Synthesis Paper

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Submit your Synthesis Paper using this assignment portal. Please note in the instructions, this paper should have no more than 4 pages of content. Coaches will stop grading after the fourth page of content, so please be sure to be concise in your writing.

See the Synthesis Paper Assignment Instructions for details.

Due by 2359 on Saturday of Module 7.

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Professional Paper Worksheet

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 Directions

  1. Carefully read these directions and the grading rubric below.
  2. Download the required template below under Template.
  3. Rename that template as Your Last Name Professional Paper Worksheet.docx.  This must be saved as a Microsoft Word document (.docx). Save it to  your own computer or flash drive in a location where you will be able to  retrieve it later. Type your assignment directly on the saved document.  Save your work often..

5. This assignment must use the required article and sentences stated  in the announcement described above to complete the following items:

  1. Reference for the assigned journal article,
  2. Quotation with citation,
  3. Paraphrased area with citation, and
  4. Assigned article summary.

6. Each of required items above is clearly described on the  Professional Paper Worksheet Template. Page numbers for resources in the  current APA Manual are provided on the template for your use

7. The Assigned Article Summary that you write must be 175-200 words.  The Summary must contain the assigned sentence for quotation and  citation as noted in the announcement, the assigned sentence for the  paraphrased area with citation as noted in the announcement, several  additional paraphrased areas, and appropriately formatted citations. You  may also include one more short quotation if you wish.

8. When your Professional Paper Worksheet Assignment is completed, save  and close the completed template. Click the Submit button at the top of  this page to upload your completed assignment.

The required sentence for quotation and citation  is located on page 65 in the first full paragraph in the second column.  The sentence begins with the words: Nurse leaders are in a unique  position…

The required sentence for paraphrasing and citation  is also located on page 65 in the second column underneath the heading  Promote a Growth Mindset. The sentence begins with the words:  Constructive feedback that is taken and put into practice can lead to…

Follow the directions on the Graded Assignment pages to complete each  assignment. Contact your instructor with any questions. Thank you.

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Case Study : Mr. C

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. C., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. C., a 32-year-old single male, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He currently works at a catalog telephone center. He reports that he has always been heavy, even as a small child, gaining approximately 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has sleep apnea and high blood pressure, which he tries to control by restricting dietary sodium. Mr. C. reports increasing shortness of breath with activity, swollen ankles, and pruritus over the last 6 months.

Objective Data:

  1. Height: 68 inches; weight 134.5 kg
  2. BP: 172/98, HR 88, RR 26
  3. 3+ pitting edema bilateral feet and ankles
  4. Fasting blood glucose: 146 mg/dL
  5. Total cholesterol: 250 mg/dL
  6. Triglycerides: 312 mg/dL
  7. HDL: 30 mg/dL
  8. Serum creatinine 1.8 mg/dL
  9. BUN 32 mg/dl

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. C.’s potential diagnosis and intervention(s). Include the following:

  1. Describe the clinical manifestations present in Mr. C.
  2. Describe the potential health risks for obesity that are of concern for Mr. C. Discuss whether bariatric surgery is an appropriate intervention.
  3. Assess each of Mr. C.’s functional health patterns using the information given. Discuss at least five actual or potential problems can you identify from the functional health patterns and provide the rationale for each. (Functional health patterns include health-perception, health-management, nutritional, metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception/self-concept, role-relationship, sexuality/reproductive, coping-stress tolerance.)
  4. Explain the staging of end-stage renal disease (ESRD) and contributing factors to consider.
  5. Consider ESRD prevention and health promotion opportunities. Describe what type of patient education should be provided to Mr. C. for prevention of future events, health restoration, and avoidance of deterioration of renal status.
  6. Explain the type of resources available for ESRD patients for nonacute care and the type of multidisciplinary approach that would be beneficial for these patients. Consider aspects such as devices, transportation, living conditions, return-to-employment issues.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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WK10 ASSIGN NURS 6630

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Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.

In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/

To prepare for this Assignment:
  • Review this week’s Learning Resources, including the Medication Resources indicated for this week.
  • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment: 5 pages

Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

  • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

  • Which decision did you select?
  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

  • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
  • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
  • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

  • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Week 10: Therapy for Patients With Impulsive/Substance Use Disorders (SUD)

Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things, such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat patients, you must understand how these disorders differ as well as how their symptoms impact patients and their families.

This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of patients with these disorders. You also consider ethical and legal implications of these therapies.

Learning Objectives

Students will:

  • Assess patient factors and history to develop personalized therapy plans for patients with impulsivity, compulsivity, and addiction
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for impulsivity, compulsivity, and addiction
  • Synthesize knowledge of providing care to patients presenting for impulsivity, compulsivity, and addiction
  • Analyze ethical and legal implications related to prescribing therapy for patients with impulsivity, compulsivity, and addiction

Learning Resources

Required Readings (click to expand/reduce)

Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series, no. 32. http://www.ncbi.nlm.nih.gov/books/NBK64350/
Chapter 1, “Substance Use Among Adolescents”
Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”
Chapter 7, “Youths with Distinctive Treatment Needs”University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control. Journal of Psychosocial Nursing & Mental Health Services, 54(4), 15.Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.xHulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology, 30(3), 164–172. https://doi.org/10.1002/hup.2467Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. https://doi.org/10.3928/00989134-20160314-04Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. https://doi.org/10.1080/15504263.2012.648439Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex. https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

  • naltrexone (revia/vivitrol)
  • naloxone
  • acamprosate
  • disulfiram

Required Media (click to expand/reduce)

Case Study: A Puerto Rican Woman with Comorbid Addiction 
Note: This case study will serve as the foundation for this week’s Assignment.Optional Resources (click to expand/reduce)

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. https://doi.org/10.1155/2014/537306

Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Select what you should do:

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeksAntabuse (disulfiram) 250 mg orally dailyCampral (acamprosate) 666 mg orally three times/day

Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection
  • Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
  • Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early
  • She is asking today for an increase the Valium dose or frequency

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student
Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.
The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.
Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.
Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).
Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.
You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

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Holistic Assessment of the Older Adult

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Part 2: **Signature Assignment**

Holistic Assessment of the Older Adult

This assignment is a voice over PowerPoint recording of 13-15 minutes.

For the PowerPoint and recorded presentation, create a presentation that addresses each of the following points/questions. Be sure to completely answer all the prompts or questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least four (4) scholarly sources throughout your presentation, referencing in APA style. Include title and references slides in the presentation. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Ensure that you have permission from your older adult to conduct the health assessment and ensure that they are not identified on the PPT. Review the Signature Assignment rubric criteria for this assignment.

Part 1: Assessment: Choose an adult (65 years or older) friend or relative and perform a holistic health assessment. Clearly discuss your discovered holistic health assessment data. Your assessment should include the following parts for the holistic assessment:

  • General Health History
  • Physiological Assessment
  • Psychological Assessment
  • Social Assessment
  • Cultural Assessment
  • Developmental Assessment
  • Spiritual Assessment

Part 2: Interpretation (Abnormality and Coping)

  • Choose one abnormality from the data gained in the assessments and discuss possible reasons/causes for the abnormality.
  • How does this abnormality impact the other areas of the patient’s life?
  • Discuss the client’s stress and coping mechanisms.
    • Are they healthy?
    • What recommendations and improvements could be made that are individualized for this person?

Part 3: Teaching Plan: Create a teaching plan that addresses the client holistically by applying the assessment data you have analyzed.

  • Describe at least one client goal for each of the six categories (each category should have a goal) (physical, psychological, social, cultural, developmental, and spiritual).
  • Discuss one strategy per goal you would use to teach your client about each individual goal
  • Explain how you will evaluate if your teaching was effective
    • Title Slide (1 slide)
    • Objective Slide (1 slide)
    • Assessment
      • General Health History (1slide)
      • Physical (1 slide)
      • Psychological (1 slide)
      • Social (1 slide)
      • Cultural (1 slide)
      • Developmental (1 slide)
      • Spiritual (1 slide)
    • Interpretation (Abnormality and Coping)
      • Abnormality, Reasons/Causes, Impact on Life (1 slide)
      • Stress, Coping, Recommendations (1 slide)
    • Teaching Plan
      • Physical Goal and Teaching Strategy (1 slide)
      • Psychological Goal and Teaching Strategy (1 slide)
      • Social Goal and Teaching Strategy (1 slide)
      • Cultural Goal and Teaching Strategy (1 slide)
      • Developmental Goal and Teaching Strategy (1 slide)
      • Spiritual Goal and Teaching Strategy (1 slide)
      • Evaluation Plan (1 slide)
    • References (1 slide)

Assignment Expectations:

Length: PPT of 19-21 slides; Recording 13-15 min

Structure: Include a title slide, objective slide, content slides, and reference slide in APA format. Recording is of PPT slides, with voice only.

References: Use appropriate APA style in-slide citations and references for all resources. A minimum of four (4) scholarly sources are required.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as an mp4 or share the link to the recording

File name: Name your saved file according to your first initial, last name, and the assignment number (for example RHall Assignment 1.docx)

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Week 3 discussion form: peer review for scientific and mathematical analytic inquiry draft

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Post a draft of your scientific and mathematical/analytical inquiry paper for peer review. You should also post your level 1 and level 2 research questions. Identify any questions or challenges you faced with the assignment, or mention something new you learned about the research question and inquiry paper process. Pose specific questions you would like your peers to address.

Level 1 Research Questions/Writing Prompts
SCIENTIFIC Perspective of Inquiry

  • What are the anatomical, physiological, pathological, or epidemiological issues?
  • Which body systems are affected?
  • What happens at the cellular or genetic level?
  • Which chemical or biological issues are most important?

Level 2 Research Questions/Writing Prompts
MATHEMATICAL/ANALYTICAL Perspective of Inquiry

  • What are the economic issues involved?
  • Which economic theories or approaches best explain the issue?
  • What are the statistical facts related to the issue?
  • Which statistical processes used to study the issue provide for the best explanation or understanding?

Posting directions: Title your post with your name (e.g., Jenny Smith Scientific/Math Inquiry Paper) and write in your submission or attach a document for peer review.

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Assessment 2 Instructions: Quality Improvement Initiative Evaluation

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Deliver to the interprofessional team a presentation (20 minutes; 12-15 slides) that analyzes an existing workplace quality improvement initiative related to a specific disease, condition, or public health issue of interest. The presentation’s purpose is to inform and get buy-in from the interprofessional team.

Introduction

Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—various groups talking among themselves about results and enhancements. Nurses are critical to the delivery of high-quality, efficient health care. As a result, they must develop their skills in reviewing and evaluating performance reports. They also need to be able to communicate outcome measures related to quality initiatives effectively. Patient safety and positive institutional health care outcomes mandate collaboration among nursing staff members to ensure the integration of their perspectives in all quality care initiatives.

In this assessment, you will have the opportunity to analyze a quality improvement initiative in your workplace. You will then present your analysis to a group of nurses and other health care professionals. The purpose of your presentation is to inform and enlist support for the initiative from your audience.

Preparation

Quality Initiative Selection

In this assessment you will deliver an analysis of an ongoing quality improvement initiative in your workplace. The initiative you analyze must relate to a specific disease, condition, or public health issue of personal or professional interest to you. The purpose of your analysis is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Your audience consists of nurses and selected health care professionals with specializations or interest in your selected condition, disease, or issue. You hope to inform and garner support for the initiative from your audience.

Recording Your Presentation

To prepare to record a voice-over for your presentation:

  • Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.
  • Practice using the equipment to ensure the audio quality is sufficient.
  • Consult Using Kaltura for guidance on how to record your presentation and upload it in the courseroom.
  • Microsoft PowerPoint also allows you to record your narration with your slides. If you choose this option, simply submit your presentation to the appropriate area of the courseroom. Your narration will be included with your slides.
  • Remember to practice delivering and recording your presentation multiple times to ensure effective delivery.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services at DisabilityServices@Capella.edu to request accommodations.

Instructions

The optional QI Initiative Evaluation Presentation Template [PPTX] is provided to help you prepare your slides. If you choose to work without the template, consider referring to Guidelines for Effective PowerPoint Presentations [PPTX].

In your presentation, you will:

  • Analyze a current quality improvement initiative in a health care or practice setting according to strategic organizational initiatives.
    • Explain the rationale behind the QI improvement initiative. What prompted the initiative?
    • Detail problems that were not addressed and any issues that arose from the initiative.
  • Evaluate the success of a current quality improvement initiative according to recognized national benchmarks.
    • Analyze the benchmarks used to evaluate success. Which aspects of the initiative were most successful? What outcome measures are missing or could be added?
    • Incorporate one appropriate supporting visual (such as a graph or chart) that showcases the most critical aspect of this presentation.
  • Incorporate interprofessional perspectives related to initiative functionality and outcomes.
  • Integrate the perspectives of interprofessional team members involved in the initiative. Who did you talk to? What are their professions? How did their perspectives impact your analysis?
  • Recommend additional indicators and protocols to improve and expand outcomes of a quality initiative.
    • Identify specific process or protocol changes as well as technologies that would improve quality outcomes.
  • Ensure slides are easy to read and error free. Provide detailed speaker notes. Also ensure audio is clear, organized, and professionally presented.
  • Organize content with clear purpose/goals and with relevant and evidence-based sources (published within 5 years).

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Summary and Descriptive Statistics

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There is often the requirement to evaluate descriptive statistics for data within the organization or for health care information. Every year the National Cancer Institute collects and publishes data based on patient demographics. Understanding differences between the groups based upon the collected data often informs health care professionals towards research, treatment options, or patient education.

Using the data on the “National Cancer Institute Data” Excel spreadsheet, calculate the descriptive statistics indicated below for each of the Race/Ethnicity groups. Refer to your textbook and the Topic Materials, as needed, for assistance in with creating Excel formulas.

Provide the following descriptive statistics:

  1. Measures of Central Tendency: Mean, Median, and Mode
  2. Measures of Variation: Variance, Standard Deviation, and Range (a formula is not needed for Range).
  3. Once the data is calculated, provide a 150-250 word analysis of the descriptive statistics on the spreadsheet. This should include differences and health outcomes between groups.

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Pressure Injury: Prevention

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EVIDENCE- BASED CARE SHEET

ICD-9 707.0

ICD-10 L89

Authors Tanja Schub, BS

Cinahl Information Systems, Glendale, CA

Eliza Schub, RN, BSN Cinahl Information Systems, Glendale, CA

Reviewers Eva Beliveau, RN, MSN, CNE

Professor of Nursing, Northern Essex Community College

Gina DeVesty, BSN, MLS Cinahl Information Systems, Glendale, CA

Nursing Executive Practice Council Glendale Adventist Medical Center,

Glendale, CA

Editor Diane Hanson, MM, BSN, RN, FNAP

August 13, 2021

Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2021, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

Pressure Injuries: Prevention Strategies

What We Know › Pressure injuries (PIs ; Figure 1 )—referred to as “pressure ulcers” until the change in

terminology by the National Pressure Ulcer Advisory Panel (NPUAP; 2016) and also referred to as decubitus ulcers, pressure sores, or bedsores—are localized, oftentimes painful, areas of damaged skin and/or underlying soft tissue resulting from prolonged or intense pressure or a combination of pressure and shear. The skin at the site of a PI can be intact or the injury can appear as an open ulcer. PIs usually occur over bony prominences or in areas where medical or other devices or surfaces exert prolonged pressure against the skin. Factors that can potentiate the injurious effects of pressure and shear include prolonged skin moisture, poor nutrition, and poor perfusion.(11) (For details, see Quick Lesson About … Pressure Injuries: an Overview )

Figure 1: Graphic illustrating four of the eight pressure injury classifications established by the National Pressure Ulcer Advisory Panel (NPUAP).

Additional categories include Unstageable, Deep Tissue, Medical Device Related, and Mucosal Membrane Pressure Injury. Copyright©

Nanoxyde, 2008. Licensed under Creative Commons Attribution-Share Alike 3.0 Unported, 2.5 Generic, 2.0 Generic and 1.0 Generic License

• Of note, the majority of current literature does not yet reflect the NPUAP’s recent change in terminology; it is expected that the termpressure injury will gradually replace pressure ulcer anduse of Arabic numerals to identify PIs stagesinstead of Roman numeral,as acknowledgement of the change becomes widespread(1)

–The European Pressure Ulcer Advisory Panel (EPUAP) continues to support the guidelines issued in 2014 and has not yet adopted the new terminology and pressure ulcer classification system propounded by NPUAP in April 2016(8)

• PI risk factors include older age, impaired mobility, physical inactivity, being subject to friction and shear, moisture, low body mass index (BMI) and/or poor nutritional status (especially low protein intake), dehydration, incontinence, sensory loss, cognitive impairment, certain medical conditions (e.g., diabetes mellitus, [DM] peripheral vascular

 

 

disease [PVD], stroke, and spinal cord injury [SCI]), drugs that affect wound healing (e.g., corticosteroids), hip fracture, smoking, and need for assisted ventilation(4,5,6,10,14)

• PIs are associated with a decrease in quality of life and a 1-yearmortality rate that approaches40%(14)

• Up to 95% of PIs are thought to be preventable(15)

–As of 2008, the Centers for Medicare & Medicaid Services (CMS) in the United States no longer reimburses facilities for treatment of facility-acquired Stage 3 and 4 PIs(2)

› Standard prevention strategies include risk assessment using standardized PI risk assessment tools (e.g., Braden scale), skin care, frequently redistributing pressure (particularly over bony prominences) by frequent repositioning, maintaining good hygiene, minimizing moisture (especially that caused by incontinence), management of incontinence by scheduled toileting plans, use of mattresses and/or cushions to reduce/relieve pressure, preventing skin damage through use of topical agents (e.g., creams, ointments) or dressings, avoiding over-sedation, and optimizing nutrition(4,5,6,9,10,14,15)

• PI risk assessment scales have low to modest predictive ability and Cochrane reviewers found no reliable evidence demonstrating that the use of structured risk assessment tools reduces the incidence of PIs(13)

• Although the value of regular patient repositioning in reducing the risk of developing PIs has been confirmed, and clinical practice guidelines commonly recommend patient repositioning every 2 hours, the optimal frequency for repositioning has not been established in clinical trials(6)

• Cochrane reviewers analyzed 59 randomized trials and found evidence that(9)

–constant low-pressure support surfaces reduce the incidence of PIs compared to standard foam mattresses –sheepskin mattress overlays reduce the incidence of PIs –pressure-relieving overlays on the operating table reduce the incidence of PIs –alternating pressure mattresses reduce the incidence of PIs compared to standard foam mattresses –alternating pressure mattresses and constant low-pressuresupport surfaces have similar efficacy for reduction of PIs –alternating pressure mattresses and alternating pressure overlays have similar efficacy for reduction of PIs –addition of a Jay Gel cushion to foam wheelchair cushions reduces PI risk

• Cochrane reviewers of256 recent studies for the prevention and treatment of PI report the focus on repositioning, nutrition, and support surfaces continue to be major recommendations(13)

• Although malnutrition is associated with increased PI risk, there is insufficient evidence to support the routine use of vitamin C and zinc supplementation to reduce PI risk(6)

• Authors of a recent systematic review found no evidence supporting the use of any behavioral or educational interventions for PI prevention in adults with SCI(3)

–Researchers in South Korea randomized 47 patients with SCI to a self-efficacy enhancement program or a control group. Patients in the intervention group had greater improvements in self-care knowledge, self-efficacy, and self-carebehaviors for PI prevention. However, there was no significant difference in incidence of PIs between the groups(7)

› The prevalence of PIs in U.S. facilities has declined over the last decade(12)

• Researchers who conducted the International Pressure Ulcer Prevalence Survey, a 10-year study of 918,621 inpatients in the U.S., observed that the overall prevalence of PIs declined from 13.5% in 2006 to 9.3% in 2015. The prevalence of facility-acquired PIs declined from 6.2% in 2006 to 3.1–3.4% in 2013–2015(12)

What We Can Do › Learn more about PI prevention so you can accurately assess your patients’ personal characteristics and health education

needs; share this knowledge with your colleagues(5)

› Collaborate with an interdisciplinary healthcare team at your facility to develop a PI prevention plan to reduce the risk for PI development

› Assess PI risk and skin condition(6,14)

• On admission, assess for skin compromise, especially at bony prominences; signs of recent trauma; effects of friction or shear; immobility and/or functional incapacity; factors that influence healing (e.g., nutritional status); and incontinence. Ask about medical history (including previous treatments or surgeries); and measure body weight(6)

• Reassess risk daily in acute care settings, at each home care visit, and weekly in long-term care settings

 

 

–Use a valid risk assessment scale (e.g., Braden Scale for Predicting PI Risk; the most widely used risk assessment tool according to facility protocol(6,14)

– Risk assessment tools permit routine organized assessment of the skin and factors related to skin integrity › Optimize nutrition and hydration(6)

• Request referral to a registered dietitian for patient evaluation and recommendation of specific amounts of proteins, calories, fluids, electrolytes, and micronutrients –Provide liquid nutritional supplements, enteral nutrition, or total parenteral nutrition, as prescribed

• Perform ongoing nutritional assessment –Use of a standardized nutrition assessment tool, such as the Mini Nutritional Assessment (MNA), can assist in

determining the extent of malnutrition • Assess body composition (height and weight), and for alteration in laboratory values (e.g., serum albumin, prealbumin, and

Hgb), which can indicate malnutrition › Manage moisture and maintain skin integrity—cleanse and dry skin after each incontinent event; use noncytotoxic cleansers

to avoid drying or irritating skin; do not rub the skin(14)

• For incontinent patients, use special supplies (e.g., topical skin barriers, a pouching system, or indwelling catheters) and frequently inspect skin

• For patients with dry skin, use moisturizer frequently because dry skin is more susceptible to breakdown › Minimize pressure, friction, and shear(6,14)

• Use heel protective devices (Figure 2) for patients at high-risk for PIs • Provide a pressure-redistributing support surface instead of a standard mattress, per clinician orders or facility protocol

(Figure 3)

Figure 2: The convoluted foam of the heel protector increases cushioning, promotes air circulation, and dissipates heat for protection against skin breakdown. Copyright ©2015, EBSCO Information Services

 

 

Figure 3: Example of continuous pressure air-suspension mattress overlay that is utilized to reduce the risk for pressure injury development. Copyright© 2014, EBSCO Information Services

• Use lift sheets, overhead trapeze bars, and hoists; do not drag or pull the patient • Reposition the patient frequently

–Turn the patient every 1–2 hours using a hoist, trapeze, or lift sheet –Use pressure-redistributing devices (e.g., pillows, wedges) to reduce pressure on bony prominences; frequently evaluate

their effectiveness – Avoid use of donut-type ring cushions as support devices because they can increase the size of the PI by causing further

ischemia rather than reducing risk for PI development –Do not massage bony prominences (6)

› Educate patient and family about PI etiology, risk factors, and prevention strategies (e.g., good nutrition, regular inspection of skin, frequent repositioning), and when to seek medical attention

Coding Matrix References are rated using the following codes, listed in order of strength:

M Published meta-analysis

SR Published systematic or integrative literature review

RCT Published research (randomized controlled trial)

R Published research (not randomized controlled trial)

C Case histories, case studies

G Published guidelines

RV Published review of the literature

RU Published research utilization report

QI Published quality improvement report

L Legislation

PGR Published government report

PFR Published funded report

PP Policies, procedures, protocols

X Practice exemplars, stories, opinions

GI General or background information/texts/reports

U Unpublished research, reviews, poster presentations or other such materials

CP Conference proceedings, abstracts, presentation

References 1. Black, J.M., Goldberg, M., McNichol, L., & Moore, L. (2016). Revised national pressure ulcer advisory panel pressure injury staging system: Revised pressure injury staging

system. Journal of wound, ostomy, and continence nursing, 43(6), 585-597. doi:10.1097/WON.0000000000000281 (G)

2. Centers for Medicare & Medicaid Services. (2020, February 11). Hospital-acquired conditions. Retrieved June 15, 2020, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html (GI)

3. Cogan, A. M., Blanchard, J., Garber, S. L., Vigen, C., Carlson, M., & Clark, F. A. (2017). Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clinical Rehabilitation, 31(7), 871-880. doi:10.1177/0269215516660855 (SR)

4. Doh, G., & Heo, C.Y. (2021). Pathogenesis and prevention of pressure ulcer. Journal of the Korean Medical Association, 64(1), 16-25. doi:10.5124/jkma.2021.64.1.16 (RV)

5. Dunk, A. M., & Carville, K. (2016). The international clinical practice guidelines for prevention and treatment of pressure ulcers/injuries. Journal of Advanced Nursing, 72(2), 243-244. doi:10.1111/jan.12614 (G)

6. European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance. (2016). Prevention and treatment of pressure ulcers: Quick reference guide. Retrieved June 15, 2021, from http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf (G)

7. Kim, J. Y., & Cho, E. (2017). Evaluation of a self-efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury. Japan Journal of Nursing Science, 14(1), 76-86. doi:10.1111/jjns.12136 (RCT)

8. Markova, A. (2019). Pressure ulcer terminology. European Pressure Ulcer Advisory Panel. Retrieved June 15, 2021, from http://www.epuap.org/news/pressure-ulcer-terminology/ (GI)

9. McInnes, E., Jammali-Blasi, A., Bell-Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD001735. doi:10.1002/14651858.CD001735.pub5 (M)

10. National Institute for Health and Care Excellence (NICE). (2015). Pressure ulcers. Retrieved June 25, 2021, from https://www.nice.org.uk/guidance/qs89/resources/pressure-ulcers-pdf-2098916972485 (G)

 

 

11. National Pressure Ulcer Advisory Panel. (2016, April 13). National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury. Retrieved June 15, 2021, from http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-injury-and-updates-the-stages-of-pressure-injury/ (G)

12. VanGilder, C., Lachenbruch, C., Algrim-Boyle, C., & Meyer, S. (2017). The International Pressure Ulcer Prevalence™ Survey: 2006-2015: A 10-year pressure injury prevalence and demographic trend analysis by care setting. Journal of Wound, Ostomy, and Continence Nursing, 44(1), 20-28. doi:10.1097/WON.0000000000000292 (R)

13. Walker, R.M., Gillespie, B.M., Mcinnes, E., Moore, Z., Eskes, A.M., Patton, D., & Chaboyer, W. (2020). Prevention and treatment of pressure injuries: A meta-sythesis of Cochrane Reviews. Journal of Tissue Viability, 29(4), 227-243. doi:10.1016/j.jtv.2020.05.004 (M)

14. Welesko, M.-B., & Javier, N. M. (2018). Pressure injury. In F. F. Ferri (Ed.), 2018 Ferri’s clinical advisor: 5 books in 1 (pp. 1056-1058). Philadelphia, PA: Elsevier. (GI)

15. Zack, A. M. (2018). Pressure ulcer. In F. J. Domino (Ed.), The 5-minute clinical consult 2018 (26th ed., pp. 808-809). Philadelphia, PA: Wolters Kluwer. (GI)

 

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Nursing homework help

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An 86-year-old male parishioner is on hospice care at home, and his daughter, who is a nurse, has been trying to meet all his physical needs around the clock. The pastor, who made a home visit, calls the faith community nurse to express his concern that the daughter is becoming “burned out.” How can the faith community nurse engage the faith community as a whole to provide volunteer support to this family?

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Reply 1:Me

The faith community nurse can educate community members and facilitate group learning, especially in disease management and faith, wellness concerns, and behavior that affects the community’s population. This would motivate community members to support the family, therefore decreasing the workload for the daughter of the patient. The nurse can encourage the population by requesting support through expounding the points of view and making people to ”understand” another perspective (Balint, 2015). Advocacy can come in many forms, and it may include prayers with or for clients and their families. By advocating and requesting support from the community, the community can sympathize with the patient’s family, thus offering their support.

By liaising between the patient and the community of faith, the caregiver can influence access to health services and support networks in the local community (Balint, 2015). This leads to better management and coordination of care to the patient with the help of the community. The community can be engaged by educating and organizing volunteers to support the patient. Through this, the community members can offer their voluntary services with ease, giving the patient’s daughter an easy time.

As a community member, the nurse can work to provide the patient with care and limit complications. He/she can be a role model, which can then encourage the community to offer their services voluntarily. By forming partnerships with other communities, there can be a promotion of health and achievement of goals concerning the patient. Faith community nurses are a group of committed individuals who practice nursing in faith-based individuals. Their ability to convince the community to offer voluntary services is vital to patient care and the community’s overall wellbeing.

 

Professor question: Burn out is a serious condition that can lead to both care giver health problems and patient safety issues. It is critically important to recognize the initial signs of “burning out” condition and timely address the issue. There are multiple ways to lesser the pressure and stress of a care giver. Those include minimizing the work load by eliminating some duties; this can be achieved by introducing additional caregiver or another family member. In addition, one can introduce stress reliving activities such as massage chair, relaxing music, or just taking an extra outside walk, even reading an inspirational book. But the main help would definitely come from the faith community who can and should support the family both with physical help and spiritually.

What are other specific ways they can reduce stress and burn out?

Reply 2: Deneshia

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The faith community nurse plays a lot of role in the community when it comes mostly to anything to do with the homecare. The faith community nurses’ role is so many depending on what is needed at a particular time in society. Most of the faith community nurses usually come from health ministry transformation, which means that just like all the ministry personnel, their in the society to make it a better place by empowering people to do many things. They bring health solutions to the community and most of all empowering the community to ways in which can make the society at large to be more successful.

In this way, the faith community nurse is usually trusted by all communities. In most cases, the community will always be ready to help the faith community nurse do things (Brown, 2016). For the 86-year-old male parishioner who needs home care, the community can be convinced to provide volunteer support to the family in different ways. The first way in which a faith community nurse can do to convince the faith community as a whole by simply teaching and explaining to them what the older man is suffering from; in doing that, the nurse should also explain the condition of the family and prove that the family needs support.

Also, the faith community nurse has the role of being a coordinator of the health ministry volunteers. The nurse can take advantage of that and make the faith community at large intervene in the volunteering of the older man who needs the community’s support. Finally, the faith community nurse can start by helping the family; these will set an example for the reset, and eventually, they will all come in and support the older man and all the family at large. The faith community nurse should be a trusted person meaning that the community will entrust their love ones health in their hands.

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