Perform a Health assessment on an older adult

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In this assignment, you will be completing a health assessment on an older adult. To complete this assignment, do the following:

1. Perform a Health History on an older adult. Students who do not work in an acute setting may “practice” these skills with a patient, community member, neighbor, friend, colleague, or loved one. (If an older individual is not available, you may choose a younger individual).

2. Complete a physical examination of the client using the “Health History and Examination” assignment resource. Use the “Functional Health Pattern Assessment” resource as a guideline to assist you in completing the template.

3. Document findings of complete physical examination in Situation-Background-Assessment-Recommendation (SBAR) format. Refer to the sample SBAR Template located on the National Nurse Leadership Council website athttps://www.ihs.gov/nnlc/includes/themes/newihstheme/display_objects/documents/resources/SBARTEMPLATE.pdf as a guide Perform a Health assessment on an older adult.

4. Document the findings of the physical examination in the assessment worksheet.

5. Using the “Health History and Examination” assignment resource, provide the physical examination findings summary with planned interventions for the client. Include any community services in the interventions.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion Perform a Health assessment on an older adult.

The pharmacological agents most often used in the treatment of a disease or health condition

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Create a 10-slide PowerPoint presentation to identify medications associated with a chosen disease or health condition, explain the actions and side effects of the medications, and discuss any controversies related to the medications. Explain a treatment regime, including pharmacology, for the disease or health condition you selected, along with how the treatment regime may affect a client’s lifestyle.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

· Competency 1: Apply practice guidelines and standards of evidence-based practice related to pharmacology for safe and effective nursing practice.

. Identify the pharmacological agents most often used in the treatment of a disease or health condition.

. Describe the treatment regime, including pharmacology, most often prescribed for a disease or health condition.

. Explain the controversies related to a pharmacological agent The pharmacological agents most often used in the treatment of a disease or health condition.

· Competency 2: Explain the relationship between quality patient outcomes, patient safety, and the appropriate use of pharmacology and psychopharmacology.

. Explain the types of actions, side effects, indications, and contraindications that may be expected from a pharmacological treatment.

. Describe how a treatment regime, including pharmacology, may impact a client’s lifestyle.

. Describe how to monitor a client following a prescribed treatment regime, including pharmacology, in order to obtain a quality patient outcome.

· Competency 4: Communicate in a manner that is scholarly, professional, and consistent with expectations of a nursing professional.

. Write content clearly and logically with correct use of grammar, punctuation, and mechanics.

. Correctly format citations and references using current APA style.

· By having a thorough understanding of pharmacology, nurses can eliminate possible medication errors in their nursing practices. The basic principles of pharmacology include pharmacokinetics (what the body does to a drug) and pharmacodynamics (what a drug does to the body). Pharmacology plays a significant role in the nursing profession, so it is extremely important for nurses to understand the actions of the pharmacological agents they will administer to patients in order to intervene appropriately if necessary.

· Another critical skill for a nurse is the ability to apply and evaluate evidence-based practices, principles, models, and pharmacological guidelines and protocols commonly used in nursing practice. Understanding how specific protocols and guidelines are developed will aid nurses in treating patients with a multitude of physiological and psychological conditions The pharmacological agents most often used in the treatment of a disease or health condition.

· Nurses must be able to measure outcomes of pharmacological interventions when caring for patients. The effective use of evidence-based practice guidelines, models, and principles is one way that nurses can analyze quality outcomes for the pharmacological treatments used for patients.

· Pharmacology includes different categories of major drugs used in the treatment of primary diseases. The same drug may be used to treat more than one disease or condition, while two patients with the same disease may require different drug treatments. In addition, the professional nurse must be aware of what types of things can influence a patient’s response to a drug. Some things are obvious—other medications, for example—while some are less so. Things like age, weight, herbs—even foods people eat every day—can influence how a person responds to a particular drug. At times, even a strong cultural belief can influence how a drug will react. Nurses who administer drugs have a responsibility to assess patients for both the desired response, as well as for any unwanted and potentially harmful reactions that may occur.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.

· What constitutes a medication error? How can medication errors be prevented?

· How do you use evidence-based practice in your workplace?

Internet Resources

Access the following resources by clicking the links provided. Please note that URLs change frequently. Permissions for the following links have either been granted or deemed appropriate for educational use at the time of course publication The pharmacological agents most often used in the treatment of a disease or health condition.

· Institute for Safe Medication Practices. (n.d.). Retrieved from http://ismp.org/

· Healthy People 2020. (2015). Retrieved from http://www.healthypeople.gov/

· National Heart, Lung, and Blood Institute. (n.d.). Retrieved from http://www.nhlbi.nih.gov/

· Heart Failure Society of America. (n.d.). Retrieved from http://www.hfsa.org/

. You may wish to explore this Web site and review information related to heart failure classification.

· Montalvo, I. (2007). The National Database of Nursing Quality Indicators (NDNQI). OJIN: The Online Journal of Issues in Nursing, 12(3).

Assessment Instructions

Imagine your supervisor has asked you to conduct a lunch and learn session to educate your fellow nursing staff on pharmacological interventions.

Preparation

Select a disease or health condition that requires pharmacological intervention. You may choose any disease or health condition you wish, but the disease or health condition must be relevant to nurses from a variety of settings (for example: ER, pediatrics, public health, et cetera).

Requirements

Once you have selected a disease or health condition, create a PowerPoint presentation you could use in your lunch and learn session, including the following:

· Identify the disease or health condition you have chosen, along with the areas where nurses are likely to see it. (Do this in the agenda slide or next slide after the agenda.)

· Identify the three drugs used most often in the treatment of the disease or health condition.

· Explain the types of actions, side effects, indications, and contraindications that could be expected from the pharmacological treatment.

· Describe the treatment regime most often prescribed for the disease or health condition. This should include pharmacology but not be limited to pharmacology.

· Explain how the treatment regime (including pharmacology) may impact a client’s lifestyle. Consider things such as finances, ease or complexity of administration, instructions (frequency, duration), et cetera.

· Describe how a nurse should monitor a client being treated for the disease or health condition in order to obtain a quality patient outcome.

· Explain any controversies associated with the drugs used in the treatment. For example, is there a black box warning with any of the drugs?

Use the notes section of each slide to expand your points or draft your mock oral presentation (or both) and reference your resources. Use at least 3 peer-reviewed or professional resources to support your work in this assessment. Be sure your PowerPoint includes a title slide, a slide with your agenda or list of topics to be covered, and a reference slide. Follow current APA style and formatting guidelines for your citations and references.

Additional Requirements

· Number of slides: 10, not including the title and reference slides.

· Be creative. Consider your intended audience The pharmacological agents most often used in the treatment of a disease or health condition.

How current policies impact how you as a nurse provide health care

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                          Discussion: Health Care Policy

In this week’s media presentation, Dr. Trautman, Dr. Wakefield, and Ms. Coyle discuss how public policies initiated at the national or state level ultimately influence what occurs at the institutional and local level of nursing practice and health care delivery. Health care policy usually is developed to address health care cost, quality, or access, or a combination of the three. Due to the nature of their interaction with patients, nurses are well situated to be effective, knowledgeable advocates for their patients.

In this week’s Discussion, you will examine how current policies impact how you as a nurse provide health care. You will then select an issue of interest and determine how you could advocate for policy in that area How current policies impact how you as a nurse provide health care. 

                                                   To prepare:

Select one public policy that currently is impacting you and your practice. Consider the following:

What health care driver was the policy designed to address: cost, quality, access, or a combination?

Does the policy appear to be achieving its intended results? On what data are you basing your assumption?

What have been the effects (adverse or positive) of this policy on health care cost, quality, and access?

How is this policy affecting your nursing practice?

Next, select a health care issue—something you see or experience on a daily basis—about which you would like to influence a practice change through the policy process. 

Review the Learning Resources, focusing on Kingdon’s Model. How would you utilize this model to guide your policy development?

Post a brief description of a public policy that is having an impact on your practice; summarize your analysis of the policy using the bulleted list above as a guide. Then, summarize the issue you would like to influence though a change in public policy, and outline how you would utilize Kingdon’s Model to guide your policy development How current policies impact how you as a nurse provide health care.

                                             Required Readings

Milstead,  J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.).  Burlington, MA: Jones and Bartlett Publishers.

Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. xvi -13) 

This chapter explains public policy and the nurse’s role in directing health care issues to the government and securing a response.

Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention” (pp. 16-34) 

This chapter provides examples of the process of moving a problem to the attention of the government so the solution can be considered at the state and federal levels.

Chapter 3, “Government Response: Legislation” (pp. 36-54) 

This chapter explores the multiple factors that influence the development of public policy through the legislative branch of government. How current policies impact how you as a nurse provide health care

Psychotherapy and psychopharmacologic treatment for the sexual dysfunction of female orgasmic disorder

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Week 11: Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

I have been under a lot of stress lately. Between my job, the house and kids, and my wife complaining, I don’t seem to have the “staying power” I used to. Our sex life used to be perfect, but now I cannot perform as well or as often as I used to. My wife does not seem to understand and now I am feeling inadequate. I have a long life in front of me and I don’t want to live without feeling like a true man.”

Larry, age 40

This week’s topics include gender dysphoria, paraphilic disorders, and sexual dysfunction. The term gender dysphoria is the diagnosis describing those persons who experience incongruence between their gender assigned at birth and their experienced gender. Paraphilic disorders include pedophilia, exhibitionism, fetishism, and voyeurism, for example. Sexual dysfunction disorders include, most commonly, male erectile disorder, female orgasmic disorder, and other disorders. These diagnoses may be treated with pharmacologic and psychotherapy modalities Psychotherapy and psychopharmacologic treatment for the sexual dysfunction of female orgasmic disorder.

This week, you will explore ways to assess and care for persons with gender dysphoria, paraphilic disorders, and sexual dysfunction disorders as outlined in the DSM-5.

Photo Credit: Rick Gomez / Blend Images / Getty Images

Discussion: Assessment and Treatment of Gender Dysphoria, Paraphilic Disorders, and Sexual Dysfunction

Sexuality is an important part of each person’s quality of life. Research indicates that awareness of sexual identity and its importance may begin as early as age 3. However, individuals with varying diagnoses, disorders, or dysfunctions may grapple with issues related to their sexuality in their teen years, as well as into adulthood.

Assignment

· Explain the diagnostic criteria for the sexual dysfunction of female orgasmic disorder.

· Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the sexual dysfunction of female orgasmic disorder.

· Compare differential diagnostic features of gender/sexual disorders

· Support your rationale with references to the Learning Resources or other academic resource

· N.B: Please remember to include Introduction, Conclusion and references less than 5 years old.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus Psychotherapy and psychopharmacologic treatment for the sexual dysfunction of female orgasmic disorder.

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 17, “Human Sexuality and Sexual Dysfunctions” (pp. 564–599)

· Chapter 18, “Gender Dysphoria” (pp. 600–607)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 37, “Sexual Dysfunctions”

· Chapter 38, “Paraphilias and Paraphilic Disorders”

· Chapter 39, “Gender Dysphoria”

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

· “Gender Dysphoria”

· “Paraphilic Disorders”

· “Sexual Dysfunctions”

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Sexual dysfunction
bupropion

Johnson, L., Shipherd, J., & Walton, H. M. (2016). The psychologist’s role in transgender-specific care with U.S. veterans. Psychological Services, 13(1), 69–76. doi:10.1037/ser0000030

Levenson, J. S., & Grady, M. D. (2016). The influence of childhood trauma on sexual violence and sexual deviance in adulthood. Traumatology, 22(2), 94–103. doi:10.1037/trm0000067

Hawes, S. W., Boccaccini, M. T., & Murrie, D. C. (2013). Psychopathy and the combination of psychopathy and sexual deviance as predictors of sexual recidivism: Meta-analytic findings using the Psychopathy Checklist—Revised. Psychological Assessment, 25(1), 233–243. doi:10.1037/a0030391

Required Media

Johnson, S. (Producer). (n.d.). Emotionally focused therapy with same-sex couples [Video file]. Mill Valley, CA: Psychotherapy.net Psychotherapy and psychopharmacologic treatment for the sexual dysfunction of female orgasmic disorder.

The importance of compliance in terms of policy, regulation, and finance

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The importance of compliance in terms of policy, regulation, and finance

Investigate your organization’s compliance rate with one specific core measure of your choice and write a 2-page (maximum) executive summary analyzing the financial and regulatory impact of organizational compliance with your chosen measure. Include recommendations for improving performance on the measure.

In order to promote safe, caring, patient-centered environments, nurse leaders must both conceptually understand and be proficient at performing a wide variety of leadership skills. Effective nursing leaders develop and maintain awareness of issues that emerge at many levels within and outside of their organizations. In addition to developing self-assessing competencies necessary for their roles, nurse leaders must also acquire organizational and systems leadership skill sets.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

· Competency 4: Policy, Finance, and Regulations – Understand the scope and role of policy, finance, and regulatory environments in relationship to individual and population outcomes.

. Compare the compliance rates of a specific measure for different organizations The importance of compliance in terms of policy, regulation, and finance.

. Explain the importance of compliance in terms of policy, regulation, and finance.

· Competency 5: Communication – Communicate effectively with all members of the health care team, including interdepartmental and interdisciplinary collaboration for quality outcomes.

. Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a nursing professional.

· Competency 6: Organizational and Systems Management – Apply knowledge of organizational behavior, nursing theory, and systems (micro- and macro-) as appropriate for the scope and role of one’s own practice.

. Explain strategies to overcome described organizational barriers to change.

· Competency 9: Professional Role – Incorporate the qualities, skills, behaviors, and knowledge required to function as a patient advocate, practice high-quality care, assess and evaluate patient outcomes, and provide leadership in improving care.

. Identify the stakeholders affected by changes to a specific compliance measure and describe changes that would improve compliance of a specific measure.

For this assessment, write an executive summary analyzing the financial and regulatory impact of organizational compliance with a specific core measure of your choice. The summary must include recommendations for improving performance on the measure.

You must be able to explain the financial implications associated with the measure, as well as its importance in terms of policy, regulation, and finance. This is another good opportunity to consult with a key stakeholder within the organization. Talking to someone who works closely with the organization’s finances can help you develop a deeper understanding of the financial aspects of compliance. You also need to suggest ways your organization can improve compliance and how you would implement changes and overcome obstacles.

This may seem like an enormous undertaking, but you should approach it as if you were to present this information to your supervisor or manager. Keeping in mind that people in these positions do not have time to read a 10–12-page report, you would typically give them only an executive summary of your analyses and recommendations. That means that you will need to be very clear and very concise with the information you choose to include in the executive summary. Say as much as possible with as few words as possible The importance of compliance in terms of policy, regulation, and finance.

Directions

Select a core measure and investigate your organization’s compliance rate with the measure. In your executive summary, address the following:

1. Compare the compliance rates of your organization with those of other organizations.

2. Explain why the measure is important in terms of policy, regulation, and finance.

3. Describe changes that could be made that would improve compliance with the measure.

4. Identify the stakeholders who would be affected by the changes.

5. Identify obstacles you would expect to encounter and explain strategies to overcome these obstacles.

Additional Requirements

· Format: Include a title page and references page. As this is an executive summary, do not use APA style and formatting. To determine the appropriate format, it may be helpful for you to review the documents used in your organization. How do they look? What kind of language is used in memos? These can help guide your development of this executive summary. Certainly, feel free to use bullet points as appropriate.

· Length: Write a 2–3-page (maximum) summary of your information, not including the title page and references page.

· References: You must still reference scholarly resources to support your work. Use at least three current scholarly or professional resources The importance of compliance in terms of policy, regulation, and finance.

Comparative analysis of five contemporary leadership approaches

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Comparative analysis of five contemporary leadership approaches

Top of Form

Bottom of Form

Assignment Content

Top of Form

Perform a comparative analysis of five contemporary leadership approaches, including:

o Situational leadership

o Transactional leadership

o Transformational leadership

o Servant leadership

Use the Contemporary Leadership Matrix in Appendix B of the Example Paper to compare each approach on the following domains:

o Description

o Primary characteristics

o Strengths

o Criticisms

o Discipline-specific applications

Submit the Example Paper with:

o a properly formatted title page,

o the revised Historical Leadership section,

o properly formatted references,

o the matrix from Week 1 in Appendix A, and

o the matrix on Contemporary Leadership in Appendix B Comparative analysis of five contemporary leadership approaches. 

Discussions 1

Assessments

II. Working with others

  B. Leadership and Team Skills

      1. What’s my leadership style?

2.    What was your score on the “concern for people” and “concern for task” dimensions of the What’s my Leadership Style Assessment? Explain how your score promotes or fails to promote effective leadership. What can you do to be more effective as a leader?

3.    In your daily work life, what leadership strengths or talents do you rely on most? What is the result or outcome of using these strengths?

Discussions 2

This activity centers on one of the most prominent leaders in the world: the US president.

1) Using chapters 4-11 of Northouse, choose the leadership style you believe best characterizes President Trump.

2) Discuss and substantiate your choice with examples of his behavior you believe are best aligned with your choice. Include two additional peer-reviewed sources to your remarks.

· Caution! This is an exercise in critical thinking, not political proselytizing.

· Avoid emotional statements aimed at forwarding a political cause – or starting inappropriate political bantering.

· Stick with your sources to substantiate your claim. You can add substantiating links via video messages if you like Comparative analysis of five contemporary leadership approaches.

Ineffective Time Management

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Hi, this is the instruction for my 2-3 paragraph discussion board:

Marilyn is the manager of a Medical Surgical unit in a busy city hospital. Budget time is approaching, and administration has become increasingly intolerant of overtime. Marilyn has been studying the payroll sheets for her unit, and she now recognizes that 4 nurses have been responsible for over half the end of shift overtime hours. These nurses have all been working on this unit for over 8 years, and provide exemplary patient care. The following are Marilyn’s observations concerning these nurses: Ineffective Time Management

-Care provided is safe and thorough.

-Report is given promptly and thoroughly.

-Seldom are tasks carried over for the next shift.

-Nurses following these nurses are confident that the care and the report were complete.

-Almost all documentation by these nurses is done after their shift.

In view of these observations, Marilyn feels she needs to address the overtime issue with these nurses. She wants to be sure they know she appreciates their quality contributions to the unit.Discuss the following points:

1-How should Marilyn address this time management problem?

2-Where should documentation fall as a priority?

3-How might appropriate delegation help?

4-What action plan would you suggest?Your response should consist of complete sentences and should be at least one complete paragraph, but it should be no more than three paragraphs in length Ineffective Time Management

Understanding how research designs contribute to the quality of a study

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Quantitative Research Designs

In order to find the best information on a topic, not only should you develop a question and search for resources, but you should also know how to analyze the value of the resources that you identify. There are different ways to evaluate resources, such as using the hierarchy of evidence, which you explored in Week 4 of this course. Another way to evaluate resources is to consider the appropriateness of the research design. Understanding how research designs contribute to the quality of a study is essential for being able to analyze resources when conducting a literature review or locating evidence for practice.

In this Discussion, you consider the different research designs and evaluate how these designs have been used to research a specific topic. You also consider strategies for selecting an appropriate research design.

To prepare:

· Review the information in the Course Text on Quantitative Research Designs. Focus on the information in Box 9.1, “Guidelines for Critiquing Research Designs in Quantitative Studies” located on page 230 of the course text Understanding how research designs contribute to the quality of a study.

· Select a Topic from the list below and search the Walden Library to find Two Different Quantitative Research Studies addressing that issue:

. Caregiver stress

. Anxiety in children

. Sleep apnea

. Depression in college freshmen

. Rural health care issues

. Post-traumatic stress syndrome

. Traumatic brain injury in veterans

. Health effects of environmental contaminants

. Bipolar disorder

. End-of-life ethical issues

. Alternative medicine

· For Each of the sources that you Select, Identify the Type of Quantitative Research Design used, and Evaluate whether it is the Most appropriate approach to the Research.

· Consider the Ramifications of choosing an Inappropriate Design for a Research Study.

By Day 3

Post the Topic you Selected, References for the Two Sources you identified, and the Quantitative Research Design used in Each.

Critique the Appropriateness of the Design Used and Justify your Comments with information from the Learning Resources.

Discuss the ramifications of Choosing an Inappropriate Design for a Research Study. Understanding how research designs contribute to the quality of a study

Information you should obtain to develop and implement culturally appropriate plans of care for an individual

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The Course Outcomes covered this week are below.

CO2: Communicate effectively with culturally diverse individuals, families, and organizations. (PO3)

CO4:  Perform a culturally competent nursing assessment. (PO7)

This week

  • select and read one of the chapters of particular interest to you listed in Assignments under Readings;
  • discuss what information you should obtain to develop and implement culturally appropriate plans of care for an individual of this group; and
  • share a brief case study or exemplar as a way to share your formation.

Examples:

Childbearing: A young Hasidic mom just emigrated from Israel to the United States. She is at term and comes to your Mother/Baby Unit for delivery Information you should obtain to develop and implement culturally appropriate plans of care for an individual.

Children: Oman is 5 years old. His family members are refugees from Syria. At the local community center a routine blood sugar test indicated his results were very high. He now needs hospitalized for control.

Adult: Luca moved to the United States after earning her BSN in Manila, Philippines. She works three jobs so that she can send money home to her family. She needs a treatment for breast cancer, but taking time off from any of the jobs will create a hardship on her local and extended family at home.

Older Adult: KC is 72 years old and came to the United States many years ago from Ghana. He is divorced, his children do not live in the area, and you often see him at the senior citizen’s center where you volunteer. He has uncontrolled hypertension.

Mental Health: Arkady was born in the former Soviet Union. He has battled depression most of his adult life and has been hospitalized again in the mental health facility 30 miles from his family for a suicide attempt. Although he has health insurance, the benefits for his diagnosis are about to expire.

Pre-requisites for person-centred care

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Pre-requisites for person-centred care: reflective paper 

Task Description:

During PEP, you will regularly encounter clinical episodes that both challenge and enhance your developing professional practice. The purpose of this task is to generate a reflective paper focussed on ONE of the five ‘prerequisites’ of the person-centred nursing framework. These ‘prerequisites’ are considered the essential attributes for health professionals to facilitate person-centred outcomes (McCormack, Manley & Titchen 2013). These are identified as follows: 

1. Professionally competent

2. Developed interpersonal skills

3. Commitment to the job 

4. Clarity of beliefs and values

5. Knowing ‘self’ Pre-requisites for person-centred care

From your PEP , consider a clinical encounter (either through direct observation of other health professional/s or your own actions), where you felt a pre-requisite may have been lacking or questionable. Briefly outline the situation and identify which pre-requisite/s may have impacted/contributed to the patient outcome. 

Choose ONE of these as your focus and briefly relate this to the literature regarding person-centred outcomes and why this pre-requisite is considered an important attribute for practitioners. You will also be required to consider your own practice to ensure you adequately meet this pre-requisite as you progress through the final stages of your degree and continue to establish your professional identity. 

Additional resources including a template to populate with your reflection is attatched.

Reference: McCormack, B., Manley, K. and Titchen, A. eds., 2013. Practice development in nursing and healthcare. John Wiley & Sons. Pre-requisites for person-centred care

I NEED 5 REFERENCES IN TEXT AND LIST FROM 2010 TO 2019 ONLY.