The Interprofessional Education Collaborative (IPEC)

The Interprofessional Education Collaborative (IPEC)

Interprofessional practice requires that health care practitioners recognize that patient outcomes are better when there is a collaborative team approach in addressing patient health issues. Also, there are barriers to interprofessional practice that must be addressed among health care practitioners. The Interprofessional Education Collaborative (IPEC) is an initiative including multiple professions designed to advance interprofessional education so that students entering health care professions are able to view collaboration as the norm and seek collaborative relationships with other providers (IPEC, 2011). The Interprofessional Education Collaborative (IPEC)

This week your Discussion will focus on interprofessional practice. This Discussion is an opportunity for you to examine your perspective and experiences with interprofessional collaborative practice and to apply your knowledge to managing patient care.

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To prepare:
  • Identify a professional nursing organization and review their position on interprofessional practice
  • Review the following case study: The Interprofessional Education Collaborative (IPEC)

Case Study:

Ms. Tuckerno has been diagnosed with multiple sclerosis (MS). The patient receives care at an internal medicine clinic. Her internist is not in the office today and she is being treated by the nurse practitioner. The patient is on two medications for her MS, three different blood pressure medications, one medication for thyroid disease, one diabetic pill daily, insulin injections twice a day, she uses medical cannabis, and uses eye drops for glaucoma. Upon assessing the patient, the nurse practitioner (NP) decides her treatment plan should be adjusted. The NP discontinues some of the patient’s meds and discontinues medical cannabis. She orders the patient to follow up in two weeks.

The patient returns and is seen by her internist. The internist speaks with the patient and reviews her medical chart. The internist states to the patient, “I am dissatisfied with the care you received from the nurse practitioner.” The internist places the patient back on originally prescribed medications and medical cannabis.

Post an explanation of your understanding of interprofessional practice. Also, explain the position on interprofessional practice for a professional nursing organization that you are a member of or of which you plan to become a member. Then, explain what you think is the best collaborative approach to manage Ms. Tuckerno’s care.

Read a selection of your colleagues’ responses. The Interprofessional Education Collaborative (IPEC)

 

Brian foster chest pain shadow health assessment Subjective Data

Brian foster chest pain shadow health assessment Subjective Data

Subjective Data Collection: 30 of 30 (100.0%)

Hover To Reveal…

Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.

  • Found:

     Indicates an item that you found.

  • Available:

     Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient. Brian foster chest pain shadow health assessment Subjective Data

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

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Chief Complaint


  • Finding:

    Established chief complaint


  • Finding:

    Reports sporadic chest pain

    (Found)

    Pro Tip: Chest pain can be a sign of many health problems, some serious and some less serious. It is important to follow up with discovery of chest pain by asking about its characteristics and severity.

    Example Question:

    Do you have chest pain?

History of Present Illness


  • Finding:

    Asked about onset of pain


  • Finding:

    Reports chest pain started appearing in the past month

    (Found)

    Pro Tip: Establishing the onset of a patient’s pain is essential in diagnosing its severity as well as the comfort of the patient.

    Example Question:

    When did your chest pain start?

  • Finding:

    Asked about location of pain


  • Finding:

    Reports pain is in center of the chest

    (Found)

    Pro Tip: Identifying the location of a patient’s pain is essential in determining which body systems are affected, the underlying cause of the pain, and how best to treat it.

    Example Question:

    Where is the pain?

  • Finding:

    Reports pain does not radiate

    (Found)

    Pro Tip: Pain radiation is an important symptom that can be helpful in understanding the cause of pain and narrowing the diagnosis.

    Example Question:

    Does the pain radiate?

  • Finding:

    Denies arm pain

    (Found)

    Pro Tip: When combined with chest pain, arm pain can be a telling sign that the complaint may be cardiac in nature.

    Example Question:

    Are you experiencing arm pain?

  • Finding:

    Denies shoulder pain

    (Found)

    Pro Tip: When combined with chest pain, shoulder pain can be a telling sign that the complaint may be cardiac in nature.

    Example Question:

    Are you experiencing shoulder pain?

  • Finding:

    Denies back pain

    (Found)

    Pro Tip: When combined with chest pain, back pain can be a telling sign that the complaint may be cardiac in nature.

    Example Question:

    Are you experiencing back pain?

  • Finding:

    Denies neck pain

    (Found)

    Pro Tip: When combined with chest pain, neck pain can be a telling sign that the complaint may be cardiac in nature.

    Example Question:

    Are you experiencing neck pain?

  • Finding:

    Asked about duration of pain episodes


  • Finding:

    Reports each episode lasted “several” minutes

    (Found)

    Pro Tip: Knowing the duration of a patient’s pain gives you a more complete picture of its severity and potential impact on the patient’s health.

    Example Question:

    How long does your chest pain last?

  • Finding:

    Asked about frequency of pain


  • Finding:

    Reports 3 episodes in past month

    (Found)

    Pro Tip: Establishing a timeline for a patient’s symptoms can help you to better diagnose his condition and most effectively treat him.

    Example Question:

    How many times in the last month have you had chest pain?

  • Finding:

    Reports that episodes did not seem related

    (Available)

    Pro Tip: Asking your patient if the episodes seem associated can point to possible factors that aggravate the episodes or trigger symptoms, and can help narrow your diagnosis.

    Example Question:

    Did the episodes seem associated?

  • Finding:

    Asked about severity of pain


  • Finding:

    Reports current pain is 0 out of 10

    (Found)

    Pro Tip: For many patients, it is difficult to clearly describe pain. Asking Brian to rate his pain on a scale from 0 to 10 develops a consistent measure of pain severity.

    Example Question:

    How would you rate your pain on a scale of zero to ten?

  • Finding:

    Reports pain severity at its worst is 5 out of 10

    (Found)

    Pro Tip: For many patients, it is difficult to clearly describe pain. Asking Brian to rate his pain at its worst gives a clearer picture of the pain’s severity.

    Example Question:

    How would you rate your pain on a scale of zero to ten?

  • Finding:

    Asked about character of pain


  • Finding:

    Describes pain as tight and uncomfortable

    (Found)

    Pro Tip: Asking Brian to describe his pain helps identify the cause and the severity of his discomfort. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.

    Example Question:

    Can you describe your pain?

  • Finding:

    Denies crushing pain

    (Found)

    Pro Tip: Asking Brian to describe his pain helps identify the cause and the severity of his discomfort. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.

    Example Question:

    Is the pain crushing?

  • Finding:

    Denies gnawing pain

    (Found)

    Pro Tip: Asking Brian to describe his pain helps identify the cause and the severity of his discomfort. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.

    Example Question:

    Is the pain gnawing?

  • Finding:

    Denies burning pain

    (Found)

    Pro Tip: Asking Brian to describe his pain helps identify the cause and the severity of his discomfort. Patients may not know how to answer, so you may need to suggest words like sharp, dull, crushing, gnawing, or burning.

    Example Question:

    Is the pain burning?

  • Finding:

    Asked about aggravating factors


  • Finding:

    Reports pain is aggravated by activity

    (Found)

    Pro Tip: Aggravating factors reveal further information about the nature of the pain and the body systems affected.

    Example Question:

    What makes the pain worse?

  • Finding:

    Pain occurred with yard work and taking stairs

    (Found)

    Pro Tip: Determining the activity that may have caused the patient’s complaint is crucial because it may reveal the root cause of the complaint.

    Example Question:

    What activity triggered the pain?

  • Finding:

    Pain does not worsen with eating

    (Available)

    Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

    Example Question:

    Is the pain worse when you eat?

  • Finding:

    Pain does not worsen after spicy foods

    (Available)

    Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

    Example Question:

    Is the pain worse after you eat spicy food?

  • Finding:

    Pain does not worsen after high-fat foods

    (Found)

    Pro Tip: It is important to ask about the patient’s diet and its impact on his complaint because cardiac complaints and gastrointestinal pain can be very similar and are frequently conflated. Ruling out one or the other can assist your diagnosis.

    Example Question:

    Is the pain worse after you eat high-fat foods?

  • Finding:

    Asked about relieving factors


  • Finding:

    Reports pain relief with brief period of rest

    (Found)

    Pro Tip: It’s important to assess the nature of pain by asking about relief. Relieving factors can help narrow the body system and assist in a more accurate diagnosis.

    Example Question:

    What relieves your pain?

  • Finding:

    Reports no medication to treat chest pain

    (Found)

    Pro Tip: It’s important to assess the nature of pain by asking about relief. Discovering any pain medication Brian takes can help you assess the nature and severity of his pain and avoid any unwanted medication interactions.

    Example Question:

    Did you take anything for the chest pain?

Medical History


  • Finding:

    Confirmed use of medications


  • Finding:

    Confirms medications

    (Found)

    Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.

    Example Question:

    What medications do you take?

  • Finding:

    Reports taking hypertension medication

    (Found)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.

    Example Question:

    Do you take medication for hypertension?

  • Finding:

    Reports taking hyperlipidemia medication

    (Found)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.

    Example Question:

    Do you take medication for hyperlipidemia?

  • Finding:

    Reports occasional ibuprofen use

    (Available)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.

    Example Question:

    Do you take over the counter medications?

  • Finding:

    Reports taking fish oil

    (Found)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication or supplements will help you to treat your patient.

    Example Question:

    Do you take any supplements?

  • Finding:

    Denies aspirin regimen

    (Available)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.

    Example Question:

    Do you take aspirin?

  • Finding:

    Followed up on hypertension treatment


  • Finding:

    Medication is Lopressor

    (Found)

    Pro Tip: Discovering which specific medications a patient takes helps you assess his health conditions, effectiveness of treatment, and guards against unwanted medication interactions.

    Example Question:

    What medication do you take for hypertension?

  • Finding:

    Lopressor dose is 100mg

    (Found)

    Pro Tip: The current dose of any patient’s prescription medications is important to learn about because it provides useful information about the patient’s treatment plan as well as potential medication interactions.

    Example Question:

    What dose of medication do you take for hypertension?

  • Finding:

    Takes Lopressor once daily

    (Found)

    Pro Tip: The frequency with which a patient takes his medications is an essential element of the complete picture of his medication treatment plan.

    Example Question:

    How frequently do you take medication for hypertension?

  • Finding:

    Followed up on hyperlipidemia treatment


  • Finding:

    Medication is Lipitor

    (Found)

    Pro Tip: Discovering which specific medications a patient takes helps you assess his health conditions, effectiveness of treatment, and guards against unwanted medication interactions.

    Example Question:

    What medication do you take for hyperlipidemia?

  • Finding:

    Lipitor dose is 20mg

    (Found)

    Pro Tip: The current dose of any patient’s prescription medications is important to learn about because it provides useful information about the patient’s treatment plan as well as potential medication interactions.

    Example Question:

    What dose of medication do you take for hyperlipidemia?

  • Finding:

    Takes Lipitor once daily

    (Found)

    Pro Tip: The frequency with which a patient takes his medications is an essential element of the complete picture of his medication treatment plan.

    Example Question:

    How frequently do you take medication for hyperlipidemia?

  • Finding:

    Takes Lipitor at bedtime

    (Available)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication information, like at what time of day Brian takes Lipitor, will help you to treat your patient.

    Example Question:

    What time of day do you take your lipitor?

  • Finding:

    Has taken Lipitor for 1 year

    (Found)

    Pro Tip: The medication that a patient takes will indicate any relevant health conditions, their treatment plan, and how well they comply with it. Asking about relevant medication will help you to treat your patient.

    Example Question:

    How long have you taken lipitor?

  • Finding:

    Confirmed allergies


  • Finding:

    Confirms allergies (no new allergies reported)

    (Found)

    Pro Tip: Asking Tina if she has any new allergies will allow you to understand how, beyond the chief complaint, Tina’s health has been.

    Example Question:

    Do you have new allergies?

  • Finding:

    Asked about possible contributing factors in health history


  • Finding:

    Reports no known diagnosis of angina

    (Found)

    Pro Tip: A history of angina can weaken the heart and lead to further cardiovascular complications. Asking Brian about angina helps you understand his overall cardiovascular health.

    Example Question:

    Do you have a history of angina?

  • Finding:

    Reports hypertension

    (Found)

    Pro Tip: Hypertension is the most important risk factor for stroke. Soliciting a health history from Brian will allow you to assess his risk of cardiovascular disease.

    Example Question:

    Do you have hypertension?

  • Finding:

    Reports high cholesterol

    (Found)

    Pro Tip: High cholesterol can lead to cardiovascular disease. Asking Brian whether he’s had a history of high cholesterol reveals important details about his cardiovascular health.

    Example Question:

    Do you have high cholesterol?

  • Finding:

    Reports no known coronary artery disease

    (Available)

    Pro Tip: Coronary artery disease is a major risk factor for further cardiac illness. Discovering coronary artery disease in a patient complaining of chest pain can be essential to an accurate diagnosis.

    Example Question:

    Do you have coronary artery disease?

  • Finding:

    Denies diabetes

    (Found)

    Pro Tip: A diagnosis of diabetes can have a major impact on many body systems, and factoring it into a cardiovascular complaint can affect your diagnosis and treatment plan.

    Example Question:

    Do you have diabetes?

  • Finding:

    Denies previous treatment for chest pain

    (Found)

    Pro Tip: Discovering any previous treatments for chest pain can be a valuable source of information for continued treatment. The success or failure of previous treatments can inform your treatment plan.

    Example Question:

    Have you had previous treatment for chest pain?

  • Finding:

    Asked about blood pressure monitoring


  • Finding:

    Does not frequently monitor BP at home

    (Found)

    Pro Tip: Monitoring blood pressure helps to keep track of a patient’s cardiovascular health. Asking Brian how often he measures his blood pressure will indicate his health literacy and a current treatment plan.

    Example Question:

    How often do you measure your blood pressure?

  • Finding:

    Reports infrequent BP checks at the doctor or drugstore

    (Found)

    Pro Tip: Monitoring blood pressure helps to keep track of a patient’s cardiovascular health. Asking Brian when he measures his blood pressure will indicate his health literacy and a current treatment plan.

    Example Question:

    When do you measure your blood pressure?

  • Finding:

    Reports not remembering typical BP reading

    (Found)

    Pro Tip: Monitoring blood pressure helps to keep track of a patient’s cardiovascular health. Asking Brian what his typical blood pressure reading is will indicate his health literacy and a current treatment plan.

    Example Question:

    What is your typical blood pressure reading?

  • Finding:

    Asked about past cardiac tests


  • Finding:

    Reports recent EKG test

    (Found)

    Pro Tip: An EKG test checks for electrical problems with the heart. Asking Brian whether he’s had an EKG will reveal his recent medical history, cardiac health, and medical literacy.

    Example Question:

    Have you recently had an EKG?

  • Finding:

    Reports annual stress test

    (Available)

    Pro Tip: A stress test can illustrate the amount of stress a patient’s heart can handle before developing irregular rhythm. Asking Brian if he’s recently had a stress test will indicate a treatment plan, cardiac health, and health literacy. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Have you recently had a stress test?

  • Finding:

    Followed up on results of cardiac tests


  • Finding:

    Reports belief that EKG was normal

    (Found)

    Pro Tip: An EKG test checks for electrical problems with the heart. Asking Brian whether he’s had an EKG will reveal his recent medical history, cardiac health, and medical literacy. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    What were the results of your last EKG?

  • Finding:

    Reports belief that stress test was normal

    (Available)

    Pro Tip: A stress test can illustrate the amount of stress a patient’s heart can handle before developing irregular rhythm. Asking Brian if he’s recently had a stress test will indicate a treatment plan, cardiac health, and health literacy.

    Example Question:

    What were the results of your last stress test?

  • Finding:

    Asked about visits to healthcare providers


  • Finding:

    Has a primary care provider

    (Found)

    Pro Tip: Asking about Brian’s current primary care provider is important in determining his current health care access, health literacy, and treatment plans.

    Example Question:

    Do you have a primary care provider?

  • Finding:

    Reports last visit 3 months ago

    (Found)

    Pro Tip: A patient’s last visit to his doctor can not only help you elicit objective data about his health, but provides you a glimpse into his access to healthcare.

    Example Question:

    When was your last visit to a healthcare provider? Brian foster chest pain shadow health assessment Subjective Data

  • Finding:

    Usually sees doctor every 6 months

    (Available)

    Pro Tip: Asking how frequently Brian sees a healthcare provider is important in determining his current health care access, health status, and treatment plans.

    Example Question:

    How often do you see a healthcare provider?

Social History


  • Finding:

    Asked about stress


  • Finding:

    Reports generally low stress lifestyle

    (Found)

    Pro Tip: Stress can have a profound effect on the patient’s health and wellness. Asking about stress is an important part of any health assessment. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    What is your stress level?

  • Finding:

    Asked about exercise


  • Finding:

    Denies regular exercise routine

    (Found)

    Pro Tip: Activity levels have an important impact on cardiovascular health. Asking Brian about his exercise patterns can help you understand how his lifestyle might affect his health.

    Example Question:

    What kind of exercise do you get?

  • Finding:

    Last regular exercising was 2 years ago

    (Found)

    Pro Tip: Activity levels have an important impact on cardiovascular health. Asking Brian about his exercise patterns can help you understand how his lifestyle might affect his health. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    When did you last exercise regularly?

  • Finding:

    Asked about typical diet


  • Finding:

    Typical breakfast is granola bar and instant breakfast shake

    (Found)

    Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Brian about his typical breakfast will allow you to assess whether his eating habits put him at risk of cardiovascular disease or other health complications.

    Example Question:

    What is a typical breakfast for you?

  • Finding:

    Typical lunch is turkey sub

    (Found)

    Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Brian about his typical lunch will allow you to assess whether his eating habits put him at risk of cardiovascular disease or other health complications. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    What is a typical lunch for you?

  • Finding:

    Typical dinner is grilled meat and vegetables

    (Found)

    Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Asking Brian about his typical dinner will allow you to assess whether his eating habits put him at risk of cardiovascular disease or other health complications. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    What is a typical dinner for you?

  • Finding:

    Denies moderation of salt intake

    (Available)

    Pro Tip: A healthy and balanced diet is crucial for maintaining good health. Salt intake in particular can have a detrimental effect on blood pressure, which is why it is important to ask a patient like Brian, who suffers from hypertension, about his salt consumption.

    Example Question:

    Do you moderate your salt intake?

  • Finding:

    Asked about liquid intake


  • Finding:

    Reports regular water intake

    (Found)

    Pro Tip: Insufficient water intake can lead to dehydration and fatigue. Asking Brian how much water he drinks every day will indicate whether he is drinking sufficient fluids. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Do you drink water every day?

  • Finding:

    Drinks a liter of water a day

    (Available)

    Pro Tip: Insufficient water intake can lead to dehydration and fatigue. Asking Brian how much water he drinks every day will indicate whether he is drinking sufficient fluids.

    Example Question:

    How much water do you drink per day?

  • Finding:

    Drinks 2 cups of coffee daily

    (Available)

    Pro Tip: Coffee is a diuretic and thus causes the patient to lose fluids. Asking Brian how much coffee he drinks per day will help you to assess the level of his fluid intake.

    Example Question:

    How much coffee do you drink per day?

  • Finding:

    Denies soda drinking

    (Available)

    Pro Tip: Soda is high in sugar and Insufficient water intake can lead to dehydration and fatigue. Asking Brian how much soda he drinks every day will indicate whether his fluid intake is primarily water or soda. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    How much soda do you drink per day?

  • Finding:

    Asked about substance use


  • Finding:

    Denies current illicit drug use

    (Available)

    Pro Tip: Many drugs affect the central nervous system or can cause cardiovascular complications. Asking Brian if he uses illicit drugs will indicate whether drug use puts him at risk for health complications.

    Example Question:

    Do you use illicit drugs?

  • Finding:

    Denies tobacco use

    (Found)

    Pro Tip: Tobacco affects the heart by reducing the amount of oxygen the blood is able to carry. Asking Brian if he uses tobacco will allow you to assess whether the condition is caused, in part, by tobacco use.

    Example Question:

    Do you use tobacco?

  • Finding:

    Reports moderate alcohol consumption

    (Found)

    Pro Tip: Chronic alcohol use can result in cardiomyopathy. Asking Brian whether he drinks alcohol will allow you to assess whether he has any indicators of alcoholism. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Do you consume alcohol?

  • Finding:

    Followed up on alcohol consumption


  • Finding:

    Reports drinking 2-3 alcoholic drinks per week

    (Found)

    Pro Tip: Consumption of alcohol can impact a patient’s health and is considered a risk factor for many medical conditions. Asking Brian about his drinking habits will help you determine his risk for disease linked to alcohol consumption. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Do you drink alcohol?

  • Finding:

    Reports 2-3 drinks in one sitting / night

    (Available)

    Pro Tip: Asking the patient to quantify his drinking is helpful because it elicits objective data on a subject that patients may otherwise downplay.

    Example Question:

    How many alcoholic drinks do you have in one sitting?

  • Finding:

    Reports drinking only on weekends

    (Found)

    Pro Tip: Asking the patient to describe his drinking habits can identify indicators of alcoholism. It may also be helpful to ask about the context and reasons for the patient’s alcohol intake. Heavy drinkers will often underestimate their drinking habits. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    When do you drink alcohol?

Review of Systems


  • Finding:

    Asked about general symptoms


  • Finding:

    Denies fever

    (Found)

    Pro Tip: Fever can signify infection and other complications, so it is important to determine the presence of a fever and treat it if there is.

    Example Question:

    Do you have a fever?

  • Finding:

    Denies chills

    (Found)

    Pro Tip: Chills can be a sign of circulation issues, fever, and more. Discovering a patient’s chills will reveal more about the cause of his complaint.

    Example Question:

    Do you have chills?

  • Finding:

    Denies fatigue

    (Found)

    Pro Tip: Fatigue can be an indicator of serious cardiovascular problems, and it is important to ask the patient about it in order to narrow your diagnosis.

    Example Question:

    Do you feel tired?

  • Finding:

    Denies night sweats

    (Found)

    Pro Tip: Unusual sweating can be a symptom of a number of medical conditions, including cardiac infection. Asking Brian about night sweats can help rule out these conditions.

    Example Question:

    Do you have night sweats?

  • Finding:

    Denies weight loss

    (Available)

    Pro Tip: Unintentional weight loss can be a distressing symptom for many body systems. It is important to ask about weight loss to rule out conditions that may be associated with it.

    Example Question:

    Have you experienced recent weight loss? Brian foster chest pain shadow health assessment Subjective Data

  • Finding:

    Denies dizziness or lightheadedness

    (Found)

    Pro Tip: Patients exhibiting dizziness may be at risk for several conditions as well as a fall risk. It is important to ask about dizziness to keep your patient safe.

    Example Question:

    Do you have dizziness?

  • Finding:

    Denies palpitations

    (Found)

    Pro Tip: Discovering palpitations can be an important clue into the patient’s cardiovascular history and current condition.

    Example Question:

    Do you have palpitations?

  • Finding:

    Asked review of systems for cardiovascular


  • Finding:

    Denies history of angina

    (Found)

    Pro Tip: A history of angina can weaken the heart and lead to further cardiovascular complications. Asking Brian about angina helps you understand his overall cardiovascular health.

    Example Question:

    Do you have a history of angina?

  • Finding:

    Denies edema

    (Found)

    Pro Tip: Swelling can be a major indicator of cardiovascular and peripheral vascular health. Asking the patient about swelling is an important part of a thorough cardio exam.

    Example Question:

    Do you have any swelling?

  • Finding:

    Denies circulation problems

    (Available)

    Pro Tip: Circulation is an important indicator of peripheral vascular and cardiovascular health. Asking Brian about his circulation can help diagnose vascular conditions.

    Example Question:

    Do you have any problems with circulation?

  • Finding:

    Denies blood clots

    (Found)

    Pro Tip: Blood clots can be a sign of serious cardiovascular or related illnesses. Asking Brian about blood clots can provide valuable information about the state of his health. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Have you ever had a blood clot?

  • Finding:

    Denies history of rheumatic fever

    (Found)

    Pro Tip: Rheumatic fever early in life can cause fibrosis of the heart valves and can weaken the cardiovascular system. Finding out if Brian has a history of rheumatic fever is crucial to understanding his complete heart health.

    Example Question:

    Do you have a history of rheumatic fever?

  • Finding:

    Denies history of heart murmur

    (Found)

    Pro Tip: Heart murmurs can be harmless or a sign of ongoing heart disease. Learning if Brian has a heart murmur is an important component of understanding his complete cardiovascular health.

    Example Question:

    Do you have a history of heart murmur?

  • Finding:

    Denies easy bleeding

    (Available)

    Pro Tip: Bleeding can be a sign of serious cardiovascular or related illnesses. Asking Brian about bleeding can provide valuable information about the state of his cardiovascular health.

    Example Question:

    Have you noticed any unusual bleeding?

  • Finding:

    Denies easy bruising

    (Available)

    Pro Tip: Ease of bruising can be a sign of serious cardiovascular or related illnesses. Asking Brian about bruising can provide valuable information about the state of his cardiovascular health.

    Example Question:

    Have you noticed any unusual bruising?

  • Finding:

    Denies cyanosis

    (Available)

    Pro Tip: Cyanosis can be a symptom of troubling cardiovascular illness, though patients may not be aware of the connection to cardiovascular health. Asking Brian if he has noticed any cyanosis is important in ruling out certain cardiac risk factors.

    Example Question:

    Has your facial skin ever turned blue?

  • Finding:

    Asked about review of systems for respiratory


  • Finding:

    Denies cough

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the respiratory system. A cough in a patient complaining of chest pain is a symptom worth investigating.

    Example Question:

    Do you have a cough?

  • Finding:

    Denies difficulty breathing

    (Found)

    Pro Tip: Difficulty breathing is a dangerous symptom and can be related to many body systems, including the cardiovascular system. Breathing is an important part of a thorough cardio exam.

    Example Question:

    Have you had difficulty breathing?

  • Finding:

    Denies orthopnea

    (Available)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the respiratory system. Orthopnea in a patient complaining of chest pain is a symptom worth investigating.

    Example Question:

    Do you have difficulty breathing when lying down?

  • Finding:

    Asked about review of systems for HEENT


  • Finding:

    Denies change in sense of taste

    (Found)

    Pro Tip: Changes in taste can be the result of various factors from a decrease in taste buds to Alzheimer’s. Asking Brian if he’s experienced a change in taste can reveal important medical concerns. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Have you experienced a change in taste?

  • Finding:

    Denies sore throat

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the respiratory system. A sore throat in a patient complaining of chest pain is a symptom worth investigating.
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  • Example Question:

    Do you have a sore throat?

  • Finding:

    Denies dysphagia

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the respiratory system. Painful or difficult swallowing in a patient complaining of chest pain is a symptom worth investigating.

    Example Question:

    Do you have dysphagia?

  • Finding:

    Asked about review of systems for gastrointestinal


  • Finding:

    Denies nausea

    (Found)

    Pro Tip: Nausea can be an urgent symptom and sign of distress in more than one body symptom. Assessing and treating a patient’s nausea is important in a cardiovascular exam.

    Example Question:

    Do you have nausea?

  • Finding:

    Denies vomiting

    (Found)

    Pro Tip: Vomiting can be a major indicator of multiple health problems. Asking the patient about vomiting is an important part of a thorough cardio exam.

    Example Question:

    Have you vomited recently?

  • Finding:

    Denies diarrhea

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. Diarrhea in a patient complaining of chest pain is a symptom worth investigating.

    Example Question:

    Do you have diarrhea?

  • Finding:

    Denies constipation

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. Constipation in a patient complaining of chest pain is a symptom worth investigating.

    Example Question:

    Do you have constipation?

  • Finding:

    Denies flatus

    (Available)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. Excessive gas in a patient complaining of chest pain is a symptom worth investigating. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Do you have flatus?

  • Finding:

    Denies bloating

    (Available)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. A patient complaining of bloating in addition to chest pain is a symptom worth investigating.

    Example Question:

    Do you have bloating?

  • Finding:

    Denies heartburn or GERD

    (Found)

    Pro Tip: The cardiovascular system is inextricably balanced with many other body systems, including the gastrointestinal system. Heartburn and GERD are of particular importance to ask about, since their symptoms closely follow the symptoms of cardiac pain.

    Example Question:

    Do you have heartburn or GERD?

Family History


  • Finding:

    Asked about relevant family history


  • Finding:

    Reports family history of heart attack

    (Found)

    Pro Tip: Family health history is an important genetic indicator of a patient’s predisposition to certain medical conditions. Asking Brian if anyone in his family has suffered a heart attack helps you develop a more complete picture of his cardiovascular health. Brian foster chest pain shadow health assessment Subjective Data

    Example Question:

    Has anyone in your family had a heart attack?

  • Finding:

    Denies family history of stroke

    (Found)

    Pro Tip: Family health history is an important genetic indicator of a patient’s predisposition to certain medical conditions. Asking Brian if anyone in his family has suffered a stroke helps you develop a more complete picture of his cardiovascular health.

    Example Question:

    Do you have a family history of stroke?

  • Finding:

    Denies family history of pulmonary embolism Brian foster chest pain shadow health assessment Subjective Data

Cultural competence and diversity in Healthcare

Cultural competence and diversity in Healthcare

Cultural competence and diversity are often considered to have the same meaning in healthcare facilities. What is the difference between these two terms and their applicability in terms of healthcare professionals in various healthcare settings?

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Although cultural competence and diversity are often considered to have the same meaning in healthcare facilities they are different. Diversity is in fact a component of cultural competency. This includes ethnic and racial backgrounds, age, physical and cognitive abilities, family status, religion, sexual orientation, etc… cultural competency wouldn’t exist without diversity . It is important for healthcare professionals to be culturally competent for the sake of the patient’s comfort in receiving services. Lack of cultural competence can lead to noncompliance, missed appointments, and patients seeking care from non-professionals. In the cultural compliance training video an older Hispanic women spoke on how her physician said they’d schedule her a new appointment and she basically said that she wouldn’t show up because it would be the same thing that happened to her at her current appointment; a miscommunication and nothing being resolved. Health professionals who are diverse tend to have a better work ethic and connection with their patients because they’re most likely to be understand certain cultural distinctions, treatment seeking behaviors, etc… (cultural  competency for the health professional-Cultural competence and diversity in Healthcare) Cultural competence and diversity in Healthcare

Nursing Assignment Paper

Nursing Assignment Paper

In a 3 page APA formatted assignment, please address the following prompts.

INCLUDE 3 REFERENCES

1. Illustrate how nursing staff support patient-centered care of individuals and families whose values differ from their own (including a discussion of the barriers and potential solutions for overcoming the barriers).

2. Explain how COVID has impacted nursing practice and patient outcomes this past year.

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3. Detail how national safety guidelines are implemented on nursing units.

4. Describe three different methods for determining staffing.

5. Prepare a tentative operating budget for a 20-bed medical unit (including staff, equipment/supplies, interdepartmental charges, revenue, etc.).Nursing Assignment Paper

Objective Data – Brian foster chest pain shadow health assessment

Objective Data – Brian foster chest pain shadow health assessment

Objective Data Collection: 30 of 33 (90.91%)

  •  Correct
  •  Partially correct
  •  Incorrect
  •  Missed
 Inspected face
1 of 1 point
Appearance (1/1 point)
  •  No visible abnormal findings
  •  Rash or lesion
  •  Cyanosis
  •  Pallor
  •  Redness or flushing
  •  Evidence of trauma (scar, laceration, or bruising)
  • Objective Data – Brian foster chest pain shadow health assessment
 Inspected for jugular venous distension
1 of 1 point
Height Of Venous Pressure (1/1 point)
  •  4 cm or less above the sternal angle
  •  More than 4 cm above the sternal angle
Inspected chest
1 of 1 point
Symmetry (1/2 point)
  •  Symmetric
  •  Asymmetric
Appearance (1/2 point)
  •  No visible abnormal findings
  •  Rash or lesion
  •  AP diameter abnormal
  •  Intercostal retraction while breathing
  •  Excessive use of accessory muscles while breathing
  •  Pectus excavatum
  •  Skin growths (freckles or moles)
  •  Evidence of skin trauma (scar, laceration, or bruising)
  • Objective Data – Brian foster chest pain shadow health assessment
 Inspected abdomen
0.67 of 1 point
Symmetry (1/3 point)
  •  Symmetric
  •  Asymmetric
Contour (No point)
  •  Flat
  •  Rounded
  •  Protuberant
  •  Hollowed
Appearance (1/3 point)
  •  No visible abnormal findings
  •  Rash
  •  Striae
  •  Bulging around umbilicus
  •  Distension
  •  Visible masses (warts, cysts, or tumors)
  •  Freckles, birthmark, or discoloration
  •  Excessive hair growth
  •  Visible scars
  •  Laceration, lesion or wound
  •  Bruising
 Inspected hands and fingernails
1 of 1 point
Right: Appearance (1/4 point)
  •  No visible abnormal findings
  •  Redness
  •  Moles or skin tags
  •  Masses (warts, cysts, or tumors)
  •  Freckles, birthmark, or other discoloration
  •  Excessive dry or flaking skin
  •  Purpura
  •  Scarring
  •  Laceration, lesion, or wound
  •  Bruising
  •  Rash
Right: Nail Changes (1/4 point)
  •  No visible abnormal findings
  •  Pallor
  •  Cyanosis
  •  Splinter hemorrhages
  •  Clubbing
Left: Appearance (1/4 point)
  •  No visible abnormal findings
  •  Redness
  •  Moles or skin tags
  •  Masses (warts, cysts, or tumors)
  •  Freckles, birthmark, or other discoloration
  •  Excessive dry or flaking skin
  •  Purpura
  •  Scarring
  •  Laceration, lesion, or wound
  •  Bruising
  •  Rash
Left: Nail Changes (1/4 point)
  •  No visible abnormal findings
  •  Pallor
  •  Cyanosis
  •  Splinter hemorrhages
  •  Clubbing
 Inspected lower extremities and toenails
1 of 1 point
Right: Appearance (1/4 point)
  •  No visible abnormal findings
  •  Visible distortion or swelling
  •  Brownish pigmentation
  •  Skin thickening
  •  Ulceration
  •  Varicose veins
Right: Nail Changes (1/4 point)
  •  No visible abnormal findings
  •  Pallor
  •  Cyanosis
  •  Splinter hemorrhages
  •  Clubbing
Left: Appearance (1/4 point)
  •  No visible abnormal findings
  •  Visible distortion or swelling
  •  Brownish pigmentation
  •  Skin thickening
  •  Ulceration
  •  Varicose veins
Left: Nail Changes (1/4 point)
  •  No visible abnormal findings
  •  Pallor
  •  Cyanosis
  •  Splinter hemorrhages
  •  Clubbing
 Inspect lower extremities for edema
1 of 1 point
Right: Edema (1/4 point)
  •  No edema
  •  Pitting
  •  Non-pitting
Right: Severity Of Edema (1/4 point)
  •  No edema
  •  1+ Slight pitting
  •  2+ Deeper pit, disappears in 10 to 15 seconds
  •  3+ Noticeably deep pit that lasts more than a minute
  •  4+ Very deep pit that lasts 2 to 5 minutes
  • Objective Data – Brian foster chest pain shadow health assessment
Left: Edema (1/4 point)
  •  No edema
  •  Pitting
  •  Non-pitting
Left: Severity Of Edema (1/4 point)
  •  No edema
  •  1+ Slight pitting
  •  2+ Deeper pit, disappears in 10 to 15 seconds
  •  3+ Noticeably deep pit that lasts more than a minute
  •  4+ Very deep pit that lasts 2 to 5 minutes
 Tested capillary refill time
1 of 1 point
Fingers (1/2 point)
  •  Less than 3 seconds
  •  Greater than 3 seconds
Toes (1/2 point)
  •  Less than 3 seconds
  •  Greater than 3 seconds
 Auscultated carotid arteries
0.5 of 1 point
Right (No point)
  •  No bruit
  •  Bruit
Left (1/2 point)
  •  No bruit
  •  Bruit
 Auscultated heart sounds
0.5 of 1 point
Heart Sounds (No point)
  •  S1 and S2 audible
  •  S1, S2, and S3 audible
  •  S1, S2, and S4 audible
  •  S1, S2, S3, and S4 audible
Extra Heart Sounds (1/2 point)
  •  No extra sounds
  •  Gallops
  •  Murmur
  •  Friction rub
  •  Valve clicks
 Auscultated breath sounds
0.33 of 1 point
Breath Sounds (1/3 point)
  •  Present in all areas
  •  Diminished in some areas
  •  Absent in some areas
Adventitious Sounds (No point)
  •  No adventitious sounds
  •  Wheezing
  •  Fine crackles
  •  Stridor
  •  Rhonchi
  •  Course crackles
Location (No point)
  •  All areas clear
  •  Adventitious sounds in anterior right upper lobe
  •  Adventitious sounds in anterior right middle lobe
  •  Adventitious sounds in anterior right lower lobe
  •  Adventitious sounds in anterior left upper lobe
  •  Adventitious sounds in anterior left lower lobe
  •  Adventitious sounds in posterior right upper lobe
  •  Adventitious sounds in posterior right lower lobe
  •  Adventitious sounds in posterior left upper lobe
  •  Adventitious sounds in posterior left lower lobe
  • Objective Data – Brian foster chest pain shadow health assessment
 Auscultated abdominal aorta
1 of 1 point
Sounds (1/1 point)
  •  No bruit
  •  Bruit
 Auscultated abdominal and lower extremity arteries
1 of 1 point
Right: Renal (1/6 point)
  •  No bruit
  •  Bruit
Left: Renal (1/6 point)
  •  No bruit
  •  Bruit
Right: Iliac (1/6 point)
  •  No bruit
  •  Bruit
Left: Iliac (1/6 point)
  •  No bruit
  •  Bruit
Right: Femoral (1/6 point)
  •  No bruit
  •  Bruit
Left: Femoral (1/6 point)
  •  No bruit
  •  Bruit
 Auscultated bowel sounds
1 of 1 point
Bowel Sounds (1/2 point)
  •  Absent
  •  Hypoactive
  •  Normoactive
  •  Hyperactive
Location Of Non Normoactive Bowel Sounds (1/2 point)
  •  All quadrants normoactive
  •  Right upper quadrant
  •  Right lower quadrant
  •  Left upper quadrant
  •  Left lower quadrant
 Palpated carotid arteries
0.5 of 1 point
Right: Vibration (No point)
  •  No thrill
  •  Thrill
Right: Amplitude (No point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated PMI
1 of 1 point
Location (1/3 point)
  •  Present at midclavicular line and 5th intercostal space
  •  Displaced laterally
Diameter (1/3 point)
  •  Less than 3 cm
  •  Greater than 3 cm
Amplitude (1/3 point)
  •  Brisk and tapping
  •  Increased amplitude (hyperkinetic)
 Palpated brachial arteries
1 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated radial arteries
1 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated femoral arteries
1 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated popliteal arteries
0.5 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (No point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (No point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated tibial arteries
1 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated dorsalis pedis arteries
1 of 1 point
Right: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Right: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
Left: Vibration (1/4 point)
  •  No thrill
  •  Thrill
Left: Amplitude (1/4 point)
  •  0 Absent
  •  1+ Diminished or barely palpable
  •  2+ Expected
  •  3+ Increased
  •  4+ Bounding pulse
 Palpated abdomen – light
1 of 1 point
Tenderness (1/3 point)
  •  None reported
  •  Tenderness reported
Location Of Tenderness (1/3 point)
  •  No quadrants tender
  •  Right upper quadrant
  •  Right lower quadrant
  •  Left upper quadrant
  •  Left lower quadrant
Observations (1/3 point)
  •  No additional observations
  •  Masses
  •  Guarding
  •  Distension
  •  Muscle resistance
  •  Rigidity
 Palpated abdomen – deep
1 of 1 point
Presence Of Unexpected Mass (1/2 point)
  •  No palpable mass
  •  Palpable mass
Location Of Mass (1/2 point)
  •  No palpable mass
  •  Right upper quadrant
  •  Right lower quadrant
  •  Left upper quadrant
  •  Left lower quadrant
  •  Around umbilicus
 Palpated liver
1 of 1 point
Detection (1/1 point)
  •  Not palpable
  •  Palpable
 Palpated spleen
1 of 1 point
Detection (1/1 point)
  •  Not palpable
  •  Palpable
 Palpated kidneys
1 of 1 point
Right (1/2 point)
  •  Not palpable
  •  Palpable
Left (1/2 point)
  •  Not palpable
  •  Palpable
 Tested skin turgor
1 of 1 point
Observations (1/1 point)
  •  No tenting
  •  Tenting
 Auscultated organs
1 of 1 point
Liver (1/2 point)
  •  No friction rub
  •  Audible friction rub
Spleen (1/2 point)
  •  No friction rub
  •  Audible friction rub
 Percussed abdomen
1 of 1 point
Observations (1/1 point)
  •  All areas generally tympanic
  •  Some areas dull, some tympanic
  •  Some areas resonant
  • Objective Data – Brian foster chest pain shadow health assessment
 Percussed spleen
1 of 1 point
Spleen (1/1 point)
  •  Tympany
  •  Dullness
 Percussed liver
1 of 1 point
Liver Span (1/1 point)
  •  Smaller than 6 cm
  •  Between 6 and 12 cm
  •  Greater than 12 cm
 Performed EKG
1 of 1 point
Sinus Rhythm (1/2 point)
  •  Regular
  •  Irregular
St Changes (1/2 point)
  •  No ST elevation
  •  ST elevation present
  • Objective Data – Brian foster chest pain shadow health assessment

Generating Evidence for Evidence-Based Practice

Generating Evidence for Evidence-Based Practice

Steps for Successful Grant Writing

The successful steps of grant writing include the Five Ps, starting with passion, progressing through planning, persuasion, then persistence and patience. Those key steps are the foundation for developing a proposal for a grant that can be successful. Generating Evidence for Evidence-Based Practice

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Develop Evidence through Quantitative and Qualitative Inquiry

Research requires appropriate inquiry. It is important to ask the key questions so that the inquiry can produce the relevant evidence from the systematic search. Quantitative and Qualitative inquiry are the means, or method of how you search for data that can be applied in practice. Developing evidence through appropriate inquiry takes the knowledge information- research, and produces knowledge transformation, or evidence-based practice.

Ethical Considerations for Evidence-Based Practice Inquiry and Implementation

There are seven key ethical principles that are applied to research, which starts with the social and scientific value. The scientific validity is then reviewed, followed by checking that fair subject selection, favorable risk-benefit ratio, independent review, respect for subjects, and informed consent are all addressed. These seven key principles guide EBP inquiry.

After completing this unit, you should be able to: 

  • Identify steps for successful grant writing.
  • Develop evidence through quantitative and qualitative inquiry.
  • Describe the ethical considerations that guide evidence-based practice inquiry and implementation.

Generating Evidence for Evidence-Based Practice

 

Chest pain shadow health assessment Education & Empathy

Chest pain shadow health assessment Education & Empathy

Education & Empathy : 5 of 6 (83.3%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A Model Statement is provided as an example of an appropriate response to each opportunity.

  • Opportunities marked as Not Encountered are opportunities that were not elicited in the interview
  • Opportunities marked as Not Followed Up are missed opportunities that were present in the interview, but where no statements were made
  • Opportunities marked as Followed Up were followed up by students, and include the dialogue between student and patient Chest pain shadow health assessment Education & Empathy
 1 Symptoms
Followed Up

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 Description: Mr. Foster describes the symptoms that have been bothering him.

This is your avatar.

Welcome Mr Foster. What brings you to the clinic today?

Question
10:29 AM PDT

Brian Foster

I have been having some troubling chest pain in my chest now and then for the past month. Chest pain shadow health assessment Education & Empathy

This is your avatar.

I am sorry that you have been having the chest pain.

Empathize
10:30 AM PDT

Brian Foster

Thanks. I appreciate that.

This is your avatar.

how long does the chest pain last ?

Question
10:37 AM PDT

Brian Foster

When I feel it, it seems to get better over the course of a couple of minutes or so.

This is your avatar.

what is the frequency of the chest pain?

Question
10:37 AM PDT

Brian Foster

Well, it has happened three times the past month. It usually goes away after about a couple of minutes.

This is your avatar.

Were episodes of your chest pains related? (Clarified to: What were you doing the last time you had chest pain?) Chest pain shadow health assessment Education & Empathy

Question
10:39 AM PDT

Brian Foster

Well, the pain seems to start when I’m doing something physical . . . the first time it happened while I was doing yard work, and the second time . . . I had to take the stairs at work because the elevator broke. Both times it got better if I took a break or sat down to rest. (Clarified to: what I was doing when I had chest pain last)

This is your avatar.

how do you feel when in pain?

Question
10:41 AM PDT

This is your avatar.

How would you rate the chest pain?

Question
10:43 AM PDT

Brian Foster

When I’m having it, it’s really tight and uncomfortable. Maybe like a 5 out of 10. Right now it’s like a zero.

This is your avatar.

is the pain crushing ? Chest pain shadow health assessment Education & Empathy

Question
10:43 AM PDT

Brian Foster

No, it’s more tight and uncomfortable.

This is your avatar.

Am sorry about that.

Empathize
10:44 AM PDT

Brian Foster

Thanks. I appreciate that.

This is your avatar.

is the pain gnawing?

Question
10:44 AM PDT

Brian Foster

No, it’s not like that. [AUDIO COMING SOON]

This is your avatar.

is the pain burning ?

Question
10:45 AM PDT

Brian Foster

Not really.

This is your avatar.

is the pain aggravated by activity?

Question
10:45 AM PDT

Brian Foster

Well, I think it’s when I’m doing something physical most of the time. The first time it happened, my chest started hurting after I was doing some yard work. The second time happened when the elevator broke at work so I had to take the stairs. My office is on the 5th floor. Chest pain shadow health assessment Education & Empathy

This is your avatar.

Thats understandable

Empathize
10:46 AM PDT

Brian Foster

Thanks. I appreciate that.

This is your avatar.

Do you have stress?

Question
11:11 AM PDT

Brian Foster

Not usually, but I’m feeling pretty anxious not knowing what’s going on with my chest.

This is your avatar.

Am sorry about this.

Empathize
11:11 AM PDT

Brian Foster

Thanks. I appreciate that.

 Model Statement: “I’m sorry you’re having these symptoms; chest pain can be uncomfortable and stressful. It’s good that you came in today so we can see what is causing your discomfort.” Chest pain shadow health assessment Education & Empathy

 2 Hypertension and High Cholesterol
Followed Up

 Description: Mr. Foster describes his past medical history of hypertension and high cholesterol.

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Have you been diagnosed with hypertension?

Question
11:02 AM PDT

Brian Foster

Yes, I supposedly have moderately high blood pressure.

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Am sorry to hear this?

Empathize
11:02 AM PDT

Brian Foster

Thanks. I appreciate that.

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Have you been monitoring your blood pressure?

Question
11:07 AM PDT

Brian Foster

Not usually. They check it when I get checkups. My doctor has never seemed overly concerned about it.

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do you remember your last blood pressure readings?

Question
11:08 AM PDT

Brian Foster

I don’t remember. I don’t think it was too bad, though.

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have you done an EKG test recently?

Question
11:08 AM PDT

Brian Foster

I had one about three months ago. They usually put one on me at my annual physical.

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well, an EKG test is all about blood pressure monitoring.

Educate
11:09 AM PDT

Brian Foster

Good to know. Thank you.

 Model Statement: “It’s good that I know you have been diagnosed with hypertension and high cholesterol, because those conditions can cause additional heart problems. I would like to find out more about your diagnosis and treatment of those conditions.” Chest pain shadow health assessment Education & Empathy

 3 Exercise
Followed Up

 Description: Mr. Foster reports that he does not exercise regularly.

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Do you exercise?

Question
11:12 AM PDT

Brian Foster

Well I used to ride my bike a lot but it got stolen a couple years ago. I guess I haven’t had much regular exercise since then. I want to get a new bike if the doctor says it is OK to exercise with this chest pain I’ve been having.

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Am sorry that the chest pain makes you not exercise.

Empathize
11:13 AM PDT

Brian Foster

Thanks. I appreciate that.

 Model Statement: “Exercise is important for everyone, and particularly for people with high blood pressure and cholesterol. Let’s talk about some healthy forms of exercise that you would be interested in trying.” Chest pain shadow health assessment Education & Empathy

 4 Diet
Followed Up

 Description: Mr. Foster describes his dietary habits.

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what is your typical breakfast?

Question
11:13 AM PDT

Brian Foster

I usually have something. Most days I drink an instant breakfast, or I’ll have a granola bar. Sometimes Maria will make a big breakfast on weekends with eggs, pancakes, bacon, hash browns, that kind of stuff. Chest pain shadow health assessment Education & Empathy

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what is your typical lunch?

Question
11:14 AM PDT

Brian Foster

There’s a sub shop near the office, so I usually get a turkey or Italian sub from there. Sometimes a salad if I’m feeling healthy . . . or guilty.

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what is your typical dinner?

Question
11:14 AM PDT

Brian Foster

My wife and I like to grill. We usually have some grilled meats and veggies for dinner.

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do you take salt?

Question
11:15 AM PDT

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Do you drink water regularly?

Question
11:15 AM PDT

Brian Foster

I usually drink water all day at work. At least four glasses, probably more. [AUDIO COMING SOON]

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Its good to take water, continue.

Educate
11:16 AM PDT

Brian Foster

Good to know. Thank you.

 Model Statement: “Paying attention to your diet is a great start. It’s best to make sure you’re eating veggies, fruits, and whole grains, and lean proteins like fish or chicken.” Chest pain shadow health assessment Education & Empathy

 5 Weight Gain
Not Encountered

 Description: Mr. Foster reports weight gain of 15 to 20 pounds in the last few years.

 Model Statement: “Gaining some weight over the years is very common. It’s a good idea to try to keep your weight in a healthy range. Things like moderate exercise and watching caloric intake can help keep you at a healthy weight.”

 6 Family History
Followed Up

 Description: Mr. Foster has a family history of heart disease.

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Do you have a family history of heart attack?

Question
11:30 AM PDT

Brian Foster

Well, my mom’s dad died of a heart attack. He was pretty young too. Chest pain shadow health assessment Education & Empathy

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Do you have a family history of stroke?

Question
11:30 AM PDT

Brian Foster

No, none that I know of.

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Do you have a family history of pulmonary embolism?

Question
11:32 AM PDT

Brian Foster

No, nobody had that.

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Thank you Mr Foster for answering for answering my questions, I will now do the Physical examination.

Educate
11:34 AM PDT

Brian Foster

Good to know. Thank you.

 Model Statement: “Thank you for sharing your family health information. It’s important that we know about any risk factors, so that you can make healthy choices to keep those risks low.” Chest pain shadow health assessment Education & Empathy

Concept Analysis Template – Teamwork and Collaboration

Concept Analysis Template – Teamwork and Collaboration

Concept Analysis Template

TEAMWORK & COLLABORATION

Definition:

  • The development of partnerships to achieve best possible outcomes using shared accountability, problem-solving and decision making Concept Analysis Template – Teamwork and Collaboration

 

Antecedents: <what must occur/be in place for concept to exist/function properly>

  • More than one person working together
  • Goal/outcome to achieve
  • Team dynamics

 

Defining Characteristics/Theoretical Links: <characteristics or theoretical associations that quantify/qualify normal/proper functioning of the concept>

  • Values/ethics (trust, respect)
  • Roles/responsibilities (understanding your own role)
  • Adaptability
  • Communication
  • Teams/teamwork

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Consequences (Positive/Desired): < Events or outcomes that occur with normal/proper functioning of the concept or its characteristics>

  • Collaborate regarding healthcare decision
  • Effective mentoring
  • Networking
  • Interprofessional (nurse to nurse)
  • Promotion of health
  • Shared governance

Risk Factors/Barriers (if present): <List the factors (physiologic; psychologic; physical) that may influence the normal functioning of the concept or its characteristics> Concept Analysis Template – Teamwork and Collaboration

  • Amount of education and/or experience regarding collaboration/teamwork
  • Amount of engagement by members
  • Communication techniques and skills
  • Culture

Consequences (Negative/Undesired): <outcomes that are a result of the improper functioning of the concept or its characteristics>

  • Negative impact on patient quality and safety
  • Inability to meet client/patient needs
  • Lack of mutual respect, trust
  • dissatisfaction with job
  • Professional identity

Interrelated concepts: <review list of concepts and identify which can be affected by the status of this concept – complete with faculty assistance>

  • Professional identity
  • Ethics
  • Communication
  • Safety
  • Healthcare quality
  • Care coordination

Exemplars in Curriculum: <List the exemplars taught within the curriculum – complete with faculty assistance> Concept Analysis Template – Teamwork and Collaboration

 

  • Interprofessional practice/Healthcare Teams
  • IPEC Competencies (IPE 400)
  • Mutual goal setting
  • Work Group Process (working groups)
  • Community partnerships
  • Skill: Demonstration of teamwork
  • Concept Analysis Template – Teamwork and Collaboration

Cultural competence and diversity in healthcare

Cultural competence and diversity in healthcare

Cultural competence and diversity are often considered to have the same meaning in healthcare facilities. What is the difference between these two terms and their applicability in terms of healthcare professionals in various healthcare settings? 

Although cultural competence and diversity are often considered to have the same meaning in healthcare facilities they are different. Diversity is in fact a component of cultural competency. This includes ethnic and racial backgrounds, age, physical and cognitive abilities, family status, religion, sexual orientation, etc… cultural competency wouldnt exist without diversity . It is important for healthcare professionals to be culturally competent for the sake of the patient’s comfort in receiving services. Lack of cultural competence can lead to noncompliance, missed appointments, and patients seeking care from non-professionals. In the cultural compliance training video an older Hispanic women spoke on how her physician said they’d schedule her a new appointment and she basically said that she wouldn’t show up because it would be the same thing that happened to her at her current appointment; a miscommunication and nothing being resolved. Health professionals who are diverse tend to have a better work ethic and connection with their patients because they’re most likely to be understand certain cultural distinctions, treatment seeking behaviors, etc… (cultural  compentency for the health professional) Cultural competence and diversity in healthcare

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2) Explain the unique circumstances under which the ancestors of most Black/African American people arrived in the Americas. Why is it important for health service professionals to understand this history?

The first Africans in the New World arrived with Spanish and Portuguese explorers and settlers. By 1600 an estimated 275,000 Africans, both free and slave, were in Central and South America and the Caribbean area. Africans first arrived in the area that became the United States in 1619, when a handful of captives were sold by the captain of a Dutch man-of-war to settlers at Jamestown. Others were brought in increasing numbers to fill the desire for labor in a country where land was plentiful and labor scarce. By the end of the 17th century, approximately 1,300,000 Africans had landed in the New World. From 1701 to 1810 the number reached 6,000,000, with another 1,800,000 arriving after 1810. Some Africans were brought directly to the English colonies in North America. Others landed as slaves in the West Indies and were later resold and shipped to the mainland. (African  American History: Scholastic , n.d.) However many “black” colored individuals rather identify themselves with their family-related nationality rather than where they were born or raised. Some rather the term black when being identified and some rather be identified as African American. This is very complex. I know, myself, I do not like to identified as Black I prefer to identify myself and Haitian/Bahamian because I consider the Black culture as people who only speak English and are just Americans with darker colored skin, who eat American meals and have American traditions. I speak English and Creole, I eat Haitian meals and follow Haitian traditions. I was born in America but my parents and older sisters were born in Bahamas and had the Haitian culture bestowed in them so I identify as that. It is important for health service professionals to understand the history of how most Black/African Americans were brought to the Americas so they’d be able to establish a positive relationship with their patients. The best way to approach patients on the matter would be to just humbly ask the person how they identify themselves. (cultural compentency for the  health professional) Cultural competence and diversity in healthcare

3) Is Hispanic a racial or ethnic category? Explain. How might this impact the status of the African/Black group, for example, in terms of whether it is the largest or second largest minority group?

Many people confuse racial and ethnic categories when it comes to the Hispanic group. But that is because many people do not know the difference between one’s race and one’s ethnicity. Unlike with ethnicity, one can only belong to one race. See, race is your biologically engineered features. It can include skin color, skin tone, eye and hair color, as well as a tendency toward developing certain diseases. It is not something that can be changed or disguised. People can however change or impersonate ethnicities through choice and principles. Ethnicity is about tradition, learned behavior and customs. It is about learning where you come from, and celebrating the traditions and ideas that are part of that region.(difference  between ethnicity and race, n.d.). Thus, Hispanic would fall more into the ethnic category because the Hispanic group has no permanent physical characteristics, language or cultural norms. So a person of Hispanic decent can be Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Since Hispanic is not a racial group but an ethnic group, the Hispanic group comprise the largest minority group and the African/Black group comes in second as the second largest minority group. (cultural competency for the  health professional)

4) List the racial categories based on the OMB classification in the United States. Explain the geographic origins of the people designated for each of the categories. Why is it important for health professionals to understand cultural differences among and between groups?

The racial categories based on the OMB classification in the United States are as follows:

· Native Americans or Alaskan Native: A person having origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliations or community recognition.

· Asian/Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.

· African American/Black: A person having origins in any of the black racial groups of Africa.

· White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. (cultural  competency for the health professional)

In the healthcare setting it is very important for health professionals to understand cultural differences among and between groups. In health care settings, cultural alertness, compassion, and competence conducts are essential because even such concepts as health, illness, suffering, and care mean different things to different people. Being knowledgeable of cultural customs enables health care providers to provide better service and help avoid misconstructions among staff, residents/patients, and families. Health care providers trained in cultural competency: Cultural competence and diversity in healthcare

– Demonstrate greater understanding of the central role of culture in healthcare

-Recognize common barriers to cultural understanding among providers, staff, and residents/patients

-Identify characteristics of cultural competence in health care settings

-Interpret and respond effectively to diverse older adults’ verbal and nonverbal communication cues

– Assess and respond to differences in values, beliefs, and health behaviors among diverse populations and older adults

-Demonstrate commitment to culturally and linguistically appropriate services

-Work more effectively with diverse health care staff.

-Act as leaders, mentors, and role models for other health care providers (Dawn Lehman, Paula Fenza, &  and Linda Hollinger-Smith)

5. A physical therapy office in “Little Haiti” in Miami, Florida is  closed due to lack of funds. All patients’ appointments are routed to a  nearby hospital’s physical therapy department in which the predominant  population served is Cuban. List and describe a minimum some steps you  believe the department has to take to meet the needs of the patients  from a culturally competent prospective. Cultural competence and diversity in healthcare

Caucasian Man With Hip Pain Case study

Case Study: A Caucasian Man with Hip Pain

Introduction

Complex regional pain disorder is a chronic pain condition that mostly affects one limb normally after an injury (Zanotti et al, 2017). Apart from the pain, clients also experience anxiety, depression, sleep difficulties, paresthesias, and general deterioration of physical function.  In this case, the client is a 43-year-old Caucasian man who presented with chief complaint of hip pain. According to the client, the pain started 7 years ago after a fall at work and later on it was discovered that the cartilage surrounding the right hip joint was 75% torn. For mental status, the client reports euthymic mood Caucasian Man With Hip Pain Case study. The diagnosis is Complex regional pain disorder (reflex sympathetic dystrophy). The purpose of this essay is to make three decisions regarding the medications to be prescribed to the client. Factors that might affect the pharmacokinetic and pharmacodynamic processes will be taken into consideration.

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The selected first decision is to prescribe the client Savella 12.5 mg orally once daily on day 1; followed by…

 

Complex Regional Pain Disorder
White Male With Hip Pain

White male on crutches

BACKGROUND

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.” Caucasian Man With Hip Pain Case study

SUBJECTIVE

The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!” Caucasian Man With Hip Pain Case study.

The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”

He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.” Caucasian Man With Hip Pain Case study.

During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports. Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation Caucasian Man With Hip Pain Case study. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented.

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

Decision Point One

Select what the PMHNP should do:
Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter
Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day
Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed
Decision Point One
Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Client comes into the office to without crutches but is limping a bit. The client states that the pain is “more manageable since I started taking that drug. I have been able to get around more on my own. The pain is bad in the morning though and gets better throughout the day”. On a pain scale of 1-10; the client states that his pain is currently a 4. When asked what pain level would be tolerable on a daily basis, the client states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.”. When questioned further, the PMHNP asks what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 4?”. The client states that since using this drug, I can get to a point on most days where I do not need the crutches. ” The client is also asked what would need to happen to get his pain from a current level of 4 to an acceptable level of 3. He states, “If I could get to the point everyday where I do not need the crutches for most of my day, I would be happy.”
  •  Client states that he has noticed that he frequently (over the past 2 weeks) gets bouts of sweating for no apparent reason. He also states that his sleep has “not been so good as of lately.” He does complain of nausea today
  •  Client’s blood pressure and pulse are recorded as 147/92 and 110 respectively. He also admits to experiencing butterflies in his chest. The client denies suicidal/homicidal ideation and is still future oriented
Decision Point Two
Select what the PMHNP should do next:
Continue with current medication but lower dose to 25 mg twice a day
Discontinue Savella and start Lyrica (pregabalin) 50 mg orally BID
Discontinue Savella and start Zoloft (sertraline) 50 mg daily
Decision Point One
Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Client comes to the office still using crutches. He states that the pain has improved but he is a bit groggy in the morning
  •  Client’s pain level is currently a 6 out of 10. The PMHNP questions the client on what would be an acceptable pain level. He states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.” He states that his pain level normally hovers around a 9 out of 10 on most days of the week before the amitriptyline was started. The PMHNP asks what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 6?” The client states, “I’m able to go to the bathroom or to the kitchen without using my crutches all the time. The achiness is less and my toes do not curl as often as they did before.” The client is also asked what would need to happen to get his pain from a current level of 6 to an acceptable level of 3. He states, “Well, that is kind of hard to answer. I guess I would like the achiness and throbbing in my right leg to not happen every day or at least not several times a day. I also could do without my toes curling in like they do. That really hurts.”
  •  Client denies suicidal/homicidal ideation and is still future oriented
Decision Point Two
Select what the PMHNP should do next:
Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning
Reduce the dose of Elavil to 75 mg at BEDTIME (dose has been titrated at weekly intervals by 25mg per week). Add on Biofreeze roll-on therapy to his right leg below the knee and into the foot and toes to be used as needed daily for muscle cramping
: Reduce dose of amitriptyline Elavil to 75 mg po orally at BEDTIME and add- on Neurontin (gabapentin) 300 mg po orally at BEDTIME. Schedule a Ffollow-up phone call in 1 week to assess pain control
Decision Point Two
Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning

RESULTS OF DECISION POINT TWO

  •  Client returns to clinic in four weeks
  •  The change in administration time seemed to help. The client states he is not as groggy in the morning and is able to start his day sooner than before
  •  Client’s current pain level is a 4 out of 10. He states that he is now taking 125 mg of amitriptyline at bedtime.
  •  Client’s has noticed that he is putting on a little weight. When asked, the client states that he has gained 5 pounds since he started taking this medication. He currently weighs in at 162 pounds. He is 5’ 7”. He states that his right leg doesn’t bother him nearly as much as it used to and his toes have only “cramped up” twice in the past month. He states that he is able to get around his apartment without his crutches and that he has even started seeing someone he met at the grocery store. The weight gain seems to bother him a lot and he is asking if there is a way to avoid it
Decision Point Three
Select what the PMHNP should do next:
Continue with the Elavil at his current 125 mg a day dose and start Qsymia (phentermine and topiramate) 3.75 mg/23 mg tablet once daily and titrate as required by package insert
Reduce the dose of Elavil to 100 mg a day and follow up in a month
Continue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise
Decision Point One
Neurontin (gabapentin) 300 mg orally at BEDTIME with weekly increases of 300 mg per day to a max of 2,400 mg if needed

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Client returns to the office today and seems to be in agony. He states that the Neurontin did not help him at all. He also states that he is foggy in the morning. His current pain level is a 9 out of 10. The PMHNP questions the client on what would be an acceptable pain level. He states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.” The client is also asked what would need to happen to get his pain from a current level of 9 to an acceptable level of 3. He states, “I guess I would like this achiness and throbbing in my right leg to not happen every day or at least not several times a day. I also could do without my toes curling in like they do. That really hurts.” Caucasian Man With Hip Pain Case study
  •  Clientis denies suicidal/homicidal ideation and is still future oriented. He does seem to be discouraged throughout the interview about his current pain
Decision Point Two
Select what the PMHNP should do next:
Discontinue Neurontin. Start Zoloft (sertraline) 50 mg orally daily and titrate at weekly intervals to a dose of 200 mg
Continue with Neurontin but double the current dose (600 mg PO orally 4 times a day)
Increase the Neurontin dose to 900 mg orally TID and add on Celexa 20 mg orally daily. Increase dose to a max of 40 mg daily
Decision Point Two
Discontinue Neurontin. Start Zoloft (sertraline) 50 mg orally daily and titrate at weekly intervals to a dose of 200 mg

RESULTS OF DECISION POINT TWO

  •  Client returns to clinic in four weeks
  •  Client returns today with a current pain level of 5 out of 10. He appears anxious, which is a new presentation. He states that he feels “amped up” and he cannot seem to control it
  •  Client also states that he hasn’t been able to get an erection in over a week and thinks his pain may be causing erectile dysfunction Caucasian Man With Hip Pain Case study.
  •  Although client’s pain is “more manageable than it has been before”, he thinks it may have gotten the best of him. His new problems really have him discouraged
Decision Point Three
Add on Wellbutrin (bupropion) XL 150 mg orally in the MORNING. Give the client a short course (2 weeks) of Ativan to help with his anxiety

Guidance to Student
Anxiety is a transient effect of SSRI and SNRI therapy and should be anticipated. Counseling the client is key in continuing the therapeutic alliance you have with the client. Short course benzodiazepines will usually be sufficient to bridge this time period. Erectile dysfunction is a side effect of all SSRI’s and should be a counseling point for men. It happens in roughly 10% of men using SSRI’s. A dose reduction in Zoloft will certainly help with the side effects but will most likely result in increased pain. A change in therapy is always an option at this point but will normally not reduce the anxiety or erectile dysfunction experienced and will still require short course benzodiazepine therapy and appropriate counseling. It would be most prudent, in this case, to add-on Wellbutrin XL 150 mg po QAM to help with the side effect of erectile dysfunction. Although we have told you throughout this course that the addition of a medication to treat a side effect is not good therapy, this is one of those cases where it is recommended, especially when the client is experiencing relief from a regimen that took time to achieve. Wellbutrin is a DNRI and does not overlap in SSRI therapy (maybe a little in the DRI of Zoloft) Caucasian Man With Hip Pain Case study.

Decision Point One
Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Client comes to the office still using crutches. He states that the pain has improved but he is a bit groggy in the morning
  •  Client’s pain level is currently a 6 out of 10. The PMHNP questions the client on what would be an acceptable pain level. He states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.” He states that his pain level normally hovers around a 9 out of 10 on most days of the week before the amitriptyline was started. The PMHNP asks what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 6?” The client states, “I’m able to go to the bathroom or to the kitchen without using my crutches all the time. The achiness is less and my toes do not curl as often as they did before.” The client is also asked what would need to happen to get his pain from a current level of 6 to an acceptable level of 3. He states, “Well, that is kind of hard to answer. I guess I would like the achiness and throbbing in my right leg to not happen every day or at least not several times a day. I also could do without my toes curling in like they do. That really hurts.” Caucasian Man With Hip Pain Case study
  •  Client denies suicidal/homicidal ideation and is still future oriented
Decision Point Two
Select what the PMHNP should do next:
Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning
Reduce the dose of Elavil to 75 mg at BEDTIME (dose has been titrated at weekly intervals by 25mg per week). Add on Biofreeze roll-on therapy to his right leg below the knee and into the foot and toes to be used as needed daily for muscle cramping
: Reduce dose of amitriptyline Elavil to 75 mg po orally at BEDTIME and add- on Neurontin (gabapentin) 300 mg po orally at BEDTIME. Schedule a Ffollow-up phone call in 1 week to assess pain control
Decision Point Two
Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning Caucasian Man With Hip Pain Case study

RESULTS OF DECISION POINT TWO

  •  Client returns to clinic in four weeks
  •  The change in administration time seemed to help. The client states he is not as groggy in the morning and is able to start his day sooner than before
  •  Client’s current pain level is a 4 out of 10. He states that he is now taking 125 mg of amitriptyline at bedtime.
  •  Client’s has noticed that he is putting on a little weight. When asked, the client states that he has gained 5 pounds since he started taking this medication. He currently weighs in at 162 pounds. He is 5’ 7”. He states that his right leg doesn’t bother him nearly as much as it used to and his toes have only “cramped up” twice in the past month. He states that he is able to get around his apartment without his crutches and that he has even started seeing someone he met at the grocery store. The weight gain seems to bother him a lot and he is asking if there is a way to avoid it
Decision Point Three
Select what the PMHNP should do next:
Continue with the Elavil at his current 125 mg a day dose and start Qsymia (phentermine and topiramate) 3.75 mg/23 mg tablet once daily and titrate as required by package insert
Reduce the dose of Elavil to 100 mg a day and follow up in a month
Continue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise Caucasian Man With Hip Pain Case study
Guidance to Student
At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias. He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg/m2. Your client’s BMI is currently 25.5 kg/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish. Caucasian Man With Hip Pain Case study

Case Study: A Caucasian Man with Hip Pain

Introduction

Complex regional pain disorder is a chronic pain condition that mostly affects one limb normally after an injury (Zanotti et al, 2017). Apart from the pain, clients also experience anxiety, depression, sleep difficulties, paresthesias, and general deterioration of physical function.  In this case, the client is a 43-year-old Caucasian man who presented with chief complaint of hip pain. According to the client, the pain started 7 years ago after a fall at work and later on it was discovered that the cartilage surrounding the right hip joint was 75% torn. For mental status, the client reports euthymic mood. The diagnosis is Complex regional pain disorder (reflex sympathetic dystrophy). The purpose of this essay is to make three decisions regarding the medications to be prescribed to the client. Factors that might affect the pharmacokinetic and pharmacodynamic processes will be taken into consideration. Caucasian Man With Hip Pain Case study.

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The selected first decision is to prescribe the client Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter. I chose Savella because Savella has been shown to be effective in treating fibromyalgia a condition that affects muscles, cartilages and other supporting tissues. Savella is a serotonin-norepinephrine reuptake inhibitor (SNRI and has NMDA antagonist activity and thus balances neurotransmitters in the brain and produces analgesia effect at the site of nerve endings (Abida et al, 2016).

Savella was selected over other options because Savella (milnacipran) does not have affinity for adrenergic, cholinergic and histaminergic receptors, and hence does not have some of the adverse and side effects evident in other medications (English et al, 2010).

The expected results are that the pain will decline and the client will stop using crutches. It is also expected that the client will have minimal side effects and that his mood will stabilize. The outcome of this decision was that the pain had reduced. However, the client reports sweating bouts, nausea, elevated blood pressure and heart rate, and experiencing butterflies in his chest.  These are some of the side effects of milnacipran (Abida et al, 2016).

The selected decision is for the client to continue with the current prescribed medication (Savella) but lower the dose to 25 mg twice daily. The rationale for choosing this decision is that this medication is proofing to be effective in reducing the pain for the patient and the client does not report any mood problems. However, since the client reported some side effects, it is appropriate to lower the dosage in order to minimize the side effects. The rationale for not selecting Lyrica is that this medication has more side effects than Savella and evidence indicate that Lyrica causes mood problems and suicidal thoughts (Goodman & Brett, 2017). Similarly, Sertraline has worse side effects and is not indicated for fibromyalgia (Zhu et al, 2013). In addition, sudden stop of milnacipran therapy is not recommended because the client may develop withdrawal symptoms (Mease et al, 2014). Caucasian Man With Hip Pain Case study

The expected result for choosing this decision was that the pain score would reduce to acceptable level of 3 and that there will be minimal side effects. The outcome of the selected decision was that the pain score has increased compared to previous prescription and this is really affecting his mood. However, the side effects have reduced. The increased pain score can be attributed to the reduced dosage that is not being effective in reducing the pain.  The recommended dosage for Milnacipran is 2.5 mg/day for the first day, 25 mg/day on the 2nd and 3rd day, 50 mg/day on 4th-7th day and after 7th day 100 mg/day. The dose can also be increased to 200 mg/day (Mease et al, 2014).  This therefore might explain the reduced efficacy of the prescribed dosage for the client in regard to pain reduction.

The selected third decision is to change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME. This decision was selected because increased dosage of Milnacipran has been shown to be more effective. Evidence shows that if the response the standard-dose milnacipran therapy is poor, the dose can be increased but keep on assessing patient responses (Hayashi et al, 2017).  In addition, the dose was increased during bedtime in order to reduce side effects when the patient is awake. The second option was not selected because if the client abruptly stops taking milnacipran he may have withdrawal symptoms. The third option was not selected because combination of Savella and Celexa (citalopram) both drugs inhibit serotonin reuptake and hence can cause serotonin toxicity or serotonin syndrome. In addition, using both medications can increase side effects for the client (Masuda et al, 2014). Caucasian Man With Hip Pain Case study

Conclusion

The first selected decision was to prescribe Savela for the client and keep on increasing the dosage as recommended. The rationale for selecting this decision is that Savella has been shown to be effective in treatment of fibromyalgia. Savella balances neurotransmitters in the brain and produces analgesia effect at the site of nerve endings. With this decision, the pain score reduced though the client experienced side effects from the medication. Therefore, the second decision was to continue Savella but lower the dose to 25 mg twice daily. This decision eradicated the side effect but the pain score increased compared to the previous higher dose. As a result, the third decision was to change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME. This decision was selected because increased dosage would increase drug efficacy and hence reduce pain score and during bedtime the client would be able to tolerate side effects better during sleep. Caucasian Man With Hip Pain Case study

References

Abida M, Alam T, Said I, Feky E & Hagg M. (2016). Recent Drugs For The Management  And   Treatment Of Fibromyalgia. IAJPS. 3 (11), pp: 1361-1365

English C, Rey J & Rufin C. (2010). Milnacipran (Savella), a Treatment Option for            Fibromyalgia. PMCID. 35(5), pp: 261–266.

Goodman C & Brett A. (2017). Gabapentin and Pregabalin for Pain — Is Increased Prescribing a             Cause for Concern? N Engl J Med. 1(377), pp: 411-414.

Hayashi M, Mimura M, Otsubo T & Kamijima K. (2017). Effect of high-dose milnacipran in         patients with depression. Neuropsychiatr Dis Treat. 3(5), pp: 699–702.

Masuda T, Inoue T, Naoki T, Shin N, Yuji K, Koyama T & Kusumi I. (2014). Effect of the          coadministration of citalopram with mirtazapine or atipamezole on rat contextual       conditioned fear. Neuropsychiatr Dis Treat. 1(10), pp: 289–295.

Mease P, Clauw D, Trugman J, Plamer R & wang Y. (2014). Efficacy of long-term milnacipran    treatment in patients meeting different thresholds of clinically relevant pain relief:          subgroup analysis of a randomized, double-blind, placebo-controlled withdrawal study. Journal of Pain Research. 1(7), pp: 679—687.

Zanotti G, Ariel P, Comba F, Buttaro M & Piccaluga F. (2017). Three cases of type-1 complex     regional pain syndrome after elective total hip replacement. SICOT J. 3(52).

Zhu H, Bogdanov MB, Boyle SH, Matson W, Sharma S, Matson S, et al. (2013). Pharmacometabolomics of Response to Sertraline and to Placebo in Major Depressive   Disorder – Possible Role for Methoxyindole Pathway. PLoS ONE. 8(7) Caucasian Man With Hip Pain Case study