Women Health – Week 6 Discussion 2nd REPLY

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 – Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  

Discussion:

Discuss the questions that would be important to include when interviewing a patient with this issue

Kayla is a 16-year old female who presents with complaints of pelvic pain and previously diagnosed with pelvic inflammatory disease. When interviewing an adolescent presenting with these symptoms, it is crucial to ask questions related to social history in privacy (Smorgick & As-Sanie, 2018). Such questions should cover the home situation, school and other activities and potentially sensitive domains of substance abuse, sexual activity, depression, eating behaviors, and safety. In particular, it would be important to ask whether she had experienced any sexual assault in school or at home and if any, whether she noticed any bleeding during the assault. Another important question to ask is whether she has noticed any discharge and the color of the discharge. A normal vaginal discharge is clear and usually odorless. However, changes in the color, amount, or smell of the vaginal discharge may indicate a problem. For example, a white discharge that is clumpy and looks similar to cottage cheese may be a sign of yeast infection, which may cause symptoms such as burning on urination or vaginal itching. Similarly, a yellow/green discharge can be a sign of STIs or bacterial infection, and which can cause pain in the pelvic (Stratton, 2019).

Describe the clinical findings that may be present in a patient with this issue

The most common symptom of pelvic inflammatory disease is pain or tenderness in the stomach or lower abdomen. Other symptoms include abnormal vaginal discharge, usually yellow or green with an unusual odor, fever, tiredness, pain and bleeding during sex, burning sensation upon urination, and pain in the upper abdomen. Other clinical findings include tenderness of fallopian tubes and ovaries and tenderness of the cervix.

Are there any diagnostic studies that should be ordered on this patient? Why?

There are several diagnostic studies that should be ordered on this patient. A pelvic exam should be ordered first to examine her reproductive organs and look for signs of infection. Vaginal culture can also be taken to check possible bacteria, while the urine test may help to rule out urinary tract infection, which causes similar pelvic pain. Also, the doctor could order for an ultrasound to get clearer images of the reproductive system or CT scans to help detect abnormal structures or growth. Another diagnostic study to be ordered is laparoscopy to view the pelvic organs and check for abnormal tissues or signs of infection.

List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each

Primary diagnosis – Pelvic inflammatory disease – The patient is sexually active and admits to having multiple sexual partners without using a condom. Besides, she has admitted pain and tenderness in the lower abdomen.

Differential diagnoses

Urinary tract infection – Having multiple sexual partners and sometimes without a condom could have caused urinary tract infection.

Ovarian torsion – The patient has come with symptoms of severe pelvic pain that she rates as 10 out of 10.

Endometriosis – The patient admits abdominal cramping and pain in the lower abdomen and pelvis.

Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

The main goal in the management plan of this patient is to alleviate symptoms and improve her quality of life. The patient needs some pain relievers such as ibuprofen or acetaminophen to provide partial relief from her pelvic pain. The patient may also need some antibiotics to help in case of any infection. In addition, the patient may be prescribed antidepressants to help improve the pelvic pain. Also, the patient needs to be educated about the benefits of practicing safe sex, particularly using condoms every time she has sex and to limit the number of sexual partners (Sanfilippo et al., 2019). She should also be advised to make an appointment for regular screening of sexually transmitted diseases and request her partners to be also tested. Also, the patient can be referred to physical therapists to help her develop coping strategies for the pain. Such include stretching exercises, massage, and other relaxation techniques.

References

Stratton, P. (2019). Evaluation of acute pelvic pain in non-pregnant adult women. UpToDate. Updated May, 9.

Sanfilippo, J. S., Smith, J. P., & Solnik, M. J. (2019). Chronic pelvic pain and endometriosis. In Sanfilippo’s Textbook of Pediatric and Adolescent GynecologySecond Edition (pp. 214-228). CRC Press.

Smorgick, N., & As-Sanie, S. (2018, March). Pelvic pain in adolescents. In Seminars in reproductive medicine (Vol. 36, No. 02, pp. 116-122). Thieme Medical Publishers.

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Assigment

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Effective Approaches in Leadership and Management 

            

In this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

  1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
  2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
  3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
  4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
  5. Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
  6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.1:       Exemplify professionalism in diverse health care settings.

1.3:       Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

3.4:       Demonstrate professional standards of practice

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Discussion 04.2: Shifting the Burden of Proof

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Discussion 04.2: Shifting the Burden of Proof

 Read the Discussion 04.2 Scenario. Refer to this scenario to answer the questions below.

1.Discuss why the doctrine of res ipsa loquitur would apply in this case. What are the elements of the doctrine, and how do the facts of this case satisfy those elements?

2.How would shifting the burden of proof from the plaintiff to the defendants using res ipsa loquitur be helpful? Would the plaintiff be able to make a normal case for negligence without being able to prove exactly what took place while he was unconscious during surgery? 

SCENARIO (BASED ON A REAL MISSOURI CASE)

At a local Missouri hospital a patient had a total right knee replacement (arthoplasty) under general

anesthesia. However, upon awakening from the anesthesia, he immediately experienced pain in his

right hand, arm and shoulder which was not present before the surgery. This was not an expected

complication from the procedure. The patient sued the hospital and the surgeon for medical

malpractice.

The patient, being under anesthesia during the entire procedure, has no idea what went wrong during

the procedure. The medical records also do not shed light on the matter, and there was no video

recording of the procedure.

The hospital immediately moves to dismiss the case, arguing that the complaint failed to make a

submissible case of negligence, because the he has failed to allege exactly how any hospital employees

breached the duty of care. The plaintiff argues that the case should proceed, because the doctrine of res

ipsa loquitur applies. The judge agrees, overrules the motion to dismiss, and the case proceeds to trial.

(Note: If you would like to see the real case this scenario is based upon, check out Zumwalt v. Koreckij,

24 S.W.3d 166 (Mo.App. E.D. 2000). Be warned—the scenario has altered the facts from the original

case. Do not rely upon the real case opinion in formulating your answer to the fictional scenario in the

discussion question.)

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Role of the Professional Nurse in Health Policy

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Write a paper on the role of the professional nurse in health policy. 

  1. Discuss the professional nurse’s role in health policy.
  2. Identify an action plan for nurses to increase involvement.

 

Submission Instructions:

  • The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
  • The paper is to be no shorter than 5 pages; nor longer than 7 pages in length, excluding the title, abstract and references page.
  • Your paper should be formatted per APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions).
  • Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to current APA style (the library (Links to an external site.) has a copy of the APA Manual).

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Discussion 4: SWOT BLOCKS

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HA4110D – Healthcare Planning and Evaluation

Discussion 4: SWOT BLOCKS

 a minimum of 2 responses.

No responses are accepted after the close of the live week.

We see SWOT presented in a 4 block matrix:

Internal: S/W

External: O/Th

Choose a department in a hospital, such as labor and delivery, orthopedic floor, emergency department; and provide an analysis that involves both internal and external matrices.

Use a valid healthcare organizations department, you can use your organization department as an example as well.

*Reminder the workbook is NOT your resource for any paper, discussion after week 1. *

Valid healthcare content is necessary

Use an outside resource for your initial post. Seek information through healthcare news articles and journals. Write in third person and do not use “I think or in my opinion”. Keep your information factual and follow APA standards on referencing. Please use the NAU Library APA guide for assistance. 

Strategic Analysis for Healthcare: Concepts and Practical Applications–Vitalsource [email protected]#magicMAN61

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psychopharma

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  1.  Stephanie is a 36-year-old female who presents to the clinic with a  history of anxiety. Social history is unremarkable. For the last 4  years, she has been well controlled on paroxetine, however she feels “it  just doesn’t work anymore.” You have decided to change her medication  regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day  based on tolerability. The patient asks, “When can I expect this to  start kicking in?” The best response is:
                      a.   3 or 4 days                   b.   1 or 2 weeks                   c.   3 or 4 weeks                   d.   10 weeks            

3.75 points   

            Question 2       

  1.   Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?
                      a.   haloperidol                   b.   lorazepam                   c.   benztropine                   d.   chlorpromazine            

3.75 points   

            Question 3       

  1.   Sam is a 48-year-old male who presents to the clinic with signs  and symptoms consistent with GAD & MDD. Which of the following  medications would be the LEAST appropriate choice when initiating  pharmacotherapy?
                      a.   duloxetine                   b.   sertraline                   c.   mirtazapine                   d.   buproprion            

3.75 points   

            Question 4       

  1.   Jason is a 6-year-old child whose mother presents to the clinic  with him. The mother says that “he’s not himself lately.” After a  thorough workup, you diagnose the patient as having GAD. Which of the  following medications would be the LEAST appropriate to prescribe to  this child?
                      a.   Sertraline                   b.   Paroxetine                   c.   Venlafaxine                   d.   Buspirone            

3.75 points   

            Question 5       

  1.   Mirza is a 75-year-old patient with a long history of  schizophrenia. During the past 5 years, she has shown significant  cognitive decline consistent with dementia. The patient has been well  controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most  appropriate course of action for this patient is:
                      a.   Increase the risperidone to 1mg QAM, 2mg QPM                   b.   Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna.                   c.   Discontinue risperidone and initiate therapy with clozapine.                   d.   Augment the patient’s risperidone with brexpiprazole.            

3.75 points   

            Question 6       

  1.   Amber is a 26-year-old female who presents to the clinic 6 weeks  postpartum. The patient states that she has been “feeling down” since  the birth of her son. She is currently breastfeeding her infant. You  diagnose the patient with Postpartum depression. Which of the following  is the LEAST appropriate option in treating her PPD?
                      a.   paroxetine                   b.   escitalopram                   c.   citalopram                   d.   sertraline            

3.75 points   

            Question 7       

  1.   Jordyn is a 27-year-old patient who presents to the clinic with  GAD. She is 30 weeks pregnant and has been well controlled on a regimen  of sertraline 50mg daily. Jordyn says that “about once or twice a week  my husband really gets on my nerves and I can’t take it.” She is opposed  to having the sertraline dose increased due to the risk of further  weight gain. You have decided to prescribe the patient a short-term  course of benzodiazepines for breakthrough anxiety. Which of the  following is the LEAST appropriate benzodiazepines to prescribe to this  patient?
                      a.   diazepam                   b.   alprazolam                   c.   clonazepam                   d.   lorazepam            

3.75 points   

            Question 8       

  1.   Steve is a 35-year-old male who presents to the primary care  office complaining of anxiety secondary to quitting smoking cold turkey 2  weeks ago. The patient has a 14-year history of smoking two packs per  day. The patient has an unremarkable social history other than a recent  divorce from his wife, Brittany. Which of the following would be the  LEAST effective medication to treat Steve’s anxiety?
                      a.   Buproprion                   b.   Sertraline                   c.   Varenicline                   d.   Alprazolam            

3.75 points   

            Question 9       

  1.   Rebecca is a 32-year-old female who was recently prescribed  escitalopram for MDD. She presents to the clinic today complaining of  diaphoresis, tachycardia, and confusion. The differential diagnosis for  this patient, based on the symptoms presenting, is:
                      a.   Panic disorder                   b.   Gastroenteritis                   c.   Abnormal gait                   d.   Serotonin syndrome            

3.75 points   

            Question 10       

  1.   The patient in the previous question states, “I can’t even last 1  more day without feeling like my insides are going to explode with  anxiety.” The most appropriate course of action would be:
                      a.   Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.                   b.   Prescribe a short-term course of low dose benzodiazepine, such as alprazolam.                   c.   Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.                   d.   Recommend in-patient mental health for the foreseeable future.            

3.75 points   

            Question 11       

  1.   John is a 41-year old-patient who presents to the clinic with  diarrhea, fatigue, and recently has been having tremors. He was  diagnosed 19 years ago with bipolar disorder and is currently managed on  Lithium 300mg BID. As the PMHNP, you decide to order a lithium level  that comes back at 2.3mmol/l. What is the most appropriate course of  action?
                      a.   Investigate other differential diagnoses for his symptoms.                   b.   Tell John to skip his next four Lithium doses and resume therapy.                   c.   Tell John he needs to go to the hospital and call an ambulance to bring him.                   d.   Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors            

3.75 points   

            Question 12       

  1.   Mark is a 46-year-old male with treatment-resistant depression. He  has tried various medications, including SSRIs, SNRI, and TCAs. You  have decided to initiate therapy with phenelzine. Which of the following  must the PMHNP take into consideration when initiating therapy with  phenelzine?
                      a.   There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.                   b.   Patient must be counseled on dietary restrictions.                   c.   MAOIs may be given as an adjunctive therapy with SSRIs.                   d.   A & B                   e.   All of the above            

3.75 points   

            Question 13       

  1.   Thomas is a 28-year-old male who presents to the clinic with signs  and symptoms consistent with MDD. He is concerned about starting  antidepressant therapy, however, because one of his friends recently  experienced erectile dysfunction when he was put on an antidepressant.  Which of the following would be the most appropriate antidepressant to  start Thomas on?
                      a.   Vilazodone                   b.   Sertraline                   c.   Paroxetine                   d.   Citalopram            

3.75 points   

            Question 14       

  1.   Melvin is an 89-year-old male who presents to the clinic with  signs/symptoms consistent with MDD. Which of the following would be the  LEAST appropriate medication to prescribe to this elderly patient?
                      a.   nortriptyline                   b.   amitriptyline                   c.   desipramine                   d.   trazodone            

3.75 points   

            Question 15       

  1.   Jane is a 17-year-old patient who presents to the office with  signs consistent with schizophrenia. She states multiple times that she  is concerned about gaining weight, as she has the perfect prom dress  picked out and she finally got a date. Which of the following is the  least appropriate choice to prescribe Jane?
                      a.   Aripiprazole                   b.   Olanzapine                   c.   Haloperidol                   d.   Brexpiprazole            

3.75 points   

            Question 16       

  1.   Richard is a 54-year-old male who suffers from schizophrenia.  After exhausting various medication options, you have decided to start  him on Clozapine. Which of the statements below is true regarding  Clozapine?
                      a.   Regular blood monitoring must be performed to monitor for neutropenia.                   b.   Clozapine can only be filled by a pharmacy that participates in the REMS program.                   c.   Bradycardia is a common side effect of Clozapine.                   d.   A & B                   e.   All of the above            

3.75 points   

            Question 17       

  1.   Cindy is a 55-year-old patient who presents with symptoms  consistent with Generalized anxiety disorder. The patient has an  unremarkable social history other than she consumes two or three glasses  of wine per night. Which of the following would be an appropriate  therapy to start this patient on?
                      a.   Xanax 0.25mg BID PRN Anxiety                   b.   Escitalopram 10mg daily                   c.   Buspirone 10mg BID                   d.   Aripiprazole 10mg daily            

3.75 points   

            Question 18       

  1.   Martin is a 92-year-old male who presents to the clinic with  signs/symptoms consistent with MDD. The patient suffers from glaucoma  and just recently underwent surgery for a cataract. Which of the  following is the LEAST appropriate course of therapy when treating the  MDD?
                      a.   sertraline                   b.   amitriptyline                   c.   duloxetine                   d.   vilazodone            

3.75 points   

            Question 19       

  1.   Which of the following statements are true?
                      a.   First-generation (typical) antipsychotics are associated with a higher incidence of EPS.                   b.   Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects.                   c.   There is evidence that atypical  antipsychotics are significantly more effective than typical  antipsychotics in the treatment of cognitive symptoms associated with  schizophrenia.                   d.   A & B                   e.   A, B, and C            

3.75 points   

            Question 20       

  1.   Earle is an 86-year-old patient who presents to the hospital with a  Community Acquired Pneumonia. During stay, you notice that the patient  often seems agitated. He suffers from cognitive decline and currently  takes no mental health medications. Treatment for the CAP include  ceftriaxone and azithromycin. The LEAST appropriate medication to treat  Earle’s anxiety is:
                      a.   sertraline                   b.   duloxetine                   c.   citalopram                   d.   venlafaxine            

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Discussion 5

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  • Select the chapter from this week’s readings that relates to your work environment and/or emergency preparedness.
  • How do you see health policy impacting nursing practice in that arena?

FYI: I work in a nursing home

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

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Assignment 04: Introduction to SWOT-EFE

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Assignment 04: Introduction to SWOT-EFE

Assignment

 

Task: Submit to complete this assignment

Directions

READ Chapters 9, 10 and 17 of the textbook.

REVIEW PowerPoints for chapters 9, 10 and 17 of the textbook.

COMPLETE exercises for chapters 9, 10 and 17 of the textbook.

Using your chosen organization, write a two-page paper with the external factors that could either now or in the future affect your organization. Consider the critical success factors that pertain to the external environment.

Use the SWOT analysis exercise on page 63 of the textbook to assist in your paper writing.

Use third person writings do not use “I think” or “in my opinion” keep it factual, third person and follow APA standards a minimum of two references are required.

Strategic Analysis for Healthcare: Concepts and Practical Applications–Vitalsource [email protected]#magicMAN61

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Developing a Culture of Evidence-Based Practice

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As your EBP skills grow, you may be called upon to share your expertise with others. While EBP practice is often conducted with unique outcomes in mind, EBP practitioners who share their results can both add to the general body of knowledge and serve as an advocate for the application of EBP.

In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry. 

To Prepare:

  • Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.
    • This may include: unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.
  • Reflect on which type of dissemination strategy you might use to communicate EBP.

By Day 3 of Week 9

Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.

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m7

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Recall from the chapter on the central nervous system (CNS) that the general senses detect such stimuli as touch, pain, and temperature. General senses refer to the fact that these receptors are relatively simple and located throughout the body in both the skin and internal organs. The special senses, in contrast, are so named because they convey a specific type of information from specialized sensory organs in discrete locations of the head. For this assignment you will;

  • Imagine you are driving or biking on a high-traffic road and you are approaching an intersection with a four-way stop and railroad train track. Additionally, there are three cars in the other lanes of the intersection and visibility is decreased because of foggy weather conditions.
    • Describe what special senses you will use to make the determination to safely proceed into the intersection.
    • Then, in a detailed summary, explain the pathways for each of the special senses involved. 
    • Describe the pathways for the special senses not involved in this case and explain why they are not used.
    • Describe how the brain interprets information from each of those special senses.
    • Describe how the brain sends messages to the body to react to information from these special senses.

 This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, recorded audio and be sure to include a reference slide. You will describe what special senses you will use to make the determination to safely proceed into the intersection.

Your submission should include a minimum of 5 peer-reviewed sources to support any of your perspective. Please review the module’s Signature Assignment Rubric before starting this assignment to ensure that you are meeting all the essential requirements. This presentation is worth 300 points for quality content and presentation.

Assignment Expectations

Length: 8 to 12 minutes, at least 17 slides

Structure:

   Title slide and reference slides in APA style. (at least 2 slides)

   Special senses: at least 4 slides

   Pathways: at least 2 slides

   Not involved senses: at least 4 slides

   Brain interpretations: at least 3 slides

   Messages: at least 2 slides

Include a title slide and reference slide in APA style. These do not count towards the minimal slide amount for this assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least five (5) scholarly sources to support your claims.

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