NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice

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NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice

Discussion: Nursing Research and Evidence-Based Practice
In your practice as a nurse you may use procedures and methods that did not necessarily originate in evidence but instead were derived from informal and unwritten conventions traditions and observations. While these techniques may have merit practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as evidence for revising practices to improve outcomes across health care. NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice

Based on this evidence you can formulate a question. In this Discussion you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

 

To prepare:
Consider a recent clinical experience in which you were providing care for a patient.
Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organizations standard procedures. How do you know if the tasks were based on research?
What questions have you thought about in a particular area of care such as a procedure or policy?
Review Chapter 2 pages 3134 on Asking Well worded Clinical Questions in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this weeks Learning Resources). Formulate your background questions and PICOT question.
Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.

Review the article Adopting Evidence-Based Practice in Clinical Decision Making in this weeks Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

Post an evaluation of the use or lack thereof of EBP in a recent clinical experience. Identify which aspects of the care delivered if any were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies procedures and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization. NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice

Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Ask a probing question substantiated with additional background information and evidence.
Share an insight from having read your colleagues postings synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.
Required Readings – NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice.
Polit D. F. & Beck C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia PA: Wolters Kluwer.
Chapter 1 Introduction to Nursing Research in an Evidence-Based Practice Environment
This chapter provides an introduction to nursing research its history and the evolution of evidence-based practice. It includes an overview of credible sources of evidences and a description of the different paradigms used in nursing research.

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Chapter 2 Evidence-Based Nursing: Translating Research Evidence into Practice – NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice.
The focus of this chapter includes an overview of the key aspects of evidence-based practice a review of how to identify credible research and appraise its value and finally a discussion on how to take the identified evidence and convert it into a practice.

Chapter 3 Key Concepts and Steps in Qualitative and Quantitative Research – NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice.
In this chapter quantitative and qualitative research models are compared and the major steps in each approach are described. Information is also presented on the different sections of a research journal article and how you can identify the research model that was utilized.
Adams J. S. (2010). Utilizing evidence-based research and practice to support the infusion alliance. Journal of Infusion Nursing 33(5) 273277.
Retrieved from the Walden Library databases.
This article examines how evidence-based research and practice supports infusion alliances. The text also specifies the increasing challenges that infusion nurses face.
Mallory G. A. (2010). Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm. Nursing Outlook 58(6) 279286.
Retrieved from the Walden Library databases.
This article describes strategies for reducing the gap between research knowledge and practice. The article also details how nursing societies could use these strategies to improve the quality of care.
Newhouse R. P. & Spring B. (2010). Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook 58(6) 309317.
Retrieved from the Walden Library databases.
In this article the authors examine the state of interdisciplinary evidence-based practice (EBP). The authors detail efforts to promote interdisciplinary EBP academic and clinical training regarding interdisciplinary EBP and strategies that may facilitate EBP translation across disciplines.
Shaheen M. Foo S. Luyt B. Zhang X. Theng Y-L. Chang Y-K. & Mokhtar I. A. (2011). Adopting evidence-based practice in clinical decision making: Nurses perceptions knowledge and barriers. Journal of the Medical Library Association 99(3) 229236. NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice
Retrieved from the Walden Library databases.
This article reviews a study that sought to determine nurses awareness of knowledge of and attitude toward EBP. The article also describes factors likely to promote barriers to EBP adoption.
Shivnan J. C. (2011). How do you support your staff? Promote EBP. Nursing Management 42(2) 1214.
Retrieved from the Walden Library databases.
This article explores the role of the nurse manager in supporting evidence-based practice. The article also explains barriers and strategies to promote EBP for a nurse manager.
Walden Student Center for Success. (2012). Clinical Question Anatomy. Retrieved July 9 2014 from http://academicguides.waldenu.edu/content.php?pid=183871&sid=2950360
Media
Laureate Education (Producer). (2012). Timeline of nursing research. Baltimore MD: Author.
This multimedia piece features a timeline of major events in nursing research. The timeline highlights how historical events and seminal research have contributed to nursing practice. NURS 5052/NURS 6052: Essentials of Nursing Research and Evidence-Based Practice.

NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

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NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

  1. Question: CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”

HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain. NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

1 of 2 Questions: Why is HDL considered the “good” cholesterol?

  1. Question: CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”

HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain. NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

2 of 2 Questions: Explain the role inflammation has in the development of atherosclerosis.

  1. Question: A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question: What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?

  1. Question: A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu didn’t seem to work. States had a slight sore throat a couple weeks ago and attributed it to the flu. Physical exam revealed thin young man who appears to be uncomfortable but not acutely ill. Posterior pharynx reddened and tonsils 3+ without exudate. + anterior and posterior cervical lymphadenopathy. Tachycardic and a new onset 2/6 high-pitched, crescendo-decrescendo systolic ejection murmur auscultated at the left sternal border. Rapid strep +. The patient was diagnosed with acute rheumatic heart disease (RHD).

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Question: Explain how a positive strep test has caused the patient’s symptoms.

  1. Question: The APRN sees a 74-year-old obese female patient who is 2 days post-op after undergoing left total hip replacement. The patient has had severe post op nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says she feels like the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT)

Question: Describe the factors that could have contributed to the development of a DVT in this patient explain how each of the factors could cause DVT. NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

  1. Question: A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. The APRN suspects the patient experienced a massive pulmonary embolus.

Question: Explain why a large pulmonary embolus interferes with oxygenation.

  1. Question: A 45-year-old woman is 10 days status post partial small bowel resection for Crohn Disease and has been recuperating at home. She suddenly develops severe shortness of breath, becomes weak, and her blood pressure drops to 80/40 mmHg (previous readings ~130/80s mmHg). The pulse oximetry is 89% on room air. While waiting for the Emergency Medical Service (EMS) to arrive, the APRN places EKG leads and the EKG demonstrates right ventricular strain.

Question: Explain why a large pulmonary embolism causes right ventricular strain.

  1. Question: A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

Question 1 of 2: Explain early asthmatic responses and the cells responsible for the responses.

  1. Question: A 12-year-old girl is brought to the Emergency Room (ER) by her mother with complaints of shortness of breath, wheezing, tachypnea, tachycardia, and a non-productive cough. The mother states they had just come from a fall festival where the entire family enjoyed a hayride. The symptoms began shortly after they left the festival but got better a couple hours after they returned home. The symptoms began again about 6 hours later and seem to be worse. The mother states there is no history of allergies or frequent respiratory infections. The child is up to date on all vaccinations. The child was diagnosed with asthma. The nurse practitioner explained to the mother that her child was exhibiting symptoms of asthma, and probably had an early asthmatic response and a late asthmatic response.

Question 2 of 2: Explain late asthmatic responses and the cells responsible for the responses.

  1. Question: A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD.

Question 1 of 2: Explain the pathophysiology of emphysema and how it relates to COPD.

  1. Question: A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema.  He asks the APRN if this means he has COPD. NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

Question 2 of 2: Explain the pathophysiology of chronic bronchitis and how it relates to COPD.

  1. Question: Mr. Jones is a 78-year-old gentleman who presents to the clinic with a chief complaint of fever, chills and cough. He also reports some dyspnea. He has a history of right sided CVA, COPD, dyslipidemia, and HTN. Current medications include atorvastatin 40 mg po qhs, lisinopril, and fluticasone/salmeterol. He reports more use of his albuterol rescue inhaler.

Vital signs Temp 101.8 F, pulse 108, respirations 21. PaO2 on room air 86% and on O2 4 L nasal canula 94%. CMP WNL, WBC 18.4. Physical exam reveals thin, anxious gentleman with mild hemiparesis on left side due to CVA. HEENT WNL except for diminished gag reflex and uneven elevation of the uvula, CV-HR 108 RRR without murmurs, rubs, or click, no bruits. Resp-coarse rhonchi throughout lung fields. CXR reveals consolidation in right lower lobe. He was diagnosed with community acquired pneumonia (CAP).

Question: Patient was hypoxic as evidenced by the low PaO2. Explain the pathologic processes that caused this patient’s hypoxemia.

  1. Question: A 64-year-old woman with moderately severe COPD comes to the pulmonary clinic for her quarterly checkup. The APRN reviewing the chart notes that the patient has lost 5% of her body weight since her last visit. The APRN questions the patient and patient admits to not having much of an appetite and she also admits to missing some meals because it “takes too much work” to cook and consume dinner.

Question: The APRN recognizes that COPD has a deleterious effect on patients. Explain why patients with COPD are at risk for malnutrition. NURS 6501 Module 2 Week 3 Knowledge Check; Cardiovascular and Respiratory Disorders

NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

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NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

  1. Question: A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

1 of 2 Questions: What factors may have contributed to the development of PUD? 

  1. Question: A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and frequent belching.  

PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.  

Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain 

Family Hx-non contributary  

Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.  

Breath test in the office revealed + urease. 

The healthcare provider suspects the client has peptic ulcer disease.

2 of 2 Questions: How do these factors contribute to the formation of peptic ulcers? 

  1. Question: A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.  NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2) 

Family history-non contributary   

Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn 

Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping    

The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD). 

Question: The client asks the APRN what causes GERD. What is the APRN’s best response? 

  1. Question: A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.

Question: What factors can contribute to an upper GI bleed? 

  1. Question: A 64-year-old steel worker presents to his Primary Care Provider (PCP) with a chief complaint of passing bright red blood when he had a bowel movement that morning. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some left lower quadrant pain for several weeks but described it as “coming and going”. He says he has had a fever and abdominal cramps that have worsened this morning. The likely diagnosis is lower GI bleed secondary to diverticulitis.

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Question: What can cause diverticulitis in the lower GI tract? 

  1. Question: A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension and tells the APRN that he was told he had chronic, non-curable cirrhosis.    

Question: How does cirrhosis cause portal hypertension? 

  1. Question: A 48-year-old man presents to his gastroenterologist for increasing abdominal girth and increasing jaundice. He has a long history of alcoholic cirrhosis and has multiple admissions for encephalopathy and GI bleeding from esophageal varices. He has been diagnosed with portal hypertension. The increased abdominal girth has been progressive, and he says it is getting hard to breathe. The APRN reviews his last laboratory data and notes that the total protein is 4.6 gm/dl and the albumin is 2.9 g/dl. Upon exam, he has icteric sclera, jaundice, and abdominal spider angiomas. There is a significant fluid wave when percussed. The APRN tells the patient that he has ascites.  NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

Question: Discuss how ascites develops as a result of portal hypertension. 

  1. Question: A 45-year-old man with known alcoholic cirrhosis, portal hypertension, and ascites is brought to the ED by his family due to increasing confusion. The family states that he had been stumbling for several days but had not fallen. The family also noted that he had been “flapping his hands” as well. Labs in the ED reveal Hgb 9.4 g/dl, Hct 28.0 %, ammonia (NH3) level is 159 μmol/L. The APRN informs the family that the patient has developed hepatic encephalopathy (HE). 

Question: Explain how hepatic encephalopathy develops in patients with cirrhosis of the liver.

  1. Question: A 65-year-old man with a history of atrial fibrillation presents to his PCP’s office 2 months after suffering from a myocardial infarction.  He declined anticoagulation due to fear he would bleed to death. He has had sudden-onset, moderately severe diffuse abdominal pain that began 18 hours ago. He has been vomiting, and he has had several episodes of diarrhea, the last of which was bloody. He has a fever of 100.9 ˚ F. CBC reveals WBC of 15,000/mm3. 

Question: What is the most likely mechanism behind his current symptoms?  

  1. Question: A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 1 of 2: Describe how gallstones are formed and why they caused the symptoms that the patient presented with. 

  1. Question: A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.  

Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl.  Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment. 

Question 2 of 2: Explain how the patient became jaundiced.

  1. Question: Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.  

Physical Exam: 

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air. 

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly. 

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs 

Resp-decreased breath sounds in both bases with poor inspiratory effort 

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed.  Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.    NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

 

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis. 

Question: Explain how pancreatitis develops and the role alcohol played in this patient’s case.

  1. Question: A 23-year-old bisexual man with a history of intravenous drug abuse presents to the clinic with a chief complaint of fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and dark urine. He says the symptoms started about a month ago and have gotten steadily worse. He admits to reusing needles and had unprotected sexual relations with a man “a couple months ago”.  

PMH-noncontributory.   

Social/family history-works occasionally as a night clerk in a hotel. Parents without illnesses. Admits to bisexual sexual relations and intravenous heroin use. He has refused drug rehabilitation. 3 year/pack history of tobacco but denies vaping.  

Physical exam unremarkable except for palpable liver edge 2 fingerbreadths below costal margin. No ascites or jaundice appreciated.  

The APRN suspects the patient has Hepatitis B given the strong history of risk factors. She orders a hepatitis panel which was positive for acute Hepatitis B. 

Question: What are the important hepatitis markers that indicated the patient had acute hepatitis B? 

  1. Question: Hannah is a 19-year-old college sophomore who came to Student Health with a chief complaint of lower abdominal pain. She says the pain has been present for 2 months and she has had multiple episodes of diarrhea alternating with constipation, and anorexia. She says she has lost about 10 pounds in these 2 months without dieting. The abdominal pain has gotten worse in the last 2 hours, but she thought she had “the GI bug” like other students at her Synagogue had.  

Physical exam-noncontributory except for the abdomen which was lightly distended with no visible masses. Normoactive BS x 4. Diffuse tenderness throughout but increased pain on deep palpation LUQ & LLQ. Slight guarding but no rebound tenderness or rigidity. 

Rectal-tight anal sphincter and patient grimacing in pain during exam. Slightly + guaiac stool. 

Based on her history and current symptoms, the APN arranges for a consult with a gastroenterologist who diagnoses Hannah with ulcerative colitis (UC). 

Question: How does ulcerative colitis develop in a susceptible person? 

  1. Question: A 64-year-old woman with long standing coronary artery disease presents to the clinic with lower extremity swelling, abdominal distension, and shortness of breath. Patient states she has a 30-pound weight gain in 6 weeks and is now requiring 3 pillows to sleep.  

On physical exam the patient is a well-developed, well-nourished female exhibiting signs of respiratory distress with use of accessory muscles. Blood pressure 150/80, pulse 105, respirations 28 and labored. Body weight 89 kg. HEENT was unremarkable. Cardiac exam had an S1, S2 and S3 without S4 or murmur. Respiratory exam was positive for bilateral rales 1/2 up both lung fields. Abdomen was enlarged with a positive fluid wave. Lower extremities were remarkable for 3+ pitting edema.  NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

Laboratory data was significant for an increase in K+ from 3.4 mmol/l to 6.1 mmol/l in 2 weeks, BUN increased from 18 mg/dl to 104 mg/dl, and creatinine increased from 0.8 mg/dl to 6.9 mg/dl.  

CXR revealed congestive heart failure. The APRN calls the cardiologist on call who admits the patient to the hospital and orders a nephrology consult.  

She was diagnosed with exacerbation of congestive heart failure (CHF) and acute kidney injury (AKI).  

Question: What type of acute kidney injury does the patient have and what factors contributed to this diagnosis? 

  1. Question: The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate.  

Question: What would be the most important concept of glomerular filtration rate that the APRN should address? 

  1. Question: The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow 

Question: What would be the most important concept of autoregulation that the APRN should address? 

  1. Question: The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow 

Question: What would be the most important concept of hormonal regulation that the APRN should address? 

  1. Question: A 28-year-old female comes to the clinic with a chief complaint of right flank pain, urinary frequency, and foul-smelling urine. The symptoms have been present for 3 days but this morning, the patient states she had a fever of 101 F and thought she should get it checked out. Physical exam noncontributory with the exception of right costovertebral angle (CVA) tenderness upon percussion. Urine dipstick shows + blood, + bacteria and + white blood cells. Renal ultrasound reveals right staghorn renal calculus and the patient was diagnosed with acute pyelonephritis.  

Question: How does a renal calculi calculus contribute to acute pyelonephritis? 

  1. Question: Mr. Kent is a 45-year-old African American male with a history of Type 2 diabetes, hypertension, and hyperlipidemia. His renal function has slowly decreased over the past 4 years and his nephrologist has told him that his GFR has decreased to 15cc ml/min and will soon need renal dialysis for chronic renal failure.  

Question: How does chronic renal failure develop?  NURS 6501 Module 3 Week 5 Knowledge Check; Gastrointestinal and Hepatobiliary Disorders

WEEK 7, NURS 6501 Discussion: Anemia

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WEEK 7, NURS 6501 Discussion: Anemia

In clinical settings, advanced practice nurses often encounter patients with blood disorders such as anemia. Consider the case of a 17-year-old girl who is rushed to the emergency room after suddenly fainting. The girl’s mother reports that her daughter has had difficulty concentrating for the past week, frequently becomes dizzy, and has not been eating normally due to digestion problems. The mother also informs the nurse that their family has a history of anemia. With the family history of anemia, it appears that this is the likely diagnosis. However, in order to properly diagnose and treat the patient, not only must her symptoms and family history be considered, but also factors such as gender, ethnicity, age, and behavior. This poses the question: How do patient factors impact the incidence and prevalence of different types of anemia? WEEK 7, NURS 6501 Discussion: Anemia

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To Prepare

  • Review Chapter 21 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.
  • Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.
  • Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.
  • Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.

BY DAY 3

Post an explanation of the pathophysiological mechanisms of iron deficiency anemia and the anemia you selected. Compare these two types of anemia, as well as their potential causes. Finally, explain how genetics, gender, ethnicity, age, and behavior might impact the anemic disorders you selected.

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 “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! WEEK 7, NURS 6501 Discussion: Anemia

Abraham Lincoln University Discussion: Cardiovascular Disorders

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Abraham Lincoln University Discussion: Cardiovascular Disorders

Description

Discussion: Cardiovascular Disorders

Veins and arteries are vital elements of the cardiovascular system. They carry the blood supply through the body and are essential for proper function. Sometimes veins and arteries malfunction, resulting in cardiovascular disorders. Malfunctions of arteries and veins are similar to malfunctions of a water hose. Consider the structure and function of a hose. A tap releases water, which then travels through the hose and comes out the other end. If the hose has been dormant for several months, dirt and rusty particles might build up inside, resulting in a restricted flow of water. Similarly, buildup of plaque inside the coronary arteries restricts blood flow and leads to disorders such as coronary heart disease. This disease is one of the most common cardiovascular disorders, and according to the National Heart, Lung and Blood Institute (2011), is the leading cause of death for men and women in the United States. In this Discussion, you examine the pathophysiology of cardiovascular disorders such as coronary heart disease. Abraham Lincoln University Discussion: Cardiovascular Disorders

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To Prepare

  • Review this week’s media presentation on alterations of cardiovascular functions, as well as Chapter 24 in the Huether and McCance text. Identify the pathophysiology of cardiovascular disorders.
  • Select one patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of cardiovascular disorders.
  • Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected.

BY DAY 3

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified. Abraham Lincoln University Discussion: Cardiovascular Disorders

Gastrointestinal Tract: Disorders of Motility Assignment

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Gastrointestinal Tract: Disorders of Motility Assignment

Description

Gastrointestinal Tract: Disorders of Motility

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned. Gastrointestinal Tract: Disorders of Motility Assignment

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

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To Prepare

  • Review this week’s media presentation on the gastrointestinal system.
  • Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
  • Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
  • Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
  • Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis. Gastrointestinal Tract: Disorders of Motility Assignment

To Complete

Write a 2- to 3-page paper that addresses the following:

  • Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
  • Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
  • Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper. Gastrointestinal Tract: Disorders of Motility Assignment

NURS6501 Purdue Pathophysiology Alterations & Adaptive Strategies of Patients Paper

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NURS6501 Purdue Pathophysiology Alterations & Adaptive Strategies of Patients Paper

Description

 

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute. NURS6501 Purdue Pathophysiology Alterations & Adaptive Strategies of Patients Paper

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

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Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep. NURS6501 Purdue Pathophysiology Alterations & Adaptive Strategies of Patients Paper

To Prepare

  • Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
  • Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
  • Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.
  • Review the Application Assignment Rubric found under Course Information

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

  • For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.
  • Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations. NURS6501 Purdue Pathophysiology Alterations & Adaptive Strategies of Patients Paper

 

NURS6501 Marymount University 5 Weeks The Pathophysiology of Disorders

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NURS6501 Marymount University 5 Weeks The Pathophysiology of Disorders

Description

Assignment 2: The Pathophysiology of Disorders

During the last 5 weeks, you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems. NURS6501 Marymount University 5 Weeks The Pathophysiology of Disorders

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To Prepare

  • From the list below, select a disorder of interest to you:
    • Alzheimer’s disease
    • Asthma in children
    • Chronic obstructive pulmonary disease (COPD)
    • Congestive heart failure
    • Hepatic disease (liver disease)
    • Hypertension
    • Hyperthyroidism and hypothyroidism
    • Seizures
    • Sepsis
  • Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems.
  • Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder.
  • Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder. NURS6501 Marymount University 5 Weeks The Pathophysiology of Disorders

To Complete

Develop 10 -slide PowerPoint presentation that addresses the following:

  • Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems.
  • Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder.
  • Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder. NURS6501 Marymount University 5 Weeks The Pathophysiology of Disorders

Disorders of the Veins and Arteries Assignment

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Disorders of the Veins and Arteries Assignment

Description

Disorders of the Veins and Arteries

To Prepare

  • Review the section “Diseases of the Veins” (pp. 598-599) in Chapter 23 of the Huether and McCance text. Identify the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Consider the similarities and differences between these disorders.
  • Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Think about how the factor you selected might impact the pathophysiology of CVI and DVT. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected. Disorders of the Veins and Arteries Assignment
  • Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct two mind maps—one for chronic venous insufficiency and one for venous thrombosis. Consider the epidemiology and clinical presentation of both chronic venous insufficiency and deep venous thrombosis.

To Complete

Write a 2- to 3-page paper that addresses the following:

  • Compare the pathophysiology of chronic venous insufficiency and deep venous thrombosis. Describe how venous thrombosis is different from arterial thrombosis.
  • Explain how the patient factor you selected might impact the pathophysiology of CVI and DVT. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
  • Construct two mind maps—one for chronic venous insufficiency and one for deep venous thrombosis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper. Disorders of the Veins and Arteries Assignment

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Required Readings

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

  • Chapter 23, “Structure and Function of the Cardiovascular and Lymphatic Systems”

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

  • Chapter 25, “Alterations of Cardiovascular Function in Children”

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.

Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.

  • Chapter 11, “Cardiovascular Disorders: Vascular Disease”

This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock. Disorders of the Veins and Arteries Assignment

Required Media

 

Laureate Education, Inc. (Executive Producer). (2012a). Alterations of cardiovascular functions PPT lecture. Baltimore, MD: Author.

 

This media presentation outlines common alterations of cardiovascular function, including disorders of the veins and arteries.

 

Review the animations, case studies, and review questions on the evolve textbook support link. http://evolve.elsevier.com/huether

Optional Resources

 

American Heart Association. (2012). Retrieved from http://www.heart.org/HEARTORG/

 

Million Hearts. (2012). Retrieved from http://millionhearts.hhs.gov/index.html

 

National Heart, Lung, and Blood Institute. (2012). Retrieved from http://www.nhlbi.nih.gov/ Disorders of the Veins and Arteries Assignment

Gastrointestinal Tract: Disorders of Motility Assignment

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Gastrointestinal Tract: Disorders of Motility Assignment

Description

 

Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned. Gastrointestinal Tract: Disorders of Motility Assignment

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

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To Prepare

  • Review this week’s media presentation on the gastrointestinal system.
  • Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
  • Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
  • Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor. Gastrointestinal Tract: Disorders of Motility Assignment
  • Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis. Gastrointestinal Tract: Disorders of Motility Assignment

To Complete

Write a 2- to 3-page paper that addresses the following:

  • Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
  • Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
  • Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper. Gastrointestinal Tract: Disorders of Motility Assignment

 

Title of the Paper in Full Goes Here

Student Name Here

Walden University

Course Number, Section, and Title

(Example: NURS 0000 Section 01, Title of Course)

Month, Day, Year

(enter the date submitted to instructor)

 

Title of the Paper

  1. Briefly detail what has been said or done regarding the topic.
  2. Explain the problem with what has been said or done.
  3. Create a purpose statement (also commonly referred to as a thesis statement) as the last sentence of this paragraph: “The purpose of this paper is to describe…”.

Level 1 Heading (Name According to the Grading Rubric Required Content)

This text will be the beginning of the body of the paper. Even though this section has a new heading, make sure to connect this section to the previous one so readers can follow along with the ideas and research presented. The first sentence, or topic sentence, in each paragraph should transition from the previous paragraph and summarize the main point in the paragraph. Make sure each paragraph addresses only one topic. When you see yourself drifting to another idea, make sure you break into a new paragraph. Avoid long paragraphs that are more than three-fourths of a page.  Per our program recommendations, each paragraph should be at least 3-4 sentences in length and contain a topic sentence, evidence, analysis, and a conclusion or lead out sentence. In your paragraphs, synthesize your resources/readings into your own words and avoid using direct quotations. In the rare instances you do use a direct quotation of a historical nature from a source, the page or paragraph numbers are also included in the citation. For example, Leplante and Nolin (2014) described burnout as “a negative affective response occurring as result of chronic work stress” (p. 2). When you transition to a new idea, you should begin a new paragraph.

Another Level 1 Heading (Name According to the Grading Rubric Required Content)

Here is another Level 1 heading. Again, the topic sentence of this section should explain how this paragraph is related to or a result of what you discussed in the previous section. Consider using transitions between sentences to help readers see the connections between ideas.

Be sure to credit your source(s) in your paper using APA style. The APA Manual 6th edition and the Walden Writing Center are your best citation resources. Writing Center resources are available at https://academicguides.waldenu.edu/writingcenter/apa/citations. You must appropriately and correctly cite all works used in your document.

The following paragraph provides examples of in-text citation examples.  According to Leplante (2014), employers cause burnout when employees are stressed by too much work.  Or you might write and cite in this manner: Employers cause burnout when employees are stressed by too much work (Leplante, 2014). When paraphrasing, the author name and year of publication in citations is required by APA to direct the reader to a specific source in the reference list. Personal communications are not listed in the reference page but are noted in text as (S. Wall, personal communication, May 24, 2018). This should immediately follow the content of the interview.

Another Level 1 Heading (Name According to the Grading Rubric Required Content)

APA can seem difficult to master, but following the general rules becomes easier with use. The Writing Center also offers numerous APA resources on its website and can answer your questions via  email . Prior to submitting your paper for grading, submit your draft to SafeAssign Drafts found in the left column of your course.

And so forth until the conclusion….

Conclusion

The conclusion section should recap the major points of your paper. Do not introduce new ideas in this paragraph; the conclusion should interpret what you have written and what it means in the bigger picture. Gastrointestinal Tract: Disorders of Motility Assignment

 

References

Please note that the following references are intended as examples only. List your own references in alphabetical order.  Also, these illustrate different types of references; you are responsible for any citations not included in this list. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list.

Journal Article; One Author; DOI

Leplante, J. P. (2014). Consultas and socially responsible investing in Guatemala: A case study examining Maya perspectives on the Indigenous right to free, prior, and informed consent. Society & Natural Resources, 27(4), 231–248. doi:10.1080/08941920.2013.861554

Journal Article, Two Authors; URL

Eaton, T. V., & Akers, M. D. (2007). Whistleblowing and good governance. CPA Journal, 77(6), 66–71. Retrieved from http://www.cpajournal.com/

Journal Article, Three to Six Authors; URL

Rasmussen, A., Hopkins, B., & Fitzpatrick, C. (2004). Systematic review. CPU Journal, 6(9), 44-51.  Retrieved from http/www.cpujournal.com/

Journal Article, Seven Authors or more; DOI

Kernis, M. H., Cornell, D. P., Sun, C. R., Berry, A., Harlow, T., Asgaard, G.,….Bach, J. S. (1993). There’s more to self-esteem than whether it is high or low: The importance of stability of self-esteem. Journal of Personality and Social Psychology, 65(9) 1190-1204.  doi:10.1080/08941920.2013.861554

 

 

Book; One Author

Weinstein, J. A. (2010). Social change (3rd ed.). Lanham, MD: Rowman & Littlefield.

Book; Chapter in an Edited Book

Christensen, L. (2001). For my people: Celebrating community through poetry. In B. Bigelow, B. Harvey, S. Karp, & L. Miller (Eds.), Rethinking our classrooms: Teaching for equity and justice (Vol. 2; pp. 16–17). Milwaukee, WI: Rethinking Schools. Gastrointestinal Tract: Disorders of Motility Assignment

Professional Organization Article

Centers for Disease Control and Prevention. (2010). Nutrition. Retrieved from http://www.cdc.gov/nutrition/

Professional Organization Web page

Centers for Disease Control and Prevention. (2018). Back to school. Retrieved from https://www.cdc.gov/features/teens-back-to-school/index.html

Professional Organization Book

American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Author.

Two or more works by same author in the same year

Wall, S. (2018a). Effects of friendship on children’s behavior. Journal of Social Psychology, 4(1), 101-105.

Wall, S. (2018b). Trials of parenting adolescents with deviant behaviors. Journal of Child Psychology, 4(12), 167-161.

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Government Article

National Institute of Mental Health. (1990). Clinical training in serious mental illness (DHHS Publication No. ADM 90-1679). Washington, DC: U.S. Government Printing Office. Gastrointestinal Tract: Disorders of Motility Assignment

Lecture Notes

Health effects of exposure to forest fires [Lecture notes]. (2005). Retrieved from https://class.waldenu.edu

Personal Communication (Only Goes in Body of Paper and not in References)

Video/DVD

Laureate Education (Producer). (2009). Title of program here [DVD]. In Title of video here. Baltimore, MD: Author.

Television (Audio)

Important, I. M. (Producer). (1990, November 1). The nightly news hour [Television broadcast]. New York, NY: Central Broadcasting Service.

APA Resources

You have other several options to assist you in the formulation of your reference page.

  • Your American Psychological Association (APA) Manual is your best reference resource. Use the current edition with a copyright date of 2009.
  • The Walden Writing Center also a great place for referencing advice at https://academicguides.waldenu.edu/writingcenter/apa/references.
  • Citation and reference examples are provided in the ‘BSN TOP Ten References and Citations” handout found in the Writing Resources tab of the course. This document covers the 10 most commonly used reference and citation formats. You are responsible to look up any that are not included on this list. Gastrointestinal Tract: Disorders of Motility Assignment