ABDOMINAL ASSESSMENT Case Study SOAP Note

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ABDOMINAL ASSESSMENT Case Study SOAP Note

ABDOMINAL ASSESSMENT Case Study SOAP Note

 

Subjective:

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

Objective:

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

Assessment:

  • Left lower quadrant pain
  • Gastroenteritis

 

Additional Information that Should Be Included in the Documentation of Subjective Data

According to Ball et al. (2015), it is critical to obtain a detailed abstract history of the torment when treating a patient with generalized stomach or abdominal pain in order to narrow the range of possible differential diagnoses. The main complaint should be “stomach or abdominal pain.”More information about the patient’s historical background regarding the current condition (HPI) and overall wellbeing from a previous time is required in the subjection section of the SOAP note in this case, which could be accomplished by asking more engaged or focused questions. More information about the patient’s overall health, eating habits and history prior to this condition is required, which could be obtained by asking more engaged or focus questions. It is also necessary to provide additional information about any changes in appetite and defecation or bowel movement. The historical context of the current illness should include information such as the beginning or onset, duration, qualities or characteristics, intensifying or exacerbating, and mitigating or alleviating symptoms in the case of the abdominal pain. It is critical to retain information on the nature of the pain, such as whether it is transitory or confined, whether the severity is increasing or decreasing, and where it originates and ends. One of the most basic questions to ask before beginning the test is about the location of the pain (Ball,2015).The patient should also be asked what he was doing before the pain started. Identifying which parts of the abdomen that the pain is felt most as well as responding to questions posed during the ROS is missing. This information is critical in narrowing down to the absolute most likely diagnose. ABDOMINAL ASSESSMENT Case Study SOAP Note

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Despite the patient’s mention of diarrhea, mote information about bowel and urinary habits should be included. This includes the length and frequency of diarrhea episodes in a day, relieving and aggravating factors, and other diarrhea related symptoms. Incontinence, hesitancy, dysuria, urgency, and increased frequency of urination should all be documented. Still on the subject of urinary habits, details about the odor, color, and discomfort felt after or during a bowel movement should be provided. It is critical to rule out any potential abdominal pain side effects such as nausea and vomiting. Clearly, the patient had a 4year history of GI bleeding. As a result, details such as the absence or presence of blood in the vomitus or stool, as well as color and smell should be included.

Patient reports of missing to take medications would be filed under meds the last time he took them, necessitating a distinction between the justification for each medicine and why it should be discontinued.Also, a differential conclusion thought to be a negative finding for colon malignant growth or cancer should be recorded in the Assessment section. Finally, the family history must return to three generations, of which two out of three is documented. This healthcare provider ROS appears to have been derailed, and he failed to take note of or complete the remainder of the PMHx.Inquiries about lifestyle and exercise for diabetes and hypertension are acceptable practice and require legitimate clinical documentation (Ball, Dains, Flynn, Solomon, and Stewart, 2019). CAGE testing can assist you in avoiding alcohol addiction. What exactly is meant by “intermittent or occasional” drinking? How many, how frequently, and what are the ramifications?

 

 

 

Additional Information that Should Be Included in the Documentation of Objective Data

In the objective a section of the SOAP note, the documentation actually requires more data on the patient’s outward appearance. This includes how quickly the patient responds to questions, whether all inquiries are addressed appropriately, whether the patient’s cleanliness or physical appearance is acceptable, and the patient’s disposition and stance.Despite the fact that an auscultation was performed, which revealed hyperactivity and pain in one lower quadrant on one foot, the outcome of the midsection inspection and percussion of the abdomen was not disclosed.The actual assessment is incorrect. To coordinate with head-to-toe evaluation or assessment, frameworks or systems are consistently documented in a specific request. This section is devoid of any sort of overall evaluation. Only certain discoveries and relevant negative discoveries are required for the objectivedata or section of the SOAP note. when using HEENT, the body systems are listed in a particular order, HEENT before Neck, Neck before chest etc. The SOAP for the contextual investigation would be VS General, Skin, Chest, Abdomen, and Genitourinary (Ball et al., 2019). These areas contain all of the organs that could be causing stomach pain. In two of the positive stomach or abdominal pain, this provider is expected to use palpation and a stethoscope. Negative results for palpation and auscultation must be documented for the remainder of the assessment.Finally, if JR has a history of GI drain, where are his CBC, skin pallor, and capillaryrefill data? Where are JR’s blood glucose and CMP levels if he is a diabetic with the runs? Since the patient is on hypertension and diabetes medication, it is necessary to include data for blood sugar level. What is the LLQ palpation discoveries’ persona? Either there will be a mass or there will not be a mass or rebound tenderness. Is it sharp or dull as it travels? The following Lab test are needed; CBC, CMP, HbA1C, Abdominal x-ray, Stool guaiac, and stool WBC. Given his high risk of colon cancer and history of GI bleed, a referral for EGD/colonoscopy is a good option (Sullivan, 2019). ABDOMINAL ASSESSMENT Case Study SOAP Note

 

Is the Assessment Supported by the Subjected or Objective Information

The assessment is partially supported and partially not supported by subjective and objective data. For example, the patient’s abdominal grumbling, which includes stomach pain, loose bowels, and sickness, supports the diagnosis of gastroenteritis.According to Martin, gastroenteritis symptoms include stomach pain, watery loose stools, fever, sickness, squeezing, and migraine or headache (2016). Despite the fact that the patient-specific information supported the gastroenteritis diagnosis, the objectivepart of the SOAP note is not taken into account in the assessment.The patient complained generalized pain, which differed significantly from the pain noted in the Objective data in the left lower quadrant (LLQ). However, the pain in the left lower quadrant may be an alluded or referred pain that needs to be investigated further because real illnesses can be concealed by GI side effects.

 

 

Diagnostic Tests

The most appropriate characteristic tests that would be used to determine or come up with a diagnose of the patient current presentation are a total blood count (CBC) and a liver function test (LFTs). Completing a tumor markers test is also important. A CBC would show a normochromic pallor, as well as sickliness or anemia and thrombocytosis, all of which are signs of pancreatic disease.Increased levels of bilirubin, basic phosphatase, serum amylase, and lipase on the LFTs indicate obstructive jaundice (Fazzalari et al., 2019). The sugar or carbohydrateantigen 19-9, which would be raised to levels of 100U/ml due to pancreatic malignant development from the common level of 33-37U/ML iscurrently the most incredible tumor marker test(Fazzalari et al., 2019).In this case, it is strongly advised to use Computed Tomography scan (CT scan) rather than Magnetic Resonance Imaging (MRI). A stomach CT scan can show the entire pelvis and mid-region. The presence of lower-thickness wounds on CT will aid in the confirmation of pancreatic malignant damage or growth.Examining the skin, stomach, or abdomen now revealed no obvious disclosures, such as the rigid concept of rigidity to propose a mass. Furthermore, there is no clinical, social, or familial history of pancreatitis or pancreatic malignancy.Regardless, the patient had abdominal and stomach pain, looseness of the bowels, and it was later revealed that, patient could eat despite some irrelevant squeamishness. Furthermore, due to the patient’s gastroenteritis condition, the pain was limited to the lower quadrant of the abdomen.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accept or reject soap

I will refuse to accept the review due to the goal details of left lower quadrant torture. In the majority of cases, the abstract information points to gastroenteritis; the patient has a low mesh fever, loose bowels, sickness and heaving, and stomach pain. Three conditions that could be considered a differential finding for this patient are as follows:

 

Irritable bowel syndrome

When food is unable to pass through the large or small digestive tracts, this occurs. According to the Mayo Foundation for Medical Education and Research, symptoms of intestinal obstruction include stomach pains, cramps, heaving, clogging, and sickness (2015).

 

A gallstone is a type of gallstone.

Strong materials that structure the gallbladder in such a way that it becomes clogged are referred to as this. WebMD lists some of the symptoms as queasiness, retching, acid reflux, and stomach pain (2017).

 

The bacteria H. Pylori causes stomach ulcers.

This is a stomach disease caused by microbes. Symptoms include stomach pain, regurgitation, loss of appetite, bulging, and sickness, according to Colledge and Cafasso (2015).

 

Diverticulitis is a digestive disease.

The most well-known cause of left lower quadrant torment is diverticula aggravation, which is caused by a tear, contamination, or growth of the diverticula, which are small pockets caused by a shortcoming of the colon. Left lower midsection pain, fever, sickness, regurgitation, and stomach discomfort are among the symptoms.

 

 

 

 

Irritable bowel syndrome (UCS) is a form of colitis

This is a differential conclusion due to the patient’s history of GI drain. The signs and symptoms include loose bowels, stomach pain, weakness, fever, and the need to poop. The color of the stool isn’t recorded in the abstract information, so there may be a hint of blood, stomach torment, weakness, fever, and the need to poop.A positive feces white platelet test would rule out ulcerative colitis and alert us to any other problems.

Nursing homework help

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Nursing homework help

Week 7: Assignment: Reflection on Learning

Start Assignment

  • Due Apr 12 by 11:59pm

 

  • Points 100

 

  • Submitting a file upload Nursing homework help

Purpose

The purpose of this activity is to deepen learning through reflective inquiry. It will allow for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals. Nursing homework help

Course Outcomes

This assessment enables the student to meet the following course outcomes:

  • CO 1: Examine the role of the DNP-prepared nurse in leading financial planning and management across healthcare settings. (PO 2, 4, 9)
  • CO 2: Formulate a needs-based organizational assessment to inform strategic leadership decision-making (POs 3, 5, 7)
  • CO 3: Develop strategies to lead project planning, implementation, management, and evaluation to promote high value healthcare. (PO 3, 5, 7)

Due Date(s)

Submit your assignment by 11:59 p.m. MT Sunday at the end of Week 7. The late assignment policy applies to this assignment.

Total points possible: 100 points

Instructions

Follow these guidelines when completing this assignment. Contact your course faculty if you have questions.

Write a brief 1-2 paragraph weekly reflection addressing the questions posed in the Reflect section of each weekly module. Edit your Reflection to include each weekly reflection.

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Include the following sections in your Reflection:

  • Week 1: Reflect upon your Week 1 learning journey in NR711 and address the following in 1-2 paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How will you promote collaborative, inter-professional relationships in a rapidly transforming healthcare environment?
    • What do you value the most about your learning this week? Nursing homework help

 

  • Week 2: Reflect upon your Week 2 learning journey in NR711 and address the following in 1-2 paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How might you use this week’s information to benefit your organization in the future as a DNP-prepared nurse?
    • What do you value most about your learning this week?

 

 

  • Week 3: Reflect upon your Week 3 learning journey in NR711 and address the following in 1-2 paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objective
    • How might you use the learning this week with your own DNP Project planning?
    • What do you value most about your learning this week?
  • Week 4: As you reflect upon your Week 4 learning journey in NR711 and address the following in 1-2 paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How might you improve on your communication skills to be more effective as a project manager?
    • What do you value most about your learning this week?
  • Week 5: Reflect upon your Week 5 learning journey in NR711 and address the following in one or two paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How might the outcomes of your project influence nursing practice and/or patient care, and/or your organization?
    • What do you value most about your learning this week?
  • Week 6: Reflect upon your Week 6 learning journey in NR711 and address the following in one or two paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How might your knowledge about budgets and financial analysis contribute to providing cost-saving solutions to patient care while improving outcomes?
    • What do you value most about your learning this week? Nursing homework help

 

  • Week 7: Reflect upon your Week7 learning journey in NR711 and address the following in one or two paragraphs:
    • As you assess your learning, provide one specific example of how you achieved one of the weekly objectives.
    • How might your knowledge about current reimbursement trends be useful for you as a DNP-prepared nurse?
    • What do you value most about your learning this week?

 

Community Assessment

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Community Assessment

 

Community Assessment Part One: Community Core (Due in Assignment 2.3)

Data Collection Tool

Name:_________________________________ Community:_________City of Madisonville________________________

Instructions: Use this tool to document your assessment findings.  Include a succinct synopsis in paragraph form for each of the assessment categories below.  Remember to provide adequate depth and breadth for each category of the assessment.  Be sure to cite the sources to support your findings and include your reference list.

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Assessment Category Findings
Historical overview of the community

Must Include:

·         When the community was settled

·         By whom

·         First Business

·         Important information about the community

 The city of Madisonville, Kentucky, was established in 1807 and was named for the then secretary of state, James Madison. The city was named the seat of Hopkins County in 1808 (Gamblin, 2018). It was formally incorporated in 1808. Farming was the primary occupation of the city’s residents, with tobacco as the leading crop. The first outcropping of coal was discovered in 1837, and the first coal mine was opened in 1869. In the early 20the century, the city of Madisonville was known for being a rail hub, coal-mining center, and a large tobacco market. Currently, it is labeled as “the best town on Earth” and serves as the leading manufacturing hub. Community Assessment
Demographic description of the community population

Must Include:

·         Birth rates

·         Death rates

·         Pertinent morbidity rates

·         Distribution of

Age

·         Sex

·         Race

·         Ancestry (i.e., German, Asian, Indian, etc.)

·         Marital status

·         Education status

·         Household types& size

 As of 2020, the city is estimated to have approximately 19,542 people making it the most populated city in Kentucky. Based on the 2019 demographic data, the city of Madisonville showed a birth rate of 23.7%. The death rate was estimated to be 1,048 per 100,000 people as of 2018. The median age in the city is 36.3 years, 41.9 years for females, and 32.8 years for males. Individuals between 18 and 64 years cover about 57% of the city’s total population; persons under 18 years cover approximately 26 %, while those above 64 years are about 17% (World Population Review, n.d.). According to US Census Bureau Statistics, females in the city make up about 50.8% while males are 449.2%. The percentage of whiles is 82.2%, African American 11.8%, American Indian and Alaska Native 0.4%, and Asian approximately 1.3%. Approximately 4,010 people (27.14% of the total population) in Madisonville are single, while about 7,100 individuals (47.75%) are married. Regarding education, the percentage of high school graduates or high is 87.6 %, while the percentage of persons with a Bachelor’s degree or higher is 20.8% (US Census Bureau, n.d.). The household types in the city include married, single female, single male, one-person, and those with children. Persons per household are estimated to be 2.40. Community Assessment
Values, beliefs, and perceptions within the community

Must Include:

·         Community’s values, beliefs, and perceptions of importance of religion

·         Degree of religious diversity in the community reflected in the faith groups

·         Cultural influences reflected in any significant ethnic or religious traditions

 Madisonville welcomes every faith. About 64.5% of the total population in the city value religion, with 53.1% Baptist, 4% Methodist, 1.1% Catholic, and 2.5% Pentecostal (City-Data, n.d.). The city offers places of worship for diverse religious backgrounds, including worship, fellowship, faith-based educational institutions, and ministries focused on helping other people. Faith community offers various church styles ranging from traditional to contemporary and Española services.
Physical Environment

·         Information will come from the windshield survey.  You should state this in your own words.

·         Provide dates of your survey.

  

The findings regarding the physical environment of the city of Madisonville will be provided once the windshield survey is completed. The survey will be conducted between March 14 and 17, 2022. Community Assessment
Economic

·         Financial status of people

o   Individuals

o   Households

·         Occupational categories in the community

·         Businesses/Industries

 Generally, about 22.4% of the total population lives below the poverty line. The city’s unemployment rate currently stands at 5.3%; however, the job Madisonville market has decreased by -1.1% during the past year. The feature job growth is predicted to be 28.4%. The average income of a city resident is $22,394 annually, while the median household income is $44,720 yearly (Census Reporter, n.d ). The percentage of persons in poverty is 22.4%. Females aged 25 to 34 are the largest demographic living in poverty, followed by those aged 35 to 44 and 6 to 11. Males in the city have an average income of 1.35 times higher than the average female income. The income inequality, measured using the Gini index, is 0.456. there are approximately 7880 people employed in the economy of Madisonville, KY, with the largest industries being Health Care and Social Assistance ( approximately 1500 people), Manufacturing (about 1000 people and Retail trade (900 people). The highest paying industries include Information ($74,890), mining, quarrying, Oil and Gas Extraction ($62,990), agriculture, fishing and mining, forestry, and mining ($62,470) (US Census Bureau, n.d.).
Transportation and Safety Types of transportation available

o   personal

o   public

·         Police protection

·         Crime statistics

·         Fire protection

·         Sanitation services

 Generally, 7,668 workers, 16 years and above, travel to work. More than 85% of the population uses personal cars (car, truck or van) while about 12% use public transport. The city has different kinds of security systems, including ADS security that serves the security needs of the residents. The average crime rate is estimated to be 13.20 per 1000 residents. There are 1.84 violent crimes per 1000 residents annually, while property crime is 11.36 per 1000 residents annually (City-Data, n.d.). There are various sanitation services available for residents of the city. These services include garbage collecting, industrial/hazardous waste management, disposal, and wastewater treatment.
Key Informant Interview

Key points from the interview with a key informant.

·

 Madisonville, KY, provides primary care and wellness services that form the backbone of employees’ and families’ best health outcomes. There is proper management of chronic disease and the cost for their treatment. Employees and their families have accessed virtual health, BlueMine, which provides online telemedicine and other related services. It has an acute and skilled care facility that emphasizes community outreach and training medical students in rural areas. Given its population, the city is directly accessible by air, rail, and highway.

 

 

References

Census Reporter. (n.d ). Census profile: Madisonville, KY. https://censusreporter.org/profiles/16000US2149368-madisonville-ky/

City-Data.(n.d.).Madisonville, Kentucky (KY 42431) profile: population, maps, real estate, averages, homes, statistics, relocation, travel, jobs, hospitals, schools, crime, moving, houses, news, sex offenders. https://www.city-data.com/city/Madisonville-Kentucky.html

Gamblin, K. (2018). Business, Life, and Bourbon: RP Drake of Madisonville, Kentucky (Doctoral dissertation, The Florida State University).

US Census Bureau.(n.d.).U.S. Census Bureau QuickFacts: Madisonville city, Kentucky. Census Bureau QuickFacts.https://www.census.gov/quickfacts/fact/table/madisonvillecitykentucky/SBO030212#SBO030212

World Population Review.(n.d.).Madisonville, Kentucky population 2022 (demographics, maps, graphs).https://worldpopulationreview.com/us-cities/madisonville-ky-population

 

 

 

 

 

 

 

 

 

 

 

 

Nursing homework help

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Nursing homework help

Assignment

 

(Note from me: you have already help with the main part of the assignment. The part that I want you to work on now is to help me responds to two post from to different colleagues. I have attached their post so read it and give a respond to their post. Just a page or less will be fine as long as it meets the discussion) Nursing homework help

 

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COVID19 is our first Pandemic of the century.  This lethal global pandemic has led to health, societal, individual, familial, and economic changes.  Using the surveillance tools available on this ever-changing pandemic, track how this pandemic has changed within a state or country since the start of the pandemic.  Compare it to another state or country.  Grade  (A-F) the response and explain your answer with evidence. Post your answer to the discussion board Nursing homework help

 

  • Respond to at least (2) of your colleague’s postings over the course of the week to continue the dialogue.

 

 

 

 

 

 

 

 

 

DISCUSSION POSTER 1

 

I decided to compare COVID-19 data between the United States and Kazakhstan. According to Johns Hopkins University & Medicine (2022), Kazakhstan has 1,393,904 confirmed cases; 19,012 deaths; and 9,168,000 of its people fully vaccinated, which is approximately 49.52% of the population. Over the past month, there have been 2,091 new cases reported and 45 new deaths as a result of the virus (Johns Hopkins University & Medicine, 2022). In the United States, there are 80,155,397 confirmed cases; 982,565 deaths, and 66.38% of the population fully vaccinated (Johns Hopkins University & Medicine, 2022). Over the past month, there have been 902,685 new cases and 25,980 new deaths recorded (Johns Hopkins University & Medicine, 2022).  Nursing homework help

I think it is difficult to compare these two countries due to population differences. With a population of approximately 329.5 million in the U.S. and 18.75 million in Kazakhstan (Data Commons, 2020), I think there are many factors that could have affected COVID-19 responses by both of these countries. If I had to “grade” Kazakhstan’s response to the pandemic, I would give them a B. I think it is actually impressive that 49.52% of the population is vaccinated. Although Kazakhstan is a large country, majority of it is rural and the population is largely dispersed throughout its region. Geographically, there are a lot of transit opportunities between shared borders, which include both Russia and China, which is why I also think it is impressive that the number of new cases over the last month is not as high as I would otherwise expect it to be. I do think more of the population could be vaccinated, but I do not think access to vaccines are as readily available as they are in the United States.

I would grade the U.S.’s response to the pandemic as a C+. I think the response was heavily delayed initially, lots of information had to be pieced together and it was unclear whether or not the information was withheld or simply unknown given the circumstances; however, I do think more of the population can and should be vaccinated. I think for the majority, there are many opportunities for individuals to get vaccinated and even boosted, however, we are still seeing a good portion of the population protesting against vaccines and ignoring vital statistical data. I think I may be biased because I lived here and wish we could have led by example in this situation, but we are constantly battling other challenges as a society on top of this pandemic, which I why I think it is difficult to judge the overall response. There are just so many factors at play.

References

Data Commons. (2020). United States of America. Data Commons Place Explorer. https://datacommons.org/place/country/USA?utm_medium=explore&mprop=count&popt=Person&hl=en

Data Commons. (2020). Kazakhstan. Data Commons Place Explorer. https://datacommons.org/place/country/KAZ?utm_medium=explore&mprop=count&popt=Person&hl=en

John’s Hopkins University & Medicine. (2022). Kazakhstan. Coronavirus Resource Center. https://coronavirus.jhu.edu/region/kazakhstan

John’s Hopkins University & Medicine. (2022). United States. Coronavirus Resource Center. https://coronavirus.jhu.edu/region/united-sta

 

 

 

 

DISCUSSION POSTER 2

 

COVID-19 is a pandemic that will linger across countries for many years. It has had a generational impact on child development, mental health, healthcare, and community settings alike. It will take years to recover across the globe, and we can only hope moving forward, that in the future we are better equipped to handle such a treacherous pandemic. Comparing Italy to the United States, they are actually quite similar. The Italian prime minister was ridiculed for not taking the pandemic seriously. For instance, a state of emergency was declared January of 2020, yet allowed the normalcy of life to continue. That was a misconception that unfortunately cost countless lives. As February came about, it became clear that COVID-19 was not contained and red zone regulations were implemented within eleven cities. A failed tactic that shortly lead to a country wide lockdown. By March, it was chaos, yet they had finally secured mask mandates, travel restrictions, and physical distancing in times of essential travel. Information was scant and people yearned for knowledge on the spread, cases, hospitalization, and mortality rate within their cities.

 

Fulfilling the need for more information, Italian researchers collaborated and created, an interactive web tool to help citizens stay in the know. Italy has a universal health system interwoven between state and government officials. Healthcare workers were deemed the most likely to spread COVID-19 due to a lack of PPE. A crisis call sent out requesting help to address unsafe working conditions for doctors, nurses, and medics was met with complete silence. No grants. No funding. No help. To date, Italy continues to struggle with COVID. Statista is another tool that shows up to date positive cases within the Italian population. As of today there remains 1.2 million positive cases, with 487 individuals in the ICU and 9.5 thousand hospitalized. I give Italy a D for not taking it more seriously, not implementing lockdown precautions sooner for the safety of their communities, and failing to act in appropriate crisis management to equip healthcare workers with adequate PPE. They have yet to utilize survelliance tools to identify the ongoig spread and strategies to reduce it. By not addressing the lack of PPE they have only allowed COVID to remain fluent.

 

The U.S mimicked Italy at a much slower rate. From January until March of 2020 it was pure chaos. Not much information was known and dread gripped communities. It was not until March that all states began declaring a state of emergency allowing governors to execute policies such as: the closure of non-essential businesses, the introduction of mask mandates for all individuals, and school closures. (Bergquist et al,. 2020). Something that was done differently, was reduce the incarcerated population, execute no visitors policies in health care related facilities, and mandatory symptom monitoring. Similar to Italy, the United States had a travel policy for essential workers to flatten the curve and slow the spread. Financially, the U.S had a crisis management plan that allowed for distribution of money and allocated resources to the socioeconomic struggling families. A few examples being, the Coronavirus Preparedness and Response Supplemental Appropriations Act, Coronavirus Aid, Relief and Economic Security (CARES) Act,and Paycheck Protection Program to protect small businesses. At one point, it aided in making mortgage or rent payments. We also had accessibility to technology to, fast track testing strategies and generate a vaccine. Early on in the pandemic tracking apps helped mitigate exposure and positive cases.

 

Healthcare shifted slightly as telemedicine became more available to treat simple ailments and those with COVID were referred to the hospital for additional evaluation and treatment. The American healthcare system maintained PPE to the best of its ability, unlike Italy. We also had overwhelmed hospitals, ICU beds, and increased fatalities. I feel The United States got lucky in managing COVID-19. With a non-universal healthcare system, grants, and statewide influence from governors, COVID-19 was a trial by error scenario that after two years appeared to have been done well. I would give us a C. The reason being, the guidelines frequently shifted and with news outlets increasing confusion there needed to be better surveillance tools. Italy did not have enough and we had too many unofficial data tools reporting false or inaccurate epidemiological information. Also, in the future it truly needs to not be political. I feel it could have been managed much more efficiently had it been uninvolved in politics. Something I feel elongated the ability to find resolution.

 

Bergquist, S., Otten, T., &Sarich, N. (2020). COVID-19 pandemic in the United States. Health policy and technology, 9(4), 623–638. https://doi.org/10.1016/j.hlpt.2020.08.007

Covid‐19 in Italy: Modelling, communications, and collaborations. (2022). Significance, 19(2), 19–21. https://doi.org/10.1111/1740-9713.01629

Ortenzi, F., Albanese, E., &Fadda, M. (2020). A Transdisciplinary Analysis of COVID-19 in Italy: The Most Affected Country in Europe. International journal of environmental research and public health, 17(24), 9488. https://doi.org/10.3390/ijerph17249488

 

 

Research Review Essay

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Research Review Essay

N320 Research Review Part 1

This is the first assignment to introduce your PICO(T) , scope and nature of the problem, background information of the problem, details regarding your research review, and the EBP approach you have taken for your research. This is a “building assignment” as part 1 and part 2 will build to complete the Final Assignment in which you will have a comprehensive Research Review.You do not need to worry about self-plagiarism when continuing to part 2 and so on. You will have a minimum of seven articles or more for the final Research Review.

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Assignment Part 1-75 possible points. – should include significant detail and synthesis of your research as it relates to your PICO.  See Assignment Part 1 Rubric and Example papers. Research Review Essay

Instructions:Follow APA 7th ed. format and follow Assignment Part 1 Rubric (refer to example paper part 1)

  1. Use APA 7th ed. Manual or recommend APA templatesites listed in content section to set up paper (Chapter 2, APA manual 7th ed.)
  2. Write in 12 font Times New Roman
  3. DO NOT write in first person. No I statements. This is a research reviewnot a study so refer to it as such in your work.
  4. Write about your topic in paragraph format
  5. Include a Tittle page (see APA 7th ed power point) (Do not use Assignment 1… as your title) The title should not be your entire PICO but should allow the reader to understand what your Research is about * see example papers in the course

You do not need to use a running head for your paper but include page # appropriately placed per APA (refer to Chapter 2 and Section 2.3 2.4.  Figure 2.2).

Example title: Comparison of pressure reduction boots versus repositioning to reduce pressure ulcers in the elderly

  1. Follow instructions for headings. Use the rubric headings for the headings in each section of your assignmentexcept “Introduction” the heading for the introduction.  In 7th ed. APA this is the restatement of your paper title( see APA 7th ed. Section 2.7)
  2. 8. Include data search table as a table labeled and referenced appropriately in your paper. (APA 7th Chapter 7, see example table 7.1)
  3. Include research model worksheet in paragraph format to describe your EBP model in your paper and include your simple diagram as a figure referenced appropriately in APA 7th ed. format in your paper.
  4. Include completed and corrected literature review tables as an Appendix labeled Appendix A and follow APA 7th ed. Instructions for correct placement of an appendix in your work ( after Reference section)
  5. References on a separate page following APA 7th ed format, Chapter 9-10.

 

 

 

 

Comparison of Silicone Foam Dressings Versus Pressure Reduction Techniques

Pressure injuries can have significant negative consequences for patients including infection, reduced quality of life, disability and even death (Campbell, et al., 2020). Pressure injuries are also very costly for patients and healthcare systems, estimated to average between $37,000-$70,000 per patient (Walker, et al. 2015). In patients who were both immobile and incontinent, Gray &Guiliano found the “prevalence of facility-acquired pressure injury in the sacral area remained statistically significant” compared to patients who were continent (2018, p. 65). Placing a silicone foam dressing over the sacrum is a commonpreventative practice in patients with stage 1 pressure injuries, but does research support this intervention when incontinence is involved? It is important to utilize evidence-based research to determine if this is the best practice to prevent skin breakdown in this population, as they have increased vulnerability to pressure injuries. Research Review Essay

Background

The first step toward preventing pressure injuries is thorough assessment. The Agency for Healthcare Research and Quality (AHRQ) recommends inspecting skin for the following: temperature, color, moisture, turgor and integrity. They advise utilization of assessment tools such as the Braden Scale to standardize skin assessments and determine patient risk for skin breakdown (Berlowitz, et al., 2014). There are two main types of skin breakdown in the pelvic area, pressure injuries and incontinence-associated dermatitis. Pressure injury is defined by Campbell et al., as “localized damage to the skin and/or underlying tissue, usually over a bony prominence” (2020, p. 30). When a patient is determined to be at risk for developing pressure injury through a Braden score or other scale, pressure reduction techniques are utilized to prevent breakdown. Pressure reduction techniques vary by hospital but typically include turning and repositioning, placing pillows to cushion bony prominences, and utilizing pressure-reducing mattresses. In contrast, incontinence-associated dermatitis (IAD) is defined by Gray &Guiliano as “erythema and edema of the surface of the skin, sometimes accompanied by serous exudate, erosion or secondary cutaneous infection” specifically found in patients who are incontinent of bowel and/or bladder (2018, p. 63). Though these two conditions are separate, incontinence is found to worsen the risk of developing pressure injuries. In their multivariate analysis on immobility, incontinence and pressure injury, Gray &Guiliano found that the presence of IAD significantly increased the likelihood of developing a pressure injury (2018.) Some of the prevention strategies overlap between these conditions, such as preventing moisture and pressure reduction techniques.

Research Problem Statement

            With this known link between IAD and pressure injury, it is important for clinicians to determine the best interventions to prevent skin breakdown in populations where both are present. This paper is comparing the use of silicone foam dressings in this population, versus pressure reduction techniques alone.

Research Purpose

The purpose of this paper is to determine whether silicone foam dressings prevent skin breakdown more effectively than pressure reduction techniques alone, in hospitalized patients who have stage 1 pressure injuries and incontinence. Research Review Essay

Research Question

            In individuals with both incontinence and stage 1 pressure injuries, how does a silicone foam dressing compared to pressure reduction techniques affect skin integrity within a hospital stay?

Research Utilization Model

The Johns Hopkins Nursing Evidenced-Based Practice Model (JHNEBP) is an appropriate research model to use for this research focus as it was developed to make incorporating evidence more manageable for nurses during clinical practice. This makes it well suited to research and implementation within a hospital system. Melnyk and Fineout-Overholt (2019) describe the three main steps: Practice Question, Evidence, and Translation. First, the question is developed and refined, a leader is determined, and an interdisciplinary team is formed. Then, evidence is screened, rated, and summarized. This phase ends with specific recommendations determined by the strength of the research. Recommendations can be one of four options such as changing the practice immediately because the evidence is strong, considering a pilot or research study, or if there is little evidence, continuing research or ending the project. Finally, the results of the study are integrated into practice (Melnyk & Fineout-Overholt, 2019, pp. 413-414).

While utilizing this model, the interdisciplinary team should be composed of bedside nurses, managers, WOC nurses and hospitalists. The research obtained will guide the interdisciplinary team in answering the research question and determining the best way to disseminate this research into clinical practice in the hospital setting. Figure 1 visually depicts the JHNEBP model utilized in this research project.

 

 

 

 

 

 

Figure 1

The Johns Hopkins Nursing Evidence-Based Practice Model

 

Search Criteria and Results

The research for this study was completed utilizing CINAHL, PubMed, Medline, and Cochrane, including 313 articles from 2015 to present. Table one notes the keywords used in these searches.

Table 1

Data Research Table

Keyword CINAHL PubMed Medline PsychInfo Cochrane
Pressure injury AND prevention AND incontinence

Full Text

2015-2020

 15 35     0
Pressure injury AND prevention AND silicone foam dressing

Full Text

2015-2020

 16 16      
Pressure injury AND silicone foam dressing

Full Text

2015-2020

 19 17 28   2
Incontinence AND silicone foam dressing

Full Text

2015-2020

 5 1      
Pressure injury AND prevention AND case study

Full Text

2015-2020

   159      

 

11 research articles were included in this research project: two systematic reviews, two randomized-controlled trials, one non-randomized controlled trial, one case study, one case study analysis, one follow-up analysis, one non-experimental analysis, and two clinical guides. Figure 2 illustrates the strength of evidence of this research visually with the Strength-of-evidencerating pyramid which was found in Melnyk & Fineout-Overholt (2019, p. 116, Figure 4.2).

Figure 2

Strength-of evidence rating pyramid.

 

 

 

 

 

 

NR534A-NEED RESPONSES

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NR534A-NEED RESPONSES

 

NR534A-NEED RESPONSES

Anna Tam

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

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

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

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

References

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

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

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

 

 

 

CyronDalida 

 

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

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

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

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

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

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

References:

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

 

 

Maria Houston 

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

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

 

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

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

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

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

 

NR514: EPIDEMIOLOGY & POPULATION HEALTH

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NR514: EPIDEMIOLOGY & POPULATION HEALTH

 

NR514-NEED RESPONSES

Lauren Brown 

 

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

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

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

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

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

Resources

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

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

 

 

Maria Houston

 

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

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

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

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

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

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

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

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

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

CyronDalida 

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

References:

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

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

 

Louann Robinson  

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

Diabetes

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

Prevalence, Incidence and Trends

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

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

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

References

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

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

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

 

Introduction And Problem Statement

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Introduction And Problem Statement

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

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Assignment Prompt

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

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

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

 

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

 

Expectations

Initial Post:

APA format with intext citations

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

Plagiarism free.

Turnitin receipt.

Approved Clinical Questions For PICOT Development List

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Screening for mild cognitive impairment in a primary care setting

 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Asthma Treatment in Pediatric Patients: Spacer versus Conventional Inhaler

 

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

 

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

 

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

 

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

 

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

 

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mental Health & Crisis Management

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Mental Health & Crisis Management

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

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

3. Fertility Awareness Methods are best utilized by:

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

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

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

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

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

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

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

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

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

 

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

 

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

 

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

 

Alcohol poisoning

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

 

Alcohol Withdrawal

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

 

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

 

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

 

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

 

Alcohol withdrawal delirium

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

 

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

 

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

 

Detoxification or Alcohol Withdrawal Treatment

 

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

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

 

Topiramate

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

 

Heart Failure Case Study Essay

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Heart Failure Case Study Essay

1509 Unit 8: Cardiac Perfusion

Heart Failure Case Study

10 points

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

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

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

 

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

 

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

 

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

 

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

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