Cardiovascular Shadow Health Reflection

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Cardiovascular Shadow Health Reflection

I learned that a thorough cardiovascular assessment will help to identify significant factors that can influence cardiovascular health such as high blood cholesterol, cigarette use, diabetes, or hypertension. Therefore, a cardiovascular exam should be a part of every abbreviated and complete assessment.    A focused cardiovascular assessment is usually indicated after a comprehensive assessment indicates a potential cardiovascular problem. The focused cardiovascular assessment is also indicated when an interval or abbreviated assessment shows a change in status from your previous assessment or the report you received, when a new symptom emerges, or the patient develops any distress.

I feel there is always room for growth, and I would say growth in documentation and placements regarding murmurs was very much discussed in the Shadow Health module.   I think an advantage of a focused assessment, like when we are doing the module, it helps us understand each body system.  The fact the modules looks at so many ways to assess, subjective, objective, and even empathy, can only improve our charting and communication.

I plan on improving by integrating the cardiovascular health history and physical exam.  It takes a lot of objective and subjective information, and knowing how assess, in order to make the correct diagnosis.  Shadow Health, makes us better NP’s by working with the patient and talking into the computer.  It is very important that as I grow into a NP role, the correct questions are asked and for me to be able to analyze all the health information for a diagnosis. Cardiovascular Shadow Health Reflection

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Reflection on Cardiovascular Shadow Health

I learned that a thorough cardiovascular assessment will help to identify significant factors that can influence cardiovascular health such as high blood cholesterol, cigarette use, diabetes, or hypertension. Therefore, a cardiovascular exam should be a part of every abbreviated and complete assessment.    A focused cardiovascular assessment is usually indicated after a comprehensive assessment indicates a potential cardiovascular problem. The focused cardiovascular assessment is also indicated when an interval or abbreviated assessment shows a change in status from your previous assessment or the report you received, when a new symptom emerges, or the patient develops any distress.

I feel there is always room for growth, and I would say growth in documentation and placements regarding murmurs was very much discussed in the Shadow Health module.   I think an advantage of a focused assessment, like when we are doing the module, it helps us understand each body system.  The fact the modules looks at so many ways to assess, subjective, objective, and even empathy, can only improve our charting and communication.

I plan on improving by integrating the cardiovascular health history and physical exam.  It takes a lot of objective and subjective information, and knowing how assess, in order to make the correct diagnosis.  Shadow Health, makes us better NP’s by working with the patient and talking into the computer.  It is very important that as I grow into a NP role, the correct questions are asked and for me to be able to analyze all the health information for a diagnosis. Cardiovascular Shadow Health Reflection

 

Practicum: Decision Tree Assignment

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Practicum: Decision Tree Assignment

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.

Learning Objectives
Students will:
Evaluate clients for treatment of mental health disorders
Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical, as well as mental factors that might impact the client’s diagnosis and treatment. Practicum: Decision Tree

At each Decision Point stop to complete the following:

Decision #1: Differential Diagnosis
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree Assignment
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Practicum: Decision Tree
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

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Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. Practicum: Decision Tree

// A young woman with Depression
Case #2
A young woman with Depression

SUBJECTIVE
Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep. Practicum: Decision Tree Assignment
You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks. Practicum: Decision Tree
Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!”

OBJECTIVE
Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

MENTAL STATUS EXAM
Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.
At this point, please discuss any additional diagnostic tests you would perform on Stefanie.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.  Practicum: Decision Tree Assignment

Bipolar I, current phase, depressed

Bipolar II, current phase, hypomanic

Cyclothymic disorder

Decision Point One

Bipolar I, current phase, depressed
Bipolar I, current phase, depressed
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Begin Latuda 40 mg orally daily

Lamictal 100 mg orally daily

Begin psychotherapy using a psychodynamic approach

Decision Point One

BipBipolar II, current phase, hypomanic
olar II, current phase, hypomanic
Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Begin Lithium 300 mg orally twice a day

Begin Olanzapine 10 mg orally at bedtime

Begin Abilify 10 mg orally daily Practicum: Decision Tree

Cyclothymic disorder

Cyclothymic disorder

Decision Point Two
BASED ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS:

Begin Depakote 250 mg orally three times daily

Begin Abilify 10 mg orally daily

Arrange to see Stefanie every 3 months for routine follow-up  Practicum: Decision Tree Assignment

Explain the differences between electronic health record implementation, adoption, and optimization.

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Today’s healthcare organizations are challenged with multiple projects occurring simultaneously.  Electronic health record implementation is a long-term commitment of financial, physical, and human resources. One aspect of this implementation project is workflow analysis: the transition from paper-based documentation to using technology for all aspects of managing patient information poses a significant change and often challenges to how busy clinicians work. A third component of a large-scale technology project could be the implementation of a patient portal.

In a 3- to 5-page essay, respond to the following:

  • Explain the differences between electronic health record implementation, adoption, and optimization.
  • Explain the concept of an electronic health record migration path.
  • Discuss how the electronic health record is not a single application or computer device, but a complex set of software and hardware.
  • Define workflow analysis and explain the steps necessary when attempting to complete a workflow redesign within a departmental area (you may choose any department within a healthcare organization).
  • Describe the benefits a patient portal will bring to patients in a healthcare organization. Describe why patient portals are becoming more popular and how health informatics professionals can help in their management.

NR 601 SOAP note Assignment

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NR 601 SOAP note Assignment

Week 2: Discussion Part Two8 8 unread replies. 34 34 replies. Physical examination:
Vital Signs
Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 150/86 T 98.0 po P 100 R 22, non-labored
HEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus. NR 601 SOAP note
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpable
LUNGS: inspiratory crackles NR 601 SOAP note Assignment

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HEART: Normal S1 with S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids.
ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses.
PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally
GENITOURINARY: no CVA tenderness; not examined
MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady.
PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22. NR 601 SOAP note
SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet.

NR 601 SOAP note Discussion Questions Part Two:
Post your SOAP note for this patient’s encounter.

Review the SOAP note format for the course. Summarize the history and results of the physical exam. Include one evidence-based journal article that supports your rationale for all diagnoses with ICD 10 codes and include a complete treatment plan that include medications, further diagnostics, patient education, referral and plan for follow-up. Each step of the plan must include an in-text citation to a scholarly source. Review the Reference Guidelines document in Course Resources. NR 601 SOAP note Assignment

Eleven Blue Men Essay Assignment

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Eleven Blue Men Essay Assignment

Read the 11 Blue Men Story, to access, please click here. (Links to an external site.)

Download the Eleven Blue Men Worksheet and address the questions in a Q/A format, using complete sentences. Please know that although this is not a formal written paper, you still use APA formatting:

  • Double-spaced with 1-inch margins
  • Separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Reference page formatted according to APA style
  • Citations as required according to APA style

Your Eleven Blue Men essay must use atleast two additional sources to support your answers to the case study questions (this does not include the case itself or the textbook) Eleven Blue Men Essay Assignment

 

11 Blue Men Worksheet

  1. Draw a timeline marking the time each of the 11 blue men presented symptoms. Explain the point of mapping out the incident time frame (i.e. why would epidemiologists need this information and how would it be used)
  2. Describe the key symptoms and incubation period for the illness affecting the eleven blue men.
  3. Describe each step of an outbreak investigation as it pertains to this particular event, indicating all of the key points in the investigation (include how it started, why epidemiologists got involved, where did the investigation take the epidemiologists, who was interviewed, what/who were the potential culprits identified during the investigation) Eleven Blue Men Essay Assignment
  4. Identify three questions that Dr. Greenberg and Dr. Pellitteri asked the patients. Explain why these three questions were relevant.
  5. Identify three questions that the epidemiologists asked the Eclipse Cafeteria employees. Explain why these three questions were relevant.
  6. Identify the final culprit and how it was discovered.
  7. Explain why were these specific men more affected than other people who ate in the cafeteria?

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References

APA format

 

Eleven Blue Men (Berton Roueché)

At about eight o’clock on Monday morning, September 25, 1944, a ragged, aimless old man of eighty-two collapsed on the sidewalk on Dey Street, near the Hudson Terminal. Innumerable people must have noticed him, but he lay there alone for several minutes, dazed, doubled up with abdominal cramps, and in an agony of retching. Then a policeman came along. Until the policeman bent over the old man, he may have supposed that he had just a sick drunk on his hands; wanderers dropped by drink are common in that part of town in the early morning. It was not an opinion that he could have held for long. The old man’s nose, lips, ears, and fingers were sky-blue. The policeman went to a telephone and put in an ambulance call to Beekman-Downtown Hospital, half a dozen blocks away. The old man was carried into the emergency room there at eight-thirty. By that time, he was unconscious and the blueness had spread over a large part of his body. The examining physician attributed the old man’s morbid color to cyanosis, a condition that usually results from an insufficient supply of oxygen in the blood, and also noted that he was diarrheic and in a severe state of shock. The course of treatment prescribed by the doctor was conventional. It included an instant gastric lavage, heart stimulants, bed rest, and oxygen therapy. Presently, the old man recovered an encouraging, if painful, consciousness and demanded, irascibly and in the name of God, to know what had happened to him. It was a question that, at the moment, nobody could answer with much confidence.

For the immediate record, the doctor made a free-hand diagnosis of carbon-monoxide poisoning – from what source, whether an automobile or a gas pipe, it was, of course, pointless even to guess. Then, because an isolated instance of gas poisoning is something of a rarity in a section of the city as crammed with human beings as downtown Manhattan he and his colleagues in the emergency room braced themselves for at least a couple more victims. Their foresight was promptly and generously rewarded. A second man was rolled in at ten-twenty-five. Forty minutes later, an ambulance drove up with three more men. At eleven-twenty, two others were brought in. An additional two arrived during the next fifteen minutes. Around noon, still another was admitted. All of the nine men were also elderly and dilapidated, all had been misery for at least an hour, and all were rigid, cyanotic, and in a state of shock. The entire body of one, a bony, seventy-three-year-old consumptive named John Mitchell was blue. Five of the nine, including Mitchell, had been stricken in the Globe Hotel, a sunless, upstairs flophouse at 190 Park Row, and two in a similar place, called the Star Hotel, at 3 James Street. Another had been found slumped in the doorway of a condemned building on Park Row not far from City Hall Park, by a policeman. The ninth had keeled over in front of the Eclipse Cafeteria, at 6 Chatham Square. At a quarter to seven that evening, one more aged blue man was brought in. He had been lying, too sick to ask for help, on his cot in a cubicle in the Lion Hotel, another flophouse, at 26 Bowery, since ten o’clock that morning. A clerk had finally looked in and seen him.

By the time this last blue man arrived at the hospital, an investigation of the case by the Department of Health, to which all outbreaks of an epidemiological nature must be reported, had been under way for five hours. Its findings thus far had not been illuminating. The ‘investigation was conducted by two men. One was the Health Department’s chief epidemiologist, Dr. Morris Greenberg, a small, fragile, reflective man of fifty-seven, who is now acting director of the Bureau of Preventable Diseases; the other was Dr. Ottavio Pellitteri, a field epidemiologist, who, since 1946, has been administrative medical inspector for the Bureau. He is thirty- six years old, pale, and stocky, and has a bristling black mustache. One day, when I was in Dr. Greenberg’s office, he and Dr. Pellitteri told me about the case. Their recollection of it is, understandably, vivid. The derelicts were the victims of a type of poisoning so rare that only ten previous outbreaks of it had been recorded in medical literature. Of these, two were in the United States and two in Germany; the others had been reported in France, England, Switzerland, Algeria, Australia, and India. Up to September 25, 1944, the largest number of people stricken in a single outbreak was four. That was in Algeria, in 1926. Eleven Blue Men Essay Assignment

The Beekman-Downtown Hospital telephoned a report of the occurrence to the Health Department just before noon. As is customary, copies of the report were sent to all the Department’s administrative officers. “Mine was on my desk when I got back from lunch,” Dr. Greenberg said to me. “It didn’t sound like much. Nine persons believed to be suffering from carbon-monoxide poisoning had been admitted during the morning, and all of them said that they had eaten breakfast at the Eclipse Cafeteria, at 6 Chatham Square. Still, it was a job for us. I checked with the clerk who handles assignments and found that Pellitteri had gone out on. It. That was all I wanted to know. If it amounted to anything, I knew he’d phone me before making a written report. That’s an arrangement we have here. Well, a couple of hours later I got a call from him. My interest perked right up.”

“I was at the hospital,” Dr. Pellitteri told me, “and I’d talked to the staff and most of the men. There were ten of them by then, of course. They were sick as dogs, but only one was in really bad shape.”

“That was John Mitchell,” Dr. Greenberg put in. “He died the next night. I understand his condition was hopeless from the start. The others, including the old boy who came in last, pulled through all right. Excuse me, Ottavio, but I just thought I’d get that out of the way. Go on.”

Dr. Pellitteri nodded. “I wasn’t at all convinced that it was gas poisoning,” he continued. “The staff was beginning to doubt it, too. The symptoms weren’t quite right. There didn’t seem to be any of the headache and general dopiness that you get with gas. What really made me suspicious was this: Only two or three of the men had eaten breakfast in the cafeteria at the same time. They had straggled in all the way from seven o’clock to ten. That meant that the place would have had to be full of gas for at least three hours which is preposterous. It also indicated that we ought to have had a lot more sick people than we did. Those Chatham Square eating places have a big turnover. Well, to make sure, I checked with Bellevue, Gouverneur, St. Vincent’s, and the other downtown hospitals. None of them had seen a trace of cyanosis. Then I talked to the sick men some more.

I learned two interesting things. One was that they had all got sick right after eating. Within thirty minutes. The other was that all but one had eaten oatmeal, rolls, and coffee. He ate just oatmeal. When ten men eat the same thing in the same place on the same day and then all come down with the same illness . . . I told Greenberg that my hunch was food poisoning.”Eleven Blue Men Essay Assignment

“I was willing to rule out gas,” Dr. Greenberg said. A folder containing data on the case lay on the desk before him. He lifted the cover thoughtfully, then let it drop. “And I agreed that the oatmeal sounded pretty suspicious. That was as far as I was willing to go. Common, ordinary, everyday food poisoning – I gathered that was what Pellitteri had in mind – wasn’t a very satisfying answer. For one thing, cyanosis is hardly symptomatic of that. On the other hand, diarrhea and severe vomiting are, almost invariably. But they weren’t in the clinical picture, I found, except in two or three of the cases. Moreover, the incubation periods – the time lapse between eating and illness – were extremely short. As you probably know, most food poisoning is caused by eating something that has been contaminated by bacteria. The usual offenders are the staphylococci- they’re mostly responsible for boils and skin infections and so on – and the salmonella. The latter are related to the typhoid organism. In a staphylococcus case, the first symptoms rarely develop in under two hours. Often, it’s closer to five. The incubation period in the other ranges from twelve to thirty-six hours. But here we were with something that hit in thirty minutes or less. Why, one of the men had got only as far as the sidewalk in front of the cafeteria before he was knocked out. Another fact that Pellitteri had dug up struck me as very significant. All of the men told him that the illness had come on with extraordinary suddenness. One minute they were feeling fine, and the next minute they were practically helpless. That was another point against the ordinary food- poisoning theory. Its onset is never that fast. Well, that suddenness began to look like a lead. It led me to suspect that some drug might be to blame. A quick and sudden reaction is characteristic of a great many drugs. So is the combination of cyanosis and shock.”

“None of the men were on dope,” Dr. Pellitteri said. “I told Greenberg I was sure of that. Their pleasure was booze.” “That was O.K.,” Dr. Greenberg said. “They could have got a toxic dose of some drug by accident. In the oatmeal, most likely. I couldn’t help thinking that the oatmeal was relevant to our problem. At any rate, the drug idea was very persuasive.”

“So was Greenberg,” Dr. Pellitteri remarked with a smile.

“Actually, it was the only explanation in sight that seemed to account for everything we knew about the clinical and environmental picture.”

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“All we had to do now was prove it,” Dr. Greenberg went on mildly. “I asked Pellitteri to get a blood sample from each of the men before leaving the hospital for a look at the cafeteria. We agreed he would send the specimens to the city toxicologist, Dr. Alexander O. Gettler, for an overnight analysis. I wanted to know if the blood contained methemoglobin. Methemoglobin is a compound that’s formed only when anyone of several drugs enters the blood. Gettler’s report would tell us if we were at least on the right track. That is, it would give us a yes-or-no answer on drugs. If the answer was yes, then we could go on from there to identify the particular drug. How we would go about that would depend on what Pellitteri was able to turn up at the cafeteria. In the meantime, there was nothing for me to do but wait for their reports. I’d theorized myself hoarse.” Eleven Blue Men Essay Assignment

Dr. Pellitteri, having attended to his bloodletting with reasonable dispatch, reached the Eclipse Cafeteria at around five o’clock. “It was about what I’d expected,” he told me. “Strictly a horse market, and dirtier than most. The sort of place where you can get a full meal for fifteen cents. There was a grind house on one side, a cigar store on the other, and the ‘L’ overhead. Incidentally, the Eclipse went out of business a year or so after I was there, but that had nothing to do with us. It was just a coincidence. Well, the place looked deserted and the door was locked. I knocked, and a man came out of the back and let me in. He was one of our people, a health inspector for the Bureau of Food and Drugs, named Weinberg. His bureau had stepped into the case as a matter of routine, because of the reference to a restaurant in the notification report. I was glad to see him and to have his help. For one thing, he had put a temporary embargo on everything in the cafeteria. That’s why It was closed up. His main job, though, was to check the place for violations of the sanitation code. He was finding plenty.

“Let me read you a few of Weinberg’s findings,” Dr. Greenberg said, extracting a paper from the folder on his desk. “None of them had any direct bearing on our problem but I think they’ll give you a good idea of what the Eclipse was like – what too many restaurants are like. This copy of his report lists fifteen specific violations. Here they are: ‘Premises heavily infested with roaches. Fly infestation throughout premises. Floor defective in rear part of dining room. Kitchen walls and ceiling encrusted with grease and soot. Kitchen floor encrusted with dirt. Refuse under kItchen fixtures. Sterilizing facilities inadequate. Sink defective. Floor and walls at serving tables and coffee urns encrusted with dirt. Kitchen utensils encrusted with dirt and grease. Storage- cellar walls, ceiling, and floor encrusted with dirt. Floor and shelves in cellar covered with refuse and useless material cellar ceiling defective. Sewer pipe leaking. Open sewer line in cellar.’ Well .. .” He gave me a squeamish smile and stuck the paper back in the folder.

“I can see it now”, Dr. Pellitteri said. “And smell it. Especially the kitchen, where I spent most of my time. Weinberg had the proprietor and the cook out there and I talked to them while he prowled around. They were very cooperative. Naturally, they were scared to death. They knew nothing about gas in the place and there was no sign of any, so I went to work on the food. None of what had been prepared for breakfast that morning was left. That, of course, would have been too much to hope for. But I was able to get together some of the kind of stuff that had gone into the men’s breakfast, so that we could make a chemical determination at the Department. What I took was ground coffee, sugar, a mixture of evaporated milk and water that passed for cream, some bakery rolls, a five-pound carton of dry oatmeal, and some salt. The salt had been used in preparing the oatmeal. That morning, like every morning, the cook told me, he had prepared six gallons of oatmeal, enough to serve around a hundred and twenty-five people. To make it he used five pounds of dry cereal, four gallons of water – regular city water – and a handful of salt. That was his term – a handful. There was an open gallon can of salt standing on the stove. He said the handful he’d put in that morning’s oatmeal had come from that. He refilled the can on the stove every morning from a big supply can. He pointed out the big can- it was up on a shelf- and as I was getting it down to take with me, I saw another can, just like it, nearby. I took that one down, too. It was also full of salt, or, rather, something that looked like salt. The proprietor said it wasn’t salt. He said it was saltpetre – sodium nitrate – that he used in corning beef and in making pastrami. Well, there isn’t any harm in saltpetre; it doesn’t even act as an anti-aphrodisiac, as a lot of people seem to think. But I wrapped it up with the other loot and took it along, just for fun. The fact is, I guess, everything in that damn place looked like poison.”

After Dr. Pellitteri had deposited his loot with a Health Department chemist, Andrew J. Pensa, who promised to have a report ready by the following afternoon, he dined hurriedly at a restaurant in which he had confidence and returned to Chatham Square. There he spent the evening making the rounds of the lodging houses in the neighborhood. He had heard at Mr. Pensa’s office that an eleventh blue man had been admitted to the hospital, and before going home he wanted to make sure that no other victims had been overlooked. By midnight, having covered all the likely places and having rechecked the downtown hospitals, he was satisfied. He repaired to his office and composed a formal progress report for Dr. Greenberg. Then he went home and to bed. Eleven Blue Men Essay Assignment

The next morning, Tuesday, Dr. Pellitteri dropped by the Eclipse, which was still closed but whose proprietor and staff he had told to return for questioning. Dr. Pellitteri had another talk with the proprietor and the cook. He also had a few inconclusive words with the rest of the cafeteria’s employees — two dishwashers, a busboy, and a counterman. As he was leaving, the cook, who had apparently passed an uneasy night with his conscience, remarked that it was possible that he had absent-mindedly refilled the salt can on the stove from the one that contained saltpetre. “That was interesting,” Dr. Pellitteri told me, “even though such a possibility had already occurred to me, and even though I didn’t know whether it was important or not. I assured him that he had nothing to worry about. We had been certain all along that nobody had deliberately poisoned the old men.” From the Eclipse, Dr. Pellitteri went on to Dr. Greenberg’s office, where Dr. Gettler’s report was waiting.

“Gettler’s test for methemoglobin was positive,” Dr. Greenberg said. “It had to be a drug now. Well, so far so good. Then we heard from Pensa.”

“Greenberg almost fell out of his chair when he read Pensa’s report,” Dr. Pellitteri observed cheerfully.

“That’s an exaggeration,” Dr. Greenberg said. “I’m not easily dumfounded. We’re inured to the incredible around here. Why, a few years ago we had a case involving some numskull who stuck a fistful of potassium-thiocyanate crystals, a very nasty poison, in the coils of an office water cooler, just for a practical joke. However, I can’t deny that Pensa rather taxed our credulity. What he had found was that the small salt can and the one that was supposed to be full of sodium nitrate both contained sodium nitrite. The other food samples, incidentally, were O.K.”

“That also taxed my credulity,” Dr. Pellitteri said.

Dr. Greenberg smiled. “There’s a great deal of difference between nitrate and nitrite,” he continued. “Their only similarity, which is an unfortunate one, is that they both look and taste more or less like ordinary table salt. Sodium nitrite isn’t the most powerful poison in the world, but a little of it will do a lot of harm. If you remember, I said before that this case was almost without precedent – only ten outbreaks like it on record. Ten is practically none. In fact, sodium- nitrite poisoning is so unusual that some of the standard texts on toxicology don’t even mention it. So Pensa’s report was pretty startling. But we accepted it, of course, without question or hesitation. Facts are facts. And we were glad to. It seemed to explain everything very nicely. What I’ve been saying about sodium-nitrite poisoning doesn’t mean that sodium nitrite itself is rare. Actually, it’s fairly common. It’s used in the manufacture of dyes and as a medical drug. We use it in treating certain heart conditions and for high blood pressure. But it also has another important use, one that made its presence at the Eclipse sound plausible. In recent years, and particularly during the war, sodium nitrite has been used as a substitute for sodium nitrate in preserving meat. The government permits it but stipulates that the finished meat must not contain more than one part of sodium nitrite per five thousand parts of meat. Cooking will safely destroy enough of that small quantity of the drug.” Dr. Greenberg shrugged. “Well, Pellitteri had had the cook pick up a handful of salt – the same amount, as nearly as possible, as went into the oatmeal- and then had taken this to his office and found that it weighed approximately a hundred grams. So we didn’t have to think twice to realize that the proportion of nitrite in that batch of cereal was considerably higher than one to five thousand. Roughly, it must have been around one to about eighty before cooking destroyed part of the nitrite. It certainly looked as though Gettler, Pensa, and the cafeteria cook between them had given us our answer. I called up Gettler and told him what Pensa had discovered and asked him to run a specific test for nitrites on his blood samples. He had, as a matter of course, held some blood back for later examination. His confirmation came through in a couple of hours. I went home that night feeling pretty good.”

Dr. Greenberg’s serenity was a fugitive one. He awoke on Wednesday morning troubled in mind. A question had occurred to him that he was unable to ignore. “Something like a hundred and twenty-five people ate oatmeal at the Eclipse that morning,” he said to me, “but only eleven of them got sick. Why? The undeniable fact that those eleven old men were made sick by the ingestion of a toxic dose of sodium nitrite wasn’t enough to rest on. I wanted to know exactly how much sodium nitrite each portion of that cooked oatmeal had contained. With Pensa’s help again, I found out. We prepared a batch just like the one the cook had made on Monday. Then Pensa measured out six ounces, the size of the average portion served at the Eclipse, and analyzed it. It contained two and a half grains of sodium nitrite. That explained why the hundred and fourteen other people did not become ill. The toxic dose of sodium nitrite is three grains. But it didn’t explain how each of our eleven old men had received an additional half grain. It seemed extremely unlikely that the extra touch of nitrite had been in the oatmeal when it was served. It had to come in later. Then I began to get a glimmer. Some people sprinkle a little salt, instead of sugar, on hot cereal. Suppose, I thought, that the busboy, or whoever had the job of keeping the table salt shakers filled, had made the same mistake that the cook had. It seemed plausible. Pellitteri was out of the office – I’ve forgotten where – so I got Food and Drugs to step over to the Eclipse, which was still under embargo, and bring back the shakers for Pensa to work on. There were seventeen of them, all good-sized, one for each table. Sixteen contained either pure sodium chloride or just a few inconsequential traces of sodium nitrite mixed in with the real salt, but the other was point thirty-seven per cent nitrite. That one was enough. A spoonful of that salt contained a bit more than half a grain.”

“I went over to the hospital Thursday morning,” Dr. Pellitteri said. “Greenberg wanted me to check the table-salt angle with the men. They could tie the case up neatly for us. I drew a blank. They’d been discharged the night before, and God only knew where they were.” Eleven Blue Men Essay Assignment

“Naturally,” Dr. Greenberg said, “it would have been nice to know for a fact that the old boys all sat at a certain table and that all of them put about a spoonful of salt from that particular shaker on their oatmeal, but it wasn’t essential. I was morally certain that they had. There just wasn’t any other explanation. There was one other question, however. Why did they use so much salt? For my own peace of mind, I wanted to know. All of a sudden, I remembered Pellitteri had said they were all heavy drinkers. Well, several recent clinical studies have demonstrated that there is usually a subnormal concentration of sodium chloride in the blood of alcoholics. Either they don’t eat enough to get sufficient salt or they lose it more rapidly than other people do, or both. Whatever the reasons are, the conclusion was all I needed. Any animal, you know, whether a mouse or a man, tends to try to obtain a necessary substance that his body lacks. The final question had been answered.”

Discussion Questions

What did you learn about the process of medical problem solving through this piece?
Has this piece affected how you will manage the mysterious cases you encounter in the future? Eleven Blue Men Essay assignment

 

Role of Nurses in Policy Making Paper

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Role of Nurses in Policy Making Paper

Comment on the following Role of Nurses in Policy Making

Electoral system refers to procedures and norms used in an election to decide on which leader will hold a certain position of influence. The electoral process allows democracy to prevail by allowing voters to make decision on who is to be their leader. The type of government that takes office is however influenced by the electoral process. The government is responsible for making laws that influence the lives of people. Laws pertaining health and economics influence our daily. A government that promotes health reforms aimed at availing health care affects people positively.

Nurses are expected to take care of the patients and participate less in policy making. However, there is need for nurses to participate in campaigns politics. The legislators are responsible for making policies in the health sector and in most cases they make misinformed policies that are not beneficial to the nurses and patients. Nurses therefore come on board during political campaigns to enlighten the citizens on what policies are beneficial and which leadership will influence the health sector positively (Oestberg, 2017). Nurses take advantage of the respect they have earned from citizens in advocating for health reforms and policies. Role of Nurses in Policy Making Paper

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Nurses employ various strategies in making their voice heard. First is by networking with other nurses in making a health decisions. He networking process allows the nurses to interact and discus some of the issues that are affecting the health sector and how they can be improved. Second is the use of evidence-based practice to influence decisions by the legislators. Nurses through research can advocate for changes in policies (Phillips, 2017). Lastly, nurses use their personal experiences in practice as a strategy of influencing decisions.

References

Oestberg, F. (2017). Getting involved in policy and politics. Evidence based journal for acute and critical care nurses. Retrieved 5 October 2017, from http://journals.lww.com/nursingcriticalcare/Fulltext/2013/05000/Getting_involved_in_policy_and_politics.10.aspx

Phillips, R. (2017). Health Care Policy: The Nurse’s Crucial Role | American Academy of Ambulatory Care Nursing. Aaacn.org. Retrieved 5 October 2017, from https://www.aaacn.org/health-care-policy-nurses-crucial-role Role of Nurses in Policy Making Paper

NR 509 week 2 Assignment

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NR 509 week 2 Assignment

Even though your patient may have abnormal findings, you must document the expected normal exam findings for the system. If you would like to include the abnormal findings they should be noted in parenthesis next to the normal expected findings. The complete subjective and objective sections must be included.  You may include the assessment and plan portion of the SOAP note, but these sections will not be graded.

Place your order now, we write everything from scratch

You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use the chief complaint of sinus congestion, rash, and abdominal pain. You should also focus the ROS based on the patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format document in Course Resources as necessary. This will be the same format that faculty will follow during the immersion weekend.

* There are videos of the exams to be performed at immersion in Modules → Introduction and Resources→ Immersion section. Also the immersion evaluation forms are located in the Course Resources section. They should be reviewed and practiced often.  NR 509 week 2 Assignment

 

SOAP Note

Patient Information:

Initials T.K Age 30. , Sex female. Race Jewish descent Insurance United Health

 Chief Complain: Sinus Congestion, Abdominal pain and rash

Assessment:   

Onset of flare up:  3 days ago

Abdominal pain related to flare up from ulcerative colitis, fatigued, weight loss, chronic diarrhea with or without blood.

When percussed the abdomen had drum like sound due to inflammation and patient grimaced when palpated.

Vital Signs:  B/P 120/70, HR 85 RR, 26, T 98.3, height 5.7, weight 120 lb

Sinus Congestion, Abdominal pain and rash NR 509 week 2

Abdominal pain: Cramping, aching and bloating pain present

Aggravating Factors: bloating, diarrhea random cramping/aching bothersome pain.

Relieving Factors: Anti-diarrhea Motrin 200 mg with food as needed for pain.

Differential Diagnosis: Ulcerative colitis, Sinusitis and urticaria

Current Medications: Imodium AD

Ibuprofen 200 mg, take 1 caplet every 4 to 6 hours while symptoms persist

If pain does not respond to 1 caplet, 2 caplets may be used

Allergies: Hives when exposed to cold weather (Cold intolerance)

Patients Medical History:  Sinusitis, Ulcerative colitis and headaches

Chronic diarrhea with or without blood, persistent desire to empty bowel, anorexia, nausea, vomiting present.

Last PCP visit and annual exam 2 weeks ago

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Flu shot: current

Family history:

Father: Suffers from mild Ulcerative Colitis

Mother: Active healthy and owns cleaning business, had years of secondary infertility after client was born.

Siblings: None

Psychosocial History: Close relationship with both parents and Feels safe in home environment with parents.

Hobbies: reading and watching movies

ROS:

CONSTITUTIONAL:  No weight loss, sinusitis, abdominal pain and rash present

HEENT:

Head: Hair texture appears very soft and malnourished.

Eyes: patient is using contact lens. Last eye exam 7 months ago & WNL.  No visual loss, blurred vision, double vision or yellow sclera noted. Conjunctival sac pale.

Ears: No hearing loss or drainage noted

Nose: Sinus congestion, runny nose, sneezing present, grimaced when sinus was palpated.

Throat: No abnormal findings noted

SKIN:  warm, dry, rash and mild itching noted. NR 509 week 2 Assignment

 

CARDIOVASCULAR:  Breath sounds clear and equal bilaterally. Heart S1 S2, neither accentuated nor diminished. No murmur or extra heart sounds. No palpitations noted

 

RESPIRATORY:  Admits having shortness of breath with regular activities, such as climbing stairs, walking short distance sometimes and no coughing present.

 

GASTROINTESTINAL: Abdominal pain present, weight loss apparent. Drum like sound when percussed, frequent diarrhea from ulcerative colitis flare ups. Abdominal pain related to disease process present. TK grimaced when palpated

GENITOURINARY:  patient denies signs and symptoms of UTI, denies hesitancy, urgency, burning, no complaints reported.

NEUROLOGICAL:  Patient denies dizziness, vertigo, but fatigued and tingling, loss of sensation. No change in bowel or bladder control.

 

MUSCULOSKELETAL:  Extremities warm and equal bilaterally. All pulses present, 2+ and equal bilaterally. No lymphadenopathy present. Sensory modalities intact in legs and feet. No lesions noted.

HEMATOLOGIC:  Anemia noted, blood present in stool sometimes.

 

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

 

PSYCHIATRIC:  patient has no history of depression but needs social support and a lot of encouragement to deal with disease process. Strong family ties present.

 

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

Differential Diagnosis for Rash

Urticaria

Urticaria (hives) is a pruritic, often immune-mediated skin eruption of well-circumscribed wheals on an erythematous base as cited by (Wanderer, 2000). Urticaria is the consequence of a mast cell release of mediators that increase vascular permeability, which leads to extravasation into the skin of protein-rich fluid from small blood vessels, usually post capillary venules. It is estimated that up to one fifth of the population will experience an urticarial episode and women are more likely to be affected than men however menstrual cycle can predispose a woman to urticarial or other erythematous rash especially, during the premenstrual time period. The condition could worsen three to 10 days prior to the onset of menses.  Most chronic urticaria resolves within 1 year, although persistent ones occurs in approximately 10% of cases. Many mechanisms have been implicated, and much remains incompletely understood, but mast cell activation is usually the final common pathway. Precipitants range from physical stimuli to autoimmune mechanisms. Heat, fever, emotional stress, alcohol, and premenstrual state. All of these stated precipitants can exacerbate urticaria, independent of the specific pathophysiology. Additional precipitants and mediators of the urticarial reaction are constantly being identified. The localized accumulation of fluid produces the characteristic edematous, erythematous, well-circumscribed itchy wheals, which blanch on pressure, range in size from a few millimeters to several centimeters, and manifests with serpiginous borders. Individual lesions may persist for 12 to 24 hours, but most resolve spontaneously much sooner.  NR 509 week 2 Assignment

Laboratory work: history is the most useful component of the evaluation and yields clues to an underlying cause or precipitant far more often than does the physical examination or laboratory studies.

Treatment

Antihistamines provide excellent symptomatic control. The H1blockers, such as hydroxyzine (10 to 25 mg daily at bedtime) and diphenhydramine (25 to 50 mg daily at bedtime), have been the mainstay of antihistamine therapy depending on the severity. These medications are inexpensive and effective but have a sedating effect. The non-sedating H1 blockers (e.g., fexofenadine 60 mg or cetirizine 10 mg every morning) are also effective and are better tolerated for daytime use. It is often best to use a non-sedating antihistamine during the day and a more sedating agent at night. Chlorpheniramine and diphenhydramine are useful alternatives for nighttime use because they are available over the counter and are less expensive.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD). Of the large intestine that affects the mucosal layer beginning in the rectum and colon and spreading into the adjacent tissue. Although the exact etiology of UC is unclear, it appears to be the result of an abnormal inflammatory response to intestinal microbes in genetically susceptible individuals. Predominant symptoms of UC are frequent and bloody diarrhea, cramping, abdominal tenderness, rectal bleeding, and intermittent tenesmus (i.e., straining or feeling urgency to defecate without a productive bowel movement). Severe disease is indicated by bloody or nocturnal diarrhea, weight loss, and low energy levels. Pallor, constipation, anorexia, severe weight loss, fever, vomiting, dehydration, tachycardia, and extra intestinal disease manifestations can be present. Ulcerative Colitis sufferer’s relapses or goes into remission sometimes. Mild UC is characterized by < 4 bowel movements per day with or without blood, no signs of toxicity, and normal erythrocyte sedimentation rate (ESR). Moderate UC is characterized by > 4 bowel movements per day and minimal signs of toxicity. In severe disease, bowel movements are more frequent (> 6/day) and there is evidence of toxicity, such as fever, tachycardia, anemia, and elevated ESR. NR 509 week 2. Extra intestinal disease affects 10–15% of patients with UC and can involve the joints, skin, mouth, and eyes, or manifest as liver disease, gallstones, kidney stones, peptic ulcer disease, osteoporosis, mal-absorption, amyloidosis, or thromboembolic disease. Possible complications include perforation, pseudo-polyps, toxic mega-colon, colorectal cancer (CRC), skin disorders, arthritis, lung disease, thromboembolism, and hemolytic anemia. UC is diagnosed based on patient history, physical examination, laboratory testing, radiography, and colonoscopy.  9–12 new cases per 100,000 persons diagnosed each year. Age at onset of UC shows a bimodal distribution with a large peak between 15 and 35 years of age Clinical management is focused on early recognition and resolution of severe attacks, achievement and maintenance of remission with medication, enhancement of patient quality of life, and reduction of CRC risk as cited by (Domagalski, 2017). NR 509 week 2 Assignment

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Laboratory Tests:  CBC might show low hemoglobin and/or hematocrit levels, indicating anemia; WBC and platelet counts might be elevated; PT might be prolonged. Serum electrolytes and serum albumin levels will typically be decreased.  Inflammatory markers (e.g., ESR, C-reactive protein) might be elevated.  Peri-nuclear anti-neutrophil cytoplasmic antibodies with perinuclear staining (p-ANCA) are present in ~ 85% of patients with UC › Other Diagnostic Tests/Studies.  Abdominal x-ray will show the extent of disease and exclude toxic mega-colon. Endoscopic procedures (e.g., flexible sigmoidoscopy, colonoscopy) with biopsy confirm the diagnosis and define the extent and severity of disease; leukocyte scanning can be used when severe disease prohibits endoscopy.  Air-contrast barium enema in cases of mild to moderate UC show mucosal changes and complications. NR 509 week 2.

Treatment: is individualized and commonly includes amino-salicylates, glucocorticoids, tumor necrosis factor (TNF) inhibitors, immune modulators, antibiotics, and antidiarrheal drugs. It is important to assess the severity of the disease. Bed rest or restrictive activity can be recommended. Medications like amino-salicylates (e.g., sulfaSALAzine, mesalamine), TNF inhibitors (e.g., inFLIXimab), immune modulators (e.g., azaTHIOprine), and/or I.V. corticosteroids (e.g., prednisone and antidiarrheal agents like loperamide can be helpful for client. Will continue to monitor number of stools in other to evaluate the effectiveness of treatment. It is important to closely monitor electrolyte imbalance and replace nutritional Losses and Provide Optimum Fluid Volume/Electrolyte Balance. Low residue and high calorie diet is recommended. Client will be encouraged to seek dietitian consult to individualize the diet according to tolerance, preference, meal frequency, and food presentation to minimize anorexia. Client will be encouraged to take supplemental vitamins, calcium, potassium, and iron, as ordered. Evaluation of treatment response through monitoring of intake and output, vital signs, weight, and laboratory values as well as antibiotics may be ordered whenever infectious complications develop. Client will benefit from counseling on strategies for coping with a chronic disease and to a social worker for identification of local support groups. Client will be encouraged to keep stool diary to identify irritating foods.  Health care provider will recommend nothing by mouth during exacerbation period.

Differential for Sinus Congestion

Sinusitis is an inflammation of one or more of the four paired para-nasal sinuses surrounding the eyes. It is extremely common but likely an over diagnosed condition, with more than 30 million Americans treated for acute sinusitis annually. Many patients with nasal and sinus symptoms have self-limited viral infections or allergic conditions; the physician must distinguish these patients from the patient with a bacterial infection who may require antibiotics. Although acute sinusitis is often self-limited, there is significant morbidity associated with sinusitis. The extension of infection into the central nervous system and bone may be life threatening. The normal sinuses have sterile structures lined with ciliated epithelium. Mucus is cleared from the sinus in a directed manner toward the Ostia, or openings, which drain into the nasal cavity at the superior meatus and middle meatus. The superior meatus drains the posterior ethmoid and sphenoid sinuses, and the middle meatus drains the frontal, maxillary, and anterior ethmoid sinuses. Occlusion of these ostio-meatal complexes can lead to dysfunction of the normal sinus epithelium and bacterial infection. Although any sinus can become occluded through viral infection, anatomic abnormalities (including septal deviation, tumors, and polyps) or allergies can also predispose one to infection NR 509 week 2.

Acute Sinusitis

The common cold is actually a rhino-sinusitis that frequently involves the para-nasal sinuses. Computed tomographic study of patients with the common cold as cited by (Aring, 2011). According to (Goroll, 2014) more than n 85% have a self-limited para-nasal sinusitis which can resolve without treatment. The maxillary sinuses are the most common sites (87%), followed by ethmoidal (65%), sphenoidal (39%), and frontal (32%) involvement. Rhinorrhea and nasal stuffiness are the typical symptoms. Although symptoms may persist for well more than 10 days, those of uncomplicated viral rhino-sinusitis usually start to improve by 7 to 10 days as cited by (Chow, 2012).   Failure to improve suggests bacterial super infection. In about 0.5% to 2% of cases of the common cold, bacterial infection of the sinuses occurs, resulting in acute purulent bacterial sinusitis. It is characterized by nasal congestion, purulent nasal discharge, facial pain (which classically increases when the patient stoops forward), fever, fatigue, and other constitutional symptoms. Sinus pain or pressure and purulent nasal discharge are the defining clinical features of acute sinusitis. Maxillary sinusitis is the most common and produces pain and tenderness over the cheeks. The pain is referred to the teeth in some patients NR 509 week 2. Frontal sinusitis produces pain and tenderness over the lower forehead. Ethmoid sinusitis results in retro-orbital pain and may have tenderness over the upper lateral aspect of the nose. Isolated sphenoid sinusitis is uncommon but can present as retro-orbital, frontal, or facial pain. Purulent nasal discharge may be visualized in the middle meatus if the frontal, maxillary, or anterior ethmoid sinus is involved.

Laboratory work: Elevated erythrocyte sedimentation rate or C-reactive protein is useful in diagnosing sinusitis; however, it is not common practice to obtain these tests.

Treatment:  Patients with mild acute sinusitis may respond sufficiently well to the treatments listed and will not require antibiotics. In more severe cases of acute purulent sinusitis, antibiotics are commonly used. Meta-analyses of earlier studies indicate some small advantage for antibiotics in clinical improvement at 7 days, at the expense of antibiotic side effects. NR 509 week 2 Assignment

Decongestants are available in both topical and systemic preparations. The mixed adrenergic agonist pseudoephedrine is reasonably effective and can be administered by mouth. Popular sympathomimetic nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin), which is the longest acting of the topical decongestants. Patients should be instructed to spray each nostril once and then wait a minute to allow the anterior nasal mucosa to shrink. A repeat spray will then reach the upper and posterior mucosa, including the nasal turbinate’s and sinus Ostia. This procedure can be repeated as needed every 4 hours with phenylephrine and every 12 hours with oxymetazoline for up to 3 days. Tachyphylaxis and irritation develop with prolonged topical use, but risk is minimal with short-term administration (1 to 3 days).    Non-pharmacologic treatment: Although large well-designed trials have not been conducted in acute sinusitis, the inhalation of steam or water and nasal irrigation with warm hypertonic saline appear to relieve symptoms of nasal congestion. Saline irrigation has improved airway patency, mucociliary clearance, and quality of life scores. A neti pot, which is a container designed for nasal irrigation, can be used several times a day NR 509 week 2.

 

Reference

Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician 2011;83:1057. (A concise review of diagnosis and treatment, advocating watchful waiting for seven days, followed by narrow-spectrum antibiotics if there is no improvement.)

 

Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012;54:e72. (IDSA guideline that advocates only using antibiotics for patients with symptoms lasting more than 10 days or with severe symptoms for 3 days. Amoxicillin– clavulanate is recommended as the first-line treatment based on epidemiology of causative agents. NR 509 week 2)

 

Domagalski, J. E. (2017). Ulcerative colitis. In F. J. Domino (Ed.), The 5-minute clinical consult standard 2017 (25th ed., pp. 1078-1079). Philadelphia, PA: Wolters Kluwer.

 

Wanderer AA, Bernstein IL, Goodman DL, et al. The diagnosis and management of urticaria: a practice parameter. Ann Allergy Asthma Immunol 2000;85:521. (A practice parameter paper.)  NR 509 week 2 Assignment

 

PSYC 6717 Discussion: Behaviorism

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One skill of an applied behavior analyst is collaborating to identify negative behaviors an individual is exhibiting and then developing treatments for those behaviors (e.g., strategies, interventions, etc.) to help them change the behaviors and derive improved outcomes for themselves PSYC 6717 Discussion: Behaviorism. Radical behaviorism posits there is a science of behavior that has shown the environment as a significant cause of behavior and that experiential factors play a primary role in determining behavior (Cooper et al., 2020). The strategies and interventions of the applied behavior analyst represent efforts to change maladaptive behavior by systematically employing techniques that control circumstances in which negative behaviors arise and helping individuals learn and apply new skills.

For example, if a child in a classroom is repeatedly leaving their seat during instruction (i.e., maladaptive behavior), an applied behavior analyst would work with the child to identify the factors contributing to the maladaptive behavior and then develop strategies or interventions to generate more appropriate behavior by the child. PSYC 6717 Discussion: Behaviorism

For this week’s Discussion, you will consider your perspectives on radical behaviorism and its learning principles.

Reference:
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.). Pearson. 

To Prepare

  • Review the Learning Resources for this week as well as the required weekly media program to gain an understanding of radical behaviorism.
  • Think about whether you concur with the learning principles of radical behaviorism PSYC 6717 Discussion: Behaviorism.

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By Day 4 of Week 3

Post an explanation of whether you agree or disagree with the following statement, and why or why not:

  • Skinner’s “radical behaviorism” proposes that behavior, rather than cognitive processes, should be the primary topic of study.

Read your colleagues’ postings.

Note: For this discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the To Participate in this Discussion link, then select Create Thread to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 6 of Week 3

Respond to at least two colleagues’ posts by expanding on each colleague’s rationale for why they agree or disagree with Skinner’s proposal. Justify your response. PSYC 6717 Discussion: Behaviorism

Be sure to support your posts and responses with specific references to behavior-analytic theory and research. In addition to the Learning Resources, search the Walden Library and/or internet for peer-reviewed articles to support your posts and responses. Use proper APA format and citations, including those in the Learning Resources.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you have learned and/or any insights that you have gained because of your colleagues’ comments.

 

For this discussion, I agree with the statement that B.F. Skinner’s “radical behaviorism” focuses on behavior instead of cognitive processes as the topic of study. Rather than internal and mental processes, Behaviorism itself is concerned with observable, empirical evidence in animals and individuals in coming up with an explanation of the psyche (Cooper, Heron, & Heward, 2020). Skinner’s radical behaviorism has only intensified this concentration on behaviors by arguing that behavior is only a function of the external and environmental histories of an individual through the use of his operant conditioning chamber, also known as the “Skinner Box” (Walden University, 2021). Through his experiments on rats and pigeons, Skinner, later on, developed the principle of reinforcement, wherein behavior comes as a response from the interactions between an individual (or animal) and their environment PSYC 6717 Discussion: Behaviorism.

In this case, Skinner’s radical behaviorism has nothing to do with internal thoughts or feelings. While Behaviorists accept internal processes of the brain as valid, they never mentioned the independence of these processes from the external environment. For Skinner, all that could be objectively observed, studied, and measured, are behavioral responses from environmental interfaces. Because of these reasons, I argue that radical behaviorism concerns itself more with behavior rather than cognitive processes.

References

Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis (3rd ed.).

Pearson.

Walden University, LLC. (2021). Radical behaviorism [Video]. Walden University Blackboard. https://class.waldenu.edu PSYC 6717 Discussion: Behaviorism

NR394 Transcultural Nursing Essay

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NR394 Transcultural Nursing Essay

Week 6 Discussion

Standards of Practice

CO3: Describe standards of practice for culturally competent nursing care. (PO6)

The basis for our lesson this week came from the Standards of Practice for Culturally Competent Nursing Care Executive Summary, Transcultural Nursing Society: https://www.tcns.org/standards (Links to an external site.)NR394 Transcultural Nursing Essay Links to an external site.

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Assume your nursing leader has decided that the department needs to better incorporate these Standards of Practice for Culturally Competent Nursing Care into the nursing care delivery model at your organization. There are 12 Standards.

Download and read the Executive Summary, and select one of the 12 standards as the basis for the discussion. Think about the standards as they relate to culturally sensitive care.

Explain how your department or organization currently gives credence to this standard.

If it does not, from your newfound knowledge, offer suggestions of how the standard can be incorporated into patient care in your department or organization.

Note: Make sure you choose a standard that another student has not selected. Keep in mind that each of us does not work in an acute care setting, so examples from other practice settings will add to a more robust NR394 Transcultural Nursing Essay discussion.

Identify a public health problem that can be solved using a policy approach.

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My public health problem is Opioids

Assignment 3: The Policy Memo: A Preliminary Research
Your major assignment in this course is a learning assessment system assignment (LASA), and it is due in Module 5. In this LASA, you will write a policy memo to a government official on a public health topic of your choice. To prepare for this task, you will begin in this module by identifying your topic of interest and conducting preliminary research.
Using the module readings, Argosy University online library resources, and Internet sources, research public health problems that can be solved using a policy approach. Then, do the following:

Identify a public health problem that can be solved using a policy approach.
Describe this public health problem and explain why it interests you.
Identify the government official or agency (at the local, state, or federal level) to which you want to address your concerns and recommendations. Explain your choice.
Provide evidence of the problem. Support your position with at least three scholarly references as well as other data from credible Web sites.

Write a 2–3-page paper in Word format. Apply APA standards to citation of sources.