

11. The fetus has engaged and Mom has been pushing for 4 hours. The physician encourages an epidural to give Mom a rest. When the baby is finally delivered vaginally you notice the following:

Alcohol related disorders and Clinical Institute Withdrawal for Alcohol (CIWA-AR) Scale

 

Alcohol is the only drug for which exact objective measures of intoxication (BAL) currently exist.

 

Alcohol content varies from product to product; nevertheless, a drink is a drink is a drink, with 1.5 ounces of liquor (40% alcohol), a 12-ounce bottle of beer (5% alcohol), and a five-ounce glass of table wine (12% alcohol) all containing the same amount of ethanol. Thus all affect human physiology in a consistent manner as measured by blood alcohol content (BAC), although there are distinct differences between men and women (Table 18-5). Differences in effects from person to person produced by beverage alcohol do not generally result from the type of drink consumed, but rather from the person’s size, previous drinking experiences, and rate of consumption. A person’s feelings and activities and the presence of other people also play a role in the way the alcohol affects behaviour.

 

Assessing the patient’s behaviour can assist the nurse in (1) ascertaining whether the person accurately reported recent drinking and (2) determining level of intoxication and possible tolerance, as patient behaviours may indicate greater or lesser levels of tolerance. As tolerance develops, a discrepancy is seen between the BAL and expected behaviour: a person with tolerance to alcohol may have a high BAL but minimal signs of impairment. Alternatively, a person who is highly sensitive to alcohol or compromised medically may have a low BAL but demonstrate a high level of intoxication. Mental Health & Crisis Management

 

Alcohol poisoning

Is a state of toxicity that can result when an individual has consumed large amounts of alcohol either quickly or over time. It can produce death from aspiration of emesis or a shutdown of body systems due to severe CNS depression. Signs of alcohol poisoning include an inability to rouse the individual, severe dehydration, cool or clammy skin, respirations less than 10 per minute, cyanosis of the gums or under the fingernails, and emesis while semiconscious or unconscious. Refer to Table 18-2 for important assessment and treatment information regarding alcohol intoxication and poisoning.

 

Alcohol Withdrawal

The early signs of alcohol withdrawal, a physical reaction to the cessation or reduction of alcohol (ethanol) intake, can develop within a few hours of the last intake. Symptoms peak after 24 to 48 hours and then rapidly and dramatically disappear unless the withdrawal progresses to alcohol withdrawal delirium.

 

Severity of withdrawal tends to be dose related, with heavier drinkers experiencing more severe symptoms. Withdrawal severity is also related to age, with those over 65 years of age experiencing more severe symptoms. During withdrawal, the patient may appear hyperalert, manifest jerky movements and irritability, startle easily, and experience subjective distress often described as “shaking inside.”

 

Grand mal seizures may appear 7 to 48 hours after cessation of alcohol intake, particularly in people with a history of seizures. Careful assessment, including this history and any other risk factors, followed by appropriate medical and nursing interventions can prevent the more serious withdrawal reaction of delirium.

 

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) provides an efficient, objective means of assessing alcohol withdrawal to prevent under- or overtreating patients with benzodiazepines.

 

Alcohol withdrawal delirium

Also referred to as delirium tremens (DTs), is a medical emergency that can result in death in 20% of untreated patients. It is an altered level of consciousness that presents with seizures following acute alcohol withdrawal. Death is usually due to cardiopathy, cirrhosis, or other comorbidities requiring mechanical ventilation.

 

The state of delirium usually peaks 48 to 72 hours after cessation or reduction of intake, although it can peak later, and lasts 2 to 3 days. Features of alcohol withdrawal delirium include the following:

 

  • Autonomic hyperactivity (tachycardia, diaphoresis, elevated blood pressure)
  • Severe disturbance in sensorium (disorientation, clouding of consciousness)
  • Perceptual disturbances (visual or tactile hallucinations)
  • Fluctuating levels of consciousness (ranging from hyperexcitability to lethargy)
  • Delusions
  • Anxiety and agitated behaviours
  • Fever (38°C to 39°C)
  • Insomnia
  • Anorexia

 

Detoxification or Alcohol Withdrawal Treatment

 

Acamprosate (Campral) was approved by Health Canada in 2008 to treat people who had been alcohol dependent, had stopped drinking, and wished to remain abstinent. In randomized, double-blind, placebo-controlled trials, though without active comparators, acamprosate in conjunction with psychosocial therapy was generally significantly better than placebo plus psychosocial interventions in improving various key outcomes, including the proportion of patients who maintained complete abstinence from alcohol, the average duration of abstinence duration, and the total number of nondrinking days. Acamprosate is believed to effect a reduction in one’s intake of alcohol through suppression of excitatory neurotransmission and enhanced inhibitory transmission (Lehne, 2014; Plosker, 2015).

Naltrexone (ReVia), an agent used in reversing the effects of opioid addiction, is sometimes used in the treatment of alcohol dependency, especially for those with intense cravings and somatic symptoms. Naltrexone works by blocking opioid receptors, thereby interfering with the mechanism of reinforcement and reducing or eliminating the alcohol craving (Vuoristo-Myllys, Lipsanen, Lahti, et al., 2014). Long-acting injectable forms with the brand names Vivitrex or Vivitrol, Naltrel, and Depotrex are being tested and show promise as having relatively stable plasma levels, allowing for more sustained effects (Gordon, Kinlock, Vocci, et al., 2015; Knopf, 2016).

 

Topiramate

Similar to acamprosate, topiramate (Topamax) is purported to decrease alcohol cravings by inhibiting the release of mesocorticolimbic dopamine, which has been associated with alcohol craving. Currently topiramate is still not approved for use with alcohol-dependent persons, although preliminary findings indicate that it has a beneficial effect in individuals with a typology of craving characterized by drinking obsessions and automaticity of drinking (Guglielmo, Martinotti, Quatrale, et al., 2015).

 

Heart Failure Case Study Essay

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Heart Failure Case Study Essay

1509 Unit 8: Cardiac Perfusion

Heart Failure Case Study

10 points

Betty Johnson, a 65 year old female, presented to the emergency department (ED) 2 days ago after experiencing worsening lower extremity edema over the 3 days prior to her presenting to the ED and a sudden onset of shortness of breath 1 hour prior to her arrival. Mrs. Johnson was diagnosed with an exacerbation of her congestive heart failure (CHF) and admitted to a cardiology unit for close observation. Since then, Mrs. Johnson has been treated with diuretics and seems to be improving greatly. You arrive for your morning shift and receive report for the continuation of Mrs. Johnson’s care. The nurse giving you report states that she “just hung a bag of normal saline at 100 ml/hr” and that “she is very stable.” You decide to check on your other 3 patients first before seeing Mrs. Johnson. When you enter her room it is approximately one hour into your shift. You note that she has labored respirations, the IV pump is set to 1000 ml/hr, the normal saline is empty, and her oxygen is unplugged.  You quickly reconnect her oxygen at 3 liters and auscultate crackles in all lung fields and note that she is having trouble saying more than a couple of words at a time. You quickly call for the “rapid response team” and take her vital signs. Her vital signs are as follows: Blood pressure (BP): 212/110, Heart rate (HR):120, Respiratory rate (RR): 36, and Pulse Oximetry (SpO2): 85%. In report the nurse stated Mrs. Johnson had 3+ pitting edema to her lower extremities, which you now note to be 4+ with weeping blisters. You now determine that she is disoriented to time, but she is still able to tell you her name and that she is at Hospital X. She has no focal neurological deficits and is otherwise neurologically intact. She has good pulses in all extremities and her capillary refill time is less than 2 seconds. Her heart sounds reveal a systolic murmur. Mrs. Johnson has a Foley catheter in place and it is noted to have 100ml of concentrated amber urine and appears to be draining well. Mrs. Johnson also has a 20 gauge IV catheter in her left forearm that you note to have good blood return and flushes well with no signs of infiltration. The rapid response team now arrives and her primary care provider (PCP) calls to inquire about her current condition. Upon report to her PCP, you receive the following orders: 1) Give 80mg furosemide IV now, 2) Place patient on Bipap at a rate of 14 with 60% FiO2 and 5 of PEEP, 3) Obtain STAT arterial blood gases (ABG), a CMP, and a BNP , and 4) Upgrade patient to the intensive care unit (ICU). Prior to transport you empty Mrs. Johnson’s Foley, which now has 400ml of urine; and you retake her vital signs which are now: BP- 178/89, HR- 92, RR- 18, and SpO2- 97%. You complete the above orders and safely transport Mrs. Johnson to the ICU in an improved condition, giving report to the receiving nurse (Anna RN). Heart Failure Case Study Essay

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            Drawing from the information provided in the above scenario, provide the answers to the following questions: (2 points per question)

  • What error did the nurse notice about the IV pump? Explain how this error contributed to her worsening symptoms.

 

  • In regards to the first set of vitals, explain how each abnormal value is related to her current condition:

 

  1. BP:
  2. Pulse
  3. Respiratory Rate
  4. Pulse Oximetry:

 

  • What other assessment findings are abnormal/concerning (besides vital signs) and why?

 

  • The primary care physician ordered Lasix. Answer the following questions about this medication:
    1. What is the generic name of this medication? Heart Failure Case Study Essay
    2. What is the class?
    3. What is the action?
    4. What is the half-life?
    5. List three potential side effects.

Write a “transfer of care report” that you would provide to the receiving nurse in IC

Decision Tree for Neurological and Musculoskeletal Disorders

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Decision Tree for Neurological and Musculoskeletal Disorders

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you assess the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders. Decision Tree for Neurological and Musculoskeletal Disorders

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To Prepare

  • Review      the interactive media piece assigned by your Instructor.

http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html

Reflect      on the patient’s symptoms and aspects of the disorder presented in the      interactive media piece.

  • Consider      how you might assess and treat patients presenting with the symptoms of      the patient case study you were assigned.
  • You      will be asked to make three decisions concerning the diagnosis and      treatment for this patient. Reflect on potential co-morbid physical as      well as patient factors that might impact the patient’s diagnosis and      treatment.

Assignment

Write a 1- to 2-page summary that addresses the following: Decision Tree for Neurological and Musculoskeletal Disorders

  • Briefly      summarize the patient case study you were assigned, including each of the      three decisions you took for the patient presented.
  • Based      on the decisions you recommended for the patient case study, explain      whether you believe the decisions provided were supported by the      evidence-based literature. Be specific and provide examples. Be sure to      support your response with evidence and references from outside resources.
  • What      were you hoping to achieve with the decisions you recommended for the      patient case study you were assigned? Support your response with evidence      and references from outside resources.
  • Explain      any difference between what you expected to achieve with each of the      decisions and the results of the decision in the exercise. Describe      whether they were different. Be specific and provide examples. Decision Tree for Neurological and Musculoskeletal Disorders

Develop An Internal Memorandum

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Develop An Internal Memorandum

Scenario

Healthy Dynamics is a corporate wellness company that provides a broad range of wellness services for clients seeking to improve the health and wellbeing of their employees. One of the clients of Healthy Dynamics is not happy with their employee wellness program participation rates. Healthy Dynamics is not meeting the contract requirements of 60% engagement, resulting in lost revenue for the company and no return on investment (ROI) for the client. According to the contractual agreement, Healthy Dynamics must pay back the client $200,000,000 if the annual participation percentage is not met. Currently the client’s wellness program includes financial incentives for the employees if they complete the following wellness offerings (health assessment, biometric screening, and telephonic health coaching). The Healthy Dynamics CEO is now foreseeing a need to offer other healthcare services. The CEO has asked the Account Manager to create a business plan focused on increasing revenue and identifying risk that might negatively impact their continued relationship with the client. The Account Manager has tasked you, the Strategic Planning Manager, with preparing an internal memo to present to the CEO and to communicate to your internal team what you are envisioning as a desired future focus area to increase the bottom line for Healthy Dynamics and improve current and future client satisfaction rates. Develop An Internal Memorandum

Instructions

Develop an internal memorandum that includes:

  • A detailed description defining the differences between business planning and strategic planning in healthcare.
  • Identify a specific focus area in the healthcare industry that could increase revenue.
  • Create key questions that you will need to address in the development of your strategic plan for your focus area.

Create a workflow analysis flow chart that includes:

  • A list of healthcare leadership team members (e.g., CEO, Strategic Planning Manager, Account Manager, Marketing Manager, Project Manager, Financial Analyst, etc.,)
  • A comprehensive analysis of each team member’s roles and responsibilities in the development of the strategic plan.
  • Your assignment should include a title page, a reference page, and a minimum of three scholarly sources, two of which must be retrieved from the Rasmussen Library (See attached and choice 2 articles).

Rubric:

-Detailed description defining the differences between business planning and strategic planning in healthcare in a well-written internal memorandum.

-Clearly identified a specific focus area in the healthcare industry that could increase revenue in a well-written internal memorandum.

-Created detailed questions needed to address the development of a strategic plan in a well-written internal memorandum.

-Created a comprehensive list of healthcare leadership team members in the workflow analysis flow chart.

-Created a comprehensive analysis of each team member’s roles and responsibilities in the development of the strategic plan.

-Used and identified three or more credible sources in the memorandum. Develop An Internal Memorandum

ABDOMINAL ASSESSMENT

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ABDOMINAL ASSESSMENT

ABDOMINAL ASSESSMENT

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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 afterwards.

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)

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

Gastroenteritis

A male went to the emergency room for severe midepigastric abdominal pain. He was diagnosed with ABDOMINAL AORTIC ANEURYSM; 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 exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

 

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

 

With regard to 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 exams 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.

The Assignment

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or why not?

What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?

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.

Nursing practice paper

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Nursing practice paper

· Clearly describe the issue topic – MEDICATION ERROR

· Connect the issue to the Joint Commission National quality/safety gaols

· Include specific clinical examples/ stories that illustrate the issue

· Review the literature and incorporate published positions/ viewpoints

· Include the viewpoints of the ANA, NLN. NYSNA, NCF, NCQA, Joint Commission, QSEN

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· Include the position of your employer

· Develop a plan to manage this problem. Be specific- who needs to be involved (administration; government; nurses; patients).

· Describe how this will impact your nursing practice.

Nursing 301

Assignment : Nursing practice paper (medication error)

 

Guidelines for nursing practice paper: Write a paper addressing a current, significant problem observed in your clinical nursing practice (or previous student clinical experiences) that interferes with the provision of competent nursing care. Read chapters 6, 7, 12, 14 in the Masters book as well as the ANA, NLN, NYSNA, Joint Commission, QSEN websites for assistance in completing this assignment.

 

Be sure to

  • Clearly describe the issue topic – MEDICATION ERROR
  • Connect the issue to the Joint Commission National quality/safety gaols
  • Include specific clinical examples/ stories that illustrate the issue
  • Review the literature and incorporate published positions/ viewpoints
  • Include the viewpoints of the ANA, NLN. NYSNA, NCF, NCQA, Joint Commission, QSEN
  • Include the position of your employer
  • Develop a plan to manage this problem. Be specific- who needs to be involved (administration; government; nurses; patients).
  • Describe how this will impact your nursing practice.

 

The paper should be 5-7 pages in APA format. and as those presented in Writing at York. Points will be deducted for incorrect format, incorrect documentation and grammatical/writing errors.

 

Assignment # 4 Grading Rubric for Nursing practice paper

 

Clearly identify the problem giving definition(s), a brief history/background or any information that is relevant to it. Identify if it is a National quality/ safety goal 25%
Present nurses’ stories (examples) that illustrate how the selected problem affects the individual nurse(s) and nursing care.  Present positions or viewpoints, on the problem, that are documented in the nursing literature.  Include the positions of professional nursing organizations, if available, regarding this problem 25%
Develop a plan to manage this problem. Be specific- who needs to be involved (administration; government; nurses; professional organizations).

Describe how this will impact your nursing practice.

 50%
TOTAL 100%