Anyone done this one before?
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Please use the patient information provided below for this paper.
This assignment assesses intended course outcome(s)
#4 Use information found in patients’ health histories, genograms, and assessments to formulate an individualized plan of nursing care that focuses on the patient’s individual health promotion and disease prevention needs
Students will use the information found in Tina’s history, physical exam, and problem list to formulate an individualized health promotion and disease prevention plan of care. Recommendations should be evidence-based and from credible sources. The readings in module eight contains some suggested sources for obtaining health and screening recommendations for your patient.
The plan for addressing the health promotion and disease prevention needs for your patient should include:
Demographics:
– Age, gender and race of patient
– Education level (health literacy)
– Access to health care
Insurance/Financial status
– Is the patient able to afford medications and health diet, and other out-of-pocket expenses?
Screening/Risk Assessment
– Identified health concerns based on screening assessments and demographic information
Nutrition/Activity
– What is the patients activity level, is the environment where the patient lives safe for activity
– Nutrition recommendations based on age, race gender and pre-existing medical conditions
– Activity recommendations
Social Support
– Support systems, family members, community resources
Health Maintenance
– Recommended health screening based on age, race, gender and pre-existing medical conditions
Patient Education:
– Identified knowledge deficit areas/patient education needs (medication teaching etc).
– Self-care needs/ Activities of daily living
* The paper should be written and referenced in APA format and be no longer than 4 pages (excluding cover page and references).
Your paper will be evaluated based on the following criteria:
| Criteria | Level 3 | Level 2 | Level 1 |
| Demographics
(5%) |
Includes age, race and gender of patient | Missing one data item | Missing 2 or more data items |
| Insurance/Financial status
(10%) |
Includes information regarding patient’s insurance status and ability to afford medications and other out-of-pocket expenses | Missing some information regarding insurance status and ability to pay for medications and other out-of-pocket expenses. | Missing information regarding the patients insurance status, ability to pay of medications and other out-of-pocket expenses |
| Screening /risk assessment
(10%) |
Identifies health concerns based on screening assessments and demographic information. | Missing some information regarding health concerns, by excluding information from screening assessments and demographics | Health concerns are not identified due to information missing from screening assessments and demographics |
| Nutrition/activity
(20%) |
Completely asses patient’s nutrition and activity levels and makes recommendations based on age, race, gender and pre-existing medical conditions | Missing some information regarding the patients nutrition and activity levels, make recommendations based on age, race, gender and pre-existing medical conditions | Most of the information regarding the patient’s nutrition and activity levels are missing, recommendations are missing or not based on the patient’s age, race, gender and pre-existing medical conditions |
| Social support
(10%) |
Identifies support systems such as family members and community resources | Missing some information regarding support systems such as family members and/or community resources | Little to no information regarding social support |
| Health Maintenance
(20%) |
Overall health maintenance recommendations made based on age, race, gender and pre-existing medical conditions | Missing some recommendations, mostly based on age, race, gender and pre-existing medical conditions | Missing many recommendations, loosely related to age, race, gender and pre-existing medical conditions |
| Patient Education
(20%) |
Identified knowledge deficit areas/patient education needs including self-care needs and activities of daily living | Missing one or more areas of knowledge deficit/patient education needs including self-care and activities of daily living | Lacks identification of knowledge deficit areas/patient education needs. Does not consider self-care needs or activities of daily living. |
| Organization, spelling and grammar, APA
(5%) |
Organized, easy to read, no spelling or grammar mistakes, appropriate use of APA | Organized and easy to read, few spelling or grammar mistakes, few errors in APA | Disorganized, difficult to read, many spelling and grammar errors mistakes. Does not use APA |
| Overall score | Points
(60-100) |
Points
(24-59) |
Points
( 0-23) |
Health History
| Student Documentation | Model Documentation |
| Identifying Data & Reliability
Tina Jones is a 28 year old African american female AOX4. Pt is reliable historian |
Ms. Jones is a pleasant, 28-year-old African American single woman who presents for a pre-employment physical. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Speech is clear and coherent. She maintains eye contact throughout the interview. |
| General Survey
Alert and oriented X4. Feels tired because she was just coming from her other job. |
Ms. Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. She is well-nourished, well-developed, and dressed appropriately with good hygiene. |
| Reason for Visit
Presenting to shadow health hospital clinic for a complete health assessment for a pre-employment physical. |
“I came in because I’m required to have a recent physical exam for the health insurance at my new job.” |
| History of Present Illness
Tina Jones is a 28year old African America female with a history of diabetes and Asthma presenting to get a complete health assessment for a pre-employment physical. |
Ms. Jones reports that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. She needs to obtain a pre-employment physical prior to initiating employment. Today she denies any acute concerns. Her last healthcare visit was 4 months ago, when she received her annual gynecological exam at Shadow Health General Clinic. Ms. Jones states that the gynecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is tolerating well. She has type 2 diabetes, which she is controlling with diet, exercise, and metformin, which she just started 5 months ago. She has no medication side effects at this time. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job. |
| Medications
Metformin 850mg twice daily Yaz birth control daily in the morning Flovent MDI twice daily proventil 90mcg/spray 2 puffs as needed for wheezing |
• Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) • Metformin, 850 mg PO BID (last use: this morning) • Drospirenone and ethinyl estradiol PO QD (last use: this morning) • Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) • Acetaminophen 500-1000 mg PO prn (headaches) • Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago) |
| Allergies
Penicillin- Rash, hives cats- sneezing, itchy watery eyes, asthma exacebation No Known food allergies No latex allergies |
• Penicillin: rash • Denies food and latex allergies • Allergic to cats and dust. When she is exposed to allergens she states that she has runny nose, itchy and swollen eyes, and increased asthma symptoms. |
| Medical History
Asthma- diagnosed at age 2 1/2 Diabetes Type 2 – diagnosed at 24 was on metformin but stopped due to side effects |
Asthma diagnosed at age 2 1/2. She uses her albuterol inhaler when she is around cats. Her last asthma exacerbation was three months ago, which she resolved with her inhaler. She was last hospitalized for asthma in high school. Never intubated. Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago and initially had some gastrointestinal side effects which have since dissipated. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. First sexual encounter at age 18, sex with men, identifies as heterosexual. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months (after initiating Yaz) cycles regular (every 4 weeks) with moderate bleeding lasting 5 days. Has new male relationship, sexual contact not initiated. She plans to use condoms with sexual activity. Tested negative for HIV/AIDS and STIs four months ago. |
| Health Maintenance
Has been eating healthy and trying to stay active by walking 30-40 mins two times per week and also swimming once a week |
Last Pap smear 4 months ago. Last eye exam three months ago. Last dental exam five months ago. PPD (negative) ~2 years ago. Immunizations: Tetanus booster was received within the past year, influenza is not current, and human papillomavirus has not been received. She reports that she believes she is up to date on childhood vaccines and received the meningococcal vaccine for college. Safety: Has smoke detectors in the home, wears seatbelt in car, and does not ride a bike. Uses sunscreen. Guns, having belonged to her dad, are in the home, locked in parent’s room. |
| Family History
-Father died 2 1/2 ears ago in a car accident. History of high blood pressure,type 2 diabetes and high cholesterol -Mother is still alive. has history of hypertension and high cholesterol. -Brother is overweight -Sister has asthma |
• Mother: age 50, hypertension, elevated cholesterol • Father: deceased in car accident one year ago at age 58, hypertension, high cholesterol, and type 2 diabetes • Brother (Michael, 25): overweight • Sister (Britney, 14): asthma • Maternal grandmother: died at age 73 of a stroke, history of hypertension, high cholesterol • Maternal grandfather: died at age 78 of a stroke, history of hypertension, high cholesterol • Paternal grandmother: still living, age 82, hypertension • Paternal grandfather: died at age 65 of colon cancer, history of type 2 diabetes • Paternal uncle: alcoholism • Negative for mental illness, other cancers, sudden death, kidney disease, sickle cell anemia, thyroid problems |
| Social History
she does not have any children, has never been pregnant and has never been married. she lives with her mother and sister. currently works but is hoping to start a new jop as an accounting clerk at smith, stevens, steward silver company. drinksa alcohol ocassionally when she goes out with friends |
Never married, no children. Lived independently since age 19, currently lives with mother and sister in a single family home, but will move into own apartment in one month. Will begin her new position in two weeks at Smith, Stevens, Stewart, Silver, & Company. She enjoys spending time with friends, reading, attending Bible study, volunteering in her church, and dancing. Tina is active in her church and describes a strong family and social support system. She states that family and church help her cope with stress. No tobacco. Cannabis use from age 15 to age 21. Reports no use of cocaine, methamphetamines, and heroin. Uses alcohol when “out with friends, 2-3 times per month,” reports drinking no more than 3 drinks per episode. Typical breakfast is frozen fruit smoothie with unsweetened yogurt, lunch is vegetables with brown rice or sandwich on wheat bread or low-fat pita, dinner is roasted vegetables and a protein, snack is carrot sticks or an apple. Denies coffee intake, but does consume 1-2 diet sodas per day. No recent foreign travel. No pets. Participates in mild to moderate exercise four to five times per week consisting of walking, yoga, or swimming. |
| Mental Health History
Denies any history of depression or suicidal thoughts. denies any problems with mood. no overall safety concerns. |
Reports decreased stress and improved coping abilities have improved previous sleep difficulties. Denies current feelings of depression, anxiety, or thoughts of suicide. Alert and oriented to person, place, and time. Well-groomed, easily engages in conversation and is cooperative. Mood is pleasant. No tics or facial fasciculation. Speech is fluent, words are clear |
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Topic 4 DQ 1 question:
How often do you engage with or witness death in your work? How has this experience or the lack of it shaped your view of death? Has it gotten easier or harder for you to accept the fact of death? As you explain, include your clinical specialty.
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Pre-Briefing Simulation And Drug Cards
PATIENT: Keola Akana
THIS ASSIGNMENT HAS TWO PART QUESTIONS
INSTRUCTION
Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.
Therefore, in order to prepare for the simulation, you are required to complete the Pre-Briefing questions & Drug Cards below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.
PART 1 QUESTIONS
SCENARIO OVERVIEW:
Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring, and cardiac rehabilitation. The scenario takes place on Monday at 0900, at which time morning medications are due.
1. What are the nutritional implications, key assessment findings, and nursing interventions for a patient with hypokalemia?
2. What are the signs and symptoms of digoxin toxicity and how would the nurse assess for these symptoms? In your response, be sure to include specific body systems.
3. How would the nurse provide family-centered care?
PLEASE USE REFERENCE LESS THAN 5 YEARS OLD AND APA FORMAT NEEDED.
PART 11 QUESTIONS
SCENARIO OVERVIEW:
Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring and cardiac rehabilitation. During this scenario, students will have the opportunity to assess and manage medication administration for a patient experiencing digoxin toxicity.
FOR EACH OF THE FOLLOWING DRUGS BELOW THAT WAS PRESCRIBED FOR THE ABOVE PATIENT WITH HEART FAILURE, WRITE OUT IN DRUG CARD FORMAT FOLLOWING THE HEADING BELOW
1) THE INDICATION, (2) DOSAGE, (3) CONTRAINDICATION, (4) SIDE EFFECTS, (5) ADVERSE EFFECTS AND (6) NURSING CONSIDERATION
⦁ Patient: Keola Akana Drug Lists
Lasix 40 mg po now and daily
Potassium Chloride CR 10 mEq po daily
Digoxin 0.25 mg po now and daily
Atenolol 50mg po now and daily
Acetaminophen 650 mg po Q 4 hrs PRN mild pain or temp greater than 101.3
IV saline flush Q 8hrs and PRN
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.
In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.
To Prepare:
Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain the potential impacts of being included or not in the decision-making process. Be specific and provide examples.
Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
Discussion one that needs a response in APA 7 format and at least 2-3 references.( Micheal )
The health care industry has met with numerous changes over the years; some of the changes lay emphasis on either the patient, the organization or its employees. Of the numerous changes any given health care institution experiences, the goal of patient safety and patient satisfaction preempts the motive for necessary changes to better serve our patient population while also bearing in mind the effectiveness of the interventions that the organization is implementing. For an institution saddled with the responsibility of rendering health care services to members of its community, it is often faced with the need for constant system development of their life cycle to enhance the efficiency of the services provided while also taking patient safety into consideration. “The first step in developing a system is to understand the problems or business needs. It is followed by understanding the solution or how to address those needs; developing a plan; implementing the plan; evaluating the implementation and finally maintenance” (McGonigle, 2017, p175)
System development life cycle presents as the precursor to the innovations that trigger the much needed difference in terms of efficiency or safety, such changes sometimes suffer the brunt when nurses are excluded in the preliminary phases of planning leading up to its implementation. The consequence of not having nurses weigh in on the intended innovation includes but is not limited to having a poorly designed project since the design and planning was done without the end users input, the project may become obsolete months after its implementation for failing to meet the needs of the nurses with regards to efficiency in patient care and safety considerations. According to a Laureate video presentation by Stuart Speedie, “the goal of health care informatics and technology should be its interoperability.” (Laureate Education Producer, 2018)
In a different light, if the nurses were included as prospective end users of this innovation, ideas generated from the conversation about the intended innovation will be viewed from many perspectives which will in turn make for a better design knowing what the end user desires for the innovation to be mutually beneficial to the institution and the patient population alike. At the institution that I work, the latest innovation was the inclusion of an automated Alaris infusion pump that synchronizes information across the electronic health record platform and the medication pyxis, the nurses did not have any input on the planning or design of this new innovation.
The impact of not being included or consulted prior to designing and implementing this design were as follows; some medications were not compatible with the pump interface and will not accept manual entry this problem in its self constituted a missed medication for the patient hence delaying patient care, the network interface on the electronic health record platform was a bit confusing and needed more than just a day of orientation to say the least, over all the system launch was chaotic and stressful leading to loss of considerable man hours trying to figure things out on the go with little to no assistance especially for nurses working on the night shift. According to a Laureate video presentation by Kevin Johnson, “He highlights the need to acknowledge that the cycle is ongoing and never done even after its implementation.” (Laureate Education Producer, 2018)
References
Laureate Education (Producer). (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learn
Discussion one that needs a response in APA 7 format and at least 2-3 references.( Monica)
Discussion Week 9 Initial Post
Nursing is the largest healthcare profession in the world. According to the American Association of Colleges of Nursing (2020), there is an estimated 3.8 million registered nurses (RN) nationally and 84.5% of those nurses are employed in the healthcare setting. Nurses are so vital to healthcare organizations because they are hands on with rendering care to patients and oversee the overall care that the patient receives. Nurses serve as patient advocates and are involved on every aspect of the patient’s care. They are the integral party with the responsibility to make sure that other healthcare professionals are doing their part to ensure that patients are receiving the safest and best quality of care. High in numbers and with such an intricate role in healthcare, nurses are the heartbeat of the hospitals, therefore it would behoove healthcare organizations to involve nurses in every aspect of care including the Systems Development Life Cycle (SDLC).SDLC is a process of addressing an identified need and putting a plan/system into operation. Phases of the SDLC include planning, analysis, design, implementation, and maintenance (Laureate, 2018). Nurses can contribute greatly to the process of selecting and implementing new health systems because they are hands on and see first-hand the needs of the patients and healthcare systems.
If healthcare administrations fail to include nurses during the SDLC process of purchasing and implementing new information technology system, consequences could be failure to identify pertinent issues (Cleveland, 2019). The planning, analysis, design, implementation, and maintenance phases would not persist because nurses are the primary bodies that are hands-on and they are on the frontlines to witness how the whole process plays out. Nurses play a role that is essential to the success of the system. During the planning process, nurses contribute by identifying needs. They collaborate with multidisciplinary teams to formulate a plan to prosecute. During the analysis and design phases, nursing informaticists play a huge role by assuring that the plan is suitable and of evidence based practices. After the best practices are identified, nurses then, implement by using the system. Over time, evaluation and maintenance is done by the nursing staff. This cycle of evaluation is ongoing with the goal of the system to become more efficient with each evaluation.
About 6 years ago, I was involved in the maintenance and evaluation phase of an information technology tool (Patient Touch) that was launched 2 years prior on the medical surgical floor. The Patient Touch, similar to an iPhone, allows healthcare workers to chart all care and nurses to scan and record medication administration, It is a hand-held scanner that has many protective measures built in, and it allows workers of all entities to pull up useful information in a matter of seconds. It heavily supports evidence-based practice and has produced positive outcomes with patient care. To keep the momentum going, nursing informaticians made rounds monthly to see how using the Patient Touch was going and they asked for feedback on how to improve the tool. I mentioned to them an issue I had with it, while charting the nursing assessment using Patient Touch, there were a lot of assessment pieces that did not apply to medical surgical patients which prolonged time. There were a lot of assessments that ICU utilized, and I asked if there was anyway to eliminate the issue. A couple of months later, the informaticians implemented a division of the units and whatever unit selected, the nursing daily assessment was customized for each unit. This change eliminated a lot of unnecessary assessments that did not apply to medical surgical floor. It made a huge difference with charting and really improve our nurses time management. “Nurses play an active and vital role in electronic healthcare information system acquisition and upgrading project along- side their health informatics and IT colleagues (McLean, Frisch, &Roudsari, 2020). Nurses being involved with the SDLC process is necessary because they are the ones using the systems the most. Without the nurses’ input and expertise, healthcare administrations will miss the mark and the success rate of the tool would be minimized.
References
AACN. (2020). AACN fact sheet – Nursing. The American Association of Colleges of Nursing (AACN). https://www.aacnnursing.org/News-Information/fact-sheets/Nursing-Fact-Sheet
Cleveland, K. A., Motter, T., & Smith, Y. (2019, May 31). Affordable care: Harnessing the power of nurses. OJIN: The Online Journal of Issues in Nursing. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Affordable-Care.html?css=print
Laureate Education (Producer). (2018). Systems implementation [Video file]. Baltimore, MD: Author.
Mclean, A., Frisch, N., & Roudsari, A. (2020, September 21). Nursing’s voice in healthcare IT acquisition decisions. Canadian Journal of Nursing Informatics. https://cjni.net/journal/?p=4248#:~:text=%20Nursing%E2%80%99s%20Voice%20in%20Healthcare%20IT%20Acquisition%20Decisions,senior%20nurse%20executives%20and%20leaders%20develop…%20More%20
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
The dissemination of EBP results serves multiple important roles. Sharing results makes the case for your decisions. It also adds to the body of knowledge, which creates opportunities for future practitioners. By presenting results, you also become an advocate for EBP, creating a culture within your organization or beyond that informs, educates, and promotes the effective use of EBP.
To Prepare:
To Complete:
Create a 5-minute, 5- to 6-slide narrated PowerPoint presentation of your Evidence-Based Project.
Evidence-based practice focus on essential elements that can help create a highly integrated environment where it is possible to attain better outcomes. The evidence-based practice focuses on a specific problem where the findings can be compared with other results previously obtained. Dissemination of evidence-based practice findings can be evaluated based on different settings, mainly where the practice will be applied. The work of evidence-based practice (EBP) is a relentless process that requires practitioners to continuously provide evidence in support of their decision-making process and policy/practice changes. Healthcare workers may use the EBP model to initiate and implement policy changes which will improve patient care. During the process, practitioners must present their appeals to the lawmakers providing evidence to why should the changes happen. There are several ways of disseminating the evidence. Melnyk and Fineout-Overholt (2018) define dissemination as “the process of distributing or circulating information widely” (p. 752).
Two dissemination strategies that I would be most inclined to use
The best dissemination strategies that I would consider include a unit-level presentation and local dissemination (Harvey & Kitson, 2015). Unit-level dissemination is only successful, especially in ensuring where the issue that has been considered help improving the underlying problem within the unit. Different units with a given setting can have a varied assessment of the operational environment. This means there is a need to take into consideration the context under which the evidence-based practice. Therefore, ensuring that the engagement is strategic help ensure that based on the results, the intervention that is put in place is unit-based (Brownson et al., 2018). Organizations strive to implement essential aspects of improving their performance. However, evidence-based practice eliminated the uncertainty risk, which is crucial in attaining better outcomes.
Local dissemination entails significant players at the local level, which is a better aspect that helps provide a strong emphasis on institutional development (Hall & Roussel, 2016). However, it is essential to ensure that dissemination of outcomes is done in an environment where there exist resources and technical ability to attain better results. Skills and knowledge among the population are likely to be a challenge in successfully implementing the developed practice. There is a need to manage the needs of existing stakeholders, which is essential and help in organizational planning as well as service delivery. The implementation of evidence-based practice should focus on creating a profoundly transformed environment where it is easier to implement positive change. Therefore, training is crucial in empowering stakeholders on how to implement evidence-based practice (Brownson et al., 2018).
Least Inclined Dissemination Strategies to be used
The least inclined dissemination strategies to be used in communicating EBP are poster presentations and podium presentations. The poster presentations may not give out enough information, and the presentation may not look engaging and exciting, thereby losing the aim of the presentation. The podium presentation, on the other hand, may encounter poor turnout of participants. There could be poor publicity of the presentation leading to poor attendance.
Barriers to be Encountered and Overcoming These Barriers
The barrier that could be encountered from the unit level presentation is the lack of interest from staff. An example is a resistance from staff when a change is to be implemented that they do not like or want. One way in overcoming this barrier is by getting staff involved in the presentation. For instance, making a member of staff one of the speakers at the presentation. In that way, they will be very interested in their presentation. The barrier that could be encountered in making use of peer-reviewed journals is the lack of access to the journals. An example are journals that mandates a subscription fee, which often puts off many readers. One way in overcoming this barrier is by giving such journals free access to online readers.
References
Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: translating science to practice. Oxford University Press.
Hall, H. R., & Roussel, L. A. (Eds.). (2016). Evidence-based practice. Jones & Bartlett Publishers.
Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
References:
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Rubric:
Levels of Achievement: Excellent 81 (81%) – 90 (90%) Good 72 (72%) – 80 (80%) Fair 63 (63%) – 71 (71%) Poor 0 (0%) – 62 (62%)
Levels of Achievement: Excellent 5 (5%) – 5 (5%) Good 4 (4%) – 4 (4%) Fair 3.5 (3.5%) – 3.5 (3.5%) Poor 0 (0%) – 3 (3%)
Levels of Achievement: Excellent 5 (5%) – 5 (5%) Good 4 (4%) – 4 (4%) Fair 3.5 (3.5%) – 3.5 (3.5%) Poor 0 (0%) – 3 (3%)
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
soap note
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Complete this week’s assigned readings, chapters from 39 to 43 of the textbook:
Mason, D. J., Leavitt, J.K., Chaffee, M.W. (2016). Policy and Politics: In Nursing and Health Care. (7th• Ed) St. Louis, Missouri: Elsevier, Saunders. ISBN-13: 9780323299886
1- After completing the readings, post a reflection, approximately 2 paragraph in length, discussing your thoughts and opinions about one or several of the specific topics covered in the textbook readings.
2- Identify which MSN Essential most relates to your selected topic in your discussion.
I have attached the textbook and the MSN Essentials
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Patient information to complete the soap note. please see attachment
39-year-old Male with epigastric pain
Chief Compliant: “I’ve been having this abdominal pain, and it just seems like it won’t go away. It started probably a year ago. It used to happen a few times a week, now it hurts every day.”
History of Present Illness: Mr. Rodriguez is a 39-year-old male that recently immigrated to the United States from Dominican Republic. He complains of epigastric pain that began approximately one year ago. He describes the pain as “burning” and occurring daily. He states that the pain sometimes worsens with eating and sometimes it improves. He states that spicy foods make the pain worsen. He admits to weekly NSAID usage and drinking 3-4 alcoholic beverages a week. He quit smoking 6 months ago. He drinks an herbal tea but does not experience any relief or change in the symptoms. He denies any fever, chills, nausea, hematemesis, hematochezia, or melena.
PMH/Medical/Surgical History: No history of gastrointestinal problems in the past. No history of surgery. No known drug allergies.
Medications: Takes ibuprofen “almost daily” for aches and pains associated with working. Drinks herbal tea meant to improve GI symptoms.
Significant Family History: Patient states family history of heart disease. Father had hypertension and his mother had diabetes.
Social History: Patient denies smoking. Patient states that he quit smoking 6 months ago. Patient states that he drinks 3-4 beers weekly. No illicit drugs.
Review of Symptoms:
GENERAL: 39-year-old Spanish speaking patient. Language interpreter present. Patient is alert and oriented. Afebrile. Patient denies recent, unexplained weight loss, fever, chills, weakness or fatigue.
HEENT: Denies headache, change in vision, nose, or ear problems. Denies sore throat.
SKIN: No change in skin, hair or nails.
CARDIOVASCULAR: Regular heart rate and rhythm. S1, S2, no murmurs, rubs, or gallops.
RESPIRATORY: clear to auscultation.
GASTROINTESTINAL: Soft, flat, non-distended. Normoactive bowel sounds heard in four quadrants. Soft, non-distended, with minimal epigastric tenderness on deep palpation without rebound tenderness or guarding, no hepatosplenomegaly, and no hernia or masses.
GENITOURINARY: Denies problems with urination.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: Alert & oriented x3. Denies muscle, back pain, joint pain or stiffness.
HEMATOLOGIC: Denies anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. Denies history of splenectomy.
PSYCHIATRIC: Denies history of depression or anxiety. Patient does express concern about paying for medications and follow up visits due to lack of insurance.
ENDOCRINOLOGIC: Denies sweating, cold or heat intolerance. Denies polyuria or polydipsia..
Objective Data:
Physical Assessment Findings: Patient is alert, oriented and is cooperative.
HEENT: PERRLA, no nystagmus noted. Tympanic membranes are intact. External auditory canals are normal. Oral pharynx is normal without erythema or exudate. Tongue and gums are normal.
Lymph Nodes: Non-palpable
Carotids: equal bilaterally 2+
Lungs: clear to auscultation
Heart: Regular rate and rhythm normal S1 and S2.
Abdomen: soft, non-tender, non-distended, no masses.
Genital/Pelvic: unremarkable
Extremities/Pulses: normal pulse bilaterally
Neurologic: A&Ox3, cranial nerves intact
Laboratory and Diagnostic Testing:
Fecal Occult Blood Testing: negative
Heliobacter Pylori (H. pylori) serology test: Positive
CBC with differential to test for other conditions such as anemia or pancreatitis.
Upper GI endoscopy: can help to check for damage to the lining of the stomach and to rule out malignancies (National Institutes of Health [NIH], 2017)
Upper GI Series: Commonly used in the past to diagnose peptic ulcers however this test can miss smaller ulcers and does not allow for direct treatment of the ulcer (American College of Gastroenterology, 2017).
Chest x-ray: This test is not normally used due more effective imaging for GI issues, but could be helpful to rule out other diagnoses such as a hiatal hernia or other abnormal anatomy (Chow, 2015).
Diagnosis:
K27 Peptic Ulcer Disease
K21.9 Gastro-esophageal reflux disease without esophagitis
K29.70 Gastritis, unspecified, without bleeding
Source: ICD10Date.com, 2017.
Differential Diagnosis:
Source: Epocrates, 2017.
Plan of Care:
Initially, this patient was started on over the counter antisecretory treatment such as an histamine-2 receptor antagonist or a proton pump inhibitor therapy (PPI) (NIH, 2014). At follow up, patient reported no relief in symptoms and tested positive for H. pylori. He was then treated with standard triple therapy (American Family Physician, 2015). At the next follow up he stated that symptoms resolved during antibiotic triple therapy but returned after finishing the regimen. He was then placed on salvage therapy with included another antibiotic, Levofloxacin, a PPI and amoxicillin for 10 days. At follow up the patient was completely symptom free. The patient was educated regarding possible continuation of PPI therapy to alleviate continuing symptoms. He was counseled to avoid NSAIDS, alcohol, spicy foods, smoking and to avoid lying down after eating (American Academy of Family Physicians [AAFP], 2015)
The patient was counseled and educating using the services of a Spanish speaking interpreter and was given Spanish medication and treatment handouts. He was given instructions to recognize worsening symptoms and when to follow up in office.
Medications:
Triple Therapy:
Omeprazole (PPI): 40mg PO QD for 4 weeks
Amoxicillin: 1g PO BID for 10 days
Clarithromycin 500mg PO BID for 10 days
Second Line:
Omeprazole (PPI): 40mg PO QD for 10 days
Amoxicillin: 1g PO BID for 10 days
Levofloxacin 500mg PO QD for 10days
References:
American Academy of Family Physicians (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American Family Physicians. 91(4):236-242. Retrieved from URL: https://www.aafp.org/afp/2015/0215/p236.htm
American College of Gastroenterology (2017) Peptic Ulcer Disease. Digestive Health Topic. Retrieved from URL: http://patients.gi.org/topics/peptic-ulcer-disease/
Chow, S. (2015). Peptic Ulcer Diagnosis. News Medical Life Sciences. Retrieved from URL: https://www.news-medical.net/health/Peptic-Ulcer-Diagnosis.aspx
Epocrates (2017). Peptic Ulcer Disease. Retrieved from URL: https://online.epocrates.com/diseases/8035/Peptic-ulcer-disease/Differential-Diagnosis
ICD0Data.com (2017). Gastro-esophageal reflux disease without esophagitis. Retrieved fromhttp://www.icd10data.com/ICD10CM/Codes/K00-K95/K20-K31/K21-/K21.9
ICD10Data.com (2017). Peptic ulcer, site unspecified. Retrieved fromhttp://www.icd10data.com/ICD10CM/Codes/K00-K95/K20-K31/K27-/K27
ICD10Data.com (2017). Gastritis, unspecified, without bleeding. Retrieved from URL: http://www.icd10data.com/ICD10CM/Codes/K00-K95/K20-K31/K29-/K29.70
National Institutes of Health [NIH] (2017). Upper GI Endoscopy. Diagnostic Tests. Retrieved from URL: https://www.niddk.nih.gov/health-information/diagnostic-tests
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
Please see the attachment!
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paper
Get Answer Over WhatsApp
Order Paper Now
