p2

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Re:Topic 4 DQ 1

 

In my current position as a surgical nurse I don’t often see or deal with death.  Over the past two years I can only think of 2 patients that have actually passed on our unit, and only one of those was I part of the direct patient care.  In this case however I did find it strange because the patient was an elderly Hispanic that did not have family surrounding her at the time of passing.  This is strange for that culture.  Family had been in the day before and seen that patient and said their goodbyes, the patient was expected to pass during the night in ICU.  However ICU was short on beds so the patient had to be moved to our unit.

 

My beliefs about death and how I view it are based on my life before I was a nurse.  First of all I had several great aunts and uncles and my grandparents that all passed before I was 15.  I think this shaped my views of death differently than most because I accepted it at a young age as part of life.  I know some people who still have all their grandparents at 30 and I think when they have that first family member pass it is viewed much differently than I tend to view it.  I worked in an assisted living where patients often times had hospice come in to see them at the end of life and they were allowed with hospice to stay in the assisted living until they passed.  These were patients that I knew and took care of for years.  Watching them slowly decline over time and the pain they felt as well as the loss of abilities was hard for them and after watching them struggle and ask “why hasn’t God just taken me home” when the time came I was happy for them.  Seeing this happen so much I can say that even the patients I knew for years I felt it when they passed, however I didn’t necessarily cry because they had finally gotten to go home and were not suffering anymore.

 

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W2 Picot

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 Use the practice problem identified in the Week 1 discussion and include the sections below. Select a practice change that is client-focused, specific, measurable, and related to your future role in advanced nursing practice. Nurse practitioner students must choose a practice change that impacts client care directly and avoid topics related to changes in public policy or law, such as full-practice authority.

Include the following sections:

  1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
    • Summarize your practice problem in 2-3 sentences.
    • Write your practice question in standard PICOT format: In ________(Population), what is the effect of ___________(Intervention) in comparison to ___________ (Comparison) on _____________ (Outcome) to be completed over __________ (Time).
    • Identify components of your PICOT question where peer input would help refine those elements.

Review the PICOT questions of two of your peers. Provide substantive feedback and suggestions based on peers’ identified areas for improvement. 

  1. Engagement in Meaningful Dialogue: Engage peers by asking questions and offering new insights, applications, perspectives, information, or implications for practice:
    • Respond to at least one peer.
    • Respond to a second peer post.
    • Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
  2. Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
  3. Wednesday Participation Requirement: Provide a substantive response to the Collaboration Café topic (not a response to a peer) by Wednesday, 11:59 p.m. MT of each week.
  4. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic and two to student peers) on two different days during the week.

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Assignment: Application: Planned Change in a department or unit

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Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following: About nurse bedside reporting. APA style with 5 references within the last 5 years

 

  • Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.

 

 

 

  • Identify a problem, inefficiency, or issue within a specific department/unit.
  • Describe a specific, realistic change that could be made to address the issue.
  • Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.
  • Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.
  • Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.
  • Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.

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Pharmacological case study Women’s and Men’s Health, and Ear, Eyes, and Skin

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discussion

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Cardiology Surgery vs Medicine

The Medicine chapter of CPT has a subsection on cardiovascular. CPT codes 92950-93799.

Surgical CPT has a subsection on cardiovascular. CPT codes 33010-37799.

Explain why that is. (HINT: Non-invasive vs. Invasive)  How are you going to remember this when you begin coding for a cardiologist?

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Meaningful Use Paper

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Application 2: Meaningful Use Paper

Why are many health care organizations hesitant to adopt electronic health records (EHR) when they have the potential to improve quality, increase access, and reduce costs? Some organizations are concerned with the ethical and legal issues that may arise in daily operations. In 2010, legislators noticed health care’s reluctant transition into full EHR integration, and began to provide financial incentives to those organizations that not only adopt EHRs, but also use them meaningfully to improve quality of patient care. As an advanced practice nurse, it is important to be aware of the challenges, policies, and incentives associated with integrating EHR systems. It is also critical that you understand the concept of “meaningful use” and how it plays out in today’s health care organizations.

To prepare:

In this Application Assignment, you analyze meaningful use criteria to determine the authentic legal, financial, and ethical issues that may surround it.

  • Reflect on the information presented      in the Learning Resources, focusing on meaningful use legislation and the      “Ethics in Nursing Informatics” section of your course text.
  • Investigate the legal, financial, and      ethical issues surrounding meaningful use.
  • Ask yourself: What are the goals of      meaningful use?

By Friday 10/06/17 10 pm, write a 4- to 5-page essay in APA format with at least 5 references from my list of required readings provided below, in which you include the level one as per APA format guidelines:

1) A cover page.

2) An introduction ending with a purpose statement (e.g. “The purpose of this paper is…)

3) Summarize the legal, financial, and ethical issues that may arise as a result of meaningful use legislation.

4) Explain how these issues might present barriers to successful implementation within an organization.

5) Discuss ways that health care organizations can make the most of their electronic health record (EHR) investments in light of meaningful use.

6) Explain how EHR-related meaningful use legislation is being implemented in your organization.

7) A conclusion

8) A references pages in APA format.

Required Readings

California HealthCare Foundation. (2011).

Retrieved from http://www.chcf.org/

The California HealthCare Foundation outlines quality reform plans that improve efficiency and reduce cost for California’s patients.

Centers for Medicare & Medicaid Services. (2010). CMS EHR meaningful use overview.

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

The U.S. Department of Health and Human Services defines the term meaningful use and also its view of meaningful use criteria, requirements, and financial impact.

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

  • Chapter 14, “Usability and      Clinical Application Design”

This chapter begins by defining the terms usability and application design as they are used in the field of nursing informatics. The authors then describe the literature review and analytic process that the TIGER Collaborative group underwent to positively transform the development of HIT systems.

Gruber, D., Cummings, G. G., LeBlanc, L., & Smith, D. L. (2009). Factors influencing outcomes of clinical information systems implementation: A systematic review. CIN: Computers, Informatics, Nursing, 27(3), 151–163.

The authors analyze the outcomes of prior IT implementations to determine if certain strategies can guarantee success when launching new clinical information systems.

Kaufman, D., Roberts, W. D., Merrill, J., Lai, T., & Bakken, S. (2006). Applying an evaluation framework for health information system design, development, and implementation. Nursing Research, 55(2, Suppl. 1), S37–S42.

This article emphasizes the indispensable role of continuous evaluation throughout the development and real-time application of new information systems into the workplace.

Schlotzer, A., & Madsen, M. (2010). Health information systems: Requirements and characteristics. Studies in Health Technology and Informatics, 151, 156–166.

Use this article to examine the importance of focusing on sound design, interoperability of systems, and fulfillment of user needs when developing an effective database.

 

Course Text: American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Author.

“Ethics in Nursing Informatics” (p. 49-52)

This page of the text introduces three common ethical codes used in health care today.

Croll, P. (2010). Privacy, security and access with sensitive health information. Studies in Health Technology and Informatics, 151, 167-175.

The author proposes a model for controlling the security of health information networks and systems.

Hjort, B. (2007). AHIMA report addresses evolving role of health care privacy and security officers. Journal of Health Care Compliance, 9(3), 47-68.

This article identifies the challenges and responsibilities of health care workers employed in privacy and security positions.

Layman, E. J. (2008). Ethical issues and the electronic health record. The Health Care Manager, 27(2), 165-176.

The findings within this article provide recommendations for health personnel, leaders, and policy makers when attempting to design ethically sound electronic health records.

Mackenzie, G., & Carter, H. (2010). Medico legal issues. Studies in Health Technology and Informatics, 151, 176-182.

Within this article, the authors provide an overview of the legal issues, precautions, and potential breaches that surround the privacy and security of electronic patient records

O’Keefe-McCarthy, S. (2009). Technologically-mediated nursing care: The impact on moral agency. Nursing Ethics, 16(6), 786-796.

Examine technology’s ability to negatively affect the patient/nurse relationship as decisions are based more on data and less on emotional and pedagogical reasoning by referencing the material found in this article.

Withrow, S. C. (2010). How to avoid a HIPAA horror story. Healthcare Financial Management, 64(8), 82-88.

The HIPAA horror story that is detailed here underlines the importance of adopting HIPAA privacy and security provisions in efforts to reduce potential violations and financial threats.

 

Centers for Medicare & Medicaid Services. (2010). CMS EHR meaningful use overview.

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

The U.S. Department of Health and Human Services defines the term meaningful use and also its view of meaningful use criteria, requirements, and financial impact.

American Nurses Association. (2011). Ethics and human rights.

Retrieved from http://nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/EthicsandHumanRights.aspx

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Nursing

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Assignment 1: Applying Current Literature to Clinical Practice

Literature in psychotherapy differs from other areas of clinical practice. Generally, there are no clinical trials in psychotherapy because it is often neither appropriate nor ethical to have controls in psychotherapy research. This sometimes makes it more difficult to translate research findings into practice. In your role, however, you must be able to synthesize current literature and apply it to your own clients. For this Assignment, you begin practicing this skill by examining current literature on psychodynamic therapy and considering how it might translate into your own clinical practice. ( see attachment)

Learning Objectives
Students will:
  • Evaluate the application of current literature to clinical practice

To prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide.
  • Select one of the psychodynamic therapy articles from the Learning Resources to evaluate for this Assignment.

Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.

The Assignment

In a 5- to 10-slide PowerPoint presentation, address the following:

  • Provide an overview of the article you selected.
    • What population is under consideration?
    • What was the specific intervention that was used? Is this a new intervention or one that was already used?
    • What were the author’s claims?
  • Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?
  • Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Support your position with evidence-based literature.

Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.

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MN553 Unit 8 Practice Quiz Latest 2017

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Question

Question 1 1 / 1 point

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

Question options:

Increases peripheral vasoconstriction

Decreases detrusor muscle contractility

Lowers supine blood pressure more than standing pressure

Relaxes smooth muscle in the bladder neck

Question 2 1 / 1 point

Which of the following adverse effects are less likely in a beta1-selective blocker?

Question options:

Dysrhythmias

Impaired insulin release

Reflex orthostatic changes

Decreased triglycerides and cholesterol

Question 3 1 / 1 point

Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:

Question options:

Symptoms are severe

Patient has not responded to other therapies

Patient has concurrent hypertension

Left ventricular dysfunction is diagnosed

Question 4 1 / 1 point

You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?

Question options:

Donepezil

Tacrine

Doxazosin

Verapamil

Question 5 1 / 1 point

Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus.

Question options:

IV phenobarbital

Rectal diazepam (Diastat)

IV phenytoin (Dilantin)

Oral carbamazepine (Tegretol)

Question 6 1 / 1 point

Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

Question options:

Dwayne hasn’t been taking his carbamazepine because it causes insomnia.

Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.

Dwayne was not originally prescribed the correct amount of carbamazepine.

Carbamazepine is probably not the right antiseizure medication for Dwayne.

Question 7 1 / 1 point

Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

Question options:

Ibuprofen (Advil)

Acetaminophen with hydrocodone (Vicodin)

Oxycodone (Oxycontin)

Oral morphine (Roxanol)

Question 8 1 / 1 point

Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

Question options:

Slurred speech and insomnia

Bradycardia and confusion

Dizziness and orthostatic hypotension

Insomnia and decreased appetite

Question 9 1 / 1 point

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:

Question options:

Alprazolam (Xanax)

Diazepam (Valium)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 10 1 / 1 point

David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include:

Question options:

Paroxetine may cause intermittent diarrhea.

He may experience sexual dysfunction beginning a month after he starts therapy.

He may have constipation and he should increase fluids and fiber.

Paroxetine has a long half-life so he may occasionally skip a dose.

Question 11 1 / 1 point

An appropriate drug for the treatment of depression with anxiety would be:

Question options:

Alprazolam (Xanax)

Escitalopram (Lexapro)

Buspirone (Buspar)

Amitriptyline (Elavil)

Question 12 1 / 1 point

The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?

Question options:

They have become tolerant of the medication, which is characterized by the need for higher and higher doses.

They are a drug seeker.

They are suicidal.

They only need additional counseling on lifestyle modification.

Question 13 1 / 1 point

A first-line drug for abortive therapy in simple migraine is:

Question options:

Sumatriptan (Imitrex)

Naproxen (Aleve)

Butorphanol nasal spray (Stadol NS)

Butalbital and acetaminophen (Fioricet)

Question 14 1 / 1 point

Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:

Question options:

Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 15 1 / 1 point

Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:

Question options:

Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.

Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.

Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine.

Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.

Question 16 1 / 1 point

James has been diagnosed with cluster headaches. Appropriate acute therapy would be:

Question options:

Butalbital and aspirin (Fiorinal)

Meperidine IM (Demerol)

Oxygen 100% for 15 to 30 minutes

Indomethacin (Indocin)

Question 17 1 / 1 point

If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?

Question options:

NSAIDs, opiates, corticosteroids

Low-dose opiates, salicylates, increased dose of opiates

Opiates, non-opiates, increased dose of non-opiate

Non-opiate, increased dose of non-opiate, opiate

Question 18 1 / 1 point

Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

Question options:

Use of more than one drug to treat the pain

Multiple times when prescriptions are lost with requests to refill

Preferences for treatments that include alternative medicines

Presence of a family member who has abused drugs

Question 19 1 / 1 point

The Pain Management Contract is appropriate for:

Question options:

Patients with cancer who are taking morphine

Patients with chronic pain who will require long-term use of opiates

Patients who have a complex drug regimen

Patients who see multiple providers for pain control

Question 20 1 / 1 point

Which of the following statements is true about age and pain?

Question options:

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

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Discussion module 1 discussion 2

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Select one of the theories you have reviewed in this lesson that you use or plan to use in your practice. Why do you use this theory? Be sure to relate its use to a specific culture or cultures. The title of your post should include the name of the theory.  TALK ABOU T FLORENCE NIGHTINGALE ENVIRONMENT IN THE CENTRAL CONCEPT THEORY.

Then, comment on two postings that focus on a theory you did not write about. Be sure to say something substantial. Did you learn something new? Do you agree? Why or why not?

Your posts will be graded as follows:

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1200 word essay

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Details:

 

In a written paper of 1,200-1,500 words, apply the concepts of epidemiology and nursing research to a communicable disease.

Communicable Disease Selection

Choose one communicable disease from the following list:

Chickenpox

Tuberculosis

Influenza

Mononucleosis

Hepatitis B

HIV

Epidemiology Paper Requirements

Include the following in your assignment:

Description of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) and the demographic of interest (mortality, morbidity, incidence, and prevalence).

Describe the determinants of health and explain how those factors contribute to the development of this disease.

Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. (The textbook describes each element of the epidemiologic triangle).

Explain the role of the community health nurse (case finding, reporting, data collecting, data analysis, and follow-up).

Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organization(s) contributes to resolving or reducing the impact of disease.

A minimum of three references is required.

Refer to “Communicable Disease Chain” and “Chain of Infection” for assistance completing this assignment.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.

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